5 Questions With a Pharmacist: DeLon Canterbury From GeriatRx

From his time in community pharmacy to the trials and tribulations of being a pharmacist during the COVID-19 pandemic, DeLon Canterbury, PharmD, BCGP, didn’t immediately find his footing within the pharmacy profession. However, when he discovered an unmet need within his area of expertise in the geriatric community, he decided to take a leap of faith and founded GeriatRx Inc, a concierge pharmacist–led telehealth deprescribing consulting service that helps patients, providers, and senior-facing businesses optimize health outcomes.

In a conversation with Drug Topics, Canterbury discussed his career journey in the profession, from his time at the University of North Carolina (UNC) Eshelman School of Pharmacy to the events that led him to found GeriatRx in 2019. His story highlights how pharmacists can leverage their expertise and collaborate with other health care providers to improve multiple facets of patients’ lives.

Certified geriatric pharmacy specialist DeLon Canterbury discusses how his career journey led him to medication deprescribing. | image credit: Tarmizi / stock.adobe.com

Drug Topics: Can you tell us a little bit more about your background in pharmacy before you began your consulting service?

DeLon Canterbury, PharmD, BCGP: I was always interested in pharmacy since I was a kid. My parents come from the islands in Guyana, so we were very much into natural medicine and plant-based medicine. It got me into the world of asking what the science is behind that. Fast forward to a little bit later on, I [attended University of North Carolina] Chapel Hill School of Pharmacy...from 2010 to 2014. After that, I tried to get a residency but did not have much luck. So I ended up working in the community setting as a Walgreens pharmacist. I did that for about 5 years. I was a pharmacy manager for a specialty site, along with a pretty busy store, and then for a 24/7 pharmacy.

From 2019 to 2020 is kind of when I stepped down and wanted to do something different, [so I] took a leap of faith and ended up working [in] poison control. I worked as a poison control pharmacist briefly for about 5 months in 2020, and then COVID-19 hit. That turned into a job that was initially coded to be a poison control pharmacist, but then I became a COVID-19 hotline [pharmacist] for the state of North Carolina. Needless to say, that became just as stressful as a community setting. That led me to eventually get fired for falling asleep at my desk. I said, “You know what, I don’t need to put my faith into other people’s hands.” So I started GeriatRx, and that became the beginning of our company.

Drug Topics: Can you discuss what GeriatRx is and what led you to start offering these services?

DeLon Canterbury: Working in a community setting and then personally experiencing it with loved ones, I felt that we don’t have enough advocates in the deprescribing space. I don’t mean just in a clinical setting. We don’t have enough dialogue among caregivers and loved ones and family members to really figure it out. When I was in a retail setting, I learned that our older adults were the ones who had the most [adverse] effects and the most harm from polypharmacy and prescribing cascades. After seeing that and then actually being a part of the problem in my role, I felt a need to step away and think about how we get people off instead of adding more.

That was what prompted the idea of giving people access to an expert professional in medicine where everyone’s on a medicine. We provide the concierge service, where people have a direct membership to be a part of our GeriatRx family and can get access to cutting-edge, accurate, evidence-based information. It’s not just with a simple medicine review. [It’s] looking for ways to help people heal using nonpharmacological strategies and evidence-based medicine, along with pharmacogenomics or genetic testing. We provide that, and then people continue to work with us over the course of 6 to 12 months, depending on their needs, and we become a part of their care team. It’s very much a direct primary care model for pharmacists.

Drug Topics: What are some of the most notable successes you’ve experienced since founding GeriatRx in 2019?

DeLon Canterbury: Our very first client came from another pharmacist who had a mother-in-law who was on 36 medications. In her care, she presented as if she had severe dementia. It was pretty bad, to [point] where the family was debating about involuntarily committing her into a memory care unit. We did the review. We worked with the providers and found multiple—not just drug interactions—but duplicate therapies, 4 different providers, the whole 9 yards. We found that there were a number of medications that contributed to a very high anticholinergic burden, which was really the cause of her symptoms of cognitive impairment, urinary retention, and dehydration.

