Where Pharmacy and Urban Health meet

Mar 9, 2017 | Spotlight | News

9A Psychiatry Team9A Psychiatry Team

“In every corner of the world, certain city dwellers suffer disproportionately from poor health, and that these inequalities can be traced back to differences in their social and living conditions.”–World Health Organization, 2010

This statement likely resonates with all of us working at St. Paul’s Hospital. As the urban health centre situated next to the Downtown East Side, St. Paul’s serves patients from marginalized backgrounds each and every day. Our daily discharge planning rounds bear testament to challenges that the interdisciplinary team work to overcome  every day to ensure safe, successful discharges for our patients.

This week we shine the spotlight on the efforts of the pharmacy department, which works to promote urban health on a daily basis. The pharmacists interviewed will share their thoughts and experiences on improving urban health outcomes for patients..

Meet Mike

“Hi, I’m Mike and I work in Internal Medicine/CTU”

Why does improving outcomes in Urban Health matter to you?

“Our patients are among society’s most vulnerable. Addiction, homelessness, and mental health issues are challenges that many of our patients face. Their medical care requires a concerted team effort from a group of compassionate individuals. It also requires that health professionals advocate on their behalf because they may not be able to advocate for themselves. Improving Urban Health matters to me because I think an important measure of a society’s progressiveness is how it treats its most vulnerable. If we can improve the outcomes for these individuals, we all benefit in both tangible and intangible ways.”

How do you promote Urban Health?

“I promote Urban Health by doing my best to fulfill my role on the health care team and to advocate for my patients. I am also actively involved in the teaching of pharmacy learners and learners from other health disciplines.  The pharmacy learners that come on rotation with me learn firsthand about the challenges and successes that come with working in Urban Health. I hope that they all take away a little (or a lot) of the sense of teamwork, dedication and patient advocacy that I think PHC staff exemplify. I am also fortunate to be able to be involved in research. An example of a tangible product of this research is the vancomycin dosing nomogram that many clinicians use every day here at PHC and elsewhere in the lower mainland. Vancomycin is a particularly important antibiotic at our site because of the type of infections we see in our patient population. The nomogram allows the optimal initial vancomycin dose to be selected quickly and accurately.”

What challenges related to Urban Health do you help patients overcome on a day-to-day basis as a pharmacist?

“I work with the rest of the health care team to optimize the complex drug therapy that many of our patients require. Examples include choosing the most appropriate antibiotic, resuming medications that were inadvertently stopped on admission to hospital and adjusting the dose of medications for changes in the patient’s kidney function. Financial coverage of medications is often a challenge for our patients.  Pharmacare provides coverage for many medications, but in some cases the medication either requires special approval (special authority) or may not be covered at all. As a pharmacist, I am able to obtain special authority for the medication on behalf of my patient if the criteria are met, and if not I can identify alternatives that provide comparable therapeutic effect that are covered. I also frequently assist the rest of the team with complex hospital discharges. We sometimes need to simplify the medication regimen to once daily or arrange bubble packing to help ensure that the patient can continue to take their medications when leaving the hospital.”

In an ideal world, how do you see practice evolving to improve Urban Health outcomes?

“I would like to see more seamless transition between primary care and acute care and back again. Patients often encounter disruptions in care and in medications when they transition between care environments.  For the Urban Health population continuity of care is critical. To achieve this I think we need seamless integration of health care information systems between primary care and acute care and we need true multidisciplinary teams that include not just nurses and doctors but pharmacists and other allied health members in most (rather than just a few) primary care settings.”

Meet Tamara

“Hi, I’m Tamara and I practice in Mental Health (units 9A and 8C)”

Why does improving outcomes in Urban Health matter to you?

As an Urban Health Centre, we service high-risk populations and it is our responsibility to ensure that every patient receives the same exceptional level of care. This marginalized population is at risk of poor outcomes due to limited access to necessities such as stable housing or affordable medications. By improving access to medication and housing for this population we can in turn reduce readmission rates.

How do you promote Urban Health?

As the Clinical Pharmacy Specialist in Psychiatry, I work closely with patients and their health care teams in the hospital and community to improve outcomes by ensuring safe and effective medications are prescribed. I empower patients to take an active role in their health through medication counselling and group teaching sessions, including education on opioid overdose and the use of Take Home Naloxone kits.

What challenges related to Urban Health do you help patients overcome on a day-to-day basis as a pharmacist?

In addition to ensuring appropriate medication therapy, there are a number of practical challenges our patients face that can act as a barrier to them receiving proper treatment. Many of them do not have stable housing, so I work with them on finding a community pharmacy based on where they are living at the moment and creating a medication plan that will work for their lifestyle. Many of them also have a low income; therefore, I help educate them on Pharmacare and/or NIHB (non-insured health benefits), ensure they have the correct plan set up, and that all their special authorities are in place so they will not have any barriers to obtaining their medications in the community. Also, by educating my patients on all of their medications, I help ensure that even if they are moving around and changing health care providers, at least they are aware of the medications they should be taking.

