Tatiana Wright, PharmD, is a Clinical Pharmacy Specialist with Cureatr. In this position, she provides specialized clinical pharmacy services through direct interactions with patients and the healthcare team. She works with the Clinical Services team to facilitate the achievement of both a high level of customer satisfaction and implementation of Cureatr’s telepharmacy service initiatives. Dr. Wright joined the Cureatr team in April 2021.
In this interview, Dr. Wright discusses what she loves and finds challenging about being a pharmacist, what attracted her to Cureatr, improving care for underserved populations, addressing social determinants of health, and strengthening medication safety.
Q: What do you love about being a pharmacist?
TW: My love for clinical pharmacy started during my fourth-year clinical rotations. I fell in love with the impact that pharmacists can have when they are a direct part of the healthcare team. I graduated pharmacy school and completed a residency at the VA (U.S. Department of Veterans Affairs). As a pharmacist at the VA, you are an integral part of the healthcare team and are given an unparalleled level of autonomy. As a result, the impact a clinical pharmacist can have on patient care is significant and continues to drive me.
My passion for pharmacy comes down to patients and delivering patient-centered care. Helping patients and improving their lives is why I became a pharmacist and what pushes me every day. I get to make unique connections with my patients. So much of my interaction with them is about listening and embracing the journey of the conversation. There is laughter, tears, knowledge, and counseling. There are tough discussions and "ah-ha" moments. Some of my favorite moments happen when following up with a patient, learning that they have achieved a successful outcome, and finding that the advice I provided is a part of why.
The opportunity to positively impact the lives of patients is incredibly rewarding. I am challenged daily. I am constantly learning and evolving because science evolves. My first thoughts are and will always be “what is the best for the patient?”
Q: In your journey as a pharmacist, what led you to Cureatr?
TW: Cureatr has given me the opportunity to do everything I already said and much more. What Cureatr is doing is the future of pharmacy and healthcare. I am part of an incredible healthcare team. We are delivering patient-specific care and having a tremendous impact on patients' lives. We are empowering patients through knowledge and understanding.
It is no longer enough to say, "Take this medication and come back in a month." Science, access to information, and technological advances have empowered the patient to ask, “why?” They are researching and educating themselves and they often say "I read this online. What do you think?" Because of this, our conversations must be more open and transparent. We need to be ready to explain what a medication does, why it is prescribed, how it should be taken, and how it is likely to interact with other medications. Then we need to be ready to invite questions and have or at least be able to get the answers.
Q: What are some of the biggest challenges you face as a clinical pharmacist?
TW: Regardless of the practice setting, I think adherence is our biggest challenge. We can make sure a medication is appropriate for the condition. We can make sure a medication is safe by assessing whether there are any reasons a patient should not be on it. We can make sure that the medication is likely to be effective in that it should do what we want and need it to do. We can hand that medication over to the patient and provide the necessary instructions, but what we cannot do is make them take that medication every day how they are supposed to take it.
The challenge is bridging that gap through a combination of counseling, individualized patient care, and allowing patients to have autonomy over their own healthcare. When you give people knowledge, you empower them to make the best decision they can for themselves. The goal is to provide education and then bridge that gap in between giving a patient a medication and the patient actually taking it.
Costs can also be tremendously challenging for many patients, and that can directly lead to nonadherence. There are medications that, regardless of whether you have insurance, are expensive. Even if a patient has a $5 copay, if they have 20 medications a month and are on a fixed income, that can make a big difference. In these situations, we need to bridge that gap by determining what is causing the nonadherence and then seeing if you can make an impact when a patient's insurance does not cover a medication or cover it enough to be affordable. Then we must work to determine which medications insurance will adequately cover. Then, does the pharmacy have it in stock? How long will it take for the prescription to be filled? Does the patient need it immediately? Could the doctor's office provide samples quickly or at all? Is there a prescription assistance program available? Getting the answers to these and other questions is about helping the patient and providing opportunities to access their medications in an easy and affordable way.
Q: It is well-documented that non-English-speaking patients receive fewer preventive services than English-speaking patients. As a clinical pharmacist, what do you believe are some of the key policies and procedures that can be changed to improve the outcomes for this critically underserved patient population?
TW: Readily available interpreter services, and more specifically, ones that healthcare teams should be able to access without delay to help patients. This is an essential service needed to prevent issues caused by language barriers.
We need drug information and resources in different languages. I try to use visual aids and videos as part of counseling my patients and assessing their learning style as we all learn differently. Some patients learn through pictures, others through reading or watching videos. As such, we need the ability to effectively show them or describe to them what they need to do and do so in a language that they understand best. Two-way communication in that preferred language is critical to using the teach-back method, which is fundamental in pharmacy and healthcare.
It is essential to have a patient's language reference well-documented in their electronic medical record. If the patient has a preferred language other than English, it should be clearly documented early in that record so that we can prepare accordingly.
At Cureatr, when we are handling medication reconciliation post-discharge, we make sure the shared documentation is in the patient's preferred language. Information is not information unless the patient can understand it.
Q: What are some things that can be done to address social determinants of health more broadly?
TW: I go back to education. Quality education is vital. If we can strengthen our education system and better support schools and teachers, the possibilities are endless. It all starts with the impact of early childhood education. It is important to provide health education that focuses on matters such as the importance of a balanced diet that can help reduce the likelihood of type 2 diabetes and heart disease and the importance of routine exams. I have seen many patients that lack access to routine exams and knowledge of their genetics. When patients understand that they have the BRCA gene and what that means for their likelihood of developing breast cancer, they now have knowledge that can be used to make better decisions about the type of care they should get and when to get it.
We need to improve physical access to care and have clinics that are located close to where people live and work. It also means having extended clinic hours. The average American works from around 9:00 am to 5:00 pm, but many clinics lack hours beyond that block of time. Lastly, we should explore opportunities to reach more remote areas through telemedicine and home-based healthcare.
Patient care representatives make a difference through assistance with several patient needs, including transportation and even childcare. They have helped me assist patients with completing prescription assistance program applications to account for those particularly expensive medications. We should explore more opportunities for healthcare professionals to partner with community groups to teach communities about diabetes, smoking cessation, nutrition, heart health, and other essential health and wellness concepts.
At Cureatr, we are always advocating for our patients and providing them with the tools and knowledge they need to best manage their medications and achieve successful outcomes.
Q: What steps do you believe can be taken to improve communication and ownership of medication safety across care teams?
TW: We need policies and procedures in place that better ensure the warm transfer of patients from one caregiver to another. An important part of this is having determined roles and knowing what your role is within the healthcare team. When you train to give CPR or respond to codes within the hospital, one of the most important factors for success is knowing your role within that team. If you do not know your duties and responsibilities, you cannot contribute effectively. The same applies in knowing your colleagues’ roles to ensure everyone is working effectively towards a positive outcome.
At Cureatr, we have clearly defined expectations and exercise that warm transfer and transition of the patient from the hospital to the home. But it does not stop there. Our discharge team makes sure patients have follow-up appointments with their primary care physicians within a week and ensures that they have the correct information and documentation. Furthermore, the team also works to ensure that patients have access to any other services and specialists they need to keep them on a path to a successful outcome.
But medication safety isn't just about medicine or medical conditions. When you are working within a healthcare team, there must be an understanding about a patient's social status and socioeconomic status in order to provide a 360-degree level of care. Some of this concerns the ability for patients to access their medications. But then it is a matter of looking at issues like accessibility to transportation and any necessary help at home either via home care or nurse visits. When we think about medications and adherence broadly, it inevitably helps with improving that communication and ownership of medication safety across the team.