Kate Smullen, PharmD, CSP, thinks hospital-based specialty pharmacists can dramatically improve patient outcomes — here’s how

 Kate

Q1: You have worked in retail pharmacy, hospital pharmacy and specialty pharmacy, and received your Certified Specialty Pharmacist accreditation. From a pharmacist’s perspective, what are the two most important aspects of hospital patient care that specialty pharmacist can fix? And how would you fix them?

KATE: In the broadest terms, what we need to do is shift gears and change our perspective relative to all pharmacy service delivery, especially specialty pharmacy. We need to change from the current volume-driven service model to a more value-added service model, and we really need to get that point across to healthcare delivery partners. As specialty pharmacists, we need to invest more in integrated – physician / pharmacy - patient care. My experience has been that doing so decreases total healthcare costs, improves outcomes, and enhances quality and safety measures. As to the question of how we can achieve this, the two most important points are impact in care delivery and medication adherence.

Impact in Care Delivery: Conventional wisdom says a patient’s purchase experience and the medication information provided by pharmacists are the key drivers that impact patient outcomes. I would argue that the pharmacy provider’s impact lies in how they relate to patients and how they deliver counsel to patients.

We have the same medication and treatment information across all 50 states and yet, patients still aren’t getting a consistent message about the personal health impact, good and bad, of medications. Working successfully with patients, especially those with chronic illnesses, really comes down to a personal provider-patient connection. Yes, it’s the tone of voice that goes along with a personal relationship that matters as much as the dosage data and list of side effects that come with every prescription bag. Having a caring manner when communicating with patients is essential for improving their health outcomes. In my experience, this can’t be done from remote call centers alone. There needs to be a human connection.

Medication adherence: Medication adherence is a central component of treatment efficacy with respect to preventable disease states, progression of current chronic conditions or achieving remission, depending on goals of therapy. Each treatment course is different depending on the needs of the patient and the state of the disease being treated. We’re not always curing diseases, in many cases we are extending survival, and it’s important to get that point across to the patient and explain the reasons why they’re taking a particular medication.

Drug therapy for chronic illnesses is not always as rewarding as the instant relief of taking an aspirin to get rid of a headache. Patients can take medications and feel worse, so we really need to show patients the long-term goals of their therapy.
Finally, if patients can’t afford lifesaving medication due to high copays and deductibles then our role as pharmacists doesn’t have any relevance. About 30% of patients never even make it to the pharmacy to pick up their medications. If there is only one thing we can do in specialty pharmacy, we should start with helping patients afford their medications.

Q2: From your perspective, is an in-hospital specialty pharmacy better able to integrate care for chronically-ill patients when compared to a pharmacies outside the hospital setting?

KATE: Yes, absolutely. Having the ball in your court as a pharmacist, so to speak, allows far better access to the patient and lets an in-hospital pharmacist do complete patient-centric counseling. Having EMR access, we can integrate pharmacy care and foster seamless communication that allows for transparency across the hospital’s interdisciplinary care team. That new level of integrated, coordinated care improves patient outcomes while cutting total care costs.
When a hospital uses an off-site contract specialty pharmacy, pharmacists don’t see what happens with the patient’s care team. When pharmacists don’t have as much communication with the treatment team, then we have to provide generic counseling to the patients based almost exclusively on the medication - not on individual patient data related to the medication profile. When we can apply specific patient factors to our counseling, we can truly engage patients and determine what’s applicable to them in the research literature.

Q3: If patients benefit so much from integrated pharmacy care teams, why do you think so many hospitals haven’t started one, or get the most from their current hospital specialty pharmacy?

KATE: I think it’s education and awareness. I don’t think many hospital and health system leaders really know how much of an improvement in care is possible. For example, our current hospital partners have improved medication adherence 30% above national averages. That’s the tip of the iceberg, and that one improvement has benefits well beyond patient outcomes, although it doesn’t have to be more than that to make it worthwhile.

Another factor is the risk-averse mindset of many healthcare providers. I have worked with several health systems that only sought resolutions when things got so alarming that they needed to quickly outsource a problem to put a patch on it. By being more forward-thinking, hospital specialty pharmacists can change the face of healthcare within their institutions, setting radically new levels of expectations for patient outcomes. In the past 40 years there hasn’t been an opportunity for pharmacists to improve care and cut costs like there is today.

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