Team Up! Team-based primary and community care in action

In this episode Sarah and Morgan explore the role of Pharmacists in Primary Care. Pharmacists provide a unique lens to care through their detective skills, patient education focus, and deep expertise on medications. We will hear from two Pharmacists about the scope of practice for primary care Pharmacists and the ways in which PCNs and clinical teams can best utilize their skills to care for complex, frail and elderly, and patients on complex drug therapies.
The key takeaways of this episode are:
  1. Pharmacists are impressive detectives who will be able to see opportunities for risk mitigation and enhanced patient care that you didn’t even realize were there!
  2. Pharmacists are incredibly patient-centered and they look holistically at the patient to ensure that the prescribed treatment is effective, safe, and meets the unique values of the patient.
  3. Co-locate your pharmacist! Those relationships are key and the more they can be part of the full clinical scope, the EMR, the team, the more opportunities there will be for them to use their full scope of practice on the team.
A huge thank-you to all of our wonderful guests for this season! In this episode you heard from:
  • Barbara Gobis (BSc(Pharm), RPh, ACPR, MScPhm, PCC): Barbara is the Program Lead, Pharmacists in Primary Care Network (PCN) Program and Director, Pharmacists Clinic, at UBC Faculty of Pharmaceutical Sciences. Barbara has practiced for the past 30 years as a licensed pharmacist and joined the UBC Faculty of Pharmacy in 2013 to develop, establish and oversee the on-going success of UBC Pharm Sci's Pharmacists Clinic. She has also been instrumental in facilitating the integration of pharmacists in PCNs across BC.
  • Sadie Quintal (BSc (Pharm), RPh, BCPS): Sadie is a Pharmacist in the the Comox Valley PCN. Sadie graduated from the UBC Faculty of Pharmaceutical Sciences in 2010 and spent the next four years of her career as a Pharmacy Officer for the Canadian Forces. Working in Island Health since 2015, her varied roles have included ward-based clinical assignments, academic detailing, and temporary Pharmacy Site Coordinator.
  • Carolyn Canfield: Carolyn is the ISU’s in house patient-disruptor and adjunct faculty member in the Department of Family Practice at UBC. Carolyn is very involved in the Department of Family Practice and shares her expertise by teaching medical residents about patient experience and engagement She is also engaged in a number of national and international research projects that range in focus from patient engagement in care, to system resilience, to patient safety.
Resources and Links :

What is Team Up! Team-based primary and community care in action?

A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.

Morgan: Are you thinking about adding
a pharmacist to your primary care team?

Are you committed to the idea of
a pharmacist in primary care but

aren't quite sure what they'll do?

Yeah, me too.

Sarah: So Morgan, we know that
many PCNs and primary care clinics

are really interested in this idea
of pharmacists in primary care.

And as we prepared for this episode,
I was really surprised by just

how little I really knew about
what pharmacists actually do.

Morgan: I've been working with pharmacists
in my clinic for 16 years now, and

even before I came on board, I thought
I knew how pharmacists work, so I can

totally understand why there's such
a demand right now for pharmacists.

And yet I think a lot of people
don't know in primary care all

the things pharmacists can do.

Sarah: And you know what's really
reframed my thinking is this idea of

pharmacists as kind of detectives.

they can scan an emr, identify
patients who are at risk for medical

complications based on the drug
therapies that they're taking.

Or they can create these complex
drug interaction maps, searching

for interactions between medications
that could be causing different kinds

of secondary health issues, right?

Like that's pretty cool.

Morgan: It is, when people talk about
pharmacists doing a best possible

medication history, I know some
people get there nose outta a joint.

Like I could take medication
history too, honestly.

I take a second best if that.

because pharmacists are so thorough
and they can be such detectives

as they go along, so much of their
work, can be around patient education

and making sure that they have all
the information that they need.

And that's definitely different than what
they're doing necessarily in a dispensary.

