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Strengthening Cardiometabolic Health · Meaningful Medicine with Novant Health

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  Nolan Alexander (Host): Meaningful Medicine is a Novant Health podcast
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  bringing you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  Today, we're speaking with Glenn Herrington, a clinical
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  pharmacist practitioner, about comprehensive medication management.
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  Glenn, welcome to Meaningful Medicine.
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  Glenn Herrington, CPP, PHARMD: Thanks for having me.
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  I'm excited to talk a a little bit more about this.
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  Host: Now, we're excited to explore it with you.
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  And think most listeners are familiar with the role of a pharmacist.
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  But to start with, can you explain more about the role of a
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  clinical pharmacist practitioner?
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  Glenn Herrington, CPP, PHARMD: Sure.
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  Absolutely.
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  Yeah, I agree, most people are familiar with pharmacists, and
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  they've all interacted with their community pharmacist.
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  Here in North Carolina, all pharmacists that graduate now graduate with
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  a Doctorate of Pharmacy degree.
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  Those of us that want to work in a clinical setting, whether that's in a
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  hospital or a doctor's office, can do one to two years of residency training.
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  We can pursue board certification.
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  And the state of North Carolina allows pharmacists to pursue a clinical
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  pharmacist practitioner license, which basically allows us to provide
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  comprehensive medication management in collaboration with a supervising physician
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  and other advanced practice providers, and we can order prescriptions and order labs
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  and blood work to help manage medications the same way that other providers can.
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  Host: We a lot about the importance of a heart-healthy diet and exercise
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  and prevention, but I know it's also important to be aware of risk factors.
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  What's top of mind for you about your approach on risk assessment, and what is
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  it that you're looking for in patients?
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  Glenn Herrington, CPP, PHARMD: That's a great question.
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  So absolutely, without a doubt, healthy diet and exercise are
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  the foundation to everything.
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  So, it's not all about medications.
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  Even though I'm a pharmacist, I need to be aware of that.
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  But when we think about risk assessment, we think about things
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  like genetics, family history.
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  There's some things that go beyond diet and exercise that
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  are somewhat out of our control.
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  So, I look at a patient's personal medical history.
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  Do they have things like diabetes or pre-diabetes, or do
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  they have high blood pressure?
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  Do they have bad cholesterol?
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  What's their family history?
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  We can take some of that information and plug it into some
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  validated risk assessment tools.
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  Like, the AHA and ACC have a Prevent calculator, which will give us an
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  estimate on what somebody's 10- to 30-year risk of cardiovascular disease may be.
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  But that's kind of just general population level things.
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  And so, we also can further look at a person's individual risk
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  by checking other blood work.
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  So beyond what might just get in a routine screening, things like ApoB,
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  LP(a) cholesterol, inflammation markers.
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  And sometimes we get things like coronary artery calcium scores
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  if we're just not quite sure.
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  So, looking at the overall picture.
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  But then, also specific things about that person to kind of figure
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  out what their individual risk is.
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  Host: Glenn, the end, you mentioned some markers that have become more
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  common when it comes to talking about heart health over the past few years.
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  This seems to be a pretty comprehensive look at things.
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  Glenn Herrington, CPP, PHARMD: Absolutely.
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  And like you said, it has become more common over the past few years,
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  but these aren't really new things.
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  It's just now becoming more ingrained with the general recommendations.
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  And honestly, these are things that people should be getting screened
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  at least once in their lifetime.
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  But as a pharmacist, when people come to see me, I notice a lot of times they're
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  not having these things checked, and it's a good opportunity to kind of pause,
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  look at the big picture, provide some education to my patients, and explain
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  why it's important to check these things.
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  And then, ultimately, it's really to help my patients make the best informed
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  decisions, and the more information we have, the better we can do that.
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  Host: So, it seems you're very careful in your assessment
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  and how you go about things.
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  And in process doing that, if you find someone's at risk,
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  how do you work to reduce it?
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  Glenn Herrington, CPP, PHARMD: So again, I don't want to skip over diet and exercise.
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  Those are the foundation to everything that we do.
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  So focusing on that, and then also connecting with other specialists
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  that work in those fields.
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  So, a lot of times, we may coordinate a referral to our cardiac rehab team,
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  and that's more of a structured exercise program that's focused on preventing
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  or reducing cardiovascular risk.
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  And then, also we lean heavily on our nutrition and dietician team to
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  support some of the things that we do.
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  But then also, again, looking at the big picture, looking at that patient's
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  individual medical history and all the medications they're on and what can we
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  do to minimize drug therapy problems, duplicates, or medications being used to
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  treat a side effect of another medication, and how can we streamline things and use
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  medications that maybe address multiple problems that they have going on.
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  Host: So, I'm a little curious, locally in North Carolina, how
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  are patients learning about this?
