Never hesitate to ask questions to your pharmacist

Surveys show that Canadians find pharmacists to be the most trusted professionals, followed closely behind by physicians (1). When we also consider that most Canadians live within 2 to 5 kilometers of a pharmacy (2,3) and that pharmacists are medication experts who are an essential part of the health care team, why not “use” us to your advantage?

Instead of looking up drug information on the internet – which is a highly innaccurate source of medical knowledge – drop in to your pharmacy or give us a call and ask us! We don’t bite. In fact, it’s one of the most favorite part of the job for a lot of pharmacists: talking to you about your medications and healthcare needs! In fact, the pharmacy/dispensing fees’ general purpose is to pay for this service. The following is an incomplete list of questions every patient or caregiver should never hesitate to ask a pharmacist. Remember, there is no such thing as a stupid question so fire away!

“Are you the pharmacist? Can I talk to you in private?”

Most of the people who you see behind the prescription counter are not pharmacists, but everyone should have a name tag with their title. However, feel free to ask if they are one in case you can’t make out the small lettering. You may have to wait, but every pharmacy must legally have a pharmacist on duty to talk to you privately about your health.

Ask for a callback if he/she is tied up and you can’t wait. Also keep in mind that pharmacy assistants/technicians are able to answer some of your questions (those deemed technical like prescription refills, those concerning medical supplies like blood sugar meters, etc.) but always ask a pharmacist for specific medical questions.

“I don’t understand/know/agree why I need to take this medication”

A patient may often not know why he/she needs to take one or all of the medications that their physician/nurse practitioner orders. Sometimes they are so busy that they either forgot to explain, they did explain but the patient forgot, or they expect the pharmacist to do the explanation. It’s not a reproachable mistake on their part since they occasionally do this because of their obligation to other patients: they have to move on to their next appointment/task once the medical issue of the previous patient has been addressed. Besides, we pharmacists are more than able to educate the patient on the benefits – and risks – of one or a combination of drugs.

We have spent 5 or more years studying about all the benefits/risks of nearly all medications. When the benefits are less obvious, we can explain the reasoning behind certain prescriptions to reinforce your trust in the treatment plan; we can also recommend a more appropriate medication for you that the prescriber may have initially written; and we can even make sure that any worthwhile medication options haven’t been overlooked. Rarely, we may even have knowledge about a medication that the prescriber doesn’t fully appreciate yet (like newly discovered drug interactions or contraindications).

What are the side-effects of this/these medication(s)?

It is always important for patients to have a basic understanding of the possible risks involved with all medications. Patients often don’t bother to ask questions and instead rely on package inserts that come with their prescriptions (or look it up on the internet). In Canada, regulations require those drug inserts to contain information on most serious and some self-limiting side-effects – those not necessarily needing urgent medical attention – and typically don’t give any detail on how likely a person will develop those side-effects (common vs. rare). This is because regulators want those inserts to be easily understandable at the grade 6 to 8 reading level.

Importantly, those medication inserts do not contain “all the possible side effects you may feel…If you experience any side effects not listed here, contact your healthcare professional”(4). Your pharmacist is arguably the most convenient AND trusted source of information on potential side-effects and also what to do if you experience them because we are trained to manage those problems and to contact your physician/nurse practitioner if it is needed. In some healthcare organizations, pharmacists with additional expertise (like a “blood thinner” specialist) have additional training to manage certain medication issues without contacting a physician beforehand.

“How should I take this medication?”

Out of every 100 prescriptions written, only about 25 to 30 are taken properly. This is important because a lot of medications are useless if they’re not taken exactly as required. In medical terms, adherence means “The extent to which a patient’s behavior (in terms of taking medication, following a diet, modifying habits, or attending clinics) coincides with medical or health advice.” (5,6). However, being adherent to a treatment plan is one thing, but for patients to completely understand how they’re supposed to take a medication is an another problematic issue that pharmacists are keenly aware of.

