Bridging the Gap in Healthcare

Great Project: Citizens Giving. Here are my view and contribution

I present to you an issue I encountered while on rotation which led to an unconventional intervention. It is unconventional because while it did not prevent an adverse event from occurring in a specific patient, it did help to improve care in an entire population of patients.

I am hopeful that patients in our community psychotropic clinics will benefit from a symbiotic relationship which I helped to initiate.

During my family medicine advanced pharmacy practice experience (APPE) rotation, I worked in an established local health system which consisted of a psychotropic clinic, a pharmacotherapy clinic, a family medicine clinic and an anticoagulation clinic.

During the three weeks I was there, I noticed that the sole healthcare provider for the psychotropic clinic was the faculty physician, who would see psychiatric patients twice a week accompanied by a resident or medical student.

Despite the hard work of this physician, patients were having difficulty obtaining follow-up appointments due to limited appointment availability and drug therapy adjustments were not being monitored in a timely manner.

Patient care was being compromised simply because of understaffing. As I observed first-hand, this patient population, riddled with extensive psychiatric disorders and countless failed attempts at drug therapy regimens, was not one that could afford any deficiencies in healthcare.

The situation in the pharmacotherapy branch of the health system was drastically different than that of the psychotropic clinic. Unlike the psychiatric clinic, where a crowded schedule precluded thorough patient follow-up, adequate patient-healthcare provider interaction was made possible by the addition of pharmacists to the healthcare team.

These pharmacists would provide medication therapy management (MTM) for patients whose disease states were not improving despite interventions from their primary care provider.

Together, the pharmacist and the patient would review the patient’s drugs to assess appropriateness and tolerability of therapy, as well as assess patient compliance. A significant improvement across several disease states (mainly diabetes, hypertension, and dyslipidemia), was seen when MTM was provided by a pharmacist.

Back in the psychotropic clinic, I did my best to help fill in the gaps, assisting the resident or medical student with patient interviews, presenting patient cases and making recommendations to alter drug therapy if necessary.

After completing the rotation, however, I continued to feel uneasy about the possibility of adverse events and drug-drug interactions which may occur with prescribing multiple psychiatric medications in the absence of consistent patient follow-up. These worries stayed in the back of my mind even as I moved on to my next APPE rotation.

A few weekends later at a local health fair event, I recounted my experience at the psychiatric clinic to a pharmacist who is an Assistant Professor for central nervous system disorders, contrasting it with my experience in pharmacotherapy clinic.

I shared with this professor the improvements in outcomes I had witnessed with the incorporation of pharmacist-conducted MTM into patient care. As I was relating how comprehensive the care was at the pharmacotherapy clinic, a light bulb went on. I thought to myself,

This preceptor is an APPE preceptor with an established rotation site in the inpatient psychiatric ward for the same health system as the overburdened psychiatric clinic. Additionally, this particular professor completed a PGY2 specialized psychiatry pharmacy residency. Wouldn’t it be a great idea to see if she is interested in getting involved with the psychotropic clinic?

Details would need to be worked out, but I was sure it was possible if there was available clinic space and the staff provider was amenable to the idea of help from a pharmacist. I recalled the Asheville Project established in North Carolina, where community pharmacists scheduled consultations, performed clinical assessments, established goals, and collaborated with physicians in therapy management for patients with diabetes.

The results due to pharmacist involvement showed improved health, lower total health care costs and increased patient satisfaction. Additionally, at the psychotropic clinic, the physician would get some assistance, our pharmacy students would benefit by interning at the specialty clinic, and the professor would have the opportunity to practice her clinical expertise. Most importantly, the patients would receive a service of which they were in desperate need.

I brought up the idea of her seeing patients in psychotropic clinics and asked if she might be interested. She asked me to give her the providers contact information to open the channel of communication. Ultimately, my intervention was to introduce my professor to the staff provider at the psychotropic clinic in hopes of forming an alliance.

If all went according to plans, the end result of this alliance would be a psychotropic pharmacotherapy clinic where the professor could bring her APPE students to make interventions during standard clinic hours under her supervision, similar to the MTM sessions at the pharmacotherapy clinic.

I am ecstatic about the progress made so far. In mid-February, my professor saw patients in the psychotropic clinic for the first time. The intervention did materialize, and I am positive that having a clinical pharmacist on the team at the psychotropic clinic will positively impact patient care.

Even though I was an outside participant who just happened to recognize a large problem, I was able to get the ball rolling just by caring enough to bridge the gap in healthcare for patients in need. If health care providers can continue to work together in this way, everyone will win.