Disclaimer

This podcast is for US healthcare professionals only and is intended to be listened to as it was originally produced by Pfizer. This podcast has been funded by Pfizer, and the participants have been compensated by Pfizer for their time. The healthcare professionals featured are sharing their own opinions based on their clinical experiences. This promotional activity is not certified for continuing medical education. 

Narrator

Welcome to our podcast series, IBD TalkTract, sponsored by Pfizer, designed to engage healthcare leaders in conversations about inflammatory bowel disease (IBD) care management opportunities. Our podcasts feature IBD specialists involved in care innovation at their institutions. 

Thank you for joining us! 

John Fanikos 

Hello and welcome, everybody. I’m John Fanikos, your host and a health system pharmacy leader. The prevalence of IBD is on the rise, with nearly 3 million US adults impacted by the disease. Recent studies suggest that a follow-up with an IBD specialist may be beneficial to transitions of care for patients impacted by IBD. 

Today, we’re discussing the crucial role dedicated clinical pharmacists plays in IBD care. We’ll also touch upon some important things to keep in mind when bringing this model to other institutions. Having been a director of pharmacy at Mass General Brigham Healthcare, this is a topic of great interest to me, and I think you’ll find it valuable, too. IBD specialists may include clinical pharmacists who can make treatment decisions, provide patient education, and really much, much more. 

The inclusion of clinical pharmacists on an IBD care team reflects a growing recognition of their value in bringing specialized care and knowledge to help optimize medication management, improve patient outcomes, and enhance the overall quality of care. On today’s episode, we’re joined by a panel from 2 different health systems: Cleveland Clinic, located in Cleveland, and Ochsner Health, located in New Orleans. 

First, from the Cleveland Clinic, we have Dr Ben Cohen, co-section head and clinical director of IBD, and Dr Shubha Bhat, clinical pharmacist for GI. Next, from the Ochsner Health, we have Dr Shamita Shah, medical director of IBD, and Dr Estela Lajthia, clinical pharmacist for IBD. Welcome, everybody. Shamita, let’s begin with you.  

Shamita Shah 

Thanks for having me on the podcast, John. 

John Fanikos 

For context, please tell us a bit about your journey within healthcare and what led you to Ochsner Health. What sparked your interest in creating a care team that included a dedicated IBD pharmacist? 

Shamita Shah 

As a native of New Orleans, I was excited about the opportunity to serve my community. So, in 2015, I made a move to Ochsner Health in New Orleans to build an IBD program from the ground up. I’ve been practicing as an IBD specialist since 2008, after my IBD fellowship at University of Chicago, and then served as clinical director of IBD at Stanford. 

In Louisiana and the Gulf South, there was a big void of Crohn’s and colitis specialists, so things became busy very quickly. I knew we had to expand our team efficiently to deliver quality care to more patients, especially in the era where there had been an explosion of advanced therapies, which is when I explored options. 

John Fanikos 

Shamita, how did you and your institution identify the need for a dedicated IBD pharmacy role? 

Shamita Shah 

So, I did some research, and I was very grateful for some of my IBD colleagues at the University of Chicago, Vanderbilt, and Geisinger, who introduced me to their pharmacist and had a few virtual meetings to understand their model. 

John Fanikos 

And how did you implement it? 

Shamita Shah 

There were a few distinct ways that we had incorporated pharmacists into our practice. There is a more traditional way where I would see a patient and discuss their condition, including a review of their diagnostic tests, their symptoms, and their treatment options, and after a shared decision with the patient, we narrow it down to a few treatments. Then, my pharmacist will review these options in more detail, and review the risks of the medication, and help in successfully starting the patient on treatment by facilitating medication approval and also coordinating the medication monitoring. 

Now, there’s also another, more innovative way that we have incorporated pharmacists. In our practice, they actually serve as physician extenders, and together, they will see patients with us in clinic. Ultimately, this has allowed us to open our access to IBD referrals and deliver quality care to them. We’ve implemented protocols to standardize the management of these therapies in between visits, primarily monitoring the safety and efficacy of medications. 

John Fanikos 

Thank you, Shamita. Pure genius. Ben, can you please share with us your healthcare journey and what led you to the IBD space at the Cleveland Clinic? 

