Pharmacist makes house calls to help older patients


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“Roy” was 80 years old. Overweight, this patient had diabetes, high blood pressure, and high cholesterol, in addition to gout, osteoarthritis, and depression. He saw a psychologist for his depression, took atorvastatin for his cholesterol, and recently had added celecoxib for his worsening hip pain. The celecoxib didn’t do much, however, and eventually Roy resorted to a walker and moved around as little as possible. 


Barber

When Roy mentioned his hip pain to his psychologist, the psychologist suggested Roy contact Albert Barber, PharmD, CGP, FASCP. Barber, who specializes in geriatrics, runs a part-time consulting business, through which he makes house calls to identify and help resolve medication-related problems. Like the other pharmacists profiled in this series, Barber believes that recognition as a health care provider would maximize his ability to help patients, to collaborate with other members of the health care team, and to save the health care system money.


“One of the principal tenets of geriatric care is that any symptom in the elderly should be considered a drug side effect until proven otherwise,” Barber said. “So there’s tremendous opportunity, especially in the area of geriatrics, for pharmacists to step in and play a practitioner role, if we can get provider status.”


Solving problems


Pharmacists could help solve problems like Roy’s, which are all too common among older patients. When Barber arrived at Roy’s house and saw that he was using a walker for his hip pain, despite taking celecoxib, he knew something was amiss. “If it was truly osteoarthritis, you would expect the Celebrex to provide at least some relief, and instead he just kept getting worse,” Barber recalled. 


Learning that Roy took atorvastatin, Barber suspected that was the problem. “One of the known side effects of Lipitor is myopathy or muscle pain. And if left untreated, it can actually cause muscle damage, which can cause kidney damage, kidney failure, and lots of other issues.”


Barber contacted Roy’s physician to recommend lowering the dose of the atorvastatin and stopping or lowering the celecoxib. The physician stopped both, and Roy’s joint pain went away.


“You would think that if you take somebody off a cholesterol drug, their cholesterol would shoot right back up, but it didn’t. That’s because he was able to get more physical exercise, which helps to control cholesterol as well,” Barber said. “Within about a month, he was no longer using the walker. He could mow his lawn. And he was playing golf.” 


Besides improving Roy’s health and quality of life almost immediately, the change in medication regimen saved Roy over $2,000 a year in out-of-pocket costs.


Sustainable practices


Barber sees patients like Roy on the side, outside of his full-time practice at a long-term care pharmacy. The patients, who come from a variety of economic circumstances, pay him out of pocket. If pharmacists had provider status and could bill insurance, however, he imagines many of them would be able to set up sustainable practices like his consultancy. And the benefits to patients and the health care system would be immense.


“If the only thing pharmacists did as providers was recognize, rectify, and prevent drug-related problems, they couldn’t pay us enough,” Barber said. “Medication-related problems in older adults is one of the most expensive diseases in the U.S.”


For Barber, provider status isn’t about a means to bill insurance. It’s about recognition as a full member of the health care team. “We want to get to the point where physicians see us as another consult service just like they may refer somebody to a neurologist or a psychiatrist,” Barber says. “So if somebody has medication-related problems actual or potential, they refer them to a consulting pharmacist for that service.”

As the number of practicing geriatricians dwindles, older adults need the clinical services that Barber provides.


“Many of the problems that older adults have that lead to hospitalization, rehospitalization, and costs to the health care system are medication-related,” Barber said. “And there’s nobody in a better position to address these medication-related problems, especially in the older adults, than a pharmacist.” 


Provider status stories


Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel. If you would like to share your story, please visit PharmacistsProvideCare.com.

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