The short version: I’m a pharmacist, but I don’t fill prescriptions. As an independent consultant pharmacist, my job is to look at all of a person’s medications, from every provider, and help the care team sort out what’s working and what isn’t. I’m not tied to a dispensing pharmacy, so I have no stake in how many medications someone takes … and I have time to sit down with patients and families and ask what matters most to them. I’m independent from dispensing, not from the care team.
When most people think of a pharmacist, they picture the person behind the counter filling prescriptions. Dispensing is an important part of pharmacy, but it’s only one part of what pharmacists are trained to do.
As care gets more complex, more organizations, providers and families are turning to consultant pharmacists for help with the medication problems that tend to fall between traditional roles. Here’s what an independent consultant pharmacist is, what the work actually looks like, and why it’s become such a valuable part of caring for medically complex patients.
What Is an Independent Consultant Pharmacist?
A consultant pharmacist is a pharmacist whose focus is clinical: reviewing medication regimens, finding potential problems and making recommendations to patients and their care teams. As an independent consultant pharmacist, I do that work through a practice that’s completely separate from any dispensing pharmacy. That lets me work directly with healthcare organizations, providers, patients and families, with the focus on getting each person’s medications right.
It also means my business isn’t tied to filling prescriptions or to how many medications someone takes. My recommendations come down to what’s clinically appropriate for the patient and what fits their care plan and personal goals.
Independent doesn’t mean working alone, though. The independence is from dispensing, not from the people caring for the patient. My work depends on close collaboration with physicians, nurse practitioners, nurses, dispensing pharmacists, patients and families.
Why Medication Management Has Become So Complex
Healthcare today is highly specialized. One person may see a primary care physician, a cardiologist, a neurologist, a psychiatrist and an endocrinologist, and each of them is focused on their own area of expertise. The challenge is that medications don’t stay in one specialty. A medication prescribed by one provider can affect another condition, interact with another medication or cause side effects that change how someone thinks, moves, sleeps and gets through the day.
Over time, medications accumulate. Many older adults with several chronic conditions take 15, 17, sometimes 20 or more medications, and it gets harder for any one provider to step back and see how everything is working together. Transitions make it harder still. A hospital stay, a move to assisted living or a new specialist can change the medication list in ways that don’t always reach everyone involved.
The Missing Piece in Complex Care
Most healthcare professionals are doing exactly what they were trained to do. They don’t lack expertise … what they often lack is time. Short appointments, fragmented records and growing administrative work make it hard to evaluate every medication against a person’s overall health and goals.
That’s the gap I work in. Rather than focusing on a single diagnosis, I look at how the medications, conditions, provider recommendations and patient goals fit together as a whole, and then I work with the care team to address what we find. In a lot of ways, the role is a bridge between patients, families, providers and care teams, and it matters more as care keeps getting more complex.
What Does an Independent Consultant Pharmacist Actually Do?
The work looks a little different everywhere I go, but it usually starts in the same place. I sit down with the full medication list, including every prescription from every provider, plus the vitamins, supplements and over-the-counter products people sometimes forget to mention, and I look at how it all fits together. That’s what a comprehensive medication review is. I’m looking for medications that interact, ones that overlap, side effects that might be getting mistaken for a new problem, and medications that made sense years ago but may not anymore.
Some of the most important work is deprescribing, which means carefully reducing or stopping medications when the risks outweigh the benefits or they’re simply no longer needed. Those decisions are always made together with the patient and their prescribers. I also pay close attention to medications that increase fall risk or add to anticholinergic burden, because they can be behind the changes families and care teams notice first, like new unsteadiness, confusion or sleeping much more during the day.
After a hospital stay, I look at what changed on the medication list, what was meant to change, and whether the primary care physician, the specialists and the home health team are all working from the same information. When something doesn’t line up, I pick up the phone. A lot of what I do is getting the right people talking to each other, so medication decisions are coordinated instead of happening in isolation.
Depending on the setting, the work can also include chronic disease medication management, education for families and caregivers, quality improvement and regulatory support, and services under a collaborative practice agreement.
None of this works without time. A good medication review takes clinical knowledge, but it also takes time to understand the patient, ask the right questions and follow through with the care team. That’s usually where the information that makes a difference turns up.
Where Independent Consultant Pharmacists Work
Because the role isn’t built around a dispensing workflow, it can be shaped around what each organization actually needs. In my practice, that includes several different settings.