Ben Cohen 

Thanks for having me on the podcast, John. I’m really excited to be here today. So, I moved to the Cleveland Clinic as the clinical director for IBD in 2020 after beginning my career at Mt. Sinai in New York following my IBD fellowship. I was attracted to Cleveland Clinic because we have a very strong multidisciplinary team and a huge IBD referral population with over 6000 IBD patients seen yearly, and our group consists of 11 IBD-focused physicians, 3 advanced practice providers, 2 registered dietitians, 2 psychologists, 9 nurse care coordinators, 1 biologic navigator, and, most importantly, our IBD clinical pharmacists. 

And together, we practice in what is referred to as a multidisciplinary medical home style of care. Given the size of our team and patient population, there may be some differences in how we utilize our IBD clinical pharmacists, so it will be interesting to compare the approaches. 

John Fanikos 

Ben, would you be able to expand upon how you and your institution, the Cleveland Clinic, identified the need for a dedicated IBD pharmacy role? 

Ben Cohen 

So, I’d say that the need for an IBD clinical pharmacist was a joint epiphany at Cleveland Clinic. While we had a large multidisciplinary team, we recognized that the explosion of medical therapies for IBD and treatment paradigm shift toward earlier utilization of advanced therapies was increasing the complexity of care. So, one provider can’t cover everything in the limited time we spend with a patient, and the risk-benefit discussions may need to take place over multiple patient interactions. 

John Fanikos 

Ben, can you give us an example for some context surrounding the medications? 

Ben Cohen 

Sure. To provide context for how this works in practice, when I see an adult ulcerative colitis patient with moderate to severe disease, we first carefully review medications they may have taken previously, such as 5-aminosalicylates and steroids, as well as indicators of their disease severity, including symptoms and colonoscopy results. I’ll have an initial conversation with them about options and my recommendations. 

If they struggle with daily medications, a self-injection or infusion-based medication may work better for them. So, following that initial visit with me, we have them see our IBD pharmacist to answer the remaining questions, finalize the treatment plan, confirm pretesting is completed, and set up the monitoring evaluations. And patients really love this approach. At the same time, we recognize the value of having an IBD clinical pharmacist on our team. 

Our pharmacy department had great interest in embedding a clinical pharmacist on our team as well, as this was an opportunity to increase advanced therapy referrals to our specialty pharmacy and also advocate for cost-saving measures, such as the utilization of biosimilars. So, a unique aspect of the funding of our position is that the role is fully supported by the pharmacy department. 

And when trying to add a clinical pharmacist to your team, it’s really useful to have a discussion with your pharmacy department to see whether there’s a mutual need to support expanding the team. 

John Fanikos 

Ben, thank you for that insight. I always appreciate what you have to say. Okay, so let’s turn to the pharmacists and get their backgrounds and experiences. Estela Lajthia, it’s great to have you with us today. 

Estela Lajthia 

It is a pleasure to be here. Thank you for having me, John. 

John Fanikos 

Estela, I’ve been a pharmacist for 40 years. My family knows that I leave before sunrise, and I come home after sunset. They have no idea what I do during the course of the day. So, I have to ask you, what exactly does an IBD pharmacist do? And what brought you to this field? And how do you work with patients and other providers? 

Estela Lajthia 

There are many roles an IBD pharmacist can play depending on their practice setting. This includes clinic-based, specialty pharmacy, infusion center, or a hybrid setting. Here at Ochsner, the clinic-based IBD pharmacist plays a role in assisting the physician in treatment decision-making, and we serve as the patient’s main resource in implementing that decision. 

John Fanikos 

And Estela, pharmacists have an incredible number of options for their career. What led you to become an IBD pharmacist? 

Estela Lajthia 

So, after completing pharmacy school, I went on to do a 2-year postgraduate residency training in ambulatory care. That is what solidified my passion for working directly with patients in a multidisciplinary clinic setting. I was clinical faculty for a few years before this amazing opportunity to work with IBD patients opened up. What attracted me to this particular position was the idea of being able to build a program from scratch with Dr Shah, who had so much passion and a clear vision of her program. 

