Embracing change with pharmacy clinical services

A typical day for community pharmacist Helen Shi includes consulting with patients, conducting medication reviews, and managing chronic medical conditions. What it does not include is dispensing. “My entire job is clinical services in a retail pharmacy space,” says Shi, clinical pharmacist lead at Calgary Co-op in Calgary, AB. “I get to go home and say I truly helped someone today.”

A wide range of services are offered by the clinical team, including patient onboarding for both regular and specialty drug treatments, disease/medication education, and chronic disease management. The larger clinical pharmacist team offers care plans, medication reviews, initial prescribing, management of chronic conditions and patient education, among other services. 

Patients are often referred to the clinical pharmacy team by a family doctor, specialist, or allied health professional from all over the city in a variety of specialties including cardiology, endocrinology, dermatology, and respirology. The team also accepts walk-ins. “I’m not replacing the physician, but I can free up a lot of physicians’ time by treating conditions within the pharmacists’ scope of practice and I help people to feel better, in a timely manner,” says Shi, referring to being able to treat health concerns such as cold sores, UTIs, and yeast infections.

The clinical pharmacist team, which Shi joined in 2018, has 22 pharmacists. For these pharmacists, helping patients starts with a care plan which involves a comprehensive review of all their medical conditions and current medications, including over-the-counter products. “We identify any drug- or disease-related problems or medication interactions, and we solve as many issues as possible or propose solutions to physicians.” The team also tries to optimize a patient’s therapy to get patients to optimal treatment targets, such as prescribing for diabetes when a patient’s A1C is high. “This is about filling gaps in care.”

A certified diabetes, tobacco, and bariatric educator, Shi provides services in two key areas: diabetes and cardiovascular health, with a focus on heart failure. “I review the file, order the labs, and l determine when to do titration.” Shi is one of the very few insulin pump-trained community pharmacists in Alberta.

She also specializes in treating migraines and osteoporosis, for which there is a huge need for support. “Calgary is the migraine capital of the world, and many sufferers are still young and without a family doctor,” says Shi. “Also, some people have never had a bone-density test, despite having had a fragility fracture.”

Shi generally connects with patients two weeks after the initial consult and ensures there is ongoing communication. “I follow up as frequently as the patient needs. This can mean as often as every few days. They are very surprised when I call, but follow-up is key.” Shi notes that follow-up includes coordination and initiation of yearly care plans and bloodwork reminders.

Along with training her team to ensure consistency and a high standard of services (and to share firsthand experiences and insights), Shi enjoys mentoring pharmacy students. “Seeing this kind of practice is good for their education. This way they can see they can have a big impact on patients doing clinical work in a retail pharmacy setting.”

She recognizes that many pharmacists might be leery of this type of role because of the high level of responsibility it demands. “But do your due diligence,” she advises. “You will be uncomfortable initially, and you will make mistakes. But you have ongoing connections with a patient. You can say, ‘I don’t know,’ and you can follow-up.” Shi graduated with her Bachelor of Pharmacy from the University of Alberta in 2016 and worked for I.D.A Sandstone Pharmacies (now Neighbourly Pharmacy). She also worked as a relief pharmacist. When she interviewed for the clinical pharmacy position with Calgary Co-op (where she had previously completed a co-op term as a pharmacy student), she remembers thinking she would likely end up dispensing. “But when I got this job, I was ecstatic.”