Poor adherence is a huge problem since it causes a lot of preventable harm and extra strain on the health care system. In the United states, nonadherence accounts for 10% to 25% of hospital and nursing home admissions costing the American healthcare system 100 to 300 billions US dollars per year, and is also estimated to cause 125,000 deaths annually (7-9). The solution requires extensive communication and education with patients – which pharmacists are in an ideal position to do – so they know all the relevant information on how to take their medication to see their intended benefits. Some important information to know are:

  • the frequency
  • time(s) of day
  • relation to meal/food/drinks/exercise
  • relation to other medications/over the counter medications
  • the duration of the treatment, etc.

“Could these symptoms be caused by this medication and, if so, what should I do?”

The last thing I want to highlight is how pharmacists can help identify and manage side-effects that you may have. Some side-effects are temporary and go away by themselves days to weeks after starting the offending medication (s), while others can happen at any time or worsen as time progresses (e.g.: stomach ulcers due to anti-inflammatories). Some side-effects may be unapparent to the patient but can actually be a medical emergency (e.g.: closing of the throat after taking an antibiotic).

However, side-effects are generally moderate in severity which don’t usually require urgent medical care and, in most situations, they can be managed by talking to your pharmacist. Once he/she assesses your situation and determines that a patient is suffering from a side-effect, he/she will tell you what to do (e.g.: stop taking medication immediately or continue) and may contact your family physician and/or the original prescriber for follow up or various other reasons.

Conclusion

Nearly everyday I see patients experiencing non-urgent but troublesome side-effects that I think should be known to the physician and tell the patient to book an appointment with him/her to resolve the situation (e.g.: when a blood pressure medication needs replacing because of constant coughing). Fortunately, urgent medication problems are relatively uncommon (10). But I believe that “using” more extensively community pharmacists as trusted medication experts within a strong health care network (by increasing collaboration with physicians, hospitals, nurses, etc) can help to keep patients safer, healthier and out of hospital emergencies.

Remember when I wrote that extensive education is required for patients to be adequately adherent to their medications? Well, because medicine has become increasingly complex in the last few decades, most major medication issues can’t be addressed by pharmacists over a 5 minute discussion at the prescription counter. Fortunately, governments are finally realizing the importance of pharmacists and are paying us to provide multiple in-depth consultations (e.g. medication reviews) lasting anywhere from 15 to 60 minutes (private medication insurance is lagging in this respect). I will definitely write about medication reviews on a future date because I believe it is a very important service we provide for patients at high-risk of medication errors.

Pharmacists are ready to have a bigger presence in your overall health by allowing us to manage your medication issues more directly to prevent you from suffering from a drug related problem. All you have to do is ask!

REFERENCES

  1. K Lynas, Professionals you can trust: Pharmacists top the list again in Ipsos Reid survey, Can Pharm J (Ott). 2012 Mar; 145(2): 55. doi: 10.3821/145.2.cpj55c
  2. MR Law, et al., The geographic accessibility of pharmacies in Nova Scotia, Can Pharm J (Ott). 2013 Jan; 146(1): 39–46., doi: 10.1177/1715163512473062
  3. MR Law, et al., Geographic accessibility of community pharmacies in Ontario. Healthc Policy 2011;6:36-45
  4. Health Canada, Drugs and Health Products, Guidance Document – Product Monograph: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/guide-ld/monograph/pm_mp_2013-eng.php (accessed: 09/15)
  5. American College of Preventive Medicine, Medication Adherence Time Tool: Improving Health Outcomes, 2011: http://www.acpm.org/?MedAdherTT_ClinRef
  6. National Association of Chain Drug Stores, Pharmacies: Improving Health, Reducing Costs, July 2010. Based on IMS Health data.
  7. American Society of Consultant Pharmacists. Adult Meducation. Improving medication adherence in older adults. http://www.adultmeducation.com/downloads/Adult_Meducation.pdf.
  8. DiMatteo MR. Variation in patients’ adherence to medical recommendations. Medical Care. 2004; 42(3); 200-209.
  9. Atreja A, Bellam N, Levy S. Strategies to enhance patient adherence: Making it simple. Medacapt Gen Med. 2005:7(1): 4.
  10. Leendertse AJ, Egberts AC, Stoker LJ, et al. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;168:1890–6.
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