In an interview with Inside Patient Care, Matthew C. Osterhaus, BSPharm, FASCP, FAPhA, Co-Owner/Operator of Osterhaus Pharmacy in Maquoketa, IA, and Immediate Past President of the American Pharmacists Association, discussed the importance of patient-centered services and how to incorporate them into your practice.
What is your background?
A: I am a community and consultant pharmacist from Maquoketa, IA; at Osterhaus Pharmacy, we have a very patient-focused practice.
One of the bonuses of being in a small town is, if you are interested in providing a wide variety of services, and are willing to expend some resources, opportunities abound. Our practice is broad in that we have a long-term care pharmacy, medical equipment, and are involved with hospice care. We also provide compliance packaging, perform laboratory work within the pharmacy, and medication therapy management. We are very much a broad practice, but one that is focused on its patients.
How did your practice become so diversified?
A: In 2015, our pharmacy celebrated its 50th anniversary; we have been around for a long time. My dad bought a traditional drug store, and we have established a very progressive pharmacy practice. We are constantly looking for ways to fulfill the needs of the patients in our area.
We are not the kind of team who wants to sit around and rest on our laurels. We are looking for what’s new, and what’s different, to really match it up with the needs of our patients. That is how we have developed our patient care services.
One of our first big projects back in the 1990s, which we worked on through the American Pharmacists Association Foundation, was Project ImPACT: Hyperlipidemia. At that point, we were seeing patients with issues managing their cholesterol, who would be prescribed medication and then would not have adequate follow-up by their healthcare provider.
We began doing cholesterol tests in the pharmacy, and continued to do so every 3 months during the year of this study. As we started to closely monitor their cholesterol and educate patients, it was amazing to see how there was an opportunity for them to be more involved in their own care. The physicians in our community started to get more serious about monitoring their patients’ cholesterol, and making dosage changes and adjustments to maximize outcomes.
We see ourselves as a healthcare center. One of the other things we identified in our practice, is we had patients who travelled 40 or 50 miles to access services after having mastectomies. We started a service where we provided postmastectomy care to patients in a community pharmacy. We looked at that opportunity, and we expanded it. Now we have patients who are driving 40 or 50 miles to see us because of the way we provide those services, the way we identify with patients and their needs, and help them by working together with them and the rest of their healthcare team to maximize outcomes and get through the rough period a patient who has been diagnosed with cancer goes through.
We look at the needs of our patients and how we can help fulfill them in the most efficient way. If we can partner with a local physician to work with our mutual patients with hypertension to achieve goals faster and adhere to their medication, then we find ways to do that. If it involves working with a physical therapist or local podiatrist, we take a very broad look at what we can do within our site, and the ways our actions will impact the rest of the community.
How do you extend your network to include physicians?
A: As is the case with a lot of other things, I think the key is starting a relationship in a way that allows everybody involved to see there is a mutual benefit to being a part of that relationship team.
Identifying a need is not being met, or an area the physician is having trouble getting their patients to—even if it’s just a logistic issue for the physician, such as not being able to see a patient as often as he or she needs to—can be a good start; finding that little niche with a particular group of physicians, or single physician within a group, is where we began.
For example, we looked at different opportunities to help and explained to a physician, “You start a patient on a new medication for hypertension. You need to schedule a follow-up appointment and see them in 1 or 3 months.” What we have seen is if we can check patients’ blood pressures in the pharmacy in the first 2 weeks after they started a new hypertension medication, we may find we are on the right or wrong track, and, if on the wrong track, we have an opportunity to turn that around early. When we communicated this idea to one of our local physicians, she said, “Let’s try this.”
We see patients when they start a new hypertension medication, get baselines, and do initial hypertension education with them to talk about possible lifestyle changes that they can make to help improve their care. We check their blood pressure, and report these data along with any therapy recommendations to the physician using a 1-page fax form, because that’s the easiest way to integrate that into her workflow.
Creating a relationship with a physician needs to be mutually beneficial. Pharmacists need to find something a physician doesn’t want to do or is not able to do in their own workflow, and then help them with that. You also need to find a way to communicate as easy as possible for both of your workflows. Some people prefer communicating via e-mail, whereas others like faxes or phone calls.
Don’t go in with the idea “this is how we do it”; go in asking, “How can we do it in the best way to meet everybody’s needs?”
How do you raise patient awareness about your role as a pharmacist in their healthcare?