Home health agencies. After a hospitalization, new prescriptions, discontinued medications and the bottles already in the home can easily create confusion. I support home health teams through those transitions of care by identifying higher-risk patients, looking into medication concerns and coordinating recommendations with the care team.
Physician and nurse practitioner groups. Some medically complex patients need more medication attention than a routine office visit allows. I help with deprescribing, chronic disease medication management and coordinating recommendations across specialists, so providers aren’t carrying every medication question alone.
Long-term care and skilled nursing facilities. I work with residents, providers and facility staff to identify medication-related risks, support resident-centered care and contribute to quality and regulatory work.
Assisted living communities. I help care teams recognize when changes in a resident’s daily life, like new unsteadiness, fatigue, confusion or pulling back from activities, might be related to medications.
Individuals and families. I help older adults aging at home, and the people caring for them, make sense of complicated medication regimens and the decisions that come with them.
The services look different in each setting, but the approach stays the same … understand the full medication picture, find the opportunities to improve it, and work alongside everyone involved in the person’s care.
Building Clinical Pharmacy Services Around What Each Organization Needs
One of the things I’ve learned while building Complete Care Consult is that organizations often recognize a gap in medication management before they know what the answer should look like. A physician group may have patients taking a long list of medications from several specialists. A home health agency may want a better way to spot patients at risk for medication-related problems. A long-term care organization may be looking for more clinical support around age-friendly care or quality improvement.
So the first step is understanding what that organization is trying to accomplish. Sometimes the right answer is direct patient care and ongoing medication reviews. Other times, the work starts with looking at existing processes, building clinical protocols, identifying which patients would benefit most from a pharmacist, or designing a pilot program.
Being independent gives me the flexibility to build that approach around each organization’s patients, providers, workflows and goals. I don’t believe every organization needs the same model. What works in a skilled nursing facility can look very different from what works in a physician practice or a home health agency. What matters is finding where a pharmacist’s expertise can really help, and then building a practical way to bring it into the care team that’s already there.
Starting With What Matters
Before I look at a medication list, I always ask what matters. It sounds like a small thing, but it changes what I find.
One of my favorite stories from this work is about a resident who mentioned that he’d stopped meeting his buddies at the pop machine. His leg had been aching, and the walk down the hall just wasn’t worth it anymore. None of that was in his chart. A medication he’d been on for years turned out to be part of the problem, and after a dose change and some labs, he was back down the hall with his friends. Not everything I hear turns out to be medication related, but a lot of it is worth a second look before anyone writes it off as getting older.
Another resident I still think about spent most of her time in bed. She was usually described as sleepy, and the staff had come to see that as her baseline. Her medication list didn’t stand out at first glance for someone with her conditions. But when I added up the anticholinergic burden of everything she was taking together, her score was 12, which is a lot of exposure. Over the next several months, I worked with her care team to gradually deprescribe where it made sense, and her score came down to 3. Not long after, I came around a corner and found her laughing with one of the nurses.
Medications are only one part of how someone feels and functions. But moments like that are a big reason I look past the list to what’s happening in a person’s everyday life. When I ask patients what matters most to them, the answer is almost never a lab value. They want to feel well enough to spend time with friends, stay sharp, walk safely and stay independent for as long as they can. Their medications should support that.
Supporting Age-Friendly Care and the 4Ms
This approach lines up closely with the Age-Friendly Health Systems framework and its 4Ms. What Matters means knowing each older adult’s own goals and priorities. Medication means making sure their medications are appropriate and don’t get in the way of the other three. Mentation is about thinking and memory, including dementia, depression and delirium. And Mobility is about helping older adults move safely and stay independent.
Medication management touches every one of those. A medication can be appropriate for a diagnosis and still cause dizziness, fatigue or confusion that gets in the way of how someone lives. That’s why medication decisions need to look past whether a drug fits one condition, and ask how the whole regimen is affecting the person and whether it supports what matters most to them. Independent consultant pharmacists can help care teams put that into practice through medication reviews, recommendations and ongoing monitoring and communication.
Why Independence Matters
For me, independence is what makes it possible to approach medication management differently. Because Complete Care Consult is separate from any dispensing pharmacy, I can offer an objective medication review with no business interest in what gets dispensed. I can also build clinical partnerships around the needs of the patients and organizations I serve, whether that’s direct patient care, ongoing clinical support or organizational consulting.
