Managing medications is a challenge for many patients — from remembering to take certain pills at certain times to trying to keep track of when refills are needed. For many patients, the challenges don’t stop there. Many patients receive prescription denials from their insurance plan for one reason or another and reach out to their providers for an alternative medication. But because provider inboxes can be crowded, there isn’t a prompt response and the patient ends up in the emergency room as a result.
This common example is why it’s vital to integrate clinical pharmacists into primary care teams to support both providers and patients alike. They coordinate medication access and safety for patients, deliver direct patient education, and identify barriers that often keep patients from being able to adhere to their treatment plans.
According to a cross-sectional survey conducted in California, 90% of physicians said the integration of pharmacists into their team improved patient medication management — which echo the opportunities Clinical Pharmacist Lead Jeffrey Tingen has seen in his role at Waymark. In this interview, Jeffrey breaks down the particulars of his role and shares how he works alongside other experts on Waymark's care team — community health workers (CHWs), licensed therapists, and care coordinators — to improve patient outcomes.
What is a clinical pharmacist, and how do you support and enable primary care providers (PCPs) in your role?
A clinical pharmacist is a medication expert who works with PCPs to deliver direct patient care and optimize medication to promote health and disease prevention. A clinical pharmacist often has specialized training (an additional one to two years of residency or fellowship) and typically performs activities beyond fundamental dispensing and order entry activities; clinical pharmacists often practice in the hospital or the outpatient clinical setting.
In my role with Waymark, I assist in providing medication education to patients and break down barriers that may prevent a patient from taking medication correctly. Additionally, patients are referred to the clinical pharmacists I oversee for chronic disease state management (such as diabetes, hypertension, or other conditions). There, I’m able to optimize their medication by providing education, starting/stopping medications or changing the dose of a medication under a collaborative practice agreement with their PCP.
Why is it important for community-based teams to include pharmacists? How do you work alongside other roles, like community health workers (CHWs) and therapists?
Patients may leave their PCP visit or the hospital overwhelmed by the amount of information received during their visit, and they might also receive medications that come with complex regimens or possible side effects. Clinical pharmacists help ease concerns or fear by providing individualized patient education and frequent follow-ups to check in on how their chronic disease management is going between PCP visits.
As part of our Waymark Care Delivery Team, I collaborate with CHWs, licensed therapists and care coordinators to help patients access, understand, and adhere to their medication protocols, as well as support patient access to other resources (such as health education and PCP appointments). CHWs and therapists can come to me with clinical questions, such as if a symptom could be related to a medication the patient is taking or what may be the next medication option for a patient given their history. I also rely heavily on CHW and therapist expertise to help patients navigate mental health needs and the social drivers of health that patients bring up to me during pharmacist visits.
What brought you to Waymark?
After spending all of my career in academic medicine, I developed a strong passion for helping underserved patient populations. However, I realized that although large academic institutions can hire a clinical pharmacist to provide direct patient care, many underserved patients in the community don’t have access to this clinical service. Waymark’s care delivery model spoke to my passion for helping underserved populations by addressing some of the healthcare disparities for each individual patient while also improving their health. Importantly, many care models don’t include clinical pharmacists as part of their core team. It’s encouraging to see that Waymark views clinical pharmacists as an integral piece of the Medicaid care delivery system.
Can you share an example of how you recently helped a patient in the community?
A patient was referred to a clinical pharmacist by her care coordinator after she expressed that she was consistently having difficulty accessing her medication. She’d recently lost Medicaid coverage, then had it reinstated, and as a result, there was a gap in her ability to get the medication she needed to manage her type 2 diabetes. What’s more, during a recent visit with her specialist, she was given a paper with insulin instructions that she did not understand — so she did not restart her insulin therapy out of fear of doing it incorrectly.
I sat down with her and provided education about the different types of insulin, which empowered her to restart her insulin therapy and follow the correct instructions. Outside of being an educational opportunity, this visit had a large safety impact because the patient referred to her insulin by the color of its pen, and would likely have given herself the incorrect insulin without expert intervention. In the same visit, I also provided lifestyle education and counseling, which resulted in her choice to reduce carbohydrate intake and incorporate healthier eating habits. As a result, she saw her blood glucose levels trend from the 400s-500s down to the upper 100s-200s over the next few weeks.
In that same visit, she mentioned to me that she had been to the emergency room recently for a vascular issue but that her leg pain and discoloration continued to worsen. I was able to help her get an appointment to see her PCP, who ultimately diagnosed her with an infection and immediately implemented a treatment plan.
This story is a great example of how clinical pharmacists can support the whole patient — from medication management to lifestyle choices and beyond. It’s my privilege to serve as an advocate for the people Waymark serves, and I couldn’t be more proud to be part of such an incredible, person-centered team.
