Beyond Filling Prescriptions: Hospital Pharmacists Serve as Health Care Access Champions
October is American Pharmacists Month, a time to recognize pharmacists’ contributions to health care and spotlight the vital role they play as members of the health care team and valued providers of patient care services. Real World Health Care is honored to acknowledge the dedication of these medical professionals by profiling a board-certified clinical pediatric pharmacist who is making a difference for cystic fibrosis patients in the western United States.
Jeffery T. Zobell, PharmD, BCPPS, serves as Advanced Clinical Pharmacist in the Primary Children’s Cystic Fibrosis Center at Intermountain Primary Children’s Hospital in Salt Lake City, Utah. The Center is a fully accredited multi-disciplinary center that specializes in the coordinated care and treatment of children living with cystic fibrosis (CF). It is the only pediatric CF center in Utah and serves patients from multiple mountain states including Wyoming, Idaho, , and Nevada.
The Center cares for over 300 patients, seeing on average 35 a week (Most in-clinic visits have been replaced by telehealth visits during the COVID-19 pandemic.). Dr. Zobell meets with every single patient and family at each visit and serves as a liaison between the clinic and inpatient pharmacy teams if the patient is hospitalized.
“One of the advantages of our Center is that I and everyone on the multi-disciplinary team—gastroenterologists, pulmonologists, endocrinologists, otolaryngologists, nurse practitioners, nurses, dieticians, social workers, psychologist, respiratory therapists, physical therapist, pharmacy technician and other specialists—work in one clinic room right next to each other,” he said, adding that this extended team approach exceeds the requirements of the CF Foundation, the world’s leader in the search for a cure for cystic fibrosis. “The patient gets to see every specialist in one place and doesn’t have to repeat questions or concerns to each provider. Plus, the provider team is better able to communicate proactively with each other and with the patient and their family.”
Cystic Fibrosis and Medication Therapies
CF is an inherited disorder that causes severe damage to the lungs, digestive system, and other organs in the body. It affects the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery. But in people with CF, a defective gene causes the secretions to become sticky and thick. Instead of acting as lubricants, the secretions build up and block tubes, ducts, and passageways, especially in the lungs and pancreas. (Source: Mayo Clinic)
While there is no cure for cystic fibrosis, medication treatments can ease symptoms, reduce complications, and improve patients’ quality of life. Dr. Zobell explained that most CF patients take 10-15 medications a day, including:
- Gastrointestinal medications in pill and/or liquid form. These medications include pancreatic enzymes that help dissolve and absorb fat, sugar and protein from a patient’s diet. Medications in this category also include fat-soluble vitamins, stool softeners to prevent constipation or bowel obstruction, and drugs for liver disease.
- Inhaled medications to thin and break up mucus in the patient’s airway, so they can breathe more easily. Because the thick mucus common with CF can contain harmful bacteria, inhaled antibiotics are often prescribed as well.
- Injectable insulin to treat diabetes, which is a common complication of CF.
- Genetic therapy with CF transmembrane conductance regulator (CFTR) modulators for patients with one or more mutations in the CFTR gene. According to Dr. Zobell, these therapies are among the most effective for CF because they correct the underlying genetic defect and balance the fluids that cause mucus. They improve the patient’s ability to move mucus, which leads to clearer airways and better absorption of nutrients.
“Medication protocols for CF are complex, and for pediatric patients they require special attention to dosing, drug interactions and compliance monitoring,” said Dr. Zobell. “