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Engaging and Leveraging Clinical Pharmacists: Q&A With Zarah Mayewski

ways to increase medication compliance

Zarah Mayewski, PharmD, BCPPS, is the Director of Cureatr Clinic. In this position, she leads Cureatr’s team of expert clinical pharmacists and pharmacy technicians in the strategic development, implementation, and execution of the company's medication management services that adhere to the highest level of clinical excellence and quality as well as ensure patient and customer satisfaction. Dr. Mayewski also provides specialized clinical pharmacy services through direct interactions with patients and the healthcare team. She joined the Cureatr team in September 2020.

ZarahIn this interview, Dr. Mayewski discusses why she pursued a career as a pharmacist, what brought her to Cureatr, how healthcare providers can improve the ways they collaborate with clinical pharmacists, and what patients appreciate most about clinical pharmacists.

Q: What motivated you to become a pharmacist?

Zarah Mayewski (ZM): There were several reasons. My aunt worked in the pharmaceutical industry, and she talked about how diverse a pharmacist's career can be which sounded appealing when I was trying to decide what I wanted to be when I grew up.

I also had a seizure disorder when I was young and need medications to control it. I experienced firsthand how properly managed medications improved my quality of life. Before my medication treatment, I couldn't experience things that most kids take for granted like riding a bike or going swimming. Once my medications got my condition under control, I could take part in the things that every child should get to experience.

I also got firsthand experience with the flipside of medication treatment. Some of the side effects were intense. One medicine caused almost all my hair to fall out. Another severely increased my risk for liver damage and disease. I remember getting countless blood tests to alleviate my mother’s concerns regarding the potential liver damage.

These two together — my aunt's career and my childhood experiences— always gave me a sense that being a pharmacist would be an interesting and dynamic career. It gave me a passion and respect for medications, their ability to help and harm, and a desire to make sure they do the former to improve people's lives.

It is a very exciting and critical time to be a pharmacist. It is exciting because there are so many treatment modalities and medications for most diseases that pharmacists can really tailor medication plans to the patient, so they get the most benefit. It is critical because the explosion of medications also exponentially increases their risk of harm and me and my fellow pharmacists are at the forefront of reducing medication risks and harm.

Q: What else do you love about being a pharmacist?

ZM: Pharmacists are great listeners, detail-oriented, and bring unique expertise and skill set to the health care continuum. We have the deepest knowledge of how medications work, what their side effects are, what they will adversely react with, and how each patient’s unique situation can drastically change the efficacy of the drugs that are prescribed. There is a complex interlay of variables that need to be balanced for each person's medications to make the most positive impact in the patient’s life. When I think about why I became a pharmacist, the reason I'm here is that there are real-life consequences for not balancing the equation and I love being able to help find that balance for patients.

Q: In your journey as a pharmacist, what brought you to Cureatr?

ZM: After receiving my PharmD from the University of Pittsburgh, I started doing rotations for Indian Health Service (an operating division within the U.S. Department of Health and Human Services). While there, I became aware of the residency program at CHI Franciscan in Tacoma, WA. The pharmacy team there is treated as a crucial, valued part of the care team and consulted on all decisions. The interdisciplinary, collaborative nature of the entire health system would give me exposure to every discipline and allow me to truly operate at the top of my license. I went to interview at CHI Franciscan and instantly fell in love.

While there, I had the opportunity to lead a health system-wide committee tasked with improving blood sugar control. This made me passionate about creating innovation in pharmacy delivery to better serve patients.

Following my residency, I worked at Seattle Children's and helped launch the first emergency department pharmacy program in the State all while maintaining a part-time role with CHI Franciscan.

After about a year and a half, I went back to CHI Franciscan full-time to take lead on creating and growing a multidisciplinary infrastructure where doctors, nurses, and pharmacists work collaboratively to improve care and outcomes for pediatric patients in the NICU.

At about year three, I was given another opportunity to manage and grow a team of 30 pharmacists at over 20 different ambulatory clinics. We expanded the team’s services to 23 in-person and over 40 virtual clinics and launched a residency program. My tenure was short-lived, however, as my family decided to move back to Pittsburgh to be closer to family – now enter Cureatr.

When I joined Cureatr I instantly fell in love with the mission and the people. I was asked to help make the company’s vision a reality by creating and growing a technology-enabled telepharmacy clinic. Our structure is now me and two other pharmacists (Dr. Tatiana Wright and Dr. Tram Thai) serving as clinical program managers. We have a larger leadership structure where the three of us along with the project manager helps manage the entire clinical team. It's been a wonderful experience.

Q: What can healthcare organizations do to better engage with and leverage the skills of clinical pharmacists?

ZM: The biggest thing healthcare organizations struggle with is proving the return on investment that clinical pharmacists deliver. Clinical pharmacists are unable, in most states, to bill insurance as a doctor or nurse practitioner, for example, making it difficult to connect or services to improved outcomes.

You can see this as a downside, but you can also see it as an upside. All of healthcare is moving toward outcome-based payment models and away from fee-for-service. Pharmacists have been able to show an impact on improving outcomes, especially in areas like chronic diseases and transition of care, to name a few. When I worked in a large healthcare organization, the biggest thing that held clinical pharmacists back was getting the space needed to show our full potential.

Here at Cureatr, we're about getting pharmacists to practice at the top of their license, engage with patients immediately, and make that impact. Circling back to my childhood story, if I was a patient or parent of a patient speaking to a Cureatr pharmacist, they could help me sort through whether a medication was helping or hurting and help us assess other options.

Right now, clinical pharmacists need to be their own advocates in those healthcare organizations and explain how we can best be leveraged. In some healthcare organizations, this may require showing the impact clinical pharmacists can make and how to make this happen. There are good models out there to reference. CHI Franciscan, for example, has it down. There is a pharmacist at every table making every decision about any piece of care for the patient that involves medication. When you start putting your best foot forward in that way, things really fall into place.

I think this is an interesting space for Cureatr to become more engaged with in the future. Cureatr has the expertise to engage patients and to make a positive impact. For healthcare organizations that are newer to leveraging clinical pharmacists, we can be plugged in and help in a big way.

Q: What have you found that patients value the most about the services and support they receive from clinical pharmacists?

ZM: I find that when we speak with patients, the value they find in the service, first and foremost, is having someone who sits down and is all ears - listening to them about their lifestyle and medications and how these are intertwined. We're someone who is willing to go down into the details and say things like, "Tell me how you take your medication. Tell me how I can help you remember it. Tell me which ones don't make you feel good. Let's work through all of this together."

Another piece patients find value in — especially patients on multiple medications — is alleviating the stress around potential interactions and the overall safety of their medications. You can hear an exhale when you're speaking with the patient and you tell them, "I reviewed all your meds and this regimen looks safe" or "I don't see any major concerns but let's dive more into how you're feeling." You can see or hear patients take a breath. They instantly feel better.

The last part that patients find value in is having another person to listen to them and problem solve. Pharmacists are great at being a care net or bridging a gap. For example, they'll hear a patient is having issues with their blood sugars and their diet. The clinical pharmacist will talk through with the patient how to improve in those areas. The pharmacist will also send a message to the patient's endocrinologist and primary care doctor to say, "Hey, I spoke with the patient about this. Can you make sure to follow up about it at your next visit?"

Some of that subtle care coordination that pharmacists can do as part of their work really makes patients feel valued and feel like they are the center of their care. I think all healthcare professionals try to make patients the center of their care. Today, pharmacists are well attuned to being collaborative with all parties on the care team. We do not have prescriptive authority on that patient, so we need to be collaborative with the clinicians that do have that authority. I find patients really enjoy that collaboration.

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