A Family Medicine Pharmacist's Role in Interprofessional Care
Alison Knutson, PharmD, is a faculty pharmacist and clinical preceptor at the University of Minnesota Methodist Hospital Family Medicine Residency. In this interview, Dr. Knutson explains the vital role of the pharmacist in primary care and their importance within a multidisciplinary care team.
How did you come to decide on a career in pharmacy as faculty?
Early in pharmacy school, I had a strong interest in direct patient care. I recognized the unique role of being in the outpatient ambulatory clinic where chronic disease is most often, if not always, managed with long-term medications. I enjoyed having that partnership of being an interprofessional care team member and providing that expertise for our patients. That’s in addition to my other huge passion, which is teaching. I get to teach patients how to self-manage their medications long term, but also to teach our family medicine residents how to most intentionally and strategically use medications from a patient-centered standpoint.
What does a typical day look like for you?
I'm in the family medicine clinic four days a week. I have patient appointments for medication management scheduled in the clinic. I occasionally have pharmacy students and sometimes medical students join me for those visits. I enjoy co-visits with the patient and caregivers, the family medicine resident, and myself. In some situations, it makes more sense for the whole team to be present at the same time when we’re working towards achieving the same health goals or improved outcomes.
Interspersed between my patient care is teaching, whether that is informal and precepting support, discussing cases within the clinic, or formal lecture through conferences or topic discussions with the residents.
What do you find most rewarding about your role in the department?
I love seeing residents develop as confident physicians from their first year in the start of residency to when they're about to graduate. As a pharmacist, my goal is to help the residents hone their ability to not only manage complex chronic disease with medications—and do so in a very evidence-based way—but also to incorporate patient-focused needs into that care.
I work with residents on how they match the “textbook” evidence with what actually is going to work for a patient in the long term, and having an appreciation for the complexity of medications. It’s rewarding to be a part of shaping the future physicians in our communities.
Why is the role of a medication management pharmacist so important?
Patients who have a chronic disease, diabetes for example, may come in to see the doctor four times a year. If they have fewer complications, maybe they only come in once or twice a year. But that patient has to interact with their medications every single day. So while we only see them once in a while, the patient has a reminder on a regular basis of their chronic disease, the burden that carries, and the hard work that they are doing every single day to manage their medicines.
Being able to have a focused conversation in the healthcare setting just on medications is vital to helping a patient take ownership and understand their role within chronic disease management. I appreciate being able to serve as the care team member that has the expertise or the time for that conversation.
How do you interact with family medicine providers and others in your role?
My favorite interactions are face to face. I think when we are able to have discussions on specific patients or more general questions about certain topics, I really enjoy that.
Whether electronic or in person, I am constantly interacting with our teams on a day-to-day basis. There's a lot about clinical medicine and the pharmacotherapy of chronic disease. But from a medication standpoint, there are a ton of complexities with simply accessing medications in our healthcare system. I often get involved in a lot of those cases where a provider knows what to do or what the patient needs but can't get to the finish line. Maybe the doctor can't get them access to a medication or we're seeing barriers at the pharmacy or barriers with understanding long-term use. The additional component of engaging with medications within the healthcare system is another key area that I really enjoy.
What is an enjoyable part of your specialty that others may not think of?
Speaking to my personal role of providing medication management in a family medicine clinic, I enjoy being able to utilize my broad knowledge of medications. Providing patients with a comprehensive review of all medications and education about each of them helps patients to advocate better for themselves as well.
Having that broad knowledge and awareness of medications is part of what I enjoy the most about working in family medicine and in primary care practice.
What kind of advice might you give someone who's considering pursuing a faculty pharmacist position in family medicine?
If you are someone who likes constantly being challenged and likes to learn, this is the ideal role. I like teaching because it forces me to stay up to date and relevant on the newest evidence for medications. I think learners come in with so much new knowledge, enthusiasm and excitement, and that just perpetuates a desire to stay up to date in all of these new and exciting things that are going on in medicine.
From that standpoint, too, working with our family physicians and medical residents, we have a lot of incredibly talented physicians. So I feel like that pushes me farther in my role. I really need to be an expert in medications because they're doing a great job with it at baseline. It drives me to gain that additional knowledge that learners can incorporate to become even stronger physicians and prescribers in the future.
Is there anything else you'd like to share about your plans or how you see family medicine taking shape in the future?
In order to meet the needs of our patients and our communities, family medicine is an interprofessional practice. And that's where I get so much joy in my job here. There's a lot of complexity with the conditions and the needs that patients bring to family medicine. I see that is also becoming a focus in greater Minnesota, too, of having so many newer trained or recent graduate physicians who are going into practice and asking, “Where's the rest of my care team?”
The doctor-patient relationship isn't necessarily the one on one that it used to be. Part of that is how complex the healthcare system is—and with medications specifically, that component alone with care can be incredibly challenging. So having that whole team of support is vital. I'm proud to work in a place where we train our physicians to utilize others to best meet the needs of every one of our patients.
