EP31 The Under-Utilization of Pharmacists in the US Healthcare SystemCheckable Health
When you think of a pharmacist, the first thing that probably comes to mind is a person in a white coat behind the counter at a drugstore that prepares your medication for you. However, pharmacists do a lot more than that.
The amount of education and specialization pharmacists receive allows them to work as healthcare professionals in different settings and capacities. The rules of what pharmacists can and can't do have dramatically changed over the years, expanding from only creating medication prescribed to now providing healthcare advice, especially in areas of the country where there is a shortage of medical doctors.
In today's episode, we want to shed some light on how pharmacists can be used in a broader way to help alleviate the strain on the healthcare system from what their training entails and allows them to do, how history has shaped the profession, and some medication education!
To help educate us, we invited Elizabeth Skoy, pharmacist and associate professor at the North Dakota State University School of Pharmacy, to share with Patty Post of Checkable Health what pharmacists do behind the scenes and how the value of the pharmacist is to be a medication expert. Elizabeth explains how she teaches her students to be accessible healthcare providers for patients while serving as integral members of the healthcare team. Most of the work Elizabeth has done has been to advance the pharmacy profession to expand what it means to be a pharmacist.
Tune in to hear an enlightening conversation about an under-utilized profession to get a better picture of how pharmacy is shaping health care today!
Topics discussed in this episode:
- What goes on in a pharmacy behind the scenes
- Background history of pharmacy
- Pharmacy specialization and education
- How pharmacists are helping rural communities
- What sort of help can pharmacists provide patients
- What is the best way to administer an antibiotic to children
- Dangers of expired medicine in your medicine cabinet
- Does consistency in timing matter when taking medications
To learn more about how the pharmacy profession is being expanded, head to The Center for Collaboration and Advancement in Pharmacy (CAP) NDSU website here!
Connect with Dr. Elizabeth Skoy:
Connect with Checkable Health:
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Along with the at-home strep test, Checkable offers an array of wellness supplements and a multitude of resources, including podcasts and blogs, to help keep consumers in the know about different aspects of their health from top to bottom. And with more home tests coming soon, Checkable puts treatment options at your fingertips, so you can focus on getting better. Visit https://checkablehealth.com/ for more info.
0:00:04.9 S1: This is Patty Post, your host of the Checkable Health Podcast. And today I have Dr. Elizabeth Skoy of North Dakota [State] University, who is an associate professor at the School of Pharmacy. I call her Liz, so I will be addressing her as Liz today. So Liz, thank you so much for joining me.
0:00:26.1 S2: Thank you for having me.
0:00:27.6 S1: You guys, she is very well-credentialed, even though she looks like she's in her young 20s. She is, I have to say, when I first met you, I was like, how is she a professor? This doesn't... And she has kids too, so you're a mom of three girls. Two girls and a boy, and I'm definitely not in my 20s. But thank you. Well, you have great genes, so thank you to your parents and whatever you are doing for your skincare regimen, because you look great. So today we're going to be talking about the utility of a pharmacist, and really, I think the underutilization that we have of pharmacists in American healthcare. And if we can start out by you sharing just some of those things that we're not aware of, how often do we see a pharmacist and what does a pharmacist do?
0:01:23.5 S1: Yeah. In general, there's a lot that goes on in pharmacy behind the scenes. And so our profession is really wide ranging. And so there's a lot that, hopefully this never happens, but if you’re ever hospitalized, or sometimes even when you're in a clinic, there's a pharmacist that's working with you and you might not even know it. So pharmacists are working behind the scenes to make sure that your medication regimen is appropriate, also making sure that your medications are working for you. They're working with providers to adjust your medication doses. And they're doing a lot of behind-the-scenes work in those settings. And so a lot of that, more of what we call the inpatient side, or sometimes when the pharmacist isn't even seen, they're sometimes an unsung hero. But then there is the other face of pharmacy that most of the public associates with a pharmacist. So you're going to be thinking of the person that you see in your local community pharmacy, the place that you go to get your medication if you're sick, or if you have a chronic illness and you want to get your medication every month. So that's where most people will associate our profession of pharmacy.
