Q&A: Advanced Practice Pharmacist on Nontraditional Roles in Health Care

According to community-driven pharmacist Crystal Zhou, PharmD, APh, AHSCP, BCACP, holding nontraditional health care roles is one of the best ways to reach more patients within a community while also exhibiting expertise as a pharmacist.

“I'm an advocate for nontraditional roles,” she said. “I [thought], let's try to expand and think outside the box and see what else pharmacists are capable of doing. Because of my position here at [the University of San Francisco], I think I'm very fortunate and able to meet the right people and make this [program] happen.”

The program Zhou referred to was the Cut Hypertension Program operating in communities throughout the Bay Area in California. After connecting with other providers during her professional career, Zhou has since signed on as lead pharmacist of the Cut Hypertension Program, which is a collaborative health care practice focused on hypertension services geared toward underserved communities and patient populations.

Zhou is a proclaimed advocate of nontraditional roles within health care. | image credit: Kiattisak / stock.adobe.com

“But if you as a patient are in the community, and you don't regularly see your health care team, then you'll never know that these types of pharmacists even exist. I think the beauty of my role in the Cut Hypertension Program is I am interfacing with community members who otherwise may not have even met their health care team.”

As the program’s lead pharmacist, Zhou has the dual purpose of utilizing her expertise in a nontraditional setting and helping patients of a low socioeconomic status receive valued care at an affordable price. Read about her role within the Cut Hypertension Program and how experiences like hers can allow emerging pharmacy leaders to separate themselves amongst their peers.

READ MORE: Q&A: How Barbershops Are Transforming Hypertension Management

Drug Topics: What about the Cut Hypertension Program made you want to get involved as lead pharmacist?

Crystal Zhou: My passion has always been to try to bring pharmacy services into the community. When I first started at UCSF as an assistant professor, I didn't really know where that community spot would be. Initially, I was thinking community pharmacies, but over the years, and even now more recently, a lot of community pharmacies have been closing. I thought we really have to pivot. What are these more sustainable community spaces that are here to stay? It just so happened, a year into my role here at UCSF, the barbershop study down in Los Angeles was published in 2018. I got together with Kenji, our original program founder, Tem Woldeyesus, our current physician, and we just brainstormed and thought about how we could actually bring this model to life here in the Bay Area.

It was really my love and motivation of bringing medicine into the community and just trying to innovate for pharmacists, because pharmacists are capable of doing so much more than just standing behind the counter at a pharmacy dispensing medications. Patients, even to this day, see us as drug handlers: We just work in the pharmacy and we provide their drugs. It was really funny because I called a patient just a couple days ago, and this was one of my remote patients that I'm calling to manage blood pressure for. It was a new patient that I never met. I say, ‘I'm Crystal. I'm a pharmacist calling from the UCSF Hypertension Program.’ And he goes, ‘Oh, are you calling from my Walgreens Pharmacy?’ Because that's the first thing they think about when they hear pharmacist. I think as we continue to advance and move into the community to try to serve these more forward-facing medication management roles, more patients will see us as part of their health care team and reach out to pharmacists for more questions.

That's kind of what's been happening. Anytime I introduce myself as a pharmacist at the barbershop now, they ask me all types of questions. ‘Oh, should I be taking this medication? My friend's taking this, should I take this medication as well?’ So, I think that's how I landed myself in this position. But the other thing I just wanted to share is that I'm an advocate for nontraditional roles. I didn't want to take the easy way and just have a traditional ambulatory care pharmacist job. I was like, let's try to expand and think outside the box and see what else pharmacists are capable of doing. Because of my position here at UCSF, I think I'm very fortunate and able to meet the right people and make this [program] happen.

Drug Topics: Whether it’s your expertise in treating complications like cardiovascular disease or your forward-facing positioning within the community, how does an initiative like the Cut Hypertension Program highlight the importance of pharmacists within health care?

Crystal Zhou: Like I mentioned earlier, I think a lot of patients still see pharmacists as these drug dealers or drug handlers that are just waiting behind the counter to give them their medications. But with these more advanced roles in the community, I think we can really reshape and rewrite the story of a pharmacist. Pharmacy management happens in a lot of clinics already. In a lot of outpatient medicine clinics, cardiology clinics, even some specialty transplant clinics, there are pharmacists there who see patients independently, and they're titrating medications and ordering labs for them. But if you as a patient are in the community, and you don't go to these clinics, and you don't regularly see your health care team, then you'll never know that these types of pharmacists even exist.

I think the beauty of my role in the Cut Hypertension Program is I am interfacing with community members who otherwise may not have even met their health care team. They don't know about who else is on their health care team. I think of myself as an extension to the physician that I work with because, when we work together, he's able to see his patients, I'm able to see the patients in the barbershop. We're able to be so much more effective with blood pressure management and also efficient. [We can] see twice the number of people in the same day as one person would be able to see. I do think more roles like mine in the Cut Hypertension Program would be very, very beneficial to the community and also helping to promote the role of an advanced-practice pharmacist.

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