How to engage pharmacists ft. DeLon Canterbury
DeLon Canterbury, pharmacist and founder of GeriatRx Senior Care Consulting, joins us to discuss how care managers can best leverage pharmacists in reducing pill burdens, managing costs, and improving patients' quality of life through personalized, patient-centered care.
Key Points:
Role of Pharmacists: Beyond dispensing pharmacists are advocates, health coaches, and experts in medication management, playing a crucial role in healthcare. DeLon explains the process of safely removing unnecessary medications, deprescribing, to improve patients' quality of life and shared successful cases of deprescribing that resolved adverse effects.
Engagement with Care Managers: DeLon describes how care managers and pharmacists can collaborate to assess and manage patients' medications, ensuring accurate and up-to-date medication lists.
Cost-Saving Strategies: Pharmacists can provide critical resources to help patients afford their medications.
Episode Link: Spotify
Resources Mentioned:
Transcript
[00:00:04] Ariadne: Welcome to CareCraft. We're so happy to be here today with the DeLon Canterbury, who is a graduate of the University of North Carolina School of Pharmacy. He graduated in 2015 and has dedicated his career to serving low income, rural and geriatric populations. He's the founder and owner of GeriatRx Senior Care Consulting. They provide concierge pharmacist support to ensure that patients are getting the best health care outcomes with the least risk. So thank you so much for being on with me today. How are you doing today?
[00:00:35] DeLon: Hey, I'm doing pretty amazing. How are you, my friend?
[00:00:39] Ariadne: Doing great. I met you at a conference, so I know a little bit about your background, but it's always great for listeners to know a little bit as well.
So do you want to share how you got into a pharmacy and also kind of the genesis of GeriatRx and the work that you're doing now?
[00:00:56] DeLon: Yeah. Yeah. And a huge shout out to the ALCA Nationals Conference we met at. That was my first time and it was an amazing, amazing experience. But yeah, happy to share my journey.
So finished up school at UNC and got into pharmacy early because my mom. Was essentially an kind of an herbologist, you know, she grew up in a third world country in South America called Guyana, and all we had really were what was in your backyard, so she was always using herbal remedies and ways to heal, and as a kid with asthma, especially from Brooklyn that was an issue, but I always was intrigued by the science of how these plants are healing the body, like how do teas and herbals work, so that got me passionate about medication and medication safety, and eventually led me to the world of pharmacy.
And fast forward a little bit later, my grandmother unfortunately had mild dementia and was given an inappropriate medication while she was in that facility. Actually, somewhere in, in Park Slope, and we ended up having to move her out of the nursing home. Down in Georgia, where we grew up, because her behavioral issues with dementia just kept getting worse and we didn't really know why.
And for months and months, my mom was in this kind of caregiving hell, right? And, you know, didn't know who to really go to for support. And it was really a frustrated day where she shared how much my grandmother was just wandering, irritable, having worsening memory, to the pharmacist that eventually led to the pharmacist advocating for deprescribing, which is the safe removal of pharmacomeds.
And in this case, she was on an antipsychotic, which was pretty much inappropriate for her. And we found that that antipsychotic was the cause of all of her behavioral issues. So that, that kind of put a fire in me. And, and, you know, we were able to get the medicine stopped. The pharmacist advocated for us in a way that you don't always get with the hustle and bustle of your local shops.
So I I just really had to wonder how are we paying so much for this, right? How are we paying buku money for memory care units and the ALS and still not getting the best quality care? And that got me into the world of geriatric medicine and advocating for Do you prescribing as you know, the deep prescribing pharmacist today?
[00:03:29] Ariadne: That's quite the journey. What do you wish people understood really about the value that pharmacists bring relative to a different type of clinician or professional that might be working with patients?
[00:03:42] DeLon: We are not just dispensers. I think that's the biggest myth is people think we're some old guy in a white coat, just counting a bunch of pills and putting your name on a bottle.
And really I strive to show that we are advocates, confidants, motivators, health coaches, and extremely knowledgeable in not just medicines, but the toxicity profiles and understanding side effects and how they work. And really, there's no other clinician that has that level of expertise when it comes to medication management, so they are, I think we are one of the most accessible resources in the country.
Everyone's about 15 miles from a pharmacy. So there's someone there who has generally a Doctorate of Pharmacy. Who can really give you quick, free, and accessible information that can save your life. And that's the, the biggest myth is seeing that we can be our own consultant or advocate for you. You know, it doesn't have to be this, you know, old way of thinking of just, you know, You know, getting you on meds, we, we not only know, you know, how to work with doctors, we got to navigate the health system, we know how to advocate for cheaper costs.