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  Is it referrals from other heart specialists and primary care?
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  Glenn Herrington, CPP, PHARMD: For the most part, yes.
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  Here in North Carolina at the coast, we've started a new cardiovascular
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  kidney metabolic clinic here within the cardiology practice.
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  So, we've started that here, and the is to ultimately,you know, reach out and
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  connect with other primary care providers, endocrinologists, and then gradually grow
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  that into a larger, more formal thing.
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  So for now, the patients that see me every day are being
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  referred by their cardiologist.
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  But we do work very closely with all the providers across Novant.
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  So, patients also hear from family members, and they may reach
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  out to their other providers.
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  And so, we get a lot of patients either through the cardiology team
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  or through their primary care doctor.
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  But it's referral-based through other Novant providers
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  right now for the most part.
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  Host: So Glenn, feel like in everyone's point in time, there
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  becomes a time in life where we're trying balance medications.
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  And I'm trying to put myself in your shoes.
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  I can imagine the cardiology space.
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  There are a number of medication and dosage options to navigate.
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  And patients, they might be on multiple prescriptions.
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  So, how do you support patients like this?
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  Is that what we mean by comprehensive medication management?
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  Glenn Herrington, CPP, PHARMD: Yes, 100%.
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  So, comprehensive medication management really is the foundation
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  of the pharmacist kind of care model, regardless of where we practice.
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  If it's a community-based pharmacy, they're dispensing medications,
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  they're really screening for interactions and things as the
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  medications are being dispensed.
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  When we see patients in the clinic, we're being a little bit more proactive.
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  So, we start getting that full medical history and looking at
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  the patient's health problems.
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  And then, looking at their full medication list, including all
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  the vitamins and supplements and things that they're taking.
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  And we start by making sure that each problem is being addressed appropriately,
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  but then also each medication is used for an appropriate indication.
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  And then, we try to weed out things that maybe are not necessary or
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  potentially harmful, and then focus on, like I said earlier, medications that
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  may actually address multiple things.
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  So, we have medications like the SGLT2 inhibitors or the GLP-1 receptor
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  agonists that people are hearing a lot about now that kind of get at the core
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  of the problem with metabolic health.
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  And if you can use medications that help address blood sugar and body weight and
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  blood pressure and reduce the number of other medications that maybe lower blood
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  sugar or lower blood pressure but don't offer a larger benefit, we can really
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  streamline and optimize the medications that people are taking while achieving
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  the bigger goals, which is reducing things like heart disease and kidney disease.
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  Host: So, do patients really notice it when you try to weed out some
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  unnecessary medications, then try to look at ones if fits to
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  Nolan Alexander (Host): kill
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  Host: two birds with one stone?
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  Glenn Herrington, CPP, PHARMD: Oh, absolutely.
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  I feel like patients come away with such positivity and such
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  empowerment after their pharmacy visit because, again, we all come
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  at things with different expertise and backgrounds, and a lot of times
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  patients are just taking a medication because they were told to take it.
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  And then, the next thing they know they're taking 10 or 15 different
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  medications and don't really understand the pros and cons and what to look out
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  for with each of those medications.
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  So when we can step back and look at the bigger picture and explain the
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  pros and cons to medications and, and really help the patient ultimately
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  guide the decision-making process and be there to support them through
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  that, these are oftentimes the most meaningful visits that patients have.
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  And we hear that from our patients a lot.
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  It's very rewarding as a pharmacist.
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  Host: As prepare to close, because you're so passionate, Glenn, I want to
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  ask, what drew you to focus cardiology?
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  Glenn Herrington, CPP, PHARMD: I get that a lot from my students and residents
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  that come through on rotation with me.
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  They'll have a good experience and they may ask, "Well, how
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  do I get to be in your role?"
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  And it's not really a straightforward answer.
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  So, I was fortunate to come through Wilmington at New Hanover Regional
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  Medical Center in the cardiology practice as a student and then as a resident,
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  and developed a lot of strong mentors both in cardiology and primary care.
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  And as I was coming up through training and early in my practice was when we
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  started having medications like the SGLT2 inhibitors and GLP-1 receptor
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  agonists that initially were used for diabetes, but then have now become
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  more of a cardiovascular medication.
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  So, just kind of this pathway and relationships and preceptors I had along
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  the way just kind of laid this foundation for me, and it's been a great ride.
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  It's been almost years now, and I couldn't ask for anything better
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  Host: That's fantastic.
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  Glenn, thank you so much for joining us today on Meaningful Medicine.
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  Glenn Herrington, CPP, PHARMD: Thank you so much for having me.
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  Host: That was Glenn Herrington, a clinical pharmacist practitioner.
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  To find a physician, visit novanthealth.org.
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  For more health and wellness information from our experts,
• 10:13
  visit healthyheadlines.org