The Positive Side

Spring/Summer 2005 

The Pharmacist List

7 reasons to get to know the person behind the counter

By Derek Thaczuk

AT THE VILLAGE PHARMACY on Toronto’s Church Street, pharmacist / owner Zahid Somani was busy with a customer. I waited patiently — customers first, journalists second! This particular young woman had dropped in to ask about the safety of an herbal supplement she was considering. “It’s good you asked,” Somani told her, because, he said, supplements can sometimes interact with medications. After checking her meds lineup, Somani assured the woman that it should be fine. But, he said, “If you start taking larger dosages of the supplement, come back and let me double-check.”

This was just the sort of thing I’d come to interview Somani about: Should every pharmacist know about drug / herbal interactions? While it makes for more information to keep on top of, Somani says it’s just part of his job: “Pharmacy is not just lick ’n’ stick the labels, count ’n’ pour the pills. It’s about the patients, not the pills.”

After speaking with Somani and four other pharmacists who also specialize in HIV care, my suspicions were confirmed: Pharmacists are the unsung heroes of HIV care — a valuable and often-untapped resource for people with HIV/AIDS (PHAs).

Here are seven sorts of good pharma dharma you can get from that professional behind the counter:

 1  Help choosing a drug combination. When starting or switching highly active antiretroviral therapy (HAART), it’s tough to narrow down all the options. While the final choice is up to you and your doctor, pharmacists are ready and willing to pitch in. “There may be several treatment options that are all medically sound,” says Cara Hills of the Northern Alberta HIV Program. “The final decision often depends on practicalities, such as whether there are food restrictions. As a pharmacist, I’m often able to spend a lot more time on those issues than a specialist can. People can then go back to their doctors with a much clearer sense of their preferences.”

 2  Easy-access treatment information. Your pharmacist is probably your best bet for info and tips on meds management. Jeff Kapler, an HIV specialty pharmacist in Calgary, says specialty pharmacists can “help by teaching people about meds and treatment options — and we’re very accessible.” Kathryn Slayter, clinical pharmacist specialist at Queen Elizabeth II Health Sciences Centre in Halifax, seconds that notion. “People can call me any time. We don’t say, ‘Here are your pills, see you later’ — we chat about how to work your pills into a busy day, or whatever it is people need.” When your doc’s day is booked, your pharmacist can be the most accessible part of your health care team. “We always give people private, one-on-one time where they can discuss anything regarding medication,” says Linda Akagi of St. Paul’s Hospital Outpatient Pharmacy in Vancouver. And quick questions can often get answered right away.

 3  Advice on avoiding drug interactions. Medications can affect each other, sometimes in a harmful way — “and that includes complementary and alternative medicine (CAM) as well as over-the counter products,” Kathryn Slayter says. “My one rule with CAM is that it not interfere with HAART or add toxicity.” Your pharmacist is your best bet for checking up on interactions — stay on the lookout by letting them know everything you take. Also, sticking with a single pharmacist keeps it all under one roof, where it’s easier to flag potential problems.

 4  Tips on how to deal with side effects. Pharmacists often have useful tips for avoiding or managing side effects. “Some people are lucky and hardly skip a beat when they start new meds,” Jeff Kapler says. “Others may have mild or serious adverse effects.” Pharmacists can often suggest solutions, such as over-the-counter remedies or supplements. “If we can’t resolve the problems,” Kapler says, “we work with the physician and patient to pick alternate medications.”

Pharmacists can also shed some perspective on the appalling lists of “possible” side effects of medications. “When people look at all the listed side effects and say, ‘Oh my God,’ we can allay some of those fears by talking with them,” Kapler says. “By drawing on our experience with our other patients, we can give people that real-life perspective.”

