PharmD grad Kiera Miller set to practice in rural hospital

Kiera Miller’s advanced pharmacy practice experience (APPE) courses gave her a breadth of pharmacy experience, from big city hospitals and corporate head offices to small-town community pharmacies and family health teams. As she looks to the next stage of her career and returns to the rural area where she grew up, she is applying learnings from all these experiences to start her independent practice and provide care to her community.

“One of the things I learned is to take advantage of any interaction you have with your patient, take advantage of the fact that they're in front of you because you might be the only health care professional they can see at that time,” says Miller, who recently graduated in the 2T5 Doctor of Pharmacy (PharmD) class at the Leslie Dan Faculty of Pharmacy.

“One of the things I learned is to take advantage of any interaction you have with your patient, take advantage of the fact that they're in front of you because you might be the only health care professional they can see at that time.”

“If they have a chronic condition like diabetes or hypertension, you need to be on top of their care and create a trusting relationship so that they will come to you if they have concerns.”

Miller grew up in Stirling, Ontario, a village of 1,500 people located about 20 kilometres north of Belleville. At age 15, she started working as a pharmacy assistant in a local pharmacy, and she was hooked on the profession.

Miller studied biomedical sciences at the University of Waterloo, then came to the Leslie Dan Faculty of Pharmacy for her PharmD, drawn by the opportunity to do experiential courses in small communities outside of Toronto. Knowing she wanted to return to a small community after school, she wanted to ensure that her education provided practical experience outside of major cities.

Miller’s final year APPE courses included placements at the corporate office of a retail pharmacy chain, in educational research with Assistant Professor Andrea Swanson, and in the surgery and pre-admission departments at Toronto General Hospital. But she was particularly excited by her placements at a nurse practitioner-led clinic in Belleville and a community pharmacy in Stirling, which provided valuable experience in rural pharmacy practice.

Miller’s experiences in small communities emphasized the importance of pharmacists in these communities. In both settings, she saw firsthand the important role that pharmacists play in helping patients manage chronic conditions like diabetes and providing smoking cessation care, but also often providing care while patients were waiting to see a physician or specialist, which could sometimes take months.

“In that area, it can be hard to see a specialist because you have to travel to Kingston or Toronto, and the waitlists can be long. So, the pharmacists spend time trying to manage their condition the best they can within their scope of practice while the patients wait for that specialized care,” she says. “It can be upsetting to see that these patients sometimes need more care beyond what we can do. But we do our best to bridge their care until they can see their specialist.”

Miller expects pharmacy practice will focus on geriatrics and addiction services

With her PharmD now complete and licensing exam written, Miller will soon start a role as pharmacist at Campbellford Memorial Hospital, a 38-bed hospital that primarily serves the local population of older adults and summer tourists. Many of the patients at the hospital are “alternate level of care” (ALC) patients, who no longer require hospital care but are waiting for a bed in another care setting, such as a long-term care home.

With a significant population of older adults in the area, many of the patients at the hospital have experienced falls, and Miller hopes to collaborate with the physical and occupational therapy departments at the hospital to address this common issue.

“For many of these patients, their medications could be contributing to their falls, so as the pharmacist, I hope I can play a role by looking at the effect a patient’s medications are having and finding ways to make changes to reduce their risk,” she says. “I’m hoping that pharmacy can be part of that collaborative care because there is a lot we can do to help.”

Like many rural areas in Canada, substance use disorders are another common issue that Miller expects to encounter in the hospital. She plans to offer naloxone training and harm reduction education to patients, and she is also planning to take additional training in methadone services through CAMH.

“The plan is that I will do the training and then I can share that education with the nurses, doctors and other staff here, and I’m very excited to do that,” she says.

“The courses and professors prepared us well to practice in the real world, and the experiential courses gave me a great breadth of experiences that I could learn from.”

Miller will be the sole full-time pharmacist at the hospital, but will have colleagues at the other small hospitals within the health network, such as Peterborough and Cobourg, who can offer advice and insight. Her education from the Leslie Dan Faculty of Pharmacy and hands-on experience from her APPE courses have been essential for preparing her to take on this challenging role.

“The courses and professors prepared us well to practice in the real world, and the experiential courses gave me a great breadth of experiences that I could learn from,” says Miller. “Thinking about the community I’ll be serving, a lot of our learning focused on vulnerable sectors and social determinants of health, which has made me more aware of factors beyond medications that can impact a patient’s life and health, and that is something that will help me in my new role.”