We're like the best bar, bar, not from any geriatric care manager, but we're really good at knowing how to figure out how the meds may be impacting your quality of life. And I think we're the best kept secret in healthcare.
[00:05:15] Ariadne: It sounds like it. So what stage are care managers normally engaging you or when are you being brought in with a patient?
[00:05:23] DeLon: What we do is we work for care manager practices. And generally, we have clients that might be declining and the care managers are like, you know what, there's something a little off or we're seeing a change and usually there's something I presenting symptom or issue and that kind of clues.
That's what people are including me in some of the clients they've had for years. Some of the clients are fresh new starts and their med list is just crazy. And they're like, what the hell is all this? Where do we start? So it could be a mixed bag of people they've had ongoing. But generally when people come to us, there's an issue, there's a side effect, there's a cognitive issue going down or there may be more falls than usual, or they're having unusual urinary incontinence, things that we kind of take for granted as, oh, it's just, where we come in with the mindset of it's gotta be a medicine and that's how we're trained.
And so we, until we rule out if it's a medicine as a source essentially we're trying to prescribe as much as possible to mitigate those issues. So we're very flexible, but generally it's when there's a presenting issue and we're able to kind of pinpoint if it's a medication issue or if it's maybe something outside of that to help you guys figure out, okay, okay. Dr. Canterbury told us this. Let's go through this avenue and like rule out some other things too. So make life easy.
[00:06:45] Ariadne: So, can you explain what that process actually looks like? Like, when a care manager engages you, is it just you and them kind of going through the documents and then bringing in a client
[00:06:55] DeLon: Yeah, absolutely. So, there are, there are ways where we can do it. Generally, when we have our process of our initial consultation. We're doing a virtual, usually an hour, hour and a half deep dive with the care manager and the patient and or caregiver. So we're doing it all together and we're really, as a team, looking to match up what matters most to the patient and how can we align some of these matterification recommendations to fit the patient's best needs and quality aging.
That's really the goal. And so there's a initial zoom telehealth console. We're looking through all the meds. We're questioning all the meds. We're questioning all the doses. We're questioning if there's a drug drug interaction that's causing some issues. We're looking to see if there's a pharmacogenomic or genetic testing issue where, you know, sometimes your genes aren't going to clear meds the same as others.
So we test for that as well. And so after we're doing all this, we're meeting with both the care manager and family. And we're really just asking probing questions like, Hey, do you feel this medicine is still working to help you sleep? Or what are you doing in your lifestyle so that we can change or modify? To keep you from being anxious or feeling isolated. Right. So we're using the lifestyle choices, the non pharmacological strategies before we talk about, okay, let's throw another med on and that's where really our philosophy is. What is easy to do? What is the patient want to do or family wants to do?
And have we at least try this first before we say, okay, let's just add on another blood pressure med. So what we're doing is just kind of. Okay. We're scaling and just doing an audit of where people stand with all their meds, and if there is an initial interest in getting off their meds, we're coaching the care manager and the patient on how to essentially work with the doctors to de prescribe officially so that we have a supervised manner of doing this, and we're doing it in a safe way that's, again, aligning with the clinical goals of care along with the patient's goals.
[00:09:02] Ariadne: You had mentioned advocacy a couple times. I expect, you know, this process where you've made the decision to potentially start deprescribing is like when that advocacy piece really comes into play. So, I mean, what does that typically look like? And, and would love some examples, maybe from previous clients of like, how that advocacy has really resulted in better outcomes for everyone involved.
[00:09:28] DeLon: Yeah, yeah. Recent case with our, with our current practice with a care manager group longtime patient for the, for the practice and he's been pretty much well controlled. He's had, he's a 78 year old guy no cognitive impairment. He's got some diabetes a little bit of weight gain, but he was on like a couple of herbals and like a baby aspirin that he may not truly need anymore. So that was a piece of like, okay, do you need this? And then an initial piece to that story was this guy was frequently urinating, right? So the care manager group kept having to buy Depends and get staffing to change his linens frequently, and they didn't really know why.
And so upon looking at his chart, his meds, we found that the diabetic medicine that he was on is actually kind of being like a diuretic. And once we realized that we were able to say to the doctor, Hey, You know, our patient has just been urinating every hour, like on the hour what can we do to improve his quality of life and no one really realized that he'd been having this issue that likely was a medication related call.
So the way I advocated was to say, Hey, look, if we switched his diuretic, like diabetes drug to say metformin or whatever else, you know, we could probably still manage his diabetes and then get rid of that urination issue, which eventually is what happened. We were able to get the medication switched, but the guy was paying, you know, quite a bit of money you know, every day, just on the depends and linens and paying for caregivers to change the sheet.
