Provider Status Profile
Sonya Collins
Living with multiple chronic conditions, including diabetes, kidney failure, heart failure, seizures, HIV, and depression, “Laura” takes dozens of medications. The day after Laura’s recent hospital discharge, Olufunke Sokan, MPharm, PharmD, paid her a virtual visit at home via videoconferencing. She wanted to ensure that Laura, who has a cognitive disability, had everything she needed to continue to recover at home. “Some patients just keep coming back to the hospital,” Sokan said. “And the number one reason is medication and its use.”
Sokan is an advanced practice pharmacist at the University of Maryland School of Pharmacy eHealth Center who is working with the University of Maryland’s Medical System Mobile Integrated Health (MIH) team to provide care to high-risk patients during their transition from hospital to home. Relying on an operations center supported by physicians, nurse practitioners, a social worker, community health workers, and pharmacists, the MIH team fields a paramedic–nurse team to address any issues that might put a patient at risk for readmission.
“The School of Pharmacy recognized the importance of telehealth as a clinical tool for pharmacists long before the COVID-19 crisis. COVID-19 has brought to light how effective these tools can be on patient care,” said Magaly Rodriguez de Bittner, PharmD, FAPhA, FNAP, executive director of the Center for Innovative Pharmacy Solutions and associate dean for clinical services and practice transformation at the university.
Virtual education
On phone calls with patients, Sokan performs comprehensive medication therapy management: reconciling prescription lists, ensuring appropriate medication use, and making sure patients understand why they’re taking their medications. “A lot of times, patients say, ‘Nobody ever told me that. Okay, I’ll start taking it.’ ” Patients who need extra support, like Laura, receive a home visit from a paramedic–nurse field team while the pharmacist supervises on video. The team helps the pharmacist sort through years’ worth of prescriptions to eliminate unnecessary medications. The pharmacist can also demonstrate proper technique when necessary over video.
Sokan typically keeps track of patients for 30 days after hospital discharge. But since the pandemic started, patients continue to call her long after the follow-up period ends. When some doctors’ offices closed completely and patients couldn’t reach their primary provider, they knew they could get Sokan on the phone.
“We are still the most accessible health care providers,” she said. Sometimes, it just takes a chat with a pharmacist for patients to get on board with taking their medications.
Crisis averted
Laura would have been right back in the hospital for hypoglycemia had Sokan not intervened. During the home visit, Laura insisted her nighttime basal insulin dose was 65 units. In fact, the correct dose was 5 units.
“How did she get from 5 to 65? Luckily, she had forgotten to take it the night before,” Sokan said.
Sokan used the program’s HIPAA-compliant text messaging platform to confirm the dose with the team’s physician. She then made sure that Laura understood how to administer the insulin. Sokan also wrote a referral for a home health nurse and transportation assistance.
Laura hasn’t returned to the hospital since Sokan’s visit. Hers is one of many stories of crises averted by phone calls or visits from a pharmacist. Sokan’s interventions have prevented risky drug interactions, duplicate dosing, and potentially life-threatening contraindications.
In just 2 years of operation, the MIH team has proven its worth by cutting hospital readmission rates. Yet, the program relies on grants to keep running. Few health insurance plans reimburse for pharmacist-provided care because CMS does not recognize their services for payment.
“The top needs we address in our program are medication-related,” said Sokan. “The money we save payers by preventing hospital readmissions would more than pay a pharmacist’s salary.”
As long as medication problems are a top reason for hospital readmissions, pharmacists will continue to be a crucial part of the solution. “Pharmacists are the medication experts,” Sokan said. “If we get appropriate payment for our services and the recognition as clinical providers, we can provide more of these critical services to more patients.”
Provider status stories
Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCare.com.