The inflammatory bowel disease (IBD) patient-centered medical home offers patients an integrated experience that avoids the fragmentation of care often associated with the complex nature of the disease and its multiple comorbidities. Cleveland Clinic’s IBD medical home recently added a clinical pharmacist who specializes in IBD to its team of gastroenterologists, surgeons, nutritionists, dietitians, nurses, nurse practitioners and psychologists, who work together to capture the needs of the patient beyond the biological disease itself.
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Patient-centered medical homes aim to overcome some of the problems associated with the fragmentation of care by providing integrated care, improving patient experience and reducing costs. Although medical homes have already demonstrated advantages when applied in a primary care setting, recent incentives have aimed to apply this model of care in patients with IBD and other chronic gastrointestinal conditions.
“The ultimate goal of an IBD medical home is to optimize patient outcomes. Given complex treatment regimens that often come with insurance barriers and adverse effects, clinical pharmacists can play a significant role in overseeing and managing medications to help patients feel better, experience an improved quality of life and attain remission,” says Shubha Bhat, PharmD, who is currently the clinical pharmacy specialist in IBD.
The biologics and small molecule inhibitors often used in IBD treatment require close patient monitoring, extensive interaction with insurance companies, and time-intensive patient education. According to Dr. Bhat, the nature of these treatments opens the door for pharmacists to play a significant role in patient care.
“The pharmacist in this setting has four primary roles: medication education, medication monitoring, health maintenance assessments and financial toxicity management,” says Dr. Bhat. “In this outpatient setting, we form collaborative agreements with the partnering physician to provide these services for patients. Physicians can spend their time on diagnosis and treatment, while we provide patients with an in-depth education on the treatment itself in terms of what they need to do, what they can expect and the financial impact.” Dr. Bhat is available to meet with patients who struggle with medication adherence or adverse effects, insurance barriers, and health maintenance issues like smoking cessation and need for immunizations. She also follows patients longitudinally to provide medication monitoring and can identify patients who may warrant a change in or optimization of medications.
“Having an IBD pharmacist available to educate patients on how the treatments work, to emphasize the importance of adherence and commitment and to make them aware of financial resources allows us to provide the comprehensive care that is the hallmark of the medical home model,” says Miguel Regueiro, MD, Chairman of Cleveland Clinic’s Digestive Disease & Surgery Institute. “As a physician I consider it an invaluable resource for my patients.”
In addition to playing a crucial role in the treatment process for patients with IBD, Dr. Bhat precepts pharmacy students and residents and works with gastroenterology fellows who are learning the intricacies of IBD treatment. She also conducts research related to medications and the medication-use process, including biosimilars implementation and adoption. Additionally, her research has also focused on highlighting the role and impact of clinical pharmacists on IBD care, with hopes that other IBD practices and centers will integrate pharmacists in the multidisciplinary team setting. Dr. Bhat is also passionate about advocating for insurance reform to improve medication access for patients. “We need to transform the current landscape that requires hours upon hours of provider time gaining prior authorization for medications,” says Dr. Bhat. “Part of my research is focused on rethinking that approach entirely, as it’s a barrier to optimal patient outcomes.”