Spotlight on a consultant pharmacist practice

Describe your geriatric clinic/long-term care setting and your day-to-day activities. What is your time commitment to the practice or clinic?

I am an Assistant Professor of Pharmacy Practice at North Dakota State University College of Pharmacy, Nursing, and Allied Sciences. My practice site is based out of Fergus Falls, MN. There, I am part of a team of consultant pharmacists that provide consultant services to over 60 facilities, including Long Term Care facilities, assisted livings, Community Behavioral Health Hospitals, hospice, and community hospitals. My day-to-day activities vary greatly due to the variety of facilities we provide services for. In a given week, I may have responsibilities to any or all of these different areas. My main activity at each setting usually revolves around identifying and resolving or preventing medication related problems. I probably average 25–30 hours of direct patient care activities, with the rest of my work time being spent on administrative items, university items, travel to facilities, etc.

How long have you been practicing at your current practice?

I have been in this current practice for almost 10 years. I had done a pharmacy APPE rotation with Todd Johnson when I was a student in 1999. I enjoyed the variety of work settings and clinical opportunities his practice provided and kept in contact with him post-graduation. When his practice was short on preceptors and the university was short on teaching help, a clinical faculty position was created and I jumped at the opportunity.

How did you get to where you are today?

I have been blessed to have extremely good mentors in my pharmacy career. In my first pharmacist position, I worked with Paul Iverson, who took me under his wing and taught me everything he knew. Paul was the Minnesota Pharmacist Association President during one of the years I worked with him. He introduced me to so many different people that have helped me through my career so far. At his pharmacies, I was able to do home infusion pharmacy and also work in a very cutting-edge community pharmacy to provide MTM. It was like doing a residency, due to the variety of work and mentorship I received. With my current position, I have been able to work with Todd Johnson, who built a consultant pharmacy practice from scratch. His entrepreneurial and critical thinking skills and his tireless work ethic have pushed me to do the best job I can, every day. I have been smart enough to follow their advice and teachings.

What is the greatest impact you have had on your patients?

By continuing to work on my clinical and communication skills throughout my career, I am able to make recommendations that help to stop the prescribing cascade that is so prevalent in the elderly and can be an issue in those with dementia. Also, by teaching and precepting Pharm.D. students, I am able to pass some of my knowledge on to them.

What do you feel is the greatest need the elderly or those with Alzheimer's disease have in regards to pharmacy services?

Having a clinical pharmacist as a routine part of their interdisciplinary team no matter where they reside. In the nursing homes, pharmacy reviews are mandatory. In other settings, the clinical or consultant pharmacist does not have as defined a role due to billing issues, location, patient or administrator perception of benefit, time constraints, and so on.

Do you bill for the services you provide?

Yes and no. All of our consultant pharmacist activities are billed to the facility. Most of our MTM visits are covered by various grants that we have been successful in obtaining. We have a few MTMs that we bill third parties or the patient. We are like a lot of other practices, which would flourish with an MTM billing process that is streamlined and without so many differences between payers.

What is your favorite part of the service you provide?

My favorite part of my job is helping the patients and the families of the patients. When you are able to find a medication-related problem, resolve it, and make things improve; that is the best. That is why I went to pharmacy school.

Are you involved in any research or other projects as a part of your practice? Describe a project you are currently working on.

We are working on a number of MTM-related projects. Most have to do with the elderly and include many with dementia. One of the current projects is a MTM post-discharge project where we see people in their homes for MTM. These patients have been identified by the hospitalists, nurses, or pharmacy as someone that has trouble with their medications or are a high-risk of readmission due to their medication regimen.

How would you advise a pharmacist who would like to set up a practice in a setting such as yours?

Consider a residency, consider working with someone in geriatrics through an APPE setting, a job shadow or as a pharmacist, consider being a member of ASCP, look to fill an unmet need, and enjoy what you do.

How do you involve students or residents into your daily work?

Students and residents are a huge asset to our pharmacy team. They are a valuable drug information source for those difficult scenarios, sit-in on MTMs and help with documentation and patient/physician letters, provide in-service education for our pharmacy staff and to the different nursing staffs we work with, provide pharmacy presence at meeting we cannot attend, and ask questions that keep us on our toes

What are some resources to learn more about Alzheimer's disease or long-term care pharmacy that you would recommend?

• American Society of Consultant Pharmacists (ASCP)

• Commission for Certification in Geriatric Pharmacy (CCGP)

• Alzheimer's Association