And this is just a really unique
set of skills that's gonna be

really helpful in primary care.

Sarah: let's talk a little bit
about the scope of pharmacists

and primary care teams.

What do they do?

Barbara: So a pharmacist's focus is on the
drug therapies that a patient is taking.

Is it a suitable drug
therapy for the condition?

Is it delivering the results?

Is the dose and the frequency and the
dosage form, working for the patient?

Does the patient
understand how to take it?

Does the patient have any
concerns or unexpected impacts?

Is the medication covered by a drug plan?

Is it going to impact their
kidney function that impairs the

second drug that they're taking?

So we work alongside prescribers and
we provide the analysis, the detail,

and we come up with therapeutic
recommendations that based on what

we understand are going to give this
patient the best likelihood of success.

And then we will work with prescribers
to make sure that the treatment

plan is working accordingly.

We primarily contribute to the
care of medically complex patients.

We also spend a fair amount of our
time working with people who are

frail and older and have been on a
number of drug therapies and maybe

they don't need them all anymore.

So we will sort out what they need to
be on and what we can remove to lighten

the load psychologically, physically,
and economically for these patients.

Sarah: And that was Barbara Gobis,
who's the director of the UBC Pharmacist

Clinic and the operational program
Lead for the Pharmacist in Primary

Care Networks program, which helps
pharmacists integrate into PCNs across bc.

Morgan: So this definitely rings
true as a scope for pharmacists

that I've worked with at least.

They're often responsible for some
of the more complex patients and

assessing them, and that's often,
people as they age, they're gonna be

coming on more medications and have
more health conditions, and that's

happening in so many practices.

We're dealing with a larger
population of elderly.

Sarah: Barbara mentioned something
really interesting that I'd

love to get your take on Morgan.

The idea that pharmacists look
to kind of lighten the load

for patients psychologically,
physically, and economically.

What does that mean to you?

Morgan: Well, I think that means
that a pharmacist is gonna consider

the holistic patient and help
them understand what's happening.

Remembering that there's a mental burden
for taking medications and the physical

burden of the different side effects and
the even the costs of taking medications.

If a patient can't remember when or how
to take their medications or they're

having too many side effects, if
they can't afford medications at all,

then whatever the doctor prescribes,
doesn't have a chance to help.

Now doctors can try to think of these
things, but nobody's in a better spot to

know it all and to have the time to look
at this information than the pharmac.

Sarah: You know, I think as we've
all experienced, the number of

touchpoints that a patient has
across a system can be a lot.

We've talked a lot about how
it's a really complex system

that folks need to navigate.

Particularly, I think when we think about
unattached patients who might be seeing

different doctors that walk in clinics
or patients who have been hospitalized.

That means that the care team
might be a bit siloed, so the

pharmacist can play that role in
bringing the whole picture together.

Barbara shared a really great
example that I think is helpful here.

Barbara: an older gentleman who had
been discharged from hospital and was

not having Success with his treatment
at home and our pharmacist reviewed

all of the medications they were taking
and unfortunately, that patient was

still taking some of the medications
prescribed before their hospital

visit, as well as those prescribed
during and after their hospital visit,

altogether, and was taking things that
they weren't supposed to be taking.

So we talked to all the members of
the care team, and confirmed what

needed to be on and what needed to
be off, and made sure the patient was

understanding, got everything adjusted,
and then that patient was just fine,

but they were inadvertently in a toxic
situation, because nobody was checking.

Morgan: I think this is a great
example of how pharmacists can really

support patients through transitions.

Moving between different points
of care and finding ways to

ensure that continuity of care and
continuity is really important.

Sarah: And Barbara also shared that
the more processes we have between the

patient and the pharmacist, the more
separation between the patient and the

pharmacist, that can actually impede care.

So if a patient is discharged to their
primary care provider, who then had

to refer them to a pharmacist, That
would reduce the quality of care.