In an ideal world, how do you see practice evolving to improve Urban Health outcomes?    

I see us moving forward to bridge the gap between inpatient and outpatient care. There is already technology available to help us achieve this goal and I envision us utilizing more advanced technology to ensure seamless care for our patients.

Meet Ravinder

“Hi, I’m Ravinder and I practice in the Urban Health Unit located on 10C, at SPH. This ward is predominately comprised of patients that have either a serious infection due to an opportunistic organism or a common pathogen and either a combination of HIV, a substance use disorder, or Hepatitis C along with other active medical issues that require hospitalization."

Why does improving outcomes in Urban Health matter to you?

As a pharmacist, improving outcomes in Urban Health matters to me because I care about patients and their health. Every day we see patients in the Urban Health Unit that come from marginalized backgrounds with complex medical issues and helping them take charge of their health is an incredible experience.

How do you promote Urban Health?

I promote Urban Health through educating and counselling patients on their medications and disease states. I find that this empowers them to be knowledgeable about their condition so they can actively participate in their health. Discharge planning is another important way that I promote urban health; I am actively involved in organizing complex discharges for patients, thus ensuring seamless care from hospital to the community pharmacy for the patient. Upon discharge, I communicate therapeutic plans to patients and their community pharmacies on topics including antibiotic treatment duration, intentional medication dose adjustments, particular medications discontinued on discharge and the rationale for discontinuation, as well as ensuring appropriate HIV regimens and opportunistic antibiotic prophylaxis are continued. Moreover, I counsel patients throughout their hospital admission regarding any new medications initiated while in hospital; this is in reference to drug indications, dosage, frequency, interactions, and side effects. This process allows me to ensure that the medication is utilized by the patient safely and effectively.

I am honored that I work with such a large multi-disciplinary team of physicians specializing in Infectious Disease, Clinical Associates with a specialty in HIV medicine, Medical Residents or Students, highly qualified Nurses, as well as other Allied-Health care Professionals to promote urban health for our complex patients.

What challenges related to Urban Health do you help patients overcome on a day to day basis as a pharmacist?

Most often the patients seen on the Urban Health 10C unit at SPH have challenging social and financial backgrounds, which are often integrated with substance use disorders. Thus, having patients remain in hospital to complete a full course of their antibiotic treatment, despite feeling better quickly, sometimes involves altering dosing administration times or even changing the antibiotic altogether. Upon discharge, due to financial challenges, liaising with the Urban Health social worker and deferring to their invaluable expertise to ensure the patient has appropriate medication coverage is important. By working together and identifying these issues early on, we can make sure that systems are put into place for medication coverage to be activated so it is not barrier to discharge later on.

In an ideal world, how do you see practice evolving to improve Urban Health outcomes?

I believe that there has to be easier access to low income housing and social assistance programs. Moreover, I think that programs that include counseling and rehabilitation for individuals would be invaluable as patients would gaina greater sense of independence and accountability, which would hopefully lead to a decreased number of hospitalizations.

Meet Cindy  

“Hi, I’m Cindy and I practice in the emergency department.”

Why does improving outcomes in Urban Health matter to you?

At St. Paul’s, we are situated in the heart of downtown Vancouver and are at the forefront providing health care to the city’s urban population. Improving outcomes in Urban Health matters as we have the potential to improve a patient’s quality of life, reduce their readmissions to hospital and also reduce health care costs in the long run.

How do you promote Urban Health?

In the emergency department, even though patients present for a number of different reasons, education regarding drug therapies is something they can benefit all of them – whether it is regarding, antiretrovirals (ARVs), antibiotics, psychiatric medications, or addictions therapies. Part of this education includes stressing the potential consequences of nonadherence to the aforementioned therapies. When addressing nonadherence to therapy this often involves addressing the root cause of this nonadherence, which could be related to comorbid addiction or mental health issues. I also promote urban health through monitoring the efficacy and safety of therapies to ensure patients that are started on therapies are successfully treated, which also helps to minimize readmission rates.

What challenges related to Urban Health do you help patients overcome on a day-to-day basis as a pharmacist?

I think the most challenging aspect as a pharmacist is bridging the gap that exists between a patient and a successful treatment plan. This is often achieved through changing a patient’s perception about the drug therapies they have been started on and highlighting the importance of medication adherence. It’s a constant struggle with the surmounting workload in emergency department.

In an ideal world, how do you see practice evolving to improve Urban Health outcomes?

Having a better patient to health care professional ratio is important. It is prudent to recognize that our level of patient acuity and complexity has progressed; thus, funding that was previous adequate is no longer enough to provide optimal care for our patients. In an ideal world, I would like to see pharmaceutical care provided to every single patient admitted to the emergency department. The current reality, however, is that I can only provide care to the patients I trust are more acutely ill than the others.

 

 

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