The PharmDs offer a clinic-administrative window that cuts across the clinical and administrative barriers that patients experience in real time. When a physician orders a GLP-1 to an obese patient with type 2 diabetes, the PharmD foresees the obstacles of prior authorization and step-therapy requirements that can delay the start of the therapy or compel the change of the therapy. The foresight is paramount, as delays tend to promote the lack of adherence, which subsequently promotes readmissions. In addition to access, PharmDs understand pharmacokinetics and pharmacodynamics, which assists them in understanding where treatment of one disorder may interfere with another. Nausea and vomiting induced by GLP-1 in a cardiovascular-kidney-metabolic patient, e.g., may trigger dehydration and electrolyte imbalance, which increases the risk of arrhythmia in heart failure. The subtleties of these ties are usually noticed only when there are complications, however a PharmD is trained to notice them beforehand. They are most valuable when it comes to care transitions. Post discharge is one of the most susceptible periods to medication duplication, dosage errors or missed treatment. As medication navigators, PharmDs align regimens, counsel patients, and communicate with outpatient providers to avert an otherwise unnecessary harm in a system fragmented most. That combination of access knowledge, clinical acumen and transitioning care is what makes PharmDs irreplaceable members of the care team, especially in complex patients.
Pharmacists are frequently witnesses to the half-battle of writing a prescription, which is easily overcome by insurance obstacles such as prior authorisations, formulary restrictions, and step therapy that can slow down or even prevent access. In the case of high-demand medications, such as GLP-1s, I have had patients walk out of the hospital thinking that they would be starting their treatment immediately, only to discover that it was not covered or that they needed to make several appeals. By predicting these barriers, I can alert prescribers to potential risks of non-adherence early and propose covered alternatives before a lapse in therapy results in readmission or disease exacerbation. In complex patients, drug interactions are hardly ever simple. GLP-1 can be beneficial for weight loss and glycemic control. Still, when it leads to nausea or dehydration in a heart failure patient, this can precipitate hazardous electrolyte changes or fluid imbalance. It is here that the thoroughness of the pharmacist in pharmacokinetics and pharmacodynamics is essential--not only can we expect the desired effects, but also the side effects in more than one condition. Another domain in which pharmacists can make a significant improvement is transitional care, including reconciliation of inpatient and outpatient medication lists, patient counselling, and serving as an intermediary to prevent mistakes. In the case of patients with overlapping cardiovascular, kidney, and metabolic disease, that additional level of care is what can make the difference between discharge recovery and a fast readmission.