ChronicBabe 101
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Kevin Rynn, PharmD: Building a Relationship with Your Pharmacist

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Build relationships with pharmacists for an extra source of care

An interview with Jenni Grover and Kevin Rynn, PharmD about navigating relationships with pharmacists. Kevin explains the extent of what pharmacists can do for ChronicBabes, and teaches us how to build an effective relationship to ensure you get excellent care. 

Connect with Kevin

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Kevin Rynn, PharmD is a Chicago-based healthcare provider and instructor with many years of experience working as hospital pharmacist. He’s also vice dean and clinical professor at the University of Illinois at Chicago College of Pharmacy, where he teaches future pharmacists how to be exceptional in their careers. He has worked in emergency medicine and toxicology specialties, and he draws on those experiences in his work today as an educator.

Kevin is also the friend I pester when I want to know what really happens with drug interactions and side effects. It all seems a little bit mysterious to me, and I never know the best way to speak to my pharmacists… at least, I didn’t until this interview! I think you’re going to learn a lot from Kevin.

Jenni: Hey y’all! It’s Jenni Grover from ChronicBabe.com and this is a bonus audio interview associated with the ChronicBabe 101 book project. I’m talking with my friend Kevin Rynn, PharmD. He’s a Chicago pharmacist and vice dean at Rosalind Franklin University. He teaches pharmacists how to be awesome.

So he is my resident expert on relationships with pharmacists. I often council y’all to build those relationships, and Kevin’s gonna tell us if I’m either full of it, or if it’s a good idea—and how we can do that. Welcome, Kevin! Thank you so much for being here today.

Kevin: Thank you for having me, Jenni. It’s a pleasure.

Jenni: It’s so cool to be using you as an expert source. I love having so many good friends and colleagues that I can go to when I have questions like this, but especially because pretty much anybody who’s going to be enjoying this project I’m creating needs to have some contact, at a minimum, with a pharmacist. And you are my expert.

Kevin: Yeah, I agree. When you started the Kickstarter, we’d been friends and I kind of knew a little bit about what you did. And when you started the Kickstarter campaign was really when I learned a little bit more, and certainly checked out your website. And I’m happy to give my two cents. I know we’re not supposed to talk too long, but people tell me that I could stand up and talk for an hour about anything. So I’d be happy to answer anything. I won’t take an hour, I promise.

Jenni: Okay that’s good! No, I would edit you out anyway. [laughs]

So let’s just dive right in. I’m curious: is it a realistic thing for somebody to think that they can develop some kind of consistent relationship with their pharmacist?

Kevin: Oh, I think absolutely. Looking back, a lot of times people think of the pharmacist as sort of up-on-a-pedestal and maybe not approachable, mainly because of the ways pharmacies are constructed. Many of them were constructed that way.

But if you look at newer models of pharmacies, they’re trying to get pharmacists out there and talking to patients and being patient advocates, because the latest in healthcare is more patient-focused and patient-centered care. So we all work as a team, as an inter-professional team with the focus being on the patients and the patients’ needs.

It’s really timely right now to talk about. I think it’s something in pharmacy we’ve done for a long time with a lot of patients, but right now, with the changes in healthcare and new healthcare laws in the U.S., the pharmacist is a lot more visible and a lot more active. I don’t think people even realize all they can get from a good relationship.

Jenni: So tell me, what do you think are some of the benefits people can get from a good relationship with a pharmacist? I have a couple of ideas but I think I want to hear yours more than mine.

Kevin: I guess I’d start with their education. I don’t think people even know a lot. They are doctoral-trained, they’ve been in school anywhere from six to eight years depending on how you got your pharmD degree. So they’re extremely knowledgeable. They are on every corner, as you know, although I know Jenni you and I have talked about mail-order pharmacies too. But certainly pharmacies are on every corner; I think we’re the most accessible healthcare professionals. Believe me, when I’ve worked in stores in the past, and I’ve worked in hospital pharmacy, I get called at two in the morning from a mom who needs something for their child or for themselves even, and there’s no one else to call. Certainly there’s a pharmacist somewhere working a 24-hour shift.

Jenni: I know I’ve made many of those late-night, middle-of-the-night, panicky calls. It’s always like where can I find a local pharmacy that’s 24 hours that’s got somebody on staff because I can’t get through to my doctor usually, and y’all are who I turn to.

Kevin: Yeah, definitely. And I think for pharmacy, we’ve been giving advice away for a really long time and right now, truthfully—this is a whole different discussion, but there’s legislation at the federal level looking to identify pharmacists as providers. Right now, in many states, if you didn’t realize it or not we’re not identified as healthcare providers and that goes along with billing and how to bill for services. We bill for a product and then we counsel you on that product when you leave the store. But what you’re paying for is more the product and not the service.