0:02:34.3 S1: And that's my background. So my background is community pharmacy. That's where I started off. That's where I continue to still practice in the community pharmacy setting, as well as a lot of my work has been to advance our profession in general. So when you think back to some fun history, if you're a history buff, I'm a little bit of a history buff. But if you go back to even in the early 1900s, a pharmacist couldn't even talk to the patient about their medication. It was actually not legal for a pharmacist to actually talk to a patient about their medication. They had to just give them the medication. That was their job, was just to look at the prescription and give the medication and have the person walk out the door. Then there were a lot of legal requirements; the 90s and that the pharmacist actually had to talk to you about your medication. But things then rapidly grew. And so now not only do pharmacists talk to you about your medication, we're embraced as that medication expert, but also we do a lot of other things. And so our profession has really grown. A really good example is, again, in the 1990s, late 90s is when the profession of pharmacy started delivering vaccines.
0:03:48.7 S2: And so I don’t know if anyone who's on the call today, or podcast or listening to us has ever gotten their flu shot or vaccine from their pharmacy, that started in the late 1990s. But now, for example, during the pandemic, pharmacists actually gave nationally over 50% of all COVID-19 vaccines. And so that's kind of a go-to place where people go for other healthcare provision outside of getting their medication.
0:04:17.2 S1: And then testing as well, was COVID vaccinations, and then we would go to our pharmacist to get tested.
0:04:24.1 S1: Right, exactly. So there's been a really big kind of, started probably around like 2016-17, there started to be a really big push for more pharmacist involvement in point-of-care testing, as we call it, which means that point-of-care test means when you get the test, right, and then you can do something about it at the point of care for a positive test. And really, the pharmacy profession is perfectly positioned for this because, for one, we're accessible. And so the statistic is that over 90% of Americans live within five miles of a pharmacy. That's not the same way with clinics or hospitals, right? So we are without a doubt the most accessible healthcare professional. Another thing that people don't always realize is that we as professionals, since again, kind of the 90s, every person that's graduated has had their doctorate degree. And so they've had their doctor of pharmacy. And so typically, you're going to a doctor, a doctorate of pharmacy when you go to most of your pharmacies, you have someone who's graduated with their doctorate degree. So you have somebody who is really specialized, as well as part of pharmacy education.
0:05:43.3 S1: We learn how to take blood pressure, how to take blood glucose. We learn how to do some basic assessments of patients to do a wellness check on them. And as a part of most pharmacy education and more recently testing at that point of care has been implemented in pharmacy education for a wide variety of conditions. And then one of the reasons that we argue that pharmacy is the perfect place for this to be placed, is that if you're not feeling well, and you get a test, right, then hopefully with issues of maybe a collaborative practice agreement, meaning that the pharmacist under some states allow the pharmacist to provide an appropriate antibiotic with a positive test. Other times it's a collaboration with the doctor's office, but actually if they get a negative result, the pharmacist is right there. And the one thing that pharmacy knows better than any profession is that more education is all of those medications that are out in the aisles. If you go to the grocery store or your pharmacy and you see all of those medications out there, pharmacists are trained and very knowledgeable about all of them. And so we can provide what we call over-the-counter relief.
0:06:51.7 S2: And so we can say, you know, we can identify whether someone should go maybe to a provider or not, or if we think they can self-care at home and make the appropriate recommendations for them and kind of know exactly what should be given to them.
0:07:06.0 S1: Whereas especially if you live in a rural area or I guess even urban, what are the chances that you could get on the phone and talk to your physician? Very unlikely. Or you're talking to a triage nurse and your triage nurse is probably going to tell you to talk to your pharmacist.
