Share Our Selves pharmacists help patients unravel complex medication regimens

Federally qualified health center in California offers MTM services

“Susan” went to her appointment at a family health center in Costa Mesa, CA, with a small container full of prescription bottles, a few more stuffed in her pockets, and the remainder in the pockets of the friend who had driven her there. Her appointment was for a routine primary care visit with a physician assistant (PA), but she wanted to make sure she remembered to ask which of her medications she was still supposed to take and when. When the PA saw her, however, he referred Susan directly to the pharmacist.

“Usually the patient would make an appointment to see me at a later time, but the provider asked if I could just see the patient right then to unravel the medications,” said Mary Ann Huntsman, PharmD, CDE, who is director of clinical pharmacy services at Share Our Selves, a federally qualified health center.

Susan’s story is not unique. In fact, one in five Americans takes five or more prescription drugs, typically for multiple chronic diseases, according to recent research published in Mayo Clinic Proceedings. Studies show that people who have chronic diseases or complex medication regimens do better under a pharmacist’s care than under the care of a physician alone. Many patients get this kind of care from pharmacists in a variety of settings, but access isn’t always easy because health plans do not recognize pharmacists, like the ones in this series, as health care providers.

Some, but not all, older Americans are eligible for clinical pharmacy services through Medicare Part D. Others may have access to these services if they see a doctor at a team-based clinic such as Share Our Selves, which has a pharmacist on staff. But most people who could benefit from a pharmacist who could “unravel” their medications don’t have access to such a thing.

Among the 16 bottles Susan brought, Huntsman found duplicate and expired prescriptions, over-the-counter medications, herbal supplements, and prescriptions purchased abroad. Huntsman pulled unnecessary medications from the regimen, determined what the foreign medications were, recommended a different beta-blocker, made several other suggestions for improving the medication regimen, and showed the patient how to use her inhaler properly. 

Huntsman suspects that the visit saved the patient future emergency department visits in addition to improving the patient’s overall quality of life.

“By correctly taking the medications she needed and not taking medications that she didn’t need, or that were potentially interacting with other medications, she should start to feel better. In the long run, hopefully that improves her health outcomes, too,” she said.

But it’s not just low-resource patients, like those served at Share Our Selves, who could benefit from medication therapy management (MTM).

“Medication is confusing to many people. They don’t understand it,” Huntsman said. “Taking medication correctly is so important to the management of chronic disease, and if taken incorrectly, it can lead to adverse drug events, which are expensive and personally devastating. These services should be available to everyone.”

Huntsman cites her own parents, one a WWII veteran and the other a teacher, as examples of people who need MTM.

“They can manage the system. They can get through life really well, but the piece that constantly falls apart in their health care is that medication management,” she said. “There are so many patients that could benefit from clinical pharmacy services, and that lack of compensation really puts up a barrier to offering that.”

This barrier may soon come down for Huntsman and her pharmacist colleagues in California. The state recently passed SB 493, which grants pharmacists provider status, though the changes the bill will bring have not yet been implemented in daily pharmacy practice. 

Huntsman hopes that other states will follow suit. Giving pharmacists provider status, she says, will open doors to making clinical pharmacy services available to all patients in all settings, which will cut costs for all in the long run.

“It will help promote clinical pharmacy services within the health care system. I would hope that it would also make these services sustainable for all of our patients,” Huntsman said. “It’s been shown over and over again in the literature that pharmacists can affect the health outcomes [and] the safety of patients and decrease the cost.”