So there was an indirect cost savings from that intervention. And, you know, in this case, the doctor agreed and switched it to something else and the symptoms went away.
[00:11:17] Ariadne: That's awesome. And they it might be seemingly little things right in someone's life but to your point, right, like that really adds up both from a cost perspective and a quality of life perspective, especially if it's something that is entirely avoidable.
So that's awesome that you know, that had such a positive outcome there. What information it's helpful to you if like a care manager is looking to engage you and and to kind of kick off that conversation in the best possible way and just, you know, kick off the process.
[00:11:49] DeLon: Yeah, I get the best insights when the care managers really know their clients or patients needs and or symptoms and are able to give a timeline of when things started to go wrong or when things may be improved. That helps me paint a picture of knowing, you know, when did we start certain medications and is it truly tied to a medication?
Is it a delayed effect? Is it happening because we made a recent switch or increase in a dose? Those type of clues in the medical history helps me kind of hone in on where to focus on on the med review. So to me, knowing that patient in and out has been great. I mean, it's just necessary. And so, especially when they're in care settings where they are being monitored and surveilled.
You can, you could get a pulse on you know, what's happening at night or are they actually sleeping? So I would say just knowing those, those finer details goes a long way. Knowing the med list is key. So you gotta have an accurate and up to date med list. Like that's like the number one thing I ask of a new platform, but my business partnerships is, Hey, we're just a work I gotta know everything, including the herbals, dilutions, eye drops, they all matter. So an accurate met list is number one.
And then two, are they actually taking it? Do you know if they're actually taking it? Are you watching them administer it themselves? Do they have the ability to administer it themselves? Or do they need help with that?
So knowing those, those soft skills as well, like activities of daily living. Do they have friends? Do they eat healthy? That's pretty critical, too. Like, are they getting enough fiber and veggies? So that's the type of open ended questions I ask in our initial consults.
And then sometimes you know, care managers would just give me the patient case on the back end and I go in to their care management portal. I work up the case. I upload my recommendations and I don't have to see anybody. So that way it's not a time, you know time sucks, so to speak. But you just have on the back end.
And that's one of the models we also use is just, Hey, Dr. Canterbury, check these three people out for this month. And tell us what you think, and we reassess and follow up later on.
[00:13:57] Ariadne: How do you think care managers should be thinking about pharmacists and medication reconciliations, like, when they're putting together their care plans for a patient?
[00:14:07] DeLon: I think they're extremely integral. Not only can we help with potential cost savings, but we know, especially if you're a geriatric pharmacist, you know off bat which meds to completely avoid in older adults. And that's one of our skill sets is figuring out, all right, you're on a paroxetine versus sertraline, right?
Both antidepressants, but one has a worse, burden for people that may have dementia and you don't want to use peroxetine in anyone that has dementia because of its anticholinergic properties which affects memory. So that nuance in the med, you know, profile can be life or death. And I've had a referral from another practice who had a guy with moderate dementia on Risperdal, on paroxetine, on like another sedative, like anti seizure medicine, stuff that you probably see commonly so much you start to wonder, is it supposed to be this way?
But no, it really isn't. They're just using things to, unfortunately, because you don't have an option or you're just trying or you know what, there's no evidence, but this is all we can do. And you never know, people are trying their best, but we see a lot of inappropriate medication use, so you want a pharmacist to help with one, reducing the pill burden for the client, so nobody needs to be on 15, 20 meds for the rest of their lives, so if we can help with that, that makes it easy for the caregiver or family or even the patient to take less.
There's that angle. There's also a cost savings benefit. I've absolutely recommended some patients who have I dollar drugs to consider enrolling into a clinical trial and one of our clients. We've absolutely helped save close to like over a thousand bucks a year, just because we got that one med covered by a clinical trial.
So there's a lot of creative ways we can help people. And also I think that communicating the value of a pharmacist as an added value to your team and how you can get your own internal med reviews is is rare. We don't see enough of that in health care. So just having that professional access to a friend and say, Hey, we've got some issues here, what do you think? Can go a long way for the extra value you're conveying and the trust you're building with your patients?
[00:16:30] Ariadne: That makes perfect sense. And you mentioned cost savings and that's always like a big factor, right? And the decision of like, which medications to put someone on, which ones they continue taking, et cetera.
What are some resources or tools that you can provide care managers or patients directly to really help them lower the costs? I know you were just mentioning like clinical trials as one, but didn't know if there were others.
[00:16:56] DeLon: Yeah, it could be interesting when you have Medicare. But needy meds is always a great resource. needymeds.org or work is a is a nonprofit website and they essentially you could search drugs if they have any like patient access foundations. Some of these. Bigger name companies have funds allocated for people who can't afford their meds. Right? And so they can qualify. They meet a certain financial threshold to have some of those minutes completely covered.
