Paul Szmal: It is 816 on FLX Morning on Finger Lakes News Radio and I'm happy to welcome in a clinical pharmacist specialist from Finger Lakes Community Health. That would be Dr. Jacob Sprouse. Jacob, good morning. How are you, sir?
Jacob Sprouse: Good morning. I'm doing well, thank you.
Paul Szmal: Yeah, we use the term and we hear the term pharmacist all the time, but I don't know that people know the actual definition of what a pharmacist is and what a pharmacist does. So let's start with the first part of that equation. What is a pharmacist?
Jacob Sprouse: So a pharmacist is someone who is trained primarily in medications. That's what we do in school and I think the interaction that most people have with pharmacists is going to be heavily at retail. Every time you visit a retail pharmacy, you're not walking out of there with the prescription unless it's gone through a pharmacist's hands and you've been given an opportunity to get some education or ask questions to the pharmacist. But pharmacists do go far deeper within the health care team or in hospitals, we're in PBMs and insurance companies, we're in primary care clinics around the country.
Paul Szmal: So the pharmacist, as you refer to, is somebody that we traditionally consult with when we're picking up our medications. How many years of education and training goes into being a pharmacist?
Jacob Sprouse: It's actually different for each individual. A lot of people go to school and they'll get a four-year degree, then they'll go to pharmacy, that's about four years, and occasionally there's a residency that they'll choose to do a fellowship afterwards that can be anywhere from one to two years or beyond if they want to continue their education. But the pharmacy school piece itself is generally four years. Some places have expedited schooling that can kind of get people through that a little faster, but that's including summers and the number of hours ends up being about the same.
Paul Szmal: We're talking with Jacob Sprouse here on FLX Morning. He's a clinical pharmacist from Finger Lakes Community Health. And what do you do in your role? Do you work primarily with primary care physicians, Jacob?
Jacob Sprouse: I do. So at Finger Lakes Community Health, I was primarily brought on to oversee the clinical component of a diabetes improvement initiative. So we're focusing on patients with A1Cs 9 or higher, and that's a way of kind of quantifying the total average blood sugar over a 90-day period. That's what the A1C does. But since I've started, really, the opportunity to provide more care within the clinic has really been expanded. I've gotten into COPD, chronic pain management, some mental health changes, heart failure, blood pressure, cholesterol, and really just finding out where I can be a resource to the providers. Because medications, if anyone's keeping an eye on pipelines and drug companies these days, the medications and the knowledge is growing so much faster than I think it ever has in the past.
Paul Szmal: Well, let's take the example of working with a, perhaps working with a primary care physician who has a patient who has an A1C of 9 or higher. What is your role in their overall care program?
Jacob Sprouse: So when a patient gets referred to me and the team that I work with, we'll sit down with the patient and we'll get to know them. What are their goals? What is the baseline knowledge of diabetes? And where can we start making the most impact? So sometimes we're considering, is there chronic kidney disease or high blood pressure or cardiovascular risk that we need to consider a forefront? Because those risks really do increase with poorly controlled diabetes. So there becomes that opportunity to optimize outcomes over the long term by choosing medications. And really, my preference is heavily lifestyle, whether diet or exercise. But it goes a long way as well, choosing medications that help to minimize the risk of further strokes or heart attacks, cardiovascular problems, or worsening kidney function. And really, how can we also improve diabetes with those medications? So it's looking at optimizing the regimen.
But sometimes, you know, sometimes I get people who come in and yes, they have diabetes and it's poorly controlled, but they also have trouble breathing. So one of my favorite things to do, and I tell all my students this, is find out what's most important to the patient. Because if we can help someone breathe better, they're probably going to be more active, they're going to enjoy life better. And when you're doing those things, everything else can improve. Your sleep improves, your diabetes improves, you lose weight, your cholesterol improves, that blood pressure improves. So it's really just finding where we can make the most impact for an individual patient.
Paul Szmal: And how does that apply when you're dealing with perhaps a mental health issue versus a physical ailment?
Jacob Sprouse: Well, so some mental health issues. I worked in the Department of Veterans Affairs for five and a half years before I moved back out to New York State. And we have some awesome resources in the VA, but there was a time where we didn't have a mental health pharmacist, so the psychiatrist would work with me. And it gave me a lot of experience, time to become experienced in working with veterans on some of the more primary care appropriate mental health drugs and choices. That could range anything from certain medications just for some baseline anxiety, PTSD, and depression. But a lot of people as well have chronic pain, and there's a lot of antidepressants and medications for mood and anxiety that can also help with chronic pain, help with sleep. So sometimes it can really help that we are able to help people find that one medication that could perhaps touch on two to three possible pain points or problems for them.
Paul Szmal: And do these consultations that we're talking about, do these happen sometimes directly with the patient, or is it more universal that the primary care physician comes to you for the consult?
