Pharmacy Check-in: Meet Nafisa Merali
Nafisa Merali, B.Sc. (Pharm), CDE, CTH, BCGP (she/her)
With a commitment to health promotion, patient care and community education, Nafisa Merali and her pharmacy team truly go above and beyond the call of duty in their mission to educate patients and empower them to manage their own health. Nafisa has specialized and extensive expertise in diabetes and related topics, and she works tirelessly with patients on diabetes management, from insulin adjustment to basic survival skills. In addition, her team is involved in many community outreach programs, bringing clinical services to community centers, temples and seniors’ homes in several languages.
Nafisa has received numerous awards and recognitions, including the Vancouver Coastal Region Outstanding Health Care Professional Award, presented in recognition of the difference in improving the lives of individuals living with, affected by, and at risk of diabetes; and the Charles H. Best Award from Diabetes Canada, recognizing her as a health professional who has made a significant difference across Canada towards improving the quality of life of individuals living with diabetes.
Nafisa Merali is a graduate of the University of British Columbia. She has her Certified Diabetes Educator designation and is a Certified Immunizer for immunizations and vaccines. She holds a certificate in Travel Health and is a Board Certified Geriatric Pharmacist. She fully believes in lifelong education to provide the best possible care for her patients. Nafisa has served on the BC College of Pharmacy’s Ethics Committee and travelled the world to attend conferences on diabetes and other issues.
Q&A with Nafisa
We caught up with Nafisa ahead of Diabetes Awareness Month to chat about pharmacists' role in diabetes care.
What is the #1 thing pharmacists can do to help their patients manage diabetes?
Pharmacists play a key role in helping patients diagnosed or living with diabetes better manage their chronic disease. Pharmacists are the most accessible health-care providers and play a key role in both screening and lifelong management of this chronic disease. Medication therapy management is a key component of ensuring good outcomes in diabetes care.
What role can pharmacists play in supporting patients with diabetes? Why is it important for pharmacists to be involved?
Pharmacists play an important role in diabetes management given that we have more than 11 million people living with diabetes or pre-diabetes. This represents 1 in 4 Canadians. Given these rising rates of diabetes, we can play a role in identifying patients at risk of diabetes and offering screening tools such as the Canrisk questionnaire and/or providing blood glucose testing, which can help identify a patient with potential diagnosis. We know that that many people are living with Type 2 diabetes and are not diagnosed until their disease reaches an emergency state. We know that prompt diagnosis, lifestyle changes and the right pharmacotherapy can minimize or delay complications that uncontrolled diabetes can cause.
The number of diabetes treatment options has increased over the past years. As pharmacists, we are in a position to assist patients and providers in recommending guideline-based medication therapy that can maximize efficacy and minimize side effects. From a patient perspective, we can help improve medication adherence by explaining to our patients what the medication is expected to do and what side effects to expect and how to manage them. Helping patients manage expected adverse effects, such as hypoglycemia, enables the patient to stay on the drug regimen. We can help our patients on injectable therapy and teach them how to administer it, and we can also help them monitor their blood glucose levels and learn how to manage out of range levels.
Why did you choose to become a Certified Diabetes Educator (CDE)?
After graduating from pharmacy school, I volunteered at various health fairs and realized that the prevalence of diabetes was high, and that my patients of South Asian background were at higher risk, so I started offering free screening and information. I also realized that I needed to improve my knowledge and took some courses and worked on getting my CDE designation. For me to help and advocate for my patients it’s important to continuously improve my knowledge and become an expert on diabetes, so I could provide better care to my patients and improve their quality of life.
How does having a CDE at the pharmacy enhance patient outcomes?
CDE pharmacists have a more specialized training in diabetes care. CDE pharmacists can work with health-care providers and patients to improve outcomes. I feel that health-care providers appreciate and need the support of a CDE in providing a team based approach for patients
What makes you proud to be a pharmacist?
We as pharmacists can do more than dispense medications. We can ensure the best care for our patients and be their advocates. We can help our patients with every refill and we have the ability to improve their health and quality of life. I believe that providing care is not an option but rather an obligation. The ability to help my patients and see them live a healthier life and be part of that journey with them. I cherish my relationship with my patients and they treat me like family.
Is there anything else you’d like to share?
During COVID, patients who were newly diagnosed had an extremely difficult time using their blood glucose meter and/or administering their insulin. We used Microsoft Teams to provide virtual care to our patients to teach them virtually in a language that they can understand.
We have a unique program, the home monitoring program, where we send LPNs to patients’ homes for medication administration. As the population ages, I have found many patients end up getting repeated hospitalization as they cannot manage their insulin. We have developed this program to support this vulnerable population. We receive referrals from hospitals and health-care providers and we offer short-term or long-term support to patients on multiple medications and injections.
We are proactive and work with health-care providers to adjust insulin based on blood sugar values.
I also work with the South Asian Health Institute to develop culturally sensitive programs and resources for patients living with diabetes.