Charles Au is the Primary Care Clinical Pharmacist for the Fraser Northwest region. He completed his hospital pharmacy residency in 2012 and is also a Board Certified Pharmacotherapy Specialist. Prior to his current role, he worked as a pharmacist at Vancouver General Hospital, Vancouver and Foothills Medical Centre, Calgary.
When did you start your current position, and what is your role within the Fraser Northwest Primary Care Networks?
Charles: I started in this role in September 2021. As a Primary Care Clinical Pharmacist (PCCP), I provide comprehensive medication management services to adult patients in the primary care setting, in collaboration with their health care team. Patients are referred to me by their primary care provider — common reasons for referral include polypharmacy, chronic pain and mental health, cardiovascular risk factor management and issues with medication adherence and affordability.
What does an average day at work look like for you?
I spend the majority of my time providing direct patient care. During a patient’s initial one-hour appointment, I conduct a comprehensive assessment of their medications, problem-solve barriers to optimal medication use and provide patient education. After reviewing my recommendations with the patient, I communicate them to the referring provider and other members of the care team in a consultation note and will book care conferences with providers to discuss any complex cases. I follow-up with patients as needed to verify that they are achieving their therapeutic goals. Most of my work is currently conducted by telehealth, but I am able to see some patients in person at their provider’s clinic.
In the rest of my time, I connect with primary care providers, pharmacists and other health care team members in the Fraser Northwest, with a goal of building more collaborative and efficient ways to provide care to mutual patients. I also have a strong interest in teaching and provide education to pharmacy students, medical residents and nursing groups.
What do you enjoy the most about your work?
The most rewarding part of my work is developing longitudinal relationships with patients. I enjoy following up with patients regarding the outcomes of shared decisions and any new concerns or questions they have, and have a deep sense of satisfaction when they refer to me as “their pharmacist.”
How have patients in the Fraser Northwest region benefitted from having a Primary Care Clinical Pharmacist available to their primary care providers? How does this differ from consulting with patients' community pharmacists?
Most of my patients are fairly complex — for example, they have usually seen multiple specialists or are in a waitlist to see one, have not responded to or not tolerated several medication trials, and/or have past trauma or socioeconomic factors that impact their care.
I try to help patients decide on the best path forward for themselves by taking the time to assess their medication use, discuss feasible alternatives and how these might align with their therapeutic goals.
As an example, I am following a patient who was self-managing their chronic pain with opioids from illicit sources and had a history of multiple traumatic experiences with the health care system. Although I was not expecting much improvement, I continued to engage the patient in monthly conversations regarding their pain and opioid use. One year later, I am thrilled to report they successfully initiated opioid agonist therapy and several adjunctive analgesics, and were able to discontinue their illicit opioids.
For primary care providers in my community, my involvement with typically their most complex patients helps them provide better care as well. Instead of trying to do all the “digging” and problem-solving themselves, they can focus on my recommendations and know that I have already discussed them in detail with the patient. I hope that as part of a team-based approach to patient care, we can reduce provider burnout and improve the quality, accessibility and sustainability of primary care in the Fraser Northwest.
As a pharmacist myself, I have immense respect for existing relationships that pharmacists working in community pharmacies and other settings have with patients and health care providers.
My goal as a PCCP is to assist patients with complex medication-related needs and to facilitate continuity of care and timely communication with other pharmacists in their circle of care.
As an example, I recently reviewed a patient with poorly controlled hypertension, partly due to a complex medication schedule and frequently missed doses. I conferred with their community pharmacist who had tried to transition the patient to a blisterpack; however, the patient was also fiercely independent and wished to maintain control over their own medications. During my consultation, I engaged the patient in discussion about how we could simplify their medications and how they take them, and how this would give them more time and better health to pursue their goals in life.
With the assistance of their community pharmacist, the patient is now taking medications regularly from a blisterpack, has excellent blood pressure control and continues to be independent in the community.
What steps has your team taken to integrate your services to the primary care providers in the region?
Before I was even hired, the Pharmacists in PCN Program and Lower Mainland Pharmacy Services engaged primary care leadership to determine the best way to utilize my skillset to support providers in the Fraser Northwest. For my community, we have developed a referral pathway that prioritizes equitable, low-barrier access to my services. I have introduced myself to many clinics in the region, and we strive to continue fostering awareness of the PCCP role and collaborative relationships with primary care providers.