This idea of pharmacists being
actively on top of patient panels,

being part of the team, ideally being
co-located really could have a huge,

huge positive, impact on outcomes.

Barbara: The worst thing that you
can do is have one person be forced

to be a gatekeeper that decides who
gets referred to other care providers.

You're much better off having in a
case conference or a rounds discussing

elderly people at risk of falls,
and then the pharmacist can say,

well, this is what I'm looking at.

And then, the group will say, okay
we're gonna tag everybody who has

those risk factors and we'd like you
to review them and see if they're safe.

Or better yet, you let the pharmacist
just go into the EMR and identify the

people that are either new to the practice
who are on drug therapies and people

don't know why, patients who need extra
time to get their questions answered.

And there's really good evidence that
when you let a pharmacist manage the risk

that we see, patients do better, care
teams have less stress, and the pharmacist

feels very rewarded in their work.

Sarah: So this is really where we get into
that idea of pharmacists as detectives.

That a pharmacist could take a bunch
of data in an EMR and use their

skills to proactively prevent patients
from having health complications.

Morgan: I like the idea of allowing
pharmacists to manage some of

the risk for patients They've got
that experience and knowledge.

I know EMRs can pose challenges in terms
of access, but getting to a place where

the pharmacist is part of the team and
has access to the record, so they can see

the patient files go through some of the
history and then make recommendations and

put those recommendations in the chart so
that everybody can have access to them.

That's super important.

So I think this really points
to the whole team approach.

If MOAs or nurses or another team member
can identify patient groups, that would

benefit from some detective work from a
pharmacist, this could be really helpful.

And, using the EMR to do
this is not that hard.

You can search, the number of
medications people are on and just pull

those with a, a large number of meds.

And those are more than likely
gonna be a quick spot to

start bringing a pharmacist in.

Sarah: another thing that we learned
is that pharmacists do something

called a head to toe intake,
when meeting with new patients.

and this allows them to get a really
comprehensive picture of the patient's

health and experience with medications.

And when I was speaking with Sadie
Quintal, who's a pharmacist who works

in a PCN and supports of 10 different
clinics, she gave me a really detailed

explanation of what this kind of heads toe
intake process looked like, and I had sort

of an aha moment about the value here.

Sadie: My initial appointments will
be an hour and we sit down and we

go through a ton of information.

I'll gather information like what
their coverage is like for medications.

Do they have any issues with
affording their medications?

sometimes that's as far as we get
because things are so unaffordable and

so costly for them that we need to deal
with that first before we can move on to

trying to optimize care in other ways.

Then we move on to making sure to
clarify that I actually have an accurate

picture of their past medical history.

And this also gives me a bit of an idea
of where their health literacy is at?

So I'll clarify what their medical
conditions are, and that's stuff

I've usually pre-prepped, right?

I've gone through the chart, I've
tried to preemptively gather this

information so that I know who I'm
dealing with from a medical perspective.

and then we move on to clarify what
they're taking, how they're taking it,

are there discrepancies between how it
was prescribed and how they're taking it.

And as I'm doing that, I'll
usually ask questions about,

oh, does that work for you?

Then I ask people a series of
questions going from head to toe

and that really is a way for me to
identify possible side effects of

medications or untreated conditions.

Sarah: And I think you can
totally hear the detective at

work in Sadie's story there.

Through her questions, she kind of
pulled together the patient's experience,

asked about, you know, how are your
toes feeling, how are your legs feeling?

All the, all these things that I
wouldn't think about if , someone

was coming in for say, heart issues.

Morgan: you are gonna see this in
some of our other, roll call episodes

that a lot of us do those intake
appointments, but we all have a

slightly different flavor and focus.

And that gives us a better picture
for our patients across the team.

So I think it's really interesting
to hear that intake approach it is

different than how I do my intakes
and the intentionality and the

focus around the medications and
side effects is so, so important.