0:07:25.1 S1: Right. Yeah. Or they're going to tell you, and the common thing is that you need to come in to be seen. And that's kind of the blanket statement in all ways. And you know, for maybe safety reasons, that's a good recommendation on their part. They aren't able to see the patient and assess the patient, whereas a lot of times at the pharmacy level, you know, especially with our accessibility, usually our hours as well as our location to our patients, we typically can actually see them. We can actually look at them, see their symptoms, maybe take their blood pressure, take their temperature, see where they're at. But in kind of going back to that rural aspect, Patty, completely agree with you. You know, especially in a state like North Dakota, in a rural state, there are some counties in our state that the only healthcare provider in that county is a pharmacy. Wow. Really? There's not a clinic, there's not a hospital in that county. The only thing available to those patients is the pharmacy. And so you think of somebody who's maybe sick or they have a sick child, who's going to want to get in the car and drive them an hour and a half to see if they maybe need extra care, right?
0:08:32.6 S2: So a lot of times people try to maybe tough it out at home or try to find other ways. And so there again, that access to care is really critical for our rural pharmacies across the country even, that we're an access and a point of care for our patients.
0:08:47.5 S1: That is so interesting. Do you or your child have symptoms of strep throat, such as sore throat or fever? Do you want to help an innovative startup validate their at-home strep test? Checkable Medical is currently enrolling children ages five and up and adults for a strep-throat study. Go to www.testforstrep.com to see if there's a site near you. Again, that website is www.testforstrep.com. One thing when you're talking about your medications, like my mom has a lot of different prescriptions that she has to be on, and my dad, whether it's for high blood pressure or blood thinners. And can you show, how does someone use what they have and what they're already using? What is a medication routine?
0:09:45.5 S2: Yeah, a medication regimen.
0:09:47.8 S1: Yeah, medication regimen. And if they are sick, can they take that to a pharmacist and say, well, what can I take, what can I not take in order to feel better because I have this sinus infection or cold or something?
0:10:02.7 S1: Absolutely. So one thing we like to really encourage as a profession, and actually every healthcare provider says this, go to the same place. So when you go to multiple pharmacies, we call that poly-pharmacy, so multiple pharmacies. It's really best for patients to go to one pharmacy, to have that one pharmacist, then all of your medications are housed there. And so if I have a patient that comes in or calls me and says, can I take this? And they're my patient and I know that I sell all of their medications, I can easily review their profile and make those recommendations. And that's something that we do all of the time. Yeah, I can't tell you how many times I've gotten questions about maybe herbal remedies or over-the-counter remedies and to see if it interacts. So always double check before you ever take anything, I always say, because it's always better to know. But if you're not, if you don't have one primary pharmacist, absolutely. And one thing that pharmacies do quite regularly, especially with our older population, but we really can do it for anybody, a lot of times insurance companies cover what we call medication therapy management or what we call comprehensive medication review.
0:11:11.5 S2: And so any patient that's on Medicare, typically that qualifies for that under their insurance, they get to meet with a pharmacist at least once a year where the pharmacist goes through all of their medication regimens for them. And we make sure that they're taking the right thing, that they're not experiencing any side effects or they don't have any drug interactions, that the medications are working for the best for them. And there's been a lot of times where I've met with patients and we've discovered that there's a medication that isn't working, but they're not at the right dose, right? So they got put on it and then they kind of fell through the cracks at their provider's office and they were never titrated up to the dose that's most effective. Or maybe they have diabetes and their blood sugars aren't under control. Basically the pharmacist can recommend the right dose to get their blood sugar under control. So there's a lot of things that we can do.
0:12:01.3 S1: If you're having side effects, let's say you get on an antidepressant and you end up being really tired, is that something that you should bring to your pharmacist if you have that side effect?
0:12:14.8 S2: Absolutely. I mean, I always want to know if my patients are experiencing a side effect. I think it's really important for us to know because sometimes that side effect is normal. So sometimes it's a conversation of saying, you know, you've only been on this medication for a couple of days or a week and this will pass after a certain amount of time. Other times it might be a side effect that might be more severe, you know? So I know that even as a mom and even as a pharmacist, I know that we get a ton of information between the time that we go see a provider to the time that we get our medication filled. There can be a ton of information that's shared with you. And so anytime that a patient thinks they're experiencing a side effect with the medication or has a question on their medication, you know, that's what we're there for. And that's what we really love to do is answer those questions so we can make sure that our patients are getting the best experience possible from their treatment.
