AMBULATORY CARE.

Riding in an ambulance for the last 5 weeks has truly been an incredible experience.

If you are like me when I first heard the term “ambulatory care pharmacy”, you may have thought “I didn’t know pharmacists would have such an important role in an ambulance?” After paying about $200K for my education, I came to realize that ambulatory care pharmacy meant working in a clinic seeing patients who could walk or “ambulate” – move.

A pharmacist’s role in the clinic is much different than counting pills or handing out drugs.  This new age of pharmacy recognizes pharmacists as “healthcare providers” who provide clinical services to patients.  At my clinic, these services include managing and adjusting therapy for disease states including diabetes, hypertension, and hyperlipidemia.  We also review patient’s health record and medication list to look for improvements we can make in a patient’s therapy whether it be for safety concerns or more effective treatment alternatives.

Now, I may be biased, but I love this role.  Coming from my extensive background in tutoring, each meeting with a patient is a chance for a teaching opportunity.  And the difference between academic education and patient education is that each new concept learned can make a significant difference in a person’s health and quality of life.

For example, a pleasant, older, African American lady came in for an appointment regarding diabetes management and education.  She was very interested in ways to improve her health and learn more about healthy eating.  We were discussing counting calories and which foods contained sugars that could lead to increased blood sugars.  When watermelon came up as a fruit that contained sugar and should be only eaten in moderation the lady screamed as if she just found out Santa wasn’t real for the first time.  She said, “OHHH NO I CAN’T DO IT, I LOOOOOOOOVE MY WATERMELON”.  After the initial panic, we assured her that she could still eat her watermelon, but that she would need to take additional insulin to keep her blood glucose levels controlled.

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Everyone Loves Watermelon.

I found that there are many things we learn from our patients.  A man came in for a comprehensive medication review and kept repeating he was from the Coast and they do things differently out there.  Most sentences began with “On the Coast…” I was not sure exactly what that meant, so I continued asking him about the drugs he was taking.  When I asked him about vitamin D he mentioned he was chronically low and said, “Did you know that on the Coast we take vitamin B12 to help with vitamin D absorption?” I looked at my preceptor with surprise.  In school I learned about magnesium helping but never B12.  My preceptor return my blank stare, so I knew I should continue the exam unquestioningly.

As I progressed through learning how to independently manage pharmacological therapy and run appointments, I came to realize the relationship formed with the patient is probably the most important aspect of successful care.  Many people with whom I had discussions were fed up with the healthcare system.  They felt as though the 15 minute appointment with a physician did not answer their questions or satisfy their health needs.  Some would be prescribed insulin for the first time without any directions of how to load the syringe and administer the needle.  After much frustration they would simply not take their medication and let their diabetes run wildly out of control.  These were the patients we were designated to manage.

Yet often times, when the patients met with my preceptor and I, they opened up to us about their barriers to care.  They repeatedly told us they appreciated that we would spend an hour with each patient explaining all about their drugs and answering questions they had.  This is an excellent opportunity for pharmacist to become involved in collaborative patient therapy management.

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Pharmacists As Providers Of Patient Care.

One lady we were talking with expressed this same concern.  She was incredibly fed up with being sent around to multiple specialty providers, and was ready to stop taking all of her meds out of resentment towards her confusing care plan.  After spending an hour and a half listening to her concerns, we fixed medication duplicates she had and found drugs that would be more affordable and to her.  Finally, she agreed that she would give taking her personalized medicine regimen one more shot and make a healthly change her lifestyle.

I then saw vitamin D in her profile and she mentioned that she heard there was something that she could take to help with its absorption.  I looked at my preceptor with anticipation and blankly asked, “Is it vitamin B12…?” And she replied with excitement, “YES, that’s it!”  I almost asked her if she was from the Coast out of amusement, but I figured I would save it for another time.

I am sincerely thankful for my preceptor and her exceptional ability to communicate with patients in a way that makes them feel understood.  I hope I can have opportunities to serve my patients in this same way through my career as a pharmacist.

Dane Michaelangelo Fickes, Pharm.D. Candidate

 

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