Independence only works if it makes the team stronger, though. Most of the organizations I work with already have a dispensing pharmacy, and many have a consultant pharmacist too, and those people do important work. When someone tells me, “We already have a consultant pharmacist,” my answer is usually, “Good, that role matters.” Then we talk about where the gaps are. Usually it’s the medically complex patients who need more time, a face-to-face conversation or someone to track down three different prescribers … and that’s the part I like to take on.
The Bottom Line
Healthcare has become more complex, especially for older adults managing several chronic conditions, medications and providers at once. Pharmacists have the clinical expertise to help with a lot of the medication challenges that come with that. The real question is how we create more opportunities to use that expertise where it can make the biggest difference … and that’s what I’m working to build through Complete Care Consult.
On any given week, I might be going over a resident’s medications with a nursing team, on the phone with a physician about a patient we share, or sketching out a pilot program with a home health agency. It all comes back to the same thing for me … helping people take the medications that are actually helping them, so they can keep living the life they want to live.
Frequently Asked Questions
What does a consultant pharmacist do?
A consultant pharmacist reviews a person’s full medication regimen, looks for drug interactions, side effects and medications that may no longer be needed, and makes recommendations to patients and their care teams. Depending on the setting, consultant pharmacists may also educate patients and families, help coordinate care and support medication-related quality work.
What is the difference between a consultant pharmacist and a retail pharmacist?
Both use their clinical training to keep medication use safe and effective. Retail pharmacists are usually focused on dispensing prescriptions, counseling patients and catching problems at the pharmacy. Consultant pharmacists focus mainly on evaluating and optimizing a person’s whole medication regimen, often as part of a healthcare organization or care team. The two roles work best when they complement each other.
What does “independent” mean for a consultant pharmacist?
It means the pharmacist’s practice is separate from any dispensing pharmacy, so services can be built around patient and organizational needs instead of prescription volume. It doesn’t mean working apart from physicians, nurses, dispensing pharmacists or anyone else on the care team. Collaboration is still at the center of the work.
We already have a consultant pharmacist. Why would we work with an independent one?
Traditional consultant pharmacists provide valuable clinical and regulatory support, especially in long-term care. An independent consultant pharmacist can add to that with more time for face-to-face visits, deeper medication reviews, transitions of care support or a specialized clinical program. The point is to strengthen the care that’s already in place.
Does an independent consultant pharmacist replace the physician or nurse practitioner?
No. I work alongside physicians, nurse practitioners and the rest of the care team. I evaluate medication concerns, share recommendations and help coordinate care, and prescribing decisions stay with the provider, except for specific services I perform under a collaborative practice agreement. The goal is to give providers more insight and support, and to take something off their plate.
Can an independent consultant pharmacist help an organization build a medication management program?
Yes. An independent consultant pharmacist can help an organization look at its medication management challenges, identify which patients need more support, build clinical workflows and protocols, and design or run a pharmacist-led service. Through Complete Care Consult, I work with organizations to find an approach that fits their patients, care teams and goals.
Who can benefit from an independent consultant pharmacist?
Anyone managing a long medication list and more than one prescriber, especially older adults with several chronic conditions. On the organization side, that includes home health agencies, physician and nurse practitioner groups, long-term care and skilled nursing facilities, and assisted living communities. Individuals and families can also benefit from one-on-one medication consulting and education.
Where does Complete Care Consult work?
Complete Care Consult is based in Northeast Ohio and works with healthcare organizations, care teams and families across the region, including the Youngstown, Canton, Akron and Cleveland areas.
Let’s Connect
If your organization is looking for more clinical pharmacy support, exploring a new approach to medication management, or working to build age-friendly care into what you already do, I’d welcome a conversation. I partner with healthcare organizations, providers and care teams to create practical approaches to medication optimization for medically complex patients.
About the author: Courtney Myers, PharmD, BCGP, FASCP, is an independent consultant pharmacist and the founder of Complete Care Consult in Northeast Ohio. She partners with healthcare organizations, provider groups and care teams on medication optimization for medically complex older adults, and helps them build clinical pharmacy services that fit the way they deliver care. Her work is grounded in patient-centered medication management, age-friendly care and the belief that pharmacists can play a bigger role in complex healthcare.