Depends on the program. It depends on the drug always helps to check out, you know, coupons for medical cards check and see if the manufacturer has a discount card. There are these foundations that are completely meant to help people who may not have the ability to afford their meds. Like for instance, the Ryan White Foundation is a, is a known one.
And then sometimes your state, depends on where you are, there are some states that have what are called medication repositories where people essentially donate it expiring drugs, so to speak, but they're still good. So they're able to sell some of those drugs at a discounted rate to help save some money for some people.
So not all states allow that, but yeah, it can get very tricky, but there, there are some options out there.
[00:18:20] Ariadne: Yeah, lots of resources. And what about we talked a little bit about kind of the deprescribing that you help patients through? What if it's really an issue of adherence more so than like, you know, not being on the right treatment plan?
[00:18:36] DeLon: Yeah, so that's extremely important. For managing health conditions chronically. And if we're finding adherence, we want to know what's causing the adherence. Is it a capacity issue? Is it a physical ability? Is it not having a system? And so we help to figure out what that root issue is. We've absolutely helped to order electronic pill dispensers, train people on what to look for, how to load it.
It kind of depends what the situation is. But overall, if we do see adherence as an issue, that's definitely something we want to raise. And depending on the clinical scenario, that can even give us sometimes more argument to deprescribe and sometimes an argument to remain. On something just to kind of depends what it is.
If we're dealing with someone who's already got, you know, rheumatoid arthritis, it is painful to open the bottle. Can we consider switching to an injection or a liquid, you know, just something to ease the adherence barrier. So kind of depends. But ultimately, overall. If we do find that as an issue we want to get to the source and communicate to the doctor.
[00:19:44] Ariadne: Makes sense. And what services does GeriatRx provide specifically that care managers should keep in mind as potential options for their clients?
[00:19:54] DeLon: So we specifically provide discounted services for ALCA members and ALCA business owners. We do pharmacogenetics or genetic testing consults. We do initial consulting and we also do six month and yearly retainer services for clients. So say you have a business, you've got growing practice and you want to just do an audit on everyone in your business. We can come in and essentially you choose a set number of people you'd like for us to screen, and we will do a back end review of the medications and make some lifestyle recommendations and thoughts or tweaks that may be used as a blueprint to advocate for the patient's family they want to consider a change.
And, of course, bring to the doctor if that's something that they want to consider doing. But, most people don't have access to that type of concierge level of care. So, what I also do Or offer is essentially training and like in services and workshops around medications for your practice and your care managers.
So if you are really passionate about using less or finding more holistic ways to heal, we can do monthly kind of workshops for your care team. So you're going to go forth. We also do office hours and case presentations to say you've got you know, you just want to run a case by me real quick live.
We can do that for your team as well. And of course, if you want us to go toe to toe with your doctors and work or work in tandem with your doctors, whatever the case is, we provide those services as well.
[00:21:28] Ariadne: That's awesome. And the genetic testing. Are there is that particular types of individuals that that's more appropriate for? Or when do you think about incorporating that with the patient?
[00:21:39] DeLon: I generally believe everyone should get a genetic test biases aside. It's pretty affordable. It can give a lot of intel. Even if you're not taking medications, it can give you an idea of what you would be okay with or may have a genetic safety profile.
But the versatility of a genetic test is, is huge. It, I mean, it can help with pain management depression depressing or anxiety and depression. It helps with cancer. It helps with certain blood thinners and statins. A lot of medications are cleared by our liver and a lot of our genetic differences are in the liver.
So if we were trying to avoid the trial and error of just, okay, take this drug. Do it for three months and then see if it works and then you fail it, it loses a lot of patient trust. It loses a lot of trust in the process and the health system. Genetic testing can avoid all of that. If we at least have an idea of where to start.
And it's fairly accessible. It's a cheek swab. It's not invasive. And you can get a lot of quick answers on. Oh, no wonder I didn't do well with coding and gave me this and a lot of genetic testing can help. Clarify some of those things. So a huge fan of it. I am a certified pharmacogenomics consultant as well in addition to that.
So that's also what would be a benefit to your practice if interested.
[00:23:04] Ariadne: Thanks so much for sharing this. I think it's super valuable for care managers to understand, you know, the value pharmacists bring and then ways that they can be effective in engaging them with their clients.
So thank you so much for joining us on the podcast today. Really appreciate all of your expertise and look forward to seeing where geriatrics goes from here.
[00:23:26] DeLon: All right. so much for having me. Take it easy.