More About Dr. Setter
Stephen Setter represents a new kind of pharmacist.
The 2006-07 U.S. Department of Labor Occupational Outlook Handbook indicates a trend toward pharmacists becoming more involved in drug therapy decisions and in counseling patients. For Dr. Setter, this trend is, and has been, a way of life for quite some time.
He specializes in geriatric research, and is one of only ten certified geriatric pharmacists in the state of Washington. In this capacity, he consults with Elder Services, a social work agency based in Spokane, to make house calls in an effort to improve the care of geriatric patients in the Inland Northwest.
As part of a team including case managers, social workers, and a psychiatrist, Dr. Setter and the two pharmacy students he mentors in their last year of training make two to three home visits per week to elderly charges who often live alone and are often depressed and in the early stages of various age-related diseases. Many suffer from Alzheimer’s, Parkinson’s, diabetes, and other major chronic conditions that make it difficult for them to remain in their own living environment.
The goal of the Elder Services program is to keep patients in their own homes and out of hospitals, nursing homes, or psychiatric wards and hospitals for as long as possible. “We have a community geriatrics focus…. That really is our unique slant—that we actually are in the home,” Dr. Setter says. “We don’t dispense any medicine. All we do is educate and help work with the providers to streamline people’s care,” he adds. He also helps to educate the staff of nurses, social workers, and physical therapists working in the home.
“Everyone thinks that when you get old you go to nursing homes, but actually ninety five percent of older folks live at home … very few people out of the total geriatric population are nursing homes—they are all in the community and these people are often having major problems that no one is really paying attention to…” Dr. Setter says.
Many of the patients he visits suffer from chronic diseases that are serious, often seeing four or five doctors and receiving four or five different medications. In his experience, the greater the number of health providers involved, the greater the likelihood of overmedication. “Before you know it, we have a mess on our hands in regards to their medications,” he says.
Dr. Setter applies his expertise to solving the medication issues—improving drug therapy, helping patients’ understand their drug therapy, and ensuring that they are appropriately treated and managed.
He quotes a recent report showing that misuse of drugs, particularly in older patients, contributes to some 700,000 emergency department visits per year nationwide. “It’s what I call our other drug problem. It’s not a small problem but it’s one that’s kind of unrecognized and it’s not given much press,” he says.
In additional to his clinical work, Dr. Setter conducts cognitive impairment research. One study uses a pre-screening tool created by Soo Borson, a psychiatrist from the University of Washington, to determine cognitive impairment. The brief screening tool helps researchers to identify patients who might have a problem with dementia that has not been recognized.
“We’re using the tool and looking at the medications (people) are taking because a lot of medicines can make you cognitively impaired as well,” he says. About sixteen percent of the people screened test positive. “There’s a lot of cognitive impairment out there in the community that is not being recognized,” he says. It’s information that is provided to the patients’ health care team, so are they more likely to get further evaluated.
Dr. Setter also conducts a study that looks at the incidence of cognitive impairment in elderly patients on blood thinners. “Our theory is that people who have difficulty managing their anti-coagulation therapy may have underlying cognitive impairment and that’s why they are having difficulty managing their therapy.”
Another major project involves medication discrepancies, or the confusion suffered by patients leaving the hospital in regard to the medications they are supposed to take at home. “We’re in the early portion of the study, but almost every patient we’ve evaluated so far has had at least one… discrepancy,” he says.
The discrepancies occur when patients don’t follow directions, or when conflicting information leaves them uncertain of what to do on their own. “This research is going to show that we have a huge problem going from one environment to the next, particularly with older folks,” he notes.
Dr. Setter considers the goal of his work as providing information that leads to education, rather than that of someone who dispenses medicine. “My general philosophy as a pharmacist is that I’m kind of an anti-pharmacist because I see a lot of older folks who are harmed by their drugs and I realize the importance of proper drug care.
“So many folks I see are receiving too many prescriptions—they are being asked to do too much in a day by four or five different health care providers and it isn’t realistic—particularly when they start to become depressed or demented or have other limitations,” he adds.
A better approach, he believes, is looking at the whole person and the situation they are living in. “I think what I do is more valuable than putting pills in a bottle and handing it to someone,” he says.
Lecture Details
More About Dr. Setter
News Releases
WSU Spokane Faculty Member Receives Pharmacy Journal Award
WSU Spokane Faculty Member Achieves Certified Diabetes Educator Status
WSU Faculty Member Earns Pharmacy Honor
WSU Spokane Pharmacist Recently Certified in Geriatric Care
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