There’s a lot of changes going on in healthcare now, and pharmacies are on board with training and teaching their pharmacy students to be more active and become providers. So that’s why you see things like immunizations over the last several years in pharmacies, provided by the pharmacists. And you’ll start to see a lot more diabetes education sessions or asthma education sessions; you’re going to start to see a lot more of that available. You’re seeing stores that are opening clinics. Some of them are staffed by nurses and other healthcare providers but they’re also staffed by pharmacists who will be able to provide care and be reimbursed for that care.

I mean, that’s the bottom line in a business. You do need to be reimbursed. And that’s what I was getting at earlier—the reimbursement has been more for the product and not for the services, and that’s going to change completely when pharmacists are legally recognized as a provider, not just a provider of the product or a provider of cognitive services.

Jenni: Wow! I didn’t know about that and that’s a really interesting thing to think about. I think it even further stresses the importance of having some kind of consistent relationship with the pharmacist or pharmacy if it’s a collection of people you see over the course of a year, because if they’re going to be playing a bigger role in our care, we definitely want to feel like we can talk to them and that we can ask questions and understand the value we can get from that relationship.

Kevin: Yeah, definitely. As I said, they’re on every corner, pretty much. And I think what I’m getting to more is having that relationship will just make it easier for them to talk to you about your meds, to talk to you about when you should come for refills and how often, if you’re under- or over-utilizing your therapies.

And then they can be in touch with your provider, whoever wrote that prescription for you, whether it’s a physician or a nurse practitioner or someone else that’s your provider, to really be that link back to that. Because when you call the office sometimes it’s hard to get through to people and they’re going to call you back in a few hours… but a few hours can turn into a day or two, and it’s nobody’s fault, it’s just that people are busy.

So you can also rely on the pharmacy to tell them. They’ll call for you, and as soon as they hear back they’re going to fix whatever problem there is and then let you know about it. To be honest, when a pharmacy calls an office they’re probably going to get called back sooner than a patient. That’s just the reality of healthcare. So sometimes you’re better off working through your pharmacist if it’s a drug-related problem.

Jenni: That’s a good tip, I didn’t know that.

Kevin: I’m not implying that your healthcare providers are ignoring, it’s just busy in the office. Things get busy.

Jenni: Sure, I understand that. And I think also that’s the way healthcare providers are shifting, in this country, in the U.S. anyway. I’m part of a bigger hospital system that’s been absorbing all these smaller associated clinics into one big system and during that process, it’s actually really damaged my communication with my providers. It hasn’t actually made things better. Maybe in the long run it will but temporarily, it has actually made it harder to reach them because they’re busier and they’re learning all these new systems.

So I actually have found myself talking more with pharmacists with questions about certain things because I know it’s going to be a day before I get back a message from my doctor sometimes, and maybe I want an answer right now.

What are the kinds of things that pharmacists can talk to people about that aren’t necessarily specifics of a medication? If I went to a pharmacy and asked them about potential... what’s it called when they interact...?

Kevin: Drug interactions? Drug-food interactions. Dietary issues. Certainly.

Pharmacists are not trained to be diagnosticians, but once you are diagnosed with something, pharmacists learn all the same disease states that all the other healthcare workers learn so if you have basic questions about your disease state and management, whether it’s drug-related or not, they can certainly help you with that—and if they don’t know they can refer you.

When it comes to medication management, I always tell people with high blood pressure or really any other disease, there are so many drugs that can be chosen for you. It depends on other diseases you have. You might have high blood pressure and diabetes, or high blood pressure and renal failure or kidney failure, so what drug you choose is dependent on all those things. Pharmacists are very familiar with the drug studies that have been done to say “drug X is better than drug Y for you because you have all these other co-morbid or other conditions.” So certainly talk to them about whether you’re on the right drug or not as your plan changes.

And from there, through you, you can go back to your provider or they can contact your provider to get a medication changed if they feel there might be something better. So really: just optimizing the right drugs for you, even if you’re not having side effects or problems. But then on top of that, if there are issues coming up—you feel like you’re having side effects from your medications—they can certainly do some minimal assessment.

Pharmacists are trained in physical assessment as well. They can do a physical exam on you if they need to in a smaller clinic environment to assess whether this rash is related to your drug or not or something else is going on. So certainly coming on in and showing somebody a rash on your arm or other parts of your body certainly happens from time to time.

Jenni: Let’s all be choosy about what parts of the body to show a rash upon, though. Let’s not get crazy.

Kevin: Well I’ve seen crazy but let’s keep it G-rated, or at least PG.

