BROOKINGS – Bringing another member into the health-care team actually can make health care less expensive while also improving the quality of that care, according to data compiled by the American Pharmacists Association.

Patients are three times more likely to stay out of the hospital when pharmacists provide clinical services after discharge and, on average, $1,000 per patient per year is saved with pharmacist interventions for patients with chronic conditions, the association reports.

That thinking is what caused the cardiac rehab department at Brookings Health System and the South Dakota State University College of Pharmacy and Allied Health Professions to offer medication reviews and education for those in the hospital’s program. This is the second year that fifth-year pharmacy students are helping out at the SDSU Wellness Center, where the discharged patients engaged in prescribed exercise.

“We’re medication experts. We’re able to serve as a resource for those patients,” said Dr. Alex Middendorf, an assistant professor of pharmacy practice.

The students who meet with patients are in their fifth year of a six-year program. They have already earned their Bachelor of Science degree in pharmaceutical sciences and now are taking courses at University Center North in Sioux Falls and doing more hands-on work with health-care facilities there. Their final year is spent entirely doing rotations, providing direct patient care hands-on under the direction of pharmacist preceptors.

Middendorf, who teaches community pharmacy and practices as a community pharmacist himself, said students are anxious to work in settings like the medication review program. “It’s real patients with real problems and real medications,” he said.

No med question off limits

The program operates on Fridays twice a month during the school year with the first counseling session held Sept. 29. It’s truly the patients’ call as far as how long the sessions last and what is discussed. “It is very patient directed as far as how the conversation goes,” said Middendorf, who added that free blood sugar checks also are offered.

Taylor Thooft, of Tyler, Minnesota, was among the four students who worked the initial session. “We were expecting cardiac questions, but we got a little bit of everything,” he said.

Topics ranged from adverse reactions and side effects to the long-term impacts of taking a cancer-fighting drug more than 20 years ago.

Middendorf proctored the students, but they held their own. One patient couldn’t understand why her doctor ordered her to stop talking Aleve, which she had taken for years, now that she was on heart medication. The answer is that nonsteroidal anti-inflammatory drugs like Aleve and Advil run the risk of thinning the blood too much as well as being hard on the heart and kidneys, Thooft said.

The answer was to switch to Tylenol or some other form of acetaminophen, which does not have these side effects.

Drug interaction a key issue

The consultations are free and voluntarily, but often are recommended by Jesse Walsh, director of cardiac rehab at Brookings Health System. “They’re valuable for these patients, who are no longer receiving hospital outpatient therapy, but may have noticed side effects as a result of their new medication or just have some concerns.”

Middendorf said they recommend patients always keep with them a complete list of prescription medications, over-the-counter medications, and any vitamins and supplements they’re taking. Their pharmacist or doctor can assist on this, he said.

By knowing the potential drug interactions that multiple medications can produce, the pharmacist can often pinpoint the reason for a side effect and prevent rehospitalizations, Middendorf said. Sometimes the side effect can be the result of an over-the-counter medication, vitamins and supplements, or even grapefruit, he said.

The consults can last 20 to 60 minutes. “Patients are happy to have someone there to talk with them,” Middendorf said.

No appointment needed

“For community pharmacists, it is usually the highlight of their day to be able to answer a question using their knowledge base,” he said. But the advantage of this program with the students is “we meet patients where they are.”

In addition to these reviews, students are in the community doing flu shot clinics and screenings as part of their educational requirement to log hours of direct patient contact.

“We aren’t always behind a counter. We’re accessible and will make the time to talk to patients,” said Rebecca Matzek, of Ellsworth, Wisconsin. “We are the most accessible members of the health-care team. You don’t need an appointment to see us.”

Citing a national survey, Middendorf said, “On average, patients see their community pharmacist more than 30 times per year versus four times per year for their primary care doctor.”