Sarah: So what do you think would
change for a team if they had a

pharmacist doing this kind of intake
for patients on complex therapies?

How would this make a difference?

Morgan: Well, I mean, it's really
interesting to think about.

So if everything's going well,
then nothing would change.

But we know that's the reality is
that in this complex world of complex

patients, that's not the case.

As a doctor, there's a couple things with
pharmacists that I really appreciate.

There is that comprehensive knowledge
in the team, around medications,

that I can, reach out to, and,
connect and share and learn from.

So I might be treating a patient and
I mentioned earlier that you have

this complex set of medications and
you wanna treat the next thing, or

you need to treat something, and now
which medication is the right choice?

And that's where having a pharmacist
on the other side of the wall.

in my old practice, I literally could
knock, well, I had to knock fairly loud

because it was a thick wall, but we
shared a wall between the pharmacist

and myself, so we could share patients

so that's, a big one, in the
moment when things are shifting.

Then we talked about this other idea,
bringing a patient to see a pharmacist

and looking at everything fresh.

So just, not that I have a specific
question, but things are just complex

and I want to make sure that if we
can de-prescribe, then a pharmacist

is hugely important in that.

And that's where we can really
start to reduce the number of side

effects that impact quality of life.

And to know that somebody on
the team is looking at that and

specifically making recommendations
that I can review and follow.

That's huge.

Sarah: Well, and as a patient, , I
would love to know that someone

else was kind considering the
full picture in this way too.

, I get migraines.

And Barbara actually shared a
story, that really spoke to me.

Cause I was like, oh,
this would be so useful.

Barbara: It is not uncommon for a
person who is living with migraine

to have trouble finding the right
treatment regimen for their needs.

And so people, patients will be tried
on a drug therapy and, and it might

be considered a failure, and then
they get tried on something else and

it might be considered a failure.

And then another, and another.

and by the time they come to us,
they're on third, fourth, fifth line

drug therapies that aren't necessarily
known to be as effective and have more

risks of side effects and toxicities
and cost and everything else.

So we will go back and check whether
those treatments were really failures

or whether they just, the drug wasn't
used in the way that it was intended.

we can clean up and get a person
back on the first or second line drug

therapy fairly straightforwardly.

We can also identify if a
patient is on what we call a

medication overuse headache.

So that means a patient is taking,
perhaps acetaminophen or ibuprofen and

they've been overusing it at home so
that that overuse in and of itself starts

to trigger headaches and stopping those
therapies in a safe and effective way can

provide tremendous benefit to patients.

Morgan: So this is a really common
scenario, and Sarah, you don't

know it, but this was on my exam
when I was licensed as a scenario.

It's not something that we always
think about, although because it was

on my exam, I've never forgotten it.

And pharmacists often
will review and find this.

We all know that patients suffer with
migraines and it's a challenge to find the

right medication so having expertise of a
pharmacist to talk about what the options

are, what might have worked in the past
but it's not working now or worse causing

problems now I think is really important.

just having that extra person to bounce
ideas off of and get new ideas to

improve the quality of care is great.

Sarah: So I'm already sold on this idea
of a pharmacist in a primary care team

but I did wanna shift gears a little bit.

One of the things we heard a lot about
was how patient-centered pharmacy is and

so much of their work is sitting with
patients providing education and guidance.

so I have a really great relationship
with my community pharmacist.

He knows my kids.

The only thing I do is get that migraine
prescription filled, so he knows that I'm

usually not feeling great when I see him.

But it's really wonderful to have
that kind of relationship, oh,

this is the first time that your
kid's been on these antibiotics.

Do you want me to sit with you and go
through how they should be taking them?

that kind of education,
I think is invaluable.

And Barbara talked a lot about how the
values and beliefs of patients are so

important, to making decisions about
drug therapies and treatments to make

sure that, patients are able to follow
through on whatever's prescribed.

