Phone-a-Pharmacist

Optimal Health Outcomes, Only a Phone Call Away

The OSU-MMP started in 2014 with a crew of two professional staff, one intern and one student. Now there are nearly 40 professional staff and 130 students, 80 of those being pharmacy interns, working at the MMP, helping more than 3,000 patients each week.

“Although I saw a need for our service and expected it to grow, I had no idea that it would grow so quickly,” Nahata said.

The OSU program was modeled after the Medication Management Center (MMC) at The University of Arizona College of Pharmacy, the collegiate pioneers of telepharmacy. The MMC opened there in 2006, after the articulation of the medication therapy management movement was made to help patients be smarter and safer with their medications. Software was developed to keep a continual analysis of the medications patients were using and identify any potential problems. This led to the spinoff of SinfoníaRx, a Tabula Rasa HealthCare Company, an industry leader in MTM.

SinfoníaRx has four call centers, including the OSU-MMP and UA-MMC, with a fifth center on the way. The company keeps track of the number of interventions made and money saved since its inception. As of early October 2017, more than 1.5 million drug therapy problems had been solved and more than $1 billion healthcare dollars had been saved, per the real-time counter on the company’s website.

Dr. Osamah Eljerdi, a recent UA graduate who worked at the MMC, found telepharmacy could make a difference for so many because it can transcend transportation barriers, overcome language barriers and empower patients.

“I’ve had patients cry at the end of a call. They tell me that their doctors don’t understand them, their families don’t know what to do, and that they’re so grateful for the medication review. They ask, “What am I taking this for?’ ‘What does this do for me?’ and ‘How does this help me get better?’” Eljerdi said. “I think that understanding their medications is really important to empower them to take care of themselves and take their medications appropriately.”

Managing Medications—and People 

Eljerdi will soon work as a pharmacist at SinfoníaRx’s new clinical call center. He became more aware of the difficulties in healthcare by working at the MMC. The human interaction helped prepare him professionally by making him more understanding of people’s situations financially, socially and culturally. “You encounter every single one of those issues every single day of your experience here,” Eljerdi said.

The MMC exposed him to real people with complex issues, patients taking 10 to 20 medications for chronic diseases. He did not have to deal with the lines of community pharmacies or the distractions of hospitals. “Here, it’s so condensed,” Eljerdi explained. “You’re cutting out all the frills and getting to the meat of what it means to be a pharmacist, and that is clinical monitoring, therapeutic guidance, education, counseling and monitoring issues that arise in a way that only a pharmacist can.

“Students admit that in face-to-face communications, there’s an element of intimidation and anxiety, this sense of, ‘Here’s this patient, much older than I am, and I have to educate this individual on things I’m still learning myself.’”

Telepharmacy gives students the luxury of practicing their counseling skills over the phone. Just as a phone call can ease a nervous patient, it can take the pressure off a student, too. Plus, students know they can put the call on hold and ask pharmacists at the center for help.

“One of the best things that occurs from our telepharmacy Medication Management Program is the opportunity to hire our students and put them in the situation of evaluating a patient’s medication plan,” said Dr. Henry Mann, dean of the OSU College of Pharmacy. “The students develop enhanced communication skills and their anxiety about talking with patients erodes with practice. Our preceptors in IPPEs and APPEs have commented on how noticeable this improvement is and how it sets our students apart as practitioners. There is so much that the pharmacy profession can still add to the practice of healthcare, and programs like the telepharmacy Medication Management Program at Ohio State demonstrate the positive impact we can have on patient lives every day.” 

Telepharmacy Makes the World Feel Smaller

Every pharmacist or student pharmacist working at a telepharmacy center has calls that stay with them. Dr. Christine Prusa, lead pharmacist at the OSU-MMP, remembers a woman who was working on her blood sugar, it wasn’t evening out and she couldn’t figure out why.

Prusa and the woman were talking about her medication, which was Lantus, and at some point in the conversation, Prusa thought to ask the woman, “How are you storing your Lantus?”

She was keeping it in the freezer because the medication said it needed to be cold, and so she thought the colder, the better. “My heart broke a little bit when she told me this,” Prusa said. “She was trying so hard to control her blood sugar and here she was freezing her Lantus, and trying to inject herself with frozen Lantus. Take a moment and think what that feels like.”

Prusa educated the woman on her medication and the science of storing it. The woman was flabbergasted. 

“Patients are trying to do the best thing,” Prusa says. “They just need more help.”

People are living longer these days, but they are living with multiple health conditions, taking multiple medications and seeing multiple providers. A typical 70-year-old patient takes 12 or more medications and low health literacy affects nearly 90 percent of adults, Nahata shared. The need to educate patients is obvious and the impact telepharmacy can make is remarkable.

“It comes down to accessibility,” Prusa said. “I have worked in and I have a passion for community pharmacy, and I’ve practiced in ambulatory settings and I love those too. They have a certain place, but the scope of patients we can impact through telepharmacy is truly remarkable. … Face-to-face will always remain and be important, but telepharmacy makes the world smaller. It brings us closer to patients, and closer to patient care.”

Every day at the MMP, Prusa says patients tell her pharmacy interns, “I didn’t know that,” or “No one ever told me that.” Maybe someone did along the way, but they were too stressed at hospital discharge or too frantic in the pharmacy line to hear it. “For some reason, over one phone call, they heard us,” Prusa explained.

Advancing the Aim of Pharmacy

Beyond preparing students, telepharmacy centers are also conducting research. “That’s what universities are all about, creating new knowledge and disseminating that knowledge to our students, to our patients and to the community,” Nahata said. “To me, a key reason for academic institutions to exist is to make our communities better and healthier.”

Centers are also working to bridge interprofessional gaps. “We have an interprofessional rotation that comes through here, with nursing students, nutrition students, pharmacy students and medical students who all work on patient cases together,” said Dr. Stephanie Forbes, pharmacy director of the MMC at UA. “We are pushing to have more of an interprofessional relationship within the center, for the benefit of the patients that we serve.”

Forbes believes telepharmacy is vital, especially in Arizona and other states with wide-ranging rural areas, because patients need help. “We don’t have to go to their homes to reach them, but we can reach them in their homes,” Forbes said. 

Community pharmacies and hospital pharmacies are not able to reach every patient. That’s where telepharmacy can help the current healthcare landscape and the future of pharmacy—to reach as many people as possible to help them use their medications in the best possible way.  

“The reason I came into pharmacy was to make a difference in people’s lives through prevention and treatment of diseases,” Nahata said. “Medications can be life-saving, but they can sometimes be life-threatening, so we want to make sure we use them wisely. I always tell students, we want to make sure every medication that a patient uses is well-justified and that we use the smallest amount possible to achieve our results. That is the heart of pharmacy.

“My vision, and I hope this happens during my lifetime, is that every individual who is receiving a medication has a chance to be touched by a pharmacist. Every single one. We are not able to connect with everyone, but telepharmacy is one mechanism by which we can reach more people, more efficiently.”

Athena Ponushis is a freelance writer
based in Ft. Lauderdale, Florida.