August 23, 2017

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Gunjan Shah on Her Time as an Ambulatory Pharmacy Resident in Willmar

GunjanWhen most people think of a pharmacist, they picture someone behind a counter, filling prescriptions. However, pharmacy resident, Gunjan Shah, has helped broaden this definition, successfully bringing ambulatory pharmacy to ACMC and Cash Wise Pharmacy in Willmar. As the first resident of the program in Willmar, Gunjan faced unique challenges and achieved many milestones in the twelve months she spent in the role.

The pharmacy residency program is a partnership between Cash Wise (Coborn’s) Pharmacy, the University of Minnesota and ACMC Health. In Willmar, the program is led by preceptor Julie Hansen, a staff pharmacist with Cash Wise. Along with seeing patients and providing comprehensive medication management, the postgraduate pharmacy residency program also allows the pharmacist to work closely with staff at ACMC to establish services at the clinic and support additional ambulatory care services as needed. 

When Gunjan arrived in the new position in July 2016, she anticipated some of ACMC’s providers to be hesitant about the new pharmacy role with their patients. Because this program is the first of its kind at ACMC.  Instead she found that the doctors were open to working with her, they just didn’t know how best to use a pharmacist at first. She spent the first couple months sharing information with nurses and providers about how she is able to support them and their patients.

With the assistance of Caryn McGeary, RN, ACMC’s Director of Patient Care Services, Gunjan began working with ACMC’s star-rating project, analyzing quality measurements related to uncontrolled medication patients.  Eight primary providers agreed to work with Gunjan on this project to increase their quality measures. Through this research, she identified drug therapy problems, duplication of medicines, and patients who were uncertain what they were taking certain medications for.  This project really helped Gunjan build and strengthen relationships with the doctor and nurse teams. She was thankful for the support of ACMC receptionists, Jeannine and Nancy, who assisted with scheduling and appointment reminders and helped explain the role of the pharmacist to the patients.

This helped Gunjan develop her initial patient panel, and build her practice. Her typical schedule included one day each week in the pharmacy dispensing medications and two and half days consulting with referred patients and working through the list of patients with uncontrolled disease states and various medication related issues. In March of this year, she also helped kick off a new tobacco cessation program where 98% of the patients she saw were referred by ACMC providers.

Through relationships she established with patients Gunjan began seeing positive results. She remembers one patient who worked a busy schedule and struggled to find time to visit her in the Willmar pharmacy. After making recommendations to him in the fall, she hadn’t seen him for several months. When she ran into him in the pharmacy and saw he hadn’t made the suggested changes, she recognized that his busy schedule didn’t work with the hours she typically saw patients.  She made special accommodations to work with him when he was available, whether in the evening by phone, or on weekends when he would come to pick up his medications in the pharmacy, to help him better control his diabetes. After just two months of really working together, the patient saw major improvements to his A1C levels. “He listened to me because I took the extra time to speak with him and make time for consults based on his schedule,” Gunjan said. “I was really able to get in touch with him and have him start caring and controlling his diabetes.”

pharmacy residency teamAnother patient success story that will stay with Gunjan involved a woman who was heavily dependent on many prescription and over-the-counter medications. The woman came to her first appointment carrying four large Ziploc bags full of medications. Her life revolved around taking medications and she had no interest in cutting back. Many of the OTC meds were reacting with her prescribed medications. After working diligently together and building a trusting relationship for 4-5 months, Gunjan was able to assist her in getting off 20 different pills. “She has changed drastically from when we first met and she refused to get rid of any medications. It took many appointments to get where we are now with her,” Gunjan explained. “The goal is to establish relationships so we can help these patients.”

ACMC Family Medicine physician, Dr. Michael Nicklawsky, agrees. “It was a pleasure to have Gunjan in Willmar and my patients thoroughly enjoyed meeting with her,” said Nicklawsky. “She had a very good way of explaining things to patients that made them more comfortable with their medications and how they impacted the control of their diseases.”

Along with these experiences, Gunjan said she has gained something that they didn’t teach her in school. “I gained first-hand experience on how to build my own practice,” she explained. “I learned how to utilize the resources available to me, to do things myself and be my own advocate.”

For Gunjan, coming to Willmar, Minnesota was also an adventure after growing up in India and then living in New York for several years. “Initially it was a culture shock,” she joked. “But I think Willmar is great. I had amazing experiences and met some lifelong friends.” She was even able to capture a few firsts while in Minnesota including a pontoon ride, a trip to Lake Superior and surviving temperatures 28 degrees below freezing. “I will really miss the people I’ve met and their welcoming smiles,” said Gunjan. “And no traffic!”

With her yearlong residency complete, Gunjan was part of the selection process for the incoming pharmacy resident and her replacement, Barbara Truskolawski who began in Willmar on July 6.  Gunjan shares her advice for the new resident, “This program is still evolving and growing. You need to be flexible as sometimes things change and opportunities pop up. It’s important not to fixate on your initial goals and to be flexible in what is needed.”

Gunjan is excited for what’s next in her career as a pharmacist and is thankful for the experience she gained during her time in Willmar. Next up she’ll take some time off to travel with her parents to India and then look for a career opportunity similar to what she did during her time here. “This wouldn’t have been possible without the collaboration of Cash Wise and ACMC. They are all great people,” said Gunjan. “I’m so thankful to everyone who worked with me.