Barbara: we will follow up how a patient
is doing on a drug therapy and make sure

they got the prescription filled and
make sure they understand how to take

it at home and that if they're taking it
at home, that it's working for them so

that when the patient comes back to the
care team, the care team can have some

confidence, that the patient is in fact
getting the treatment that was intended.

We will ask patients what their
values are, what their attitudes

are towards drug therapy.

and a patient's attitude towards
drug therapy goes a long way

to giving us an idea of how
successful they're gonna be at home.

So, for example, when we work with a
person who lives in a First Nations

community and identifies as First
Nations, we want to be extremely

respectful of traditional wellness
approaches and how that intersects with

Western approaches and how we can find
something that will work for a patient.

And if that means taking patients
off of drug therapy that they

don't wanna be on, we'll do that.

Sarah: And this same kind of alignment
with patient values and making sure

that, drug therapies are gonna work
for patients was really echoed by

Carolyn Canfield, our ISU scholar
and patient disruptor extraordinaire.

Carolyn: I established a relationship,
asked questions about over-the-counter

issues that were not something I wanted
to trouble my physician with, and the

pharmacist was incredibly helpful.

I of course respect the expertise and
the information and the commitment to

service that this young pharmacist has.

But it's so wonderful to
know that he knows who I am.

I walk into the pharmacy now he
knows me by name and he extends

his sense of responsibility
to me in a really evident way.

So I had heard other patients talk about
the importance of their relationship

with their pharmacist, and I thought,
man, that doesn't make any sense to me.

You go in and you buy
pills, you leave, right?

it's not about relationships.

Now I have a very different attitude
and I feel again, I'm more than just

that particular prescription being
filled, that this person wants to know

me, wants to make sure that my questions
are answered, that I'm comfortable with

what's going on, and that if I have any
concerns that he's absolutely, there

to respond to me in a integrative way.

Morgan: Carolyn talks a lot
about the relationship with the

pharmacist in community pharmacies.

And as we move towards primary care
teams, I think we can see that patients

will build these relationships even more
readily, when a pharmacist can be part

of the team and not just be focused on
dispensing, but also the other aspects.

Sarah: And there's that
co-location piece there.

And you talked about it Morgan,
you know, being able to bang on the

wall for, the pharmacist next door.

a lot of pharmacists and teams who are
coming in and having that co-location

time and that can be so valuable.

But also then there's a lot of virtual
connection time and, and I know Sadie,

the other pharmacist that we heard
from, she works across these 10 clinics.

A lot of her work, is virtual or
she has patients coming to her.

So there really is kind of that blend.

One of the things I think that
was surprising to me was how

pharmacists described, the role
of, the pharmacist as a liaison

between the patient and prescriber.

this stems from my thinking that a
prescription gets written down and

then that is what has to happen.

There's a lot more negotiation
that could actually happen.

A lot more flexibility.

And this is, I think, something
that people like me, who aren't

primary care providers, you
might not really understand.

Barbara: I think people don't really
understand what a prescription is.

A prescription is a request
to a pharmacist to provide

drug therapy to a patient.

a pharmacist can change the request.

Refuse to fill the request.

talk to the prescriber.

Recommend that the request or
the chosen therapy be changed.

That is a pharmacist's responsibility.

So we check doses, we
check kidney function.

We make sure it's not gonna
interact with other drug therapies.

We're gonna make sure it doesn't
increase grandma's risk of falling

because she's, she's unsteady
on her feet as to begin with.

All of those kinds of things we
look at in tremendous detail.

And we do it, just sort of silently
and quietly behind the scenes.

We are also that liaison between the
prescriber and the patient because we

answer the patient's questions, we help
them understand why they're on it, how

they need to manage at home, how to
support them when they've got questions

in between the appointments with the
person who has prescribed the medication.

So we're running alongside all of
the prescriptions that are out there.

Morgan: Barbara really
highlights that idea of running

alongside the prescription.

