Some of us may think of pharmacists as generalists — professionals who can answer any question about medications and even suggest the best over-the-counter remedy for small bumps and bruises. But some pharmacists are now highly specialized, requiring additional training and focused residency, similar to clinicians.
Jillian DiClemente is such a specialist. As UM Health’s only full-time clinical pharmacist specialist in pain management, she provides clinical expertise on pain management medications to both inpatient and outpatient care teams, is a member of the inpatient Adult Acute Pain Service (APS) and Addiction Consult Team (ACT), and provides expert advice on opioid management and opioid use disorders across the organization.
She also works for institutional change through her involvement on seven committees, as well as the Rewrite the Script team – a group of doctors, nurses, therapists and volunteers dedicated to improving pain management, reducing the opioid crisis and building a supportive community. , non-stigmatizing approach to addiction.
She is an advocate of multidisciplinary education within her field, is also the coordinator of the Pain Management and Palliative Care Residency Program and currently mentors two pharmacist-specialist residents.
Headlines recently met with DiClemente to learn more about this unique specialty. Here’s what she had to say.
Q: Your role requires you to consult regularly with many inpatient and outpatient groups. How do you balance all this?
JD: One of my biggest challenges is that there’s only one of me, so it feels like there isn’t enough time in the day. Not everything is in my job description, but I make the time to take on additional roles so I can connect the dots to better understand how we care for these patients. For example, five of our pain committees cross areas such as acute pain, palliative care, and substance abuse. When we all work together, we can better align with how we address pain across the organization.
Q: Do you mainly work with patients or doctors?
JD: Both. I often work directly with patients to help them understand why a change of medication is needed. I also meet with patients to perform pain assessments, monitor or optimize medications and prepare patients for discharge with pain management planning. I also interact with the ACT and APS teams on a daily basis and am often called upon to help physicians consider and initiate treatment for patients with chronic pain or opioid use disorder.
Q: How are specialties like this changing the role pharmacists play in clinical care?
JD: I love how pharmacists can help with pain management and the opioid crisis. I’ve seen many patients who wanted to stop chronic opioid use for various reasons, but didn’t know how. I have also seen pharmacists and doctors who have been uncomfortable with tapering or varying opioid medications. Patients want to be heard and pharmacists are in a unique position to support a patient with long-term chronic pain. A doctor does not always have time, or a patient has the impression that his doctor does not have time to listen. They are often more open to conversation with pharmacists. And 99% of my recommendations are accepted and implemented by the nursing doctors.
Q: How does your work within the Rewrite the Script team differ from previous approaches to pain management?
JD: Our philosophy is to really listen to patients about their pain. Patients have a very personal and emotional experience of pain, and how they deal with it is shaped by how they experience or experience pain. We also need to understand their pain history. Often patients have already been through a lot and experienced many types of drugs before we see them for the first time.
As a team leader for RWTS, I am also responsible for a set of 12 metrics for both inpatient and outpatient patients regarding opioid prescriptions. For the first time, we can see what opioid use looks like across the organization. Our goal is not necessarily to completely stop the use of opioids, but to determine their appropriate use and focus quality improvement measures on the safe prescribing of opioids.
Q: What is your biggest challenge in this role?
JD: Stigma is a problem. Even if someone has experienced IV drug use a long time ago, it will still be part of their past, and it will still be with them even if they are no longer using. One of the biggest challenges in this role is the ability to provide just-in-time education to all of our healthcare team members to change the way they approach medication management and assess patients with complex pain or opioid use disorder. It’s also hard to know that about 30% of our hospitalized patients experience uncontrolled pain and we can’t always reach them.
Q: Why did you decide to focus on this specialty?
JD: My first year of residency was at the Henry Ford Hospital in Detroit, and I worked with my program director to create a rotation for pain and palliative care because they didn’t offer one at the time. I immediately enjoyed working with that patient population and saw the vital role pharmacists play in optimizing pain and symptom management medications. My love for this specialty grew during my second year of my residency in pain and palliative care at Johns Hopkins Hospital in Baltimore.
Q: What do you like most about your job?
JD: My work is so thankful! First, I love making an impact every day with the patients I see. I recently worked with a patient who was experiencing severe pancreatitis pain. I helped coordinate care between the primary team, APS and ACT to implement a pain management plan for him. I saw the patient a few days later and he said, “Thank you very much. I feel so much better.’ Those are great moments. Second, it’s worth educating and supporting my colleagues in coping with pain and I enjoy seeing them implement some of my approaches and patient care strategies after we’ve worked together.