Working together: Elise & Chris

We look at how pharmacist Elise Apolloni and nurse practitioner Chris Helms collaborate for better patient outcomes in the pharmacy environment

Elise Apolloni, Managing Partner at Capital Chemist Wanniassa in Canberra describes her relationship with nurse practitioner Chris Helms, who co-locates in her pharmacy two days per week, as “extremely collaborative”.

“Chris has been working with us for about three months now,” she explains.

“In that time our relationship has changed from being two health professionals that share common interests in patient outcomes and wanting to assist the public, to having a very collaborative relationship where we often are bouncing ideas off each other and trying to work out how we can problem solve in different situations.

“Having a different type of health professional on site is just really lovely, because while pharmacy is always looking to help and integrate and be part of the health system as much as we can, on a day-to-day level we’re often only surrounded by our own profession,” says Ms Apolloni.

“It’s really been quite an empowering experience to work with other health professionals so closely and then to have such a good relationship with them at the same time.”

She says Chris brings a different point of view as well as similar perspectives to the pharmacy.

“Generally our historic approach has been that we have just trained our pharmacists to do whatever we felt the gap is. And that’s always been our philosophy – for example, if we need mental health support in the community, our pharmacist will go and become qualified to provide that,” she says.

“I suppose this has shown me that there’s only so much that [pharmacists can do], there are limitations, there are regulatory issues as well, and so there are opportunities where we can make the most of helping our patients by thinking a bit differently about where the gaps are and finding people that can fill those in our wider community.

I think we have a lot to share, a lot that we can learn from each other and a lot that we can be proud of both as professions.

“Chris has a hospital background, he was at the top of his field in the US in cardio-thoracic care and is also able to prescribe as a nurse practitioner as well.

“Chris can do so many different things, his scope is quite broad – anything from extending prescriptions for patients for ongoing medications, assessing people clinically, ordering blood tests and other medical tests…

“He bulkbills patients for their first visit, and he’s able to access MBS funding for patients when they’re visiting the pharmacy.

“It’s not uncommon for Chris to spend 20-30 minutes with patients just for his regular, standard length of appointment because he is really engaged, interested and passionate about helping people.”

Ms Apolloni says there is a strong case for further collaboration between community pharmacy and nurse practitioners.

“Nurses and pharmacists have a lot in common, we have overcome or are overcoming a lot of the same hurdles in terms of how we’re trying to help patients and how we’re trying to put patients at the front of everything that we’re doing.

“Nurses too have been trying to enhance their role in the community and enhance how they help patients and the public generally for many years, not dissimilar from how pharmacists and pharmacy have been trying to see how we can make the health system even better for all Australians and the role that we play in that space,” says Ms Apolloni.

“I think we have a lot to share, a lot that we can learn from each other and a lot that we can be proud of both as professions.”

Chris Helms, a Canberra-based nurse practitioner, practised for several years in the US after graduating in nursing and completing two master’s degrees that qualified him as a nurse practitioner specialising in primary healthcare, cardiology and cardio-thoracic surgery.

After he moved to Australia, he was required to do even further training to become endorsed and registered as a nurse practitioner here.

Nurse practitioners require about 10 years of education, experience and training, he explains.

“The big difference between registered nurses and endorsed nurse practitioners is the level of autonomy that we work to and accountability,” he says.

“Nurse practitioners work at an advanced capacity where we get advanced training in assessment and diagnosis, and we’re able to autonomously prescribe medicines, request and interpret diagnostic investigations, and make referrals to medical and allied health specialists.”

Dr Helms runs a clinic called Bridging Healthcare out of Capital Chemist Wanniassa on Mondays and Tuesdays, with the latter of those days offering after-hours services.

His practice concentrates solely on primary healthcare.

“I’ll provide anything from preventative healthcare, discussing smoking cessation, nutrition, lifestyle modification and things like that, to vaccinations and health screening for common health conditions,” he says.

“I also provide services for acute minor illnesses and injuries such as your coughs, colds, strains, sprains, things like that, and management of long-term health conditions such as diabetes, heart disease, dyslipidaemia and hypertension.

“I prescribe pretty much from most medicines classes in the Australian Medicines Handbook. I don’t prescribe chemotherapeutic agents or heavy metals, but by and large I prescribe from every class including S4, S8 and across the spectrum of medicinal classes that are relevant for long-term health conditions as well as acute conditions that require antibiotics for example.”

When he’s not working at the pharmacy, Dr Helms is a course coordinator for Curtin University’s nurse practitioner program, having completed a PhD in clinical specialty learning for Australian nurse practitioners.

He describes his relationship with the Capital Chemist Wanniassa pharmacists and Elise Apolloni as “really good”.

“One of the things I’ve struggled with quite some time is that, despite being active in Australia for almost 20 years, healthcare professionals and consumers still remain uncertain about what a nurse practitioner is and what they can do,” he says.

I feel very, very fortunate to be working with Elise because she just gets collaboration.

“Traditionally Australia’s healthcare system has been overshadowed by general practitioners and general practices.

“When I work with Elise … we both really understand that healthcare is not about your role, it’s not about your political or professional agenda, it’s about what the healthcare consumer needs and providing it to them in a safe, effective and affordable way.

“Working with her has been refreshing for me because it really is a different perspective, having someone that’s an expert in medicines that can serve as a source of guidance for really complex scenarios,” says Dr Helms.

“Working in this environment has allowed me to actually explore nurse-sensitive indicators of quality care and doing that within a collaborative environment has been really amazing because Elise doesn’t have an agenda. Her only agenda is really to provide excellent patient care that’s safe, appropriate and effective for the client. We’re not constrained by tradition.

“There are certain things, healthcare conditions, where she needs a second opinion or I need a second opinion. We can bounce these ideas off each other and really build upon each other’s capabilities to maximise the benefits for the patient. So it’s been really lovely from that perspective.

“I feel very, very fortunate to be working with Elise because she just gets collaboration.”

Dr Helms believes there should be more collaboration among all health professionals in the future.

“We need to think creatively about how to maximise all health professionals within the primary healthcare context,” he says.

“Looking at alternate ways and models of care is really important to help maximise the system’s efficiencies.”

See our previous article in the series, Working together: Brad & Sudheer

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