John Fanikos 

That’s great to hear that. And how about you, Shubha? You’ve published extensively on the role of the pharmacist. You’ve contributed to national guidelines. You’re a star. Can you share with us your journey within health care in the IBD space? 

Shubha Bhat 

Thank you, John, for having me here, as well. My healthcare journey is similar to Estela, as I’m also an ambulatory care-trained pharmacist. I’ve worked previously on anticoagulation in primary care clinics, and I transitioned to gastroenterology about 6 years ago upon the completion of an outcome research fellowship. 

John Fanikos 

And what was your experience as to what an IBD pharmacist does and how do you work with patients and providers? 

Shubha Bhat 

So, in my specific practice at the Cleveland Clinic, I independently see patients with IBD in person or virtually for about 30 minutes. And in that time, I’m addressing any medication-related needs. Most of the patients that are referred to me are either planning to start or have already started advanced therapy. I will track their progress from pretreatment initiation until they stabilize on maintenance dosing. 

And then, at that point, John, I generally tend to refer them back to their advanced practice provider or gastroenterologist. There are also many administrative tasks that I handle, such as handling any formulary requests, medication IT build, optimizing medication-related workflows, prior authorization order entry, and working closely with the specialty pharmacy, as well. I also frequently respond to drug information inquiries. 

John Fanikos 

And Shubha, could you please elaborate a bit on how an IBD pharmacist manages the multiple therapy classes available for an IBD patient today? 

Shubha Bhat 

Certainly, John. So IBD pharmacists have been crucial in educating the healthcare team and patient about the treatment. This includes anything relating to the dose and the pretreatment monitoring requirements. We also now have drug interactions that we need to account for, which also add to the monitoring complexity of these treatments. And the adverse effects profiles are also evolving. 

So just to give you an example, there are some treatment options for patients with IBD who have been previously treated with conventional therapy, such as mesalamine or immunomodulators, or have tried other biologic medications such as anti-tumor necrosis factor, also known as anti-TNF. An IBD pharmacist can help review all this vital information with patients, ensure that they are up to date on the pretreatment requirements and screenings, and continuously monitor them to optimize treatment safety. 

John Fanikos 

You know, Hollywood may not know this, but you guys are stars. The work that you’re doing is amazing. The pharmacists typically have a complete perspective of all the medications that are on board and the ones that may be needed. Let’s go back to the physicians for a moment. Shamita, let me ask you about the impact that the pharmacist has on patient care. 

John Fanikos 

Could you talk a little bit about the measurement of outcomes? 

Shamita Shah 

Sure, John. So, we want to make sure we are always delivering quality care to our patients. I’ve been able to reach more patients while still offering quality care with the addition of a pharmacist by each of our IBD physicians, which has been able to increase our patient panel size, which has almost doubled since adding a pharmacist. We have an excellent specialty pharmacy and a network of infusion centers within the Ochsner system, and our clinic-based pharmacists have developed a great relationship with the pharmacists across the system, and without everyone working together, we wouldn’t be able to deliver this level of quality care. 

In addition, when we have insurance barriers, our clinic-based pharmacist can coordinate with outside specialty pharmacies and infusion centers, and we are tracking several outcomes as we collaborate with our Population Health section at Ochsner Health. 

John Fanikos 

Shamita, thank you for that insight. Estela, do you have anything you’d like to add about how your role impacts patient care or how Ochsner Health measures outcomes? 

Estela Lajthia 

Absolutely, John. We went from 600 patients between 2 physicians before the clinic-based pharmacist was implemented to approximately 1400 unique patients between the same 2 physicians today, and still were able to offer quality care. In addition to what Shubha already touched on, the IBD pharmacist can also play an important role in reviewing risks, since we all know that IBD can affect all ages. 

Since implementing vaccines in clinic, we have been able not only to recommend the 2-dose series of herpes zoster, but we also are able to administer the first dose in clinic the same day the decision is made to initiate treatment. In addition, increasing and improving vaccination rates, transitions of care, capturing prescriptions and infusions, I think what has been probably the most impactful is being able to implement clinic-based pharmacists in rheumatology, neurology, dermatology, allergy, and immunology. 

We have 15 Ochsner Clinics within the state of Louisiana that have been implementing pharmacists utilizing our model in just the last 2 years. 

