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Leveraging the Skills of Clinical Pharmacists: Q&A With Meghan Smart

ways to increase medication compliance


Meghan Smart, PharmD, BCMTMS, INHC, RYT, is a Clinical Pharmacist 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. Smart became a full-time member of the Cureatr team in November 2021.

In this interview, Dr. Smart discusses what brought her to Cureatr, what she loves about being a pharmacist, how healthcare organizations can better integrate clinical pharmacists, and recent care experiences that demonstrate how Cureatr's clinical pharmacists are improving patient health and outcomes.

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

Meghan Smart: I worked at a community pharmacy in New York when I was in high school. One of the pharmacists I worked with inspired me to pursue a career in pharmacy. He was a trusted fixture in our town, he knew everyone, was trusted by everyone, and he was dedicated to helping the people of our community every day. He was the type of person who could remember every detail of the last conversation he had with anyone.

I went to pharmacy school at Northeastern University in Boston. I came back to New York after graduation and worked as a community pharmacist in New York City. I also volunteered with pharmacy students at St. John's University, which I really loved.

In 2019, I took a break from work and traveled abroad for almost a year. I returned right before the pandemic started. I found Cureatr not long after. I signed up to be a volunteer pharmacist when Cureatr was offering Meds 360° (medication management software solution) and pharmacy services free of charge to help relieve the significant burden on the healthcare organizations during the pandemic. I eventually transitioned to a contracted pharmacist position as Cureatr launched Cureatr Clinic and became full time in November.

I love it here at Cureatr. The Clinic has been setup in a way that allows me to work with patients every day and see a positive impact in their lives.

Q: What do you love about being a pharmacist?

MS: What I love most about being a pharmacist is how accessible we are to patients. Pharmacists are in a unique position because we're easy for patients to get to and we have expertise about their medications and payment plans. We have the knowledge to help them in so many areas, including how they should be taking their medications, how they should store their medications, risky combinations of medications and other things to avoid, and steps they can take to make their medication therapy more effective, just to name a few. There is a lot that goes into medication safety and adherence, and I love that we can support patients’ safety and appropriate use of their medications while also being an easy access point for them.

I think part of what makes Cureatr Clinic great is that providing medication management services via telepharmacy is easier for patients, especially those who have a tough time getting out of the house or have some other barrier to access the care and support they need. Cureatr provides huge benefits to patients in a convenient, accessible way.

Q: Why are clinical pharmacists in the best position to take the lead on medication management?

MS: Pharmacists are the medication experts on the healthcare team. Medication management is what we do. We spend so much more time learning about medications and refining our expertise in this area than anybody else on the healthcare team.

It's exciting to see this expertise recognized and appreciated in Cureatr Clinic's provider clients. We're becoming an integral part of the care team. We have strong relationships with the providers and are using Cureatr's messaging system to be in close contact with providers when patients are being discharged. With this system, it's easy to offer insight and recommendations, and share what we know to help patients and their healthcare team when those recommendations will make the most impact.

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

MS: Historically the pharmacy department in a healthcare organization was often isolated from other parts of the team. We know that when clinical pharmacists are more integrated in the care team, patients have better outcomes. The easiest way to leverage pharmacists in the care team is to embrace the technology that brings us closer. Using a solution like Cureatr Secure Messenger makes it so much easier for the pharmacist to be in contact with providers and quickly make a recommendation or coordinate the patient's care.

When you have clinical pharmacists on the healthcare team, you see patient outcomes directly improve because of their involvement. While our expertise is in medications and medication management, we can do much more for healthcare organizations and patients. For example, pharmacists are trained in motivational interviewing and know how to get patients to better understand why it is important to take our recommendations. It's not enough to give patients information. You must help them understand the importance of that information and, ultimately, what it means for their overall health.

Helping patients connect the dots between their medications and quality of life is one of the most important things we can do.

Q: Can you share a few experiences of how your work with patients has resulted in improved health outcomes?

MS: I recently helped a 93-year-old woman. She was discharged from the hospital after being admitted for pneumonia. Besides the pneumonia, she was quite healthy for her age. But while in the hospital, she was treated with antibiotics and developed Clostridioides difficile (C. diff). It was a nasty gastrointestinal infection that threw her for a loop.

I spoke with her as she was coming home following discharge and did a little more investigating into what her normal routine looks like. I discovered that she had been taking over-the-counter Prilosec for years. People often take over-the-counter medications and think that since they're accessible without a prescription, these medications are benign, but that's not always the case. This is part of why we try to do a thorough review of a patient's medications and learn about what's happening in their lives.

The Prilosec she had been taking every day alters the microbiome and makes it easier to get an infection like C. diff. The drug pre-disposes a person to having C. diff and having a recurrence going forward. The ability to identify that a patient like this woman is taking a non-prescription drug and one that could negatively affect their health is really important and cannot be missed if we want to help keep patients safe.

Since she had been on the Prilosec for so long, it wasn't a medication we wanted to stop suddenly. I was able to work with her and her family on how to titrate off the drug and begin taking an appropriate probiotic — one that's going to be supportive for her in terms of building that microbiome and avoiding complications in the future. This kind of intervention is fairly simple for a clinical pharmacist, but it can make a big impact on a patient's quality of life.

Another patient I was working with recently exemplifies why I like the comprehensive medication management approach we have here at Cureatr. He was in his late 70s and had heart failure. I spoke with him for the first time after being discharged from the hospital. We reviewed everything, and it sounded like he was in pretty good shape. He had a good handle on his medications.

When I followed up with him a month later, he had been to the cardiologist, who wanted him to switch from his existing medication to a new medication associated with better outcomes for patients with heart failure. When I spoke with the patient, the prescription had already been sent to the pharmacy, but he wasn't going to pick it up because it would cost him $400 per month. That was an amount he couldn't afford. I was able to connect him with a patient assistance program and get him enrolled to bring that copay down so that he could afford the new medication. It really was the best choice for his treatment.

This is another example of a critical aspect of patient care that so often — and too often — falls through the cracks. There are assistance programs available to patients, but many do not know about them. We know about these options, and it's easy for us to connect patients with them and make such a big difference in their care. We know what can be done to help patients in ways that they and even other members of their healthcare team might not.

When a patient is with their healthcare provider, there's almost always no time to get into these details. That's why another thing I love about our setup at Cureatr is that I get a block of time with a patient to find out more about what's happening in their lives and how to make their medications work best for them. The time we have together is so valuable and so important.

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