Advice for Community Pharmacists

EP: 1.Defining Heart Failure: HFpEF and HFrEF

EP: 2.Diagnosis and Treatment Approaches in Heart Failure

EP: 3.Historical Treatment Options in Heart Failure

EP: 4.ARNIs for the Treatment of Heart Failure

EP: 5.The Role of Ivabradine in Patients with Heart Failure

EP: 6.Safety and Efficacy of SGLT2 Inhibitors in Heart Failure

EP: 7.The Recent FDA Approval of Vericiguat for Heart Failure

EP: 8.The Goals of Guideline-Directed Medical Therapy in HF

EP: 9.Goals of Pharmacologic Maintenance of Heart Failure

EP: 10.Optimizing Care for Patients With Heart Failure

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EP: 11.Advice for Community Pharmacists

Richard Mullvain, RPh, BCCP, BCPS, CCCC: I want you guys to sit back now. I’ll bring Randy in from the retail side, and I’ll invite others to weigh in as well. What advice do you have for community pharmacists to help them get comfortable working with physicians and other clinical pharmacists as we treat patients with heart failure? How do you approach the challenges with communication and things like that? Randy, can you start us off? What advice do you have for a community pharmacist to get them comfortable working with patients with heart failure?

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Richard, I left my academic position at the University of Iowa 15 years ago to become an owner of a community pharmacy to demonstrate or prove that clinical pharmacy could be provided in the community setting. One of the things I always teach my students and residents—we’re a residency program as well—is that our therapeutics is our foundation. We just talked about the complexity of heart failure. We also talked about how heart failure treatment has evolved over the past 10 to 20 years. It’s going to continue to evolve as we find other therapies, especially as we better understand the pathophysiology of heart failure. It’s so important to keep up with the literature. It’s so important to know how to monitor these patients appropriately. What parameters should I even be looking for?

We say, “Make every encounter count,” at our pharmacy. Which means when a patient is in front of us, that’s the time we have to do something. I’ve already mentioned that most times, I go into the encounter with a patient saying I’m going to find a medication therapy problem. I’m usually right, whether it’s adherence, for a variety of issues that we just talked about; they haven’t titrated the dose for some reason; or the patient is experiencing an adverse effect and just stopped taking the medication without telling anybody. Whatever the case, we’ve got to uncover that. The only way you can do that is having that rapport and empathetic understanding of the patient and trying to encourage them to open up to you and the other providers to help them with that.

The other thing I would say is it’s going to be very important to have a good communication line between the community pharmacist and the other providers. We started right from the get-go. When I first got to Towncrest Pharmacy, we started sending our work-ups of our patients. We started faxing it to all the physicians. People asked me, “What did physicians think?” And I said, “Well, it was interesting.” I had done that in my previous practice when I was at the University of Iowa. It took awhile for physicians to get used to, “Who’s this community pharmacist providing me with this work-up of the patient?” I followed the same format I learned during that time, and it worked. They wanted to find out, especially if the patient was seeing multiple physicians. We know someone with heart failure is probably seeing more than 1 physician, seeing multiple providers. How can I keep them all in the loop?

I see things that are unique to community pharmacists that they may not see. They had information that’s unique to them that I may not know. Can you imagine how successful we can be in treating these patients if we’re sharing that information? That’s where I see the future of community pharmacy: being more robust within the health care team. There’s information we can provide. There are things we’re seeing with that patient probably much more frequently than they are in the clinic. How we can feed that information back to the clinic, along with some clinical recommendations to make sure the patient is being appropriately treated, is important. I’m excited for not only the treatment growth of heart failure but also the impact that pharmacists in general and community pharmacists can have on this.

Richard Mullvain, RPh, BCCP, BCPS, CCCC: Randy, that was great. Alex and Ryan, I’m going to put you on the spot for the same question. I’ll start with Alex. Very briefly, what advice would you have for a community pharmacist taking care of a patient with heart failure?

Alexandra Goncharenko, PharmD, BCPS, BCCP: Some brief words of advice would be to not be afraid to call. Introduce yourself to the local primary care provider and cardiologist. We’re all on the same team. Whether we like it or not, everything is multidisciplinary these days. There are a lot of players on the patient’s medical team. Physicians, nurses, nurse practitioners, and pharmacists all play a role. Reaching out, introducing yourself, and bringing up any medication adherence or cost issues is very helpful. It helps us save time and gives us a heads-up for when we see the patient back in clinic again for anyone on the health care team. Don’t to be afraid to reach out to your local office or cardiologist, the doctors’ names you see coming through. Everyone is more than happy to get extra help.

Richard Mullvain, RPh, BCCP, BCPS, CCCC: That’s great advice, Alex. Ryan, I’m going to give you 1 last crack at it. Do you have a short piece of advice for our community pharmacists taking care of patients with heart failure?

Ryan Jacobsen, PharmD, BCPS: Yes. I would add to Alex’s and Randy’s great advice to know your pharmacist. Know your pharmacist team. As pharmacists, we spend a lot of time working on building collaborative relationships and partnerships with physicians, nurse practitioners, and PAs [physician assistants]. As the word gets out on the value of pharmacists on the team in interprofessional settings, like where Alex practices in the heart failure clinic and I practice in the heart and vascular center, we’re going to see more clinic-based pharmacists.

Pharmacist-to-pharmacist collaboration is important. Physicians collaborate across specialties. There’s no reason pharmacists shouldn’t be collaborating as pharmacist specialists, if you will. Randy is outstanding in the realm of community pharmacy. He’s way better at things than I am. As a pharmacist in the heart clinic, I might know a little more than Randy does on certain things. Alex certainly knows the ins and outs of heart failure management. We need to build off that pharmacist collaboration.

Richard Mullvain, RPh, BCCP, BCPS, CCCC: Fantastic. That brings us to a close. It went by really fast for me. Alex, Randy, and Ryan, thank you so much. Fantastic insight for pharmacists. To our viewing audience, we hope you found this Pharmacy Times® Peer Exchange to be rich and informative. Thank you, and have a great day.

Transcript edited for clarity.