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Lakeview Internal Medicine Pharmacy Services: A Doctor's Perspective

Written by Bradley Archer, M.D.

The idea to have pharmacy involvement in my clinic goes back to my own training as a pharmacist. In my fifth, and final year of pharmacy school, I spent a rotation block with a internal medicine physician. I would review medications of both hospital and clinic patients and discuss my observations with him. I was impressed at that time as to what a significant impact a pharmacist, who has the opportunity for direct discussion with a physician, can make on patient care. This experience as a pharmacist also gives me an appreciation for the depth of knowledge and skills that a pharmacist has following their rigorous academic preparation.

Both in my medical residency training and my staff teaching position, I had the pleasure of working with Dr. Geoffrey Wall at Iowa Methodist Medical Center. Dr. Wall is a Doctor of Pharmacy and a clinical faculty member at Drake University College of Pharmacy and Health Sciences. Through discussions with him, I began communicating with Drake's College of Pharmacy. Although still an evolving process, I can already appreciate the benefits of having a pharmacist in the office.

Initially, my plan was to have the pharmacist help us with running a new anticoagulation clinic. Previously, patients would have venapuncture and protime testing at random and these results would be communicated to us by the laboratory personnel long after the patient had left. Our staff would then have to phone the patient with the instructions. This was a cumbersome and time-consuming process that was also neglecting appropriate patient education. With the availability of finger-stick, immediate INR units, I wanted to offer on-site results, instruction and counseling. As in many other similar anticoagulation clinics, I believe that pharmacists are ideally trained to provide this service. We are just beginning to offer this service but patients are very pleased and we have received with many positive comments.

Another very well received service offered by the pharmacy staff has been new drug follow-up. Patients started on new long-term medications are phoned by the pharmacist approximately one week after the office visit. This improves adherence and provides the patient an opportunity to receive additional counseling and education.

Several other services have also been offered including medication therapy review, diabetic counseling and smoking cessation counseling. I have also been trying to include the Drake Doctor of Pharmacy candidates in selecting new medications for patients at the time of the office visit. Overall, pharmacy involvement seems to have been immediately accepted by my patient population with nothing but positive feedback.

We are also having the pharmacy staff manage our drug information for both patients and the health professionals in the office. Pharmaceutical representatives are able to sign-up for time to speak with the pharmacists about new products. This gives them an opportunity to spend more time than we would be able to during our office hours. The physicians are then provided an unbiased, “counter-detailed” update on new products with the opportunity for open discussion. Patient-centered information will be organized and screened for appropriateness by the pharmacy staff in the future and they will increasingly help us expand our service in this area.

I have been very pleased so far with this collaboration and look forward to continuing to find ways to improve patient care through education and research.