With all that combined, we were able to taper her from those 36 medications down to a total of just 8 medications over the course of a few months while working with the doctor. The kicker to this story was that her family was torn on forcing her into a nursing home. But we were able to prove in a court of her peers—because they were going to legally force her—that it was the medications, not just her dementia. This was the first time I was in a court setting doing a medication review, explaining my medication review, and giving people context....We ended up saving this family well over $10,000 a month because we were able to prove that she could stay at home if we tapered [her] off certain medications.

That was one of our first of many wins. We’ve ended up doing a couple of expert testimony cases. We’ve consistently gotten a number of people of medications in our work while improving quality of life. We work with other businesses. We’ve used a lot of precision medicine and genetic testing to also assist with reducing adverse events. We’ve had a number of interesting final cases over the years.

Drug Topics: What are some of the main challenges that you faced when starting GeriatRx?

DeLon Canterbury: Initially, this was a fairly new concept. The general public, at least here in my community, assumes that everything is covered by insurance. People don’t expect to pay out of pocket for this service at first, until you’re able to communicate the value of what you’re bringing and how this can impact their life. Initially, I didn’t really know how to build the practice. I didn’t know where to start. What got me ready was just talking about the problem everywhere I went: online, socially, in person. In the first 2 to 3 years, no one knew about it. There wasn’t an immediate stream of people. But then, coming into our third and fourth year, we started building a referral base. Now people are seeing it and wanting it and paying for it out of pocket.

Initially it was barriers with myself in terms of patience and leveling my expectations because we think because we’re all smart clinicians, it means we’re awesome businesspeople, and that’s not true. There was that personal growth that had to take place, and then there was building an audience of people who not only see the value but are willing to invest in their loved ones’ health preventively versus reactively. That always takes a good bit of time to get established.

Drug Topics: What are some examples of patient feedback you’ve received or common themes you see throughout your work with GeriatRx?

DeLon Canterbury: The overarching theme with our clients is that they get their loved ones back. They get to have more valuable time with the people they care most about in a happier state of mind and well-being. There’s generally some major issue, [adverse] effect, concern, and to have that resolved—where the medical system couldn’t figure that out alone—is not only rewarding as a pharmacist or clinician but also as a business owner. This is a model that most pharmacists aren’t even considering. At the end of the day, it’s a caregiver getting someone or something back and appreciating the quality of life.

There was a client who started a new diabetic medication, and he started getting more [urinary tract infections (UTIs)]. He didn’t realize that it was the diabetic medication that was really being used to manage prediabetes inappropriately. Or at least, it was diabetes that’s like 0.1 over the [hemoglobin] A_1C goal; it was ridiculous. This guy was going through Depend [incontinence products], having multiple UTIs. We were able to make that one switch to the provider, and now he’s not spending as much money on Depend [products]. He’s not having to hire staff to keep changing the bedding...There’s just overall better quality of life.

Another example was when we used a genetic test on a client who had severe dementia and was also depressed. They were trying to figure out which medicine to use. We advocated to get genetic testing done. The providers didn’t want to do it. They just started her on a new medication. Unfortunately, she ended up having a horrible event where she started attacking her daughter. We had the medication stopped immediately. After getting the test done, they saw why that person had the event, and it was because she was a poor metabolizer. With dementia, you already have someone dealing with all types of behavioral issues. There’s no [reason] to worsen that with just flippantly starting something. Us advocating for [stopping the medication], although it was too late in my eyes, did lead to clarity for providers to know what to choose next and hopefully avoid making that mistake again.

If you or a pharmacist colleague is interested in being featured in Drug Topics’ 5 Questions With a Pharmacist series, please send all inquiries to kmeara@mjhlifesciences.com.

To read these stories and more, download the PDF of the Total Pharmacy April issue here.