Jenni: Yeah, we’re big city folks so I think you see a lot of crazy. [laughs]

Kevin: They can help assess side effects you might be having (or think you’re having) from your medication, and then they can help you get them changed. Calling the providers back... sometimes if you’re lucky enough to be in a pharmacy that’s within a clinic, because that exists now, then they can walk down the hall and physically talk to somebody. But sometimes, a lot of the times, it’s via phone with the reality of the way it’s set up.

You can have interactions with drugs with dietary and food products, drugs interact with each other, not just side effects. So if you’re on two drugs that are interacting and maybe you went to two different providers, one for your lupus and someone else for your HIV disease, and they are not aware of what one is prescribing versus the other, the pharmacy is kind of the catch-all for all your meds.

You should be going to one pharmacy, that’s key. You should not be trying to go to different pharmacies because then that catch-all doesn’t happen, either. But if you’re having one provider write you one prescription and another provider writing you three and a third provider writing you a fourth prescription or a fifth prescription, then the pharmacy’s the place that knows them all and can determine whether there’s interaction, side effects, problems, stuff like that.

Jenni: So what about folks like me who are required by my insurance company to use their mail order pharmacy for all my maintenance drugs… but I sometimes need other meds for things that come up. Then when I go to the pharmacy they don’t necessarily have my whole drug list handy. So now I keep a copy of my current list—that I update as needed—on my phone so I can just hand my phone to the pharmacist and say “here’s what I’m taking.” Is that the best way? Am I a rare beast by doing that?

Kevin: Yeah, you are. For most people that are in your situation, it’s unfortunate; there are certainly pharmacists in mail-order that do great jobs but I don’t love mail-order pharmacy because it takes away this person-to-person interaction. But that’s the reality of today’s healthcare environment and there are many people like you, and like I said there are great pharmacists at the mail-order pharmacies. You can call the mail-order, or they’ll give you numbers and you can get in touch with your pharmacist there or nurses or things like that. So there’s certainly that opportunity.

But definitely come in. If you’re just getting one prescription, maybe it’s a short-term antibiotic for sinusitis you have or a sinus infection. That pharmacy might not even know that you’re on three or four other meds, or however many it is at the mail-order, so definitely let them know. Antibiotics often interact with different drugs. So you should definitely let them know, because if you don’t, you just kind of drop it off and say “ok, I’ll be back in a half hour,” or whenever it’s ready, and then you come back and pick it up, they don’t know. They think that’s the only medicine you have. They do need to know.

So to have someone like you is great. Most people just kind of drop it off, pick it up and hopefully there’s not a problem. But if there is...

Jenni: Well then I’m going to reprise what I do so often with ChronicBabes: tell people to make a list. So much of my advice comes down to “make a list.” Make a list of all your meds and keep it handy. I like to keep it in my phone because I always have my phone on me. Do whatever you need to do, but I think that makes sense.

Kevin: I always know when I have a patient who can tell me what meds they’re on, that’s also how I assess your compliance. If someone comes to me and says “I’m on a blood pressure medicine, and I might be on this or that,” that’s when a red flag goes off in my brain, like they might not be that compliant or they’re not taking it regularly if they don’t offer a little more detail. I don’t expect every detail, but as long as they can name the medicine, they don’t necessarily need to have the dose, milligram strength all the time, but as long as they have a pretty good sense or they have a list on them then I’m like “Ok, they’re taking their meds.”

Because there are a lot of people who have meds and don’t take them, either. There are different reasons why—it might be financial, it might be their own belief systems, or problems they’ve had. But it’s a way that pharmacists assess their clients, whether you are on top of it like you are… or not.

Jenni: Why is it important for you to know if we’re being good, compliant patients?

Kevin: It’s really important. Some patients tell you what you want to hear, too. So you ask “Oh, do you take your meds?” They respond “I take them every day on time, every day.” And they may be fibbing to you because they want you to not judge them either, but it’s really important.

Because if you tell me you’re taking them or I think you’re taking them and then I see where they’re not working—you’re having five asthma attacks a month or your blood pressure is through the roof—then I’m going to recommend to your doctor, “Why don’t we increase this blood pressure med?” or “Increase her asthma medication or change it around,” when I didn’t really need to change it—I just needed to make you take what you’re supposed to be taking. And then I changed it and I increased the dose and then you decide “oh my gosh, I really should start taking this regularly” and then you take it regularly but now it’s a dose that’s twice as much. I made it twice as much because I thought the lower dose wasn’t working for you, but you really just weren’t taking it for one reason or another... So now I’ve doubled the dose because I thought you needed more and now you might have side effects or problems when it really was that the patient wasn’t taking it and was afraid or didn’t want to tell their provider that they’re not taking it. We get that all the time. And actually, most people are more honest with their pharmacists than they are at the doctor’s office.