0:13:07.1 S1: That's really good to know. Now I am 100% guilty of this. When my kids would have an ear infection or strep throat, I would give them their amoxicillin and they would magically, I mean, their symptoms are subsiding within two doses, right? And then by day five, you just kind of fall off. You're like, oh, well, they're feeling great and you just get back into your normal routine and you don't administer the treatment plan for the full 10 days. Would you please give us the best way to administer an antibiotic when our kids are prescribed an antibiotic for a bacterial infection?
0:13:47.9 S1: The best thing is to make sure you take all of the antibiotics. And so that's something that will sometimes be on the directions. We try to really hone that in there. We talk with patients about that. Hey, I'm a mom too and I know sometimes getting an antibiotic or any medication down the child's throat is not easy and as soon as the symptoms subside, we're good. So sometimes if you're looking at, there's some antibiotics, like maybe a topical antibiotic for an eye infection or something that we usually say like one-to-two days past clear and that's fine. But other regimens, when we give you an antibiotic, like you mentioned amoxicillin, right? I'm going to give you an amoxicillin antibiotic for like five days, seven days, 10 days, that dose and that duration, for that many days has been extensively studied, right? So there's been clinical trials, there's been a lot of research that has gone into when that infection is typically cleared up after giving that antibiotic. And so just because somebody is feeling better does not mean that the bacteria isn’t still present in our body. And what's scary is that if we don't administer all of the antibiotics for the right amount of time and we start, you know, we only give them a part of it and then stop taking it, we can easily develop something that's called antimicrobial resistance.
0:15:04.9 S1: Those are some big words and kind of technical medical terminology. But what it does is that we haven't killed all of the bacteria and so bacteria are actually kind of smart. And so they can sometimes adapt to, oh, I know what this drug is. Well, we're going to still live, and yet I figured out how to overcome this drug. It's almost like an evolution type thing. And then what we’ve found is that there's some antibiotics that have been so overprescribed and given when they're not really needed, that then we get that antimicrobial resistance and that's when superbugs can come about. So it's really important to make sure all of the infection goes away. And that's the best way to do that is just to give all of the antibiotics that you have. So I would say stick with it. That's the best thing we can say. Even when they're feeling better, just keep giving that. Sometimes, like with my kids, I'll give them a little thing of pudding after they've gotten their dose or just a little bit of a reward to help get rid of the taste and stuff like that too.
0:16:09.0 S2: So those are some ideas that I have for children, but sometimes adults are the worst. Sometimes we're like, oh, I feel better. I'm fine. I don't have to take this drug. So I completely get it.
0:16:19.2 S1: Yeah, I keep putting that back in the refrigerator. I'm like, oh, I'm going to keep this for next time that they're sick. Like no, don't do that.
0:16:27.9 S2: Don't do that because especially the ones that are mixed, they have an actual expiration date on them. And on that date, you're worried about not only the medication not being effective, you actually can get other bacterial growth in there and you don't want to be giving that. So think of like spoiled milk or something like that. You don't want to be giving that. So there is like a specific date on there when that medication is no longer safe to take. And that same thing with even some antibiotics, some antibiotics in general and medications can degrade and even sometimes be harmful if taken past their expiration date. So most pharmacies, at least in North Dakota, have what's called a MedSafe. It's this blue box and you can drop off any non-aerosolized medications. So clean out your medicine chest, clean out your cabinets, go drop them off at the pharmacy. Otherwise law enforcement takes them back too. So get rid of them I always say.