A: We really started to change our practice in the early 1990s, from a personnel and layout standpoint, when we physically set up our pharmacy to provide patient care. We now have 7 different areas in our pharmacy where pharmacists and patients can talk privately.
Having a place where you can have a private conversation with a patient starts to change the relationship you have with them. They know they can confide in you and you can give them advice that is not being shared with everybody else in the room. I think that’s a great place to start.
Initially, patients were very skeptical to walk into these little areas. They would hang out on the outside, because they didn’t know what to expect. Now, our patients understand pretty well that this is how it’s done at Osterhaus Pharmacy. There are probably some people who don’t like that—and maybe they have chosen a different place to go—but I think, given that this provides a place where you can establish a relationship in a way that is the most beneficial to you and your patient, it is a great place to start.
I think the other part of it is the physician or physicians you are working with need to create, in the patient’s mind-set, the idea that the pharmacist and physician are working together. The physician also needs to reinforce that the patient should stop at the pharmacy in 2 weeks to have his or her blood pressure checked after a change in therapy, for example.
When the message comes from the pharmacist and the physician, there is no question you will get a better response from most patients. We continually work on communicating with patients and other members of their healthcare team, letting physicians know, for instance, when we have shared information about lifestyle choices or disease state education with a patient. We also let the patient know we have communicated information to their physician. We close the loop, which makes such a big difference in getting people to buy in and say, “Yeah, this makes sense to me. Now I’ve got a team that’s working for me.”
How can pharmacists make time to incorporate primary care services?
A: To really get the whole team on board, we have to work efficiently. Our technicians and students are coming through our practice and fully integrated into our workflow, and the care we provide. We also have a community pharmacy resident in our practice, whose primary focus is to provide patient care.
When a patient identified in our system as being in our hypertension program comes through the door and is greeted by a technician, or is waiting for their prescription, our staff will receive a notification that this is an opportunity for a patient care service. While we are processing their order, we can start that conversation with the patient, discuss any problems the patient is having with their medication, and direct the patient to a student who can check his or her blood pressure.
We take every opportunity to provide needed patient care services. It’s really about getting everybody involved so you are using people’s talents in the right way, while being aware of your time, and the patient’s time too.
Most patients do not want to stay in the pharmacy for half an hour; however, they may have to wait for their prescription to be filled, and if we can start providing some service or setting them up to provide them with a service, that is just the most efficient way to go about it. You have to staff up enough to be ready to provide services. You can’t do it on a shoestring. If you have a pharmacist who is in a practice trying to fill 200 prescriptions a day, and they’re the only one there, I don’t see how you can make that work. You have to have enough pharmacists on staff.
Again, be as efficient as you possibly can by using your technicians, and working with your patients. For example, if you have an adherence-based program for your patients and you’re calling them to say, “We’re filling all of your prescriptions. They’ll be ready for you on Wednesday. Does Wednesday work for you to pick them up?” and they say, “No, I want to come in on Thursday,” you might ask them, “Morning or afternoon? When do you think you might come in?” If they are going to come in Thursday morning, then you know that 3 or 4 days in advance. You can be ready to say, “I want a pharmacist to be available to see Mrs Smith when she comes in.”
We aren’t going to be scrambling to figure out who is going to take care of her; we have a better idea of what to expect. Get yourself to a place where patients have some expectation when they come in they are going to be able to see a pharmacist, and an appointment-based experience where their medications will be synced. That way they can come in only once a month, or once every 3 months—instead of coming in every week to pick up this, that, or the other thing—and that can really help.
I think it sets, in the mind of the patient, that there is going to be a discussion each time they are in the pharmacy. I think it gives you the opportunity to say, “Here’s a time when we’re ready for you—you’re ready to be educated or have a service provided.” It really works best for everybody that way.
Why are patient-centered services so crucial for pharmacists?
A: I think the bottom line is, all this is what our profession is about. Yes, we can efficiently distribute medications to patients; but the bottom line is it’s got to be the right medication.
Patients have to understand what their role is in taking their medication if we want that to be successful. I think the big picture is, we are care providers; we are being trained as care providers, and we need to be able to practice at the top of our license.
It’s fulfilling as a pharmacist to know how much more of an impact you can have on patient care than saying, “I filled 300 prescriptions today.” When you get down to it and you know you have impacted someone, and improved their healthcare, it’s a great feeling.
It is what we are trained to do, and there is no question, we need to move forward in that direction. It’s the way our profession needs to go, and we are going to get there.