A day-in-the-life

The day: Wednesday. The time: 8:50 am. I (KV) just received a handoff from a provider, the 9 am patient has arrived, and I am in the middle of a coordination of care phone call with a school nurse who is attempting to help facilitate proper dosing of a stimulant for a 15 y/o patient seen in the clinic yesterday.

Just twenty minutes earlier I am walking through the clinic, writing my name on the white board to indicate that I am present and available for providers. I greet my colleagues: reception, clinic manager, medical providers, registered dietician, Spanish interpreters, lactation consultant, and triage nurses.

After documenting the phone call and routing the information to those involved in this adolescent’s care, I check in with the handoff who has been non-adherent with their recently prescribed SSRI given fear of potential side effects (thank you WebMD) and concern about the cost. I provide psycho education on potential side effects, benefits, and expected response time for this particular medication. At the end of our visit I walk the patient down to our community resource staff to discuss applying for the clinic discount to ensure that this medication will be affordable for the patient and then follow up with the medical provider who gave me the handoff before rooming and seeing the 9 am patient.

Now let’s step back and imagine how this same day looks when a pharmacist is integrated into the clinic.

The day: Wednesday. The time: 8:50 am. I just received a handoff from a provider, the 9 am patient has arrived, and I am fielding a call from a school nurse. I notice my pharmacist colleague is seated at a work station just across the office. Once I determine the nurse is calling with a question regarding stimulant dosing for a 15 y/o patient, I ask the pharmacist if she has time to talk with the nurse, quickly explain the situation, and am able to hand the phone call over to her. This frees me up to move on to the provider’s handoff.

Just twenty minutes earlier I am walking through the clinic, writing my name on the white board to indicate that I am present and available for providers. I notice the clinic pharmacist’s name is also on the board, and make a mental note that she is available today to help with medication issues. I greet my colleagues: reception, clinic manager, medical providers, registered dietician, Spanish interpreters, lactation consultant, triage nurses, and pharmacist.

Back to the present…I check in with the handoff who has been non-adherent with their recently prescribed SSRI given fear of potential side effects and concern about the cost. I ask the patient if he would be willing to talk with a pharmacist teammate about his concerns. He agrees so I go back to the office where the pharmacist has just finished-up the phone call and hand the patient off to her to provide psycho education on potential side effects, benefits, and expected response time for this particular medication. I ask if at the end of the visit she could walk the patient down to our community resource staff to discuss applying for the clinic discount to ensure that this medication will be affordable for the patient.

I am off to room and see the 9 am patient! At the end of the visit I run into the pharmacist in the hall and we go together to follow up with the medical provider who originally gave me the handoff. When I get back to my computer, I notice the pharmacist has documented the telephone call from the school nurse and routed the information to myself and those involved in this adolescent’s care. I am able to finish documenting the 9am patient visit before I receive a handoff for a well-child check.

Putting it all together

The above narrative portrays ways in which a pharmacist can be utilized in a collaborative fashion within an integrated setting. While this may seem simple or obvious, jump starting successful integration of a new specialty within a practice setting can be challenging. Reflecting on two basic questions prior to integration can go a long way in facilitating successful collaboration: 1) why integrate pharmacy into the primary care site? (i.e. how can a pharmacist help the care team?), and 2) which personal skills support pharmacy integration in a way that maximizes collaboration and impact?

The importance and utility of integrating pharmacy into primary care is spoken to in Table 1. This provides ideas and suggestions of specific areas in which a pharmacist can help facilitate care already being provided by an integrated team. Table 2 references skills and characteristics that encourage collaboration among clinicians. Notice how similar these attributes are to those of a BHC or any specialty provider striving to work in a collaborative setting.