And it's, true that a lot of this
work, Sarah, for you, you don't notice

because you're not seeing it happen.

It's happening on the phone or, on fax,
Which is too bad because I think when you

start to know a pharmacist more closely,
if you're working in a small town or you

have somebody on the other side of the
wall that you work closely with, that

relationship gets built and then you
work closer and you start to trust that

other person better and that's when the
information really can flow quickly and

efficiently and effectively for patients.

It is challenging to bring,
a new team member in.

And so I'm curious about what did
Barbara and Sadie say about, bringing

pharmacist into a primary care team?

Sarah: They both had some
great suggestions here.

The first piece was really around
defining where the pharmacist

can make the most difference.

So finding out those areas of care
where, the detective skills, we

talked about, the relationship
skills, having, the time to sit with

patients where that can be most well
utilized, where scope can be optimized.

Sadie started, in the, PCN
being referred patients for

mental health medication support.

And this has been a really great
win for both her interests and

optimizing care for those patients.

Sadie: If they're thinking about bringing
on a pharmacist, it would be wise to

consider, how can we optimize this to both
improve care for our really complicated

high needs patients, but also utilize
the skills that can be used to reduce

some of the pressure and the burden on
the doctor and the other team members.

Some of the psych practice
that I do is similar.

The doctor sees someone and is
like, Hey, like I've given them

a diagnosis of depression, or
they have anxiety and they're

thinking about starting medication.

Well, sitting down to talk to someone
for 30 minutes to an hour sometimes is

what people need before they can make
a decision about that, starting on a

medication that could go on for years and
that's a tricky thing for a doctor to do.

Following up to make sure, are
you having any side effects?

As we titrate the dose upwards,
which is a common thing that happens

with psych medications, again, that
doesn't need to be the doctor, right?

Having recommendations for a second
line therapy, if that one didn't work

or they're having side effects from it,
or trying to pick a medication based on

the side effects that we want, right?

Are you having trouble sleeping?

Well, maybe we can pick something
that's a bit sedating and

you can take it at bedtime.

Morgan: So this speaks to me both
about what a pharmacist is an

expert at and then what people
have in terms of personal interest.

So Sadie's interested in mental health
I think is something that you'd learn

about as you got to know Sadie, and
that becomes one of those areas that

then you think more about the kinds of
people that you'd want Sadie to see.

Decisions about when to start or stop
medications for depression or anxiety

or, any mental illness is a big decision
for the prescriber and the patient

and the pharmacist can really help
considering the various impacts and they

might actually be a point of connection.

A patient might not come to me as
the prescriber, as the doctor and

say, I don't want to take that
med anymore, they just might stop.

And wouldn't it be better if they
felt comfortable talking to the

pharmacist on the team to get some
advice about whether that's a good idea

or not before they made that decision.

Sarah: I'm thinking, wouldn't it be
great if you had a new pharmacist on

the team and you'd sat down and had a
conversation and knew that they were

interested in mental health supports.

You would then have that sort of
automatic trigger of , okay, this is a

person I could refer to the new role.

And so often we see a new role, join
a team and then not get utilized, So

having those initial conversations
about how a role is gonna fit into

the team and then really using
that expertise is just so valuable.

Both Sadie and Barbara also talked about
the importance of working to physically

locate pharmacists within teams.

Even if they're supporting
multiple clinics.

of The personal connection that team
members can get, that relationship

piece that we keep coming back to, it's
the roses piece of the challenges of,

navigating the capacity issues in primary
care and the need for efficiency, but

really also that need for patient-centered
relationship-centered care.

So as PCNs expanded, lots of different
things have been tried to connect

pharmacists into care teams and there
really has been some great learnings

about, what works and we know that
co-location is one of these things.

Barbara: some PCNs have with very
good intentions, decided that they're

going to put the pharmacist in a
third party location so everybody

can access that pharmacist.