John Fanikos 

Well, I know success breeds success. And again, turning to our guests from Cleveland Clinic, Ben, what impact does the dedicated IBD pharmacist have on patient care? 

Ben Cohen 

Well, I think the pharmacist has had a strong impact at the patient level, the IBD section level, and then the organization level. And so, Shubha can focus her time on patients who are starting advanced therapy or recently started on advanced therapy, as this is the vulnerable time for patients. And Shubha has really increased patient comfort with therapy and has transformed the ongoing management of medications. 

And then she also educates the team on new therapies and updates at the organizational level. Pharmacists can also help utilize specialty pharmacy and allow us to really get the resources we need for our patients. And this allows us to better advocate for the use of new advanced therapies. And that can be a big cost savings to the system. 

John Fanikos 

And how does the Cleveland Clinic measure these outcomes? 

Ben Cohen 

One way is to look at achieving our treat-to-target approaches in patients who work with a clinical pharmacist and look at rehospitalization and transitioning patients from inpatient to outpatient. Another important aspect that we need to capture is patient satisfaction and retention on therapy, as this is an indirect measure of disease control and, ultimately, cost savings by not constantly switching treatments or seeking unplanned care. 

Ben Cohen 

And at the organizational leadership level, they’re going to respond most to potential cost savings. So, if you have an internal specialty pharmacy, I think you can make a strong case for the pharmacist playing an integral role in directing advanced therapy referrals to the internal specialty pharmacy. Additionally, frame how the clinical pharmacist prevents unplanned care by more effective initiation of advanced therapies, preventing rehospitalization by facilitating transitions of care, and being a champion for healthcare maintenance vaccinations to reduce preventable infection-related hospitalizations. 

John Fanikos 

Ben, thank you for laying that out so clearly. And finally, our last question today: What recommendations would you offer to other institutions that are considering integrating a similar IBD clinical pharmacist approach? Estela, let’s start with you. 

Estela Lajthia 

The first recommendation is to start collecting data of your work early on so you can show the impact you are having as a new pharmacist in an IBD clinic. Secondly, focus on the specific needs of your clinic, and keep in mind that different states have different regulations when it comes to protocols and collaborative practice agreements. We were able to utilize the data manually collected and the implementation of clinic-administered vaccinations to justify our second pharmacist that joined our team in February. 

As more institutions start seeing the value of implementing an IBD pharmacist, there will be more published data out there to help others. Dr Shah and I are currently working on a manuscript awaiting publication that describes how we were able to implement our model. 

John Fanikos 

This is fantastic work. You’re making a difference in terms of patient care and the potential outcomes that patients can reach. So, this is a huge success story. And to bring it home, Shubha, could you share some of your recommendations when it comes to integrating an IBD clinical pharmacist approach into the care team? 

Shubha Bhat 

This is definitely one of my favorite questions because I think it highlights a topic that we’re very passionate about and kind of still addresses that there’s an unmet need in a lot of IBD practices. I have recently published a consensus that outlines the role of an IBD clinical pharmacist under a collaborative scope of practice. So, I would highly recommend that any site or teams that are looking to integrate a clinical pharmacist refer to this resource. John, one of the main barriers that often comes up when asking about how to embed an IBD clinical pharmacist often comes down to position justification, especially when there’s a need for other team members, like advanced practice providers. 

So how do you justify the cost between these 2 healthcare team members? One of the potential solutions that we have identified at the Cleveland Clinic is to highlight the ability of the pharmacist to link the specialty pharmacy to the care team, and to highlight the ability of the pharmacist to help treatment outcome, which thereby may result in cost savings through reduced hospitalization and emergency room visits. 

Additionally, John, depending on state laws, there are some pharmacists that may be able to bill for their service, and this can actually result in extra revenue for the clinic. 

John Fanikos 

Thank you, Shubha. That’s great to hear that. Fantastic. I think you’ve given us a picture of cutting-edge IBD care. That brings us to the end of today’s episode. And thank you so much to our panelists for sharing their expertise and their insights today on the ways IBD care teams are collaborating to provide optimal patient care.  

Narrator

Together, we can help improve care for patients with IBD. Thank you for listening. 

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