Jenni: [laughs] I wonder why that is. Do you know why that is?

Kevin: I don’t know. Maybe it’s that we are less intimidating or less... I don’t know.

Jenni: That might be it. I mean, I can walk into any big chain pharmacy right now in Chicago and march right up to a pharmacist but I cannot walk into my doctor’s office and certainly not any of my specialist’s office and walk right up and see them, look them right in the eye immediately and say hello. I can’t do that. Huh, that’s interesting.

Kevin: That’s usually my approach too, I’m like “Okay, tell me the truth. I know what you told them over there but tell me the truth.”

Jenni: I want to start to wrap up, but I want to ask you: When people think about having a relationship with their pharmacist, one thing I always think about, I try to think about the caregiver perspective and the pressures they’re under and the things they’re experiencing and feeling. And I know that all across our healthcare system right now, we’re in a time of enormous change and everybody’s time is much more overloaded than it ever was, and demands are always increasing on people’s energy and knowledge.

So what is a good way for somebody to begin to build that relationship with their pharmacist? How appropriate is it for me, if I happen to be going by my pharmacy, can I poke my head in and go “Hey!” Is that weird?

Kevin: Oh no, it’s not weird at all. The big thing nowadays in pharmacy is medication therapy management, or MTM. So if you walked up to your pharmacist when you’re nearby… you don’t need to use those words but I guess if you want to, you can… We’re supposed to be reviewing your profile and making sure things are okay. And the buzzword now, as I said, is MTM.

So there’s nothing wrong with saying “When you get a moment, it doesn’t need to be right now, can you review my whole profile and tell me what you think and how things are?” Like you said, there are time issues and things like that, but pharmacists do have appointments. You can say “Can I come back during a certain time and sit down with you for 10 minutes and go through my medications?” And sometimes people are there for half an hour for individual appointments. They’ll do those in the cross-shifts when they have an evening and a day pharmacist, so when there’s overlap and there are two people there, they will provide sit-down consultations.

 

And the reason we can do that now, and I hate going back to the money, but it’s all about the money. We are now allowed to bill for those types of things to your insurance company. It’s in the background for you guys but it does get billed. It’s not huge reimbursements, but there’s a few dollars that get exchanged for the actual consultation on top of the medications that you receive.

So I would definitely walk on up and tell them you want a more comprehensive review of your medications, or you can throw that buzz term out there, an “MTM consultation.” They’ll know what it’s about and they’ll be surprised, like “Oh where did he or she learn that term?”

Jenni: So tell me again what MTM stands for?

Kevin: Medication therapy management.

Jenni: Okay, cool. I did not know you could make an appointment with a pharmacist to have a consultation. I think that’s a fantastic idea for a lot of people and probably a great stop-gap measure for a lot of people who are having to wait to see doctors or having issues. I think that’s such a great idea.

And I guess a thing I always counsel people to do is just show up to the counter like you would with any other meeting with a friend or family member, and be as gracious and patient and cool and authentic, be yourself, as much as you can. That’s always been my approach and I have the most positive experiences. When I show up to the counter and I’m like “Hey, Kevin! How are you today?” And usually the pharmacist looks up and goes “Wow, thanks for asking. I’m okay, sure, I’m good!”

I don’t think that happens all that much. I think people are sick, they’re frustrated, maybe they’re scared. They walk up to the counter and they want to get their meds and go home and take them and get better. And I imagine that y’all don’t get a lot of people who show up and actually give a crap about how you’re doing for even five seconds.

Kevin: Yeah, I would agree with that. That is always a nice thing when someone says hello and genuinely cares. I would definitely appreciate that. If you came into my pharmacy I would definitely appreciate that.

Jenni: Maybe we can arrange that some time.

Kevin: Okay, deal.

Jenni: I love it. Hopefully folks have been listening to this and I mean, you’ve given us so many good tips, so many pearls of wisdom—so I hope people go back and listen to this again and make sure they gather those up. Kevin, thank you for proving me right because I’ve been telling people for years to have a relationship with their pharmacist but I’ve never actually asked a pharmacist if that’s a good idea. So I’m really glad to know I haven’t been wrong this whole time!

Kevin: You’re absolutely right. Thank you for referring them. You’re doing great things.

Jenni: Thank you. Well, I’m so happy we’ve been able to talk today and I think your information and your enthusiasm for patient well-being is so awesome, and I’m really thankful for your time and I know everybody listening is, too.

Kevin: It’s been a pleasure.

Jennifer E Grover