Jacob Sprouse: It can happen both ways. Sometimes it sort of happens when it's not patient-facing. We'll just sit down and have a chat. Sometimes I can just provide education to the group. Sometimes we'll just have a video conference, me and a provider, and we'll talk about a patient. We'll go through the chart and we'll talk about, you know, maybe where some opportunities lie. But I'd say the bulk of my time is direct patient interaction where I'm sitting down with the patient. And it's not uncommon for me to, I prefer to book my appointments on the hour slots so that I have plenty of time to get to know them and find out what drives them, what is important to them. And then, and that helps us to, I think, have a more effective outcome in the end when we're just really able to sit down with each other.
Paul Szmal: And I think one of the biggest things that people think of when they think of a pharmacist is having that consult of, are these medications going to conflict with each other?
Jacob Sprouse: That's actually a really common, I appreciate you bringing that up, it's very common. And it's something that I don't think people appreciate quite as much. Sometimes they'll say, oh I'm starting new medicine, I don't want it to conflict with anything. And that's very important to consider. But another point of consideration is sometimes people will be on medications for five or ten years, which might have been fine with you ten years ago. Now your body has aged ten years, kidney function has changed, sleep patterns have changed, lifestyle has changed, and those medications can be less ideal nowadays than they were ten years ago. And people, it's something I really want to make let people know about because sometimes, not all the time, but sometimes we need to adjust the medications, even if you've been on them for a long time.
I'd say blood pressure medication is probably one of the most common. Cholesterol medications can do it too, where people start it and then they they've been on it, they just they start to feel more tired and more tired. And next thing you know they're standing up and they're dizzy and they're like, well I don't want changing my medicines, I've been on these for ten years. I'm like, oh we need to we need to make some adjustments and we can help you feel a lot better.
Paul Szmal: We're talking with Jacob Sprouse who is a clinical pharmacist specialist with Finger Lakes Community Health. You mentioned students a couple of minutes ago, so you're actually working on a teaching capacity as well as a practical capacity?
Jacob Sprouse: Yes, so the last year of pharmacy school is spent doing clinical rotations similar to nursing and physicians where the students go out and they work with patients, they work with providers who are already licensed. So I've had six students so far. I have another one starting on this coming Monday. I'm seeing students from St. John Fisher University and they're getting some experience in the ambulatory care with the primary care setting that I work in with patients, but also some of the administrative role that I'm playing at Finger Lakes as well. I've had really good feedback and it's something I've always been very passionate about teaching students and that all goes back to really the impact of my very first preceptor who helped me understand that pharmacy wasn't gonna didn't have to be just retail, like that's something that is pushed pretty hard. They teach a lot of that in school, but the clinical component really started to expand when I met with my first preceptor. So that's the way I try to teach students as well whenever I have them on my rotations.
Paul Szmal: Where do you see the role of clinical pharmacists going, growing, changing in the coming years?
Jacob Sprouse: Oh that is a good question. So in the future I really hope to see pharmacists being able to take a more supported role, maybe from an insurance standpoint, better recognition. Some states are already doing this. I came out here from Washington State where pharmacists are recognized as providers and it's actually quite simple for a pharmacist to start working with a team of physicians and start prescribing independently. That's what I did in the VA and the VA has a lot of very exciting data on how effective they are and let's be honest, the VA would not be paying for the thousands of pharmacists if they didn't bring benefit, right?
So I think seeing the opportunity that pharmacists can bring on a primary care side is going to expand in the future. I think that's going to be some of the natural direction that places want to go, especially with some of the difficulty hiring other providers. But not because we're just trying to fill gaps where we can't get other providers, but pharmacists do provide a highly specialized level of care. I like to consider the health care team, the primary care providers, almost like the quarterback calling all the shots. Like they're running the overall show or maybe we call them the head coach. And then the pharmacist is almost like the special teams. It's part of the importance of having some cross-functional collaboration and diversity within the team. We have different training and different ways of looking at the overall problem. So I've been trained to look into medications, but I've had enough experience where I can also look at potential new diagnosis and disease states that some providers may not have considered for a patient.
So if we have someone who's not smoking, he maybe stopped smoking 30 years ago, but he smoked for 40 years of his life. And chronic obstructive pulmonary disease and breathing problems might be kind of prevalent. He might be treated like he has asthma, but we sometimes can change that to optimize for the COPD component. So I think over time there's going to be more and more data that builds up that show that pharmacists really continue to have a strong impact. And I think as we move to value-based care, I do expect to see pharmacists more widely embraced.
Paul Szmal: Jacob Sprouse, clinical pharmacist with Finger Lakes Community Health. Thank you very much for joining us this morning. We've covered a lot of ground, shared a lot of good information.
Jacob Sprouse: Thank you, Paul. It's been a pleasure.