0:17:23.9 S1: Yeah. You don't want any of those expired anything in your medicine cabinet. So the last question I have about timing, specifically like let's just think of birth control. And if you are taking a birth control pill, and I just heard this and I had never realized it, if you are going to take it at eight o'clock every day, or maybe take it at 8:00 one day and then you take it at 3:00, and then you take it at 5:00, and then the next day four, you take it back at 8:00. Are you messing with the drug itself? Should you be very consistent with how you are taking the drug?
0:18:06.8 S1: Yeah. So every, you know, it kind of gets a little tricky with birth control because not all birth controls are the same. And so some birth controls have different levels of different types of hormones in them. And so sometimes as to how many days you can miss or when you take it, some are more strict than others. So it really depends on that. I always say if there's ever, if you have any doubt of that, call your pharmacist and ask them. I don't know how many times I've gotten phone calls, I missed my pill yesterday, what should I do? Sometimes it's a matter of that you need to use a backup method or not. As for your timing of the medication, it really depends on the medication. Okay. So birth control might not be treated the same as like a steroid or something for depression or anxiety. So it kind of depends on the medication that you're taking. Best thing though, just to remember to take it if you have something, is just to take it at the same time every day. Then you're just, you're cleared. However, some medications you do have to take at the same time every day, but some of them, let's say you take it in the morning and you forgot and it's now like three o'clock in the afternoon, it's not a big deal if you take it then.
0:19:20.0 S2: You know, so it just kind of depends on how long that medication stays in your body and works in your body at the level it needs to, to make its effect. Trying to be as non-technical as possible for just a general audience, because I can throw out words like half-life and like pharmacokinetics, but I don't want to do that. So I'm just trying to make it as simple as possible.
0:19:45.8 S1: Well, that just goes to show, I think that any question that you have, walk up to your counter at your local pharmacy and find one pharmacy that you like your pharmacist and you like the techs, and it's a convenient spot and build a relationship with that pharmacy staff because it can be utilized to your full extent. And there's so many different things that they can provide in our healthcare.
0:20:14.4 S2: Yeah, absolutely. I completely agree with you on that.
0:20:17.5 S1: Well this was an absolute pleasure, Liz. Thank you so much for joining us. Encourage everyone to find their favorite pharmacist and you know, give your pharmacist, is there a national pharmacist day? Like there should be.
0:20:30.8 S1: There is. National Pharmacist Month is in October. So we just passed it, but know your pharmacist, know your medication is October. That's the month of October. Okay. Well that's a great way to end it. Know your pharmacist, know your medication. Thank you so much for joining us. Dr. Liz Skoy, thank you for joining this episode of the Checkable Health Podcast. I am a huge fan of going to my local pharmacist. I think that she knows so much and I love her pharmacy techs as well. Even the over-the-counter issues that we have as moms, wondering if we should have Tylenol versus ibuprofen, and DayQuil versus Robitussin, all these different things. They can definitely be utilized and are a lot more approachable and accessible than our normal primary-care provider. Which serves a purpose as well. Thank you so much for joining us. Please follow us on our channels. We have lots of educational information on our website, it's checkablehealth.com. Also our supplements, if you are looking for your best night's sleep, I am recommending our Sleep Well melatonin. With just one gummy, one milligram of melatonin with Pasiflora, which allows you to fall asleep and stay asleep.
0:22:02.8 S1: I have to say, I just gave my dad a bottle and he has had the best nights’ sleep of his life, literally, and placed his first order on Amazon recently to reorder the melatonin. Check it out for yourself at checkablehealth.com. Then all of our social channels are @CheckableHealth. If you have a guest that you think would be great for me to interview, I'd love to hear from you. Send us a direct message and we will try to get them on the show and learn about them. I want to thank the Checkable Health Podcast crew for helping me put this together. Of course, to our guest, Dr. Elizabeth Skoy of NDSU School of Pharmacology, and also to the Grow the Show crew for all of the editing. Until then, keep thriving in health and in life. Keep empowering yourself through education, diagnostics, and utilizing all of the wonderful resources out there to bring wellness to your life and to your loved ones. With that, see you next time.
Life is too short to sit in a doctor’s office
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