Nobody has a connection with that
pharmacist and that pharmacist might

sit and that resource might languish
a little bit because they haven't been

integrated into being part of a team.

we've found that it works much better
and actually every single P C N that

has started putting the pharmacist
in a central location has come to

the realization that there are some
early adopters that wanna work with

their pharmacist and are ready to go.

That's one of the biggest lessons is
that you can't put an interprofessional

team member in a distant or a
remote location and expect them

to be able to connect with a team.

We do need to get people together.

Morgan: So I think that's
a really important piece.

The other thing that I think about, it's
not just the team getting to know each

other that co-location can help with,
but it is that, patients trust where

they go and if somebody else happens
to be there, that umbrella of trust is

then automatically shared to a degree.

Now, Sadie's clinical experience has
echoed some of what Barbara was saying,

and now she's actively supporting 10
different primary care clinics and

rotates her time through those clinics.

Now she typically spends as all of
us do, spends our time in patient

appointments and encounters and so
she needs to maximize the time to

connect with other team members,
and that's often spontaneous.

And so being in a separate office
really makes that hard to have

those hallway conversations.

Sarah: Yeah she can't
be in 10 places at once.

Sadie: So I actually prefer
to not have a dedicated space.

Some of the clinics will have a,
a set office, so a space where

you've got a desk, it's set
up, but you're really isolated.

And I find that I don't develop the
same relationship with the doctors

when I have this set space put aside.

Whereas, the clinics that have a bullpen
style or where I share maybe a smaller

office with a doctor, those ones I
find, they might be on the phone with

a patient and say, hold on, let me ask
our pharmacist, and put them on hold

and turn around and ask me a question.

Or they'll finish talking to
someone and then say, oh, you

know, I really think this would
be a good person for you to see.

Or, oh, this came up in this
appointment, what do you think?

Should I refer them to you?

So that setting of actually being
beside the doctors or other referring

practitioners on a regular basis,
I think works better and provides

a work environment that's more
fostering of the team-based approach.

When you work with people on a regular
basis, you get to learn, Hey, do you want

me to reorder this standing order for
an A1C for that patient on your behalf?

Are you comfortable with that?

I've only just been able to talk to
a few of the doctors at a few of my

clinics in the last month or two about
ordering that lab work on their behalf.

How do you feel about me updating
your medication list in the emr?

Is that something you want me
to do or not want me to do?

That's something that you work through
when you're with someone regularly.

But if I'm there once every two weeks
and I'm full of seeing patients the

entire time, and then when I'm not
seeing patients, I'm trying to chart

those aspects of being part of the team
and really integrating and optimizing

the system, I think get missed out.

Sarah: Another point that Sadie emphasized
in our conversation was that she

described a recent experience she had
doing a joint appointment with a nurse.

You know, she's only in the clinic once
a month, so follow up with patients can

be tricky, but within the team she and
the nurse worked on a care plan and then

had the patient follow up with the nurse
who was, filled in on the full situation

having been in the initial appointment.

Sadie: The other day, it was one
of the first days that I worked on

the same day as our PCN nurse, and
the doctor was there that day too.

It was pretty much a miracle that
at this particular island clinic we

had, all of the relevant staff and
I had been seeing this one woman for

diabetes care, but there's a lot of
other medical history and in this case,

some, psychological needs as well.

And the person had an appointment with
myself and then with the nurse right

after, but after, as an after lunch, she
would've had to come back, we decided,

Hey, why don't we do a joint appointment?

And we sat down with this
person and we did a joint

appointment and it was amazing.

It was so great.

And especially with some of the emotional
needs of this person, having someone else

there as part of the care team to relieve
the burden a little as you're having this

big long appointment with this person,
and because the nurse is there more.

often, she is able to
follow up on changes.

I saw this person this last week and
I was like, Hey, I'm actually not

gonna be back at this clinic for a
month but can you book in next week

to see the nurse to follow up on these
changes we just made to your insulin?

