This is the second part in a two part series about clinical pharmacists’ role in cardiac rehabilitation teams.
Here, I continue my interview with Charlotte Galenza, a clinical pharmacist with the cardiac rehabilitation program in Edmonton, Alberta. Click here to read part 1.
JB: Within the sphere of cardiac rehab, do you have a particular area of interest?
CG: I would say the area I am most interested in is smoking cessation. I recently obtained my additional prescribing authorization, and I’ve been using that ability for my smoking cessation patients to prescribe smoking cessation aids and increase their chance of quitting smoking.
JB: How has the ability to prescribe medications helped the patients you see?
CG: I think at the clinic it’s really beneficial because I am often the only prescriber on site so I can deal with a lot of issues such as renewing medications or making medication changes due to side effects. I am able to manage medication issues myself and communicate with the health care team rather than adding the extra step for the patients of referring them to see their family physician or cardiologist. For smoking cessation I especially think it makes a big difference since I can give them a prescription when they leave our appointment, especially if they are motivated to quit smoking and get started.
JB: That’s great! What kind of personal or professional experiences led to your current position?
CG: I graduated from pharmacy school in 2013 from the University of Alberta and at that point I really did not feel confident in my clinical pharmacy skills. I wanted to have a clinical practice in an ambulatory or hospital setting so I decided to enter the PharmD (Doctor of Pharmacy) program at the University of Alberta and I graduated a year later in 2014. I think the PharmD program gave me a lot more experience in different practices such as in a primary care network, a hypertension clinic, a geriatric outpatient clinic, and also inpatient cardiology, infectious disease and family medicine. I got quite a wide variety of experience in diverse clinical areas and was able to practice my skills, gain knowledge and become confident and independent after adapting and integrating myself into many different settings.
My cardiology rotation really helped me understand what goes on in the hospital before my patients get started in cardiac rehab. My experience from the PharmD program was extremely helpful in my current role since I had no overlap with the previous pharmacist. I had to jump right in and create the practice that I had envisioned!
JB: In general terms, how do you think patients can benefit the most from clinical pharmacist care?
CG: I think patients can benefit the most from clinical pharmacist care in terms of helping them manage their medications, especially if they aren’t really sure who to go to or sometimes may not even realize they have a medication issue. One example I see here is patients can get a cough because of a specific class of heart medications called ACE inhibitors. Most patients don’t think of this symptom as being a side effect from a medication. If they haven’t brought it up or talked to their pharmacist about it sometimes it does get missed.
If you’re new to medications and you notice anything different you should talk to your clinical pharmacist. I often will switch people to an alternative medication that does not cause a cough.
JB: Anything else you want to share with our readers?
CG: There are a lot of exciting changes happening in the cardiac rehab program. Our clinic has been creating more specialty programs. For example we are seeing patients who are on the waitlist for heart bypass surgery and having them start the cardiac rehab exercise/education program prior to surgery to get them started on lifestyle changes. My role is to ensure they are on the correct medications and appropriate doses prior to the surgery. We’ll then see them after the surgery to restart their rehab.
We have been seeing bone-marrow transplant patients who have not had a heart event, but are at higher risk due to their cancer treatment. We are helping them as a preventative program to get them strong after their transplants and to hopefully decrease their risk of a future heart event. We also have started a community exercise program at Clareview Community Recreation Centre, where lower risk patients are able to complete their cardiac rehabilitation out in the community vs. at our clinic. Our multidisciplinary team has a lot to offer and we are continually trying to expand our services.
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