Did you know that March is Pharmacist Awareness Month (PAM)? It’s an ideal time to get to know your clinical pharmacist, so they can collaborate with your healthcare team and manage your medications.
In celebration of PAM, I am highlighting a relatively new role for pharmacists: as members of the cardiac rehabilitation programs. Cardiac rehab is a referral-based program for people with a variety of heart diseases. The program focuses on improving your heart health by exercising, eating right, managing your medications and stress levels.
Charlotte Galenza is a clinical pharmacist with the cardiac rehabilitation program in Edmonton, Alberta. I caught up with her and toured the Jim Pattison Centre For Heart Health, located at the Mazankowski Alberta Heart Institute. Galenza also works at the cardiac rehab program at the Glenrose Rehabilitation Hospital.
Joseph Blais: Can you describe your role as a clinical pharmacist within the cardiac rehab program?
Charlotte Galenza: Patient’s come to see me on a referral basis for a one-on-one appointment. I mostly see people to assist them with smoking cessation, to discuss and resolve side effects of medications, and to deal with any medication issues that come up. I teach a class on heart medications that most patients attend while they are with the program. I also assist with chronic disease management such as high blood pressure, and diabetes.
JB: So the patients must be enrolled in the cardiac rehab program?
CG: Exactly. They will start by meeting their nurse case manager and their nurse will decide with the patient which disciplines they should be referred to. The patient can also request an appointment to see the clinical pharmacist at any time during the program.
JB: Can you tell me more about the cardiac rehab program?
CG: Our program is open to anyone with heart disease and most of our patients are either post heart-attack or post open-heart surgery. If they were recently in the hospital they will typically start rehab two weeks after leaving the hospital (or six weeks after open-heart surgery). We have a nurse who is our intake coordinator and each patient will then be assigned a nurse case-manager. This is similar to what you would see in a home-care setting.
The patient first meets with their nurse case-manager who coordinates the rest of the program and reviews their heart history. We start with patients having an exercise stress test or a six-minute walk test so that our exercise specialists can make exercise prescriptions for the patient that they’ll use in the exercise room and at home. Then we have an orientation class that the patient attends prior to starting their exercise program.
After that, they come once a week for eight weeks, where they’ll attend a one-hour exercise session that is linked with a one-hour education session. I teach one of the educational sessions on medications and it is mostly targeted for heart-attack patients where I review the usual cardiac medications. There are other sessions on stress management, heart healthy diet (including how to read nutrition labels), exercise, energy conservation, etc.
Patients have the opportunity to see any of the other team members in one-on-one appointments as well. In addition to the exercise specialists, nurses and me, we have a dietician, social worker, occupational therapist, psychologist, psychiatrist, nurse practitioner, cardiologist (on a consulting basis) and a part-time physiotherapist. The patients then see their nurse case-manager again at the end of the program for an exit interview to review how the program went and any ongoing issues. Sometimes at that interview, they may extend their involvement with the program. The nurses will call the patients a couple times in the months following, and another stress test/walk test and follow-up appointment will be made about 6 months later before the patients are discharged.
JB: In your role as the clinical pharmacist, when patients leave the program how do you handover your care? Is it to a community pharmacist, or a family physician?
CG: Patient charts remain open for 6 months after they have completed cardiac rehab so I will often follow-up with them either by telephone or see them in person, depending on what the issue is. If it is about smoking cessation, I may get them to follow-up with the Alberta Quits help line. Other times the issues will be followed-up by their cardiologist or family physician and I will communicate my recommendations by sending a letter. I am exploring how to improve communication with patient’s community pharmacies.
JB: What strengths do you bring to your practice?
CG: I think one strength I bring to my practice is that I can fill a big gap for patients who are having medication issues. I have the ability in this program to provide ongoing follow-up, as they will be here once a week for 8 weeks. My one-on-one appointments are booked for an hour, so I also have more time than some of their other health care professionals to discuss medications.
Another strength I bring to my practice is assistance with smoking cessation. I can provide counseling support and work with them to create a quit plan (and initiate medications if needed). Also, I am usually the only prescriber on site so team members will often flag medication-related issues for me. I am readily available to connect with patients in person or over the telephone.
JB: Tell me more about that initial encounter and assessment?
CG: I will usually look at their medical records in advance so that I have the necessary background about their medical conditions and current medications. In that initial appointment I have the time to ask them about each individual medication, what they know about it, and discuss any potential issues they are having.
As far as smoking cessation appointments, I have a longer amount of time to do a more intensive intervention and use motivational interviewing techniques. I try to get to the root of their barriers and concerns. We then have time to make a plan going forward.
JB: From your perspective if there was one pearl of knowledge that you could share with the public, what would that be?
One recommendation I have for the public is to pick one community pharmacy and stick with it so that they can build a therapeutic relationship with their community pharmacist. Most of my patients are brand new to medications so they have no experience with pharmacies or the medical system in general. I don’t think people realize how big a help their community pharmacist can be, as they are easily accessible, can help answer questions about medications, can determine if there is a medication side effect and how to resolve it, and can flag potential drug interactions (even with over-the-counter medications, vitamins and supplements). That’s the one thing I always encourage!
For more insight into clinical pharmacists’ role in cardiac rehab programs, stay tuned for the second part of my interview with Charlotte Galenza. To learn more about your medication and health choices, subscribe to my newsletter.