And at that first appointment we were able
to just step in with the doctor into the

room and give him a little bit of a brief,
This was the discussion we just had with

this person, these are recommendations.

Can you, write a prescription
and send it in for us?

And he agreed to do that.

Sarah: So the patient doesn't need
to repeat their story and gets

quicker access to follow up care.

Morgan: So I think this is a great
example of not only supporting each

other as teams, but an opportunity to
build relationship between the team

members and to spill that trust across.

When new providers are coming into a
community and they still don't have a

full caseload, they've got a little bit
more capacity to start with, and that's

a great time to do those joint visits.

I'm just gonna tag in with you
first, and then I'm gonna see

the patient right afterwards.

So you get to know the other
team member, and then you get to

spend more time with the patient.

Sarah: We also know from our work on
resilience and adaptive capacity, that

when teams invest in dedicated time,
to make those connections, dedicated

time to build team, they're more
resilient and they're better able to

adapt to challenges as they come up.

And, you know, this really does
extend to how pharmacists are

thought to be members of teams.

Sadie shared a really funny story
about her first year, with the

PCN and, holiday party invites.

Sadie: This


is gonna sound a little funny,
but stuff like Christmas parties.

So last year was the first
Christmas I was part of the team.

Of the nine clinics, like maybe one of
them mentioned that they were having

a Christmas party and thought about
inviting me and like, that's fine.

I don't need to go to a party.

But also like we're trying
to build a team here.

If you're going to have a holiday
party for your team and then you

just don't include people who
are meant to be part of the team.

It just kind of is a red flag to
show that we're not quite thought

of as part of the team yet.

however, this year there was like so
many invitations to Christmas parties.

It almost felt overwhelming,
especially when you have nine

But when we did, like I started, went
to Christmas party, hung out with one

of the doctors who I never see because
we're on opposite days, had a great

time, was able to get that FaceTime in.

And just knowing someone and knowing
that they're there and they're a

resource, then when you see a patient,
you think about them more because you've

had that FaceTime and you've built a
bit of a relationship and you know,

it's someone that you could pick up
the phone and call to ask a question

with or feel comfortable referring to.

So little simple things like that
I think make a huge difference.

Sarah: Those small connections and being
included, fully, make such a difference.

Social gatherings and celebrations
are a really important feature of

highly functioning teams, and I
think this means we need to advocate

for more team parties, morgan

Morgan: Sarah, I don't think
you'd ever turn down a party.

Sarah: never,

Morgan: All right, so we've
covered a lot of ground from, how

to integrate pharmacists to how
pharmacists are detectives to Sarah,

your love of going to parties.

So let's sum it all up.

What are the key takeaways?

Sarah: Okay, so first, pharmacists
are impressive detectives who will

be able to see opportunities for risk
mitigation and enhance patient care

that you didn't even realize were there.

Morgan: Pharmacists are
also very patient-centered.

They look holistically at the patient
to ensure that their medications are

effective, safe, and, meet the needs of
the patient, which is very important.

Sarah: And then lastly, you know what
to do when a pharmacist is joining

your team- find out what their areas
of interests are, come up with an

initial plan for, what that first
cohort of patients that they're really

gonna dive deeply into might be,
and then co-locate your pharmacist.

Relationships are just so important so
really build in those opportunities.

If If you can't co-locate, then
intentionally bring pharmacists into team

meetings virtually and other opportunities
for connections like Christmas parties!

Morgan: Yeah, Sarah, I think co-locating,
bringing people in together for a

short period of time just to build
that relationship, super important.

If there's one takeaway from
this, that's what you should do.

So thanks for listening to
this episode of Team Up.

We have some great primary care
roles coming up, so tune in next week

for a deep dive on social workers

Sarah: And as always, we'd
love to hear from you.

So drop us an email at with any

ideas, feedback, we'd love to
integrate it into future episodes.

Thanks for listening.