 5  Adherence assistance. Taking all your meds on time every day can be a tough pill to swallow. Everybody has challenges, whether it’s the demands of a busy schedule, drug or alcohol use, or just trouble remembering. Pharmacists can help brainstorm creative ways to deal with demanding drug timetables. One of Somani’s patients had a very complex regimen — 13 different drugs for HIV, heart disease and neuropathy. He found it too difficult to manage and keep track of them all. That’s where Somani stepped in: “I offered him a Dosettes program, where we prepackaged all his meds in a weekly pill box, divided and labeled by day and time. That worked extremely well for him — it took out the guesswork and gave him time to do things besides worrying about when to take his meds.”

Adherence also has to do with attitude. “Some people dislike taking meds because it’s a constant reminder that they’re sick,” Jeff Kapler says. “I try to make them feel more positive — that taking their meds is a way to take control of their disease. I think people feel better when they’re empowered.”

Studies have shown that PHAs who work closely with their pharmacist stand a better chance of meeting adherence goals and, therefore, successful therapy. A study published in AIDS Care (May 2004) showed that patients were much more likely to take all their meds when they used a clinic pharmacy that offered personal support. “This study demonstrates the positive impact of the pharmacist in patient care,” says study co-investigator Linda Akagi. “It showed that patients with a higher level of involvement with a pharmacist were more likely to be adherent to their meds and keep their HIV suppressed.” In fact, the well-supported patients were 1.5 times more likely to maintain an undetectable viral load than those “off-site.” (For more on adherence, see “The Importance of Being Adherent,” The Positive Side, fall/winter 2004.)

 6  Coverage costs. Meds don’t come cheap, and coverage plans can leave a lot uncovered. “I often see patients for whom the high cost of meds is a barrier to their treatment,” Somani says. “I always try to find ways to work around financial constraints to get people the drugs they need.” Even if sometimes that means braving a tangle of red tape.

 7  Advocating for your needs. We PHAs don’t always see the snarl of rules and regulations that makes it hard to get the drugs we need, though we may be all-too-painfully aware of the end result when a prescription can’t be filled. Pharmacists who know the consequences of missed doses may be willing to become bulldogs, tackling red tape on their patients’ behalf. “We’ve handled negotiations with insurance companies where there have been questions about coverage,” Linda Akagi says. “When [PCP-fighting drug] Dapsone was withdrawn from the Canadian market [for marketing reasons], the whole process of getting it became a huge hassle. We explained the problems to a provincial committee that agreed to cover it, but they might not have known how bad the situation was if [pharmacists] hadn’t laid it out for them.”

Derek Thaczuk has worked and volunteered within the HIV community for 10 years. His obsessions include health literacy, making research and information accessible, and penguins. He is now a self-employed medical writer and consultant.


PHA Prescription

When asked, “What could your patients do to get the most out of you?” our friendly pharmacists filled out the following ’script:

  • Demand the best. “If possible, pick a pharmacy that specializes in HIV that has a full-time pharmacist you can get to know,” Zahid Somani says. Ask your doc or aso for suggestions.
  • Don’t wait until zero hour. It may not be possible to arrange a refill right away. Call while you’ve got at least a few days of meds left.
  • Ask questions. “We don’t judge people’s life situations, so if you have questions about anything related to your health, go ahead and ask!” Jeff Kapler says. “If you have all the information, you can make better decisions.”
  • Brown-bag it. Every so often, bring in all your pills and bottles — including supplements and over-the-counter drugs — so your pharmacist can double-check for interactions. It’s good to do this whenever your meds change.
  • Be honest. “I don’t want people to feel they have to lie about their adherence for fear of getting scolded,” Kathryn Slayter says. If circumstances have made it tough to take your pills, say so — between you and your pharmacist, you may come up with a solution you hadn’t thought of on your own.
  • Plan ahead if you’re moving, especially between provinces. Linda Akagi says that people are often surprised to find that coverage varies between provinces — and that it may take months before coverage kicks in. If the grass looks greener elsewhere, check into drug plans to ensure continuous coverage. (Call CATIE at 1.800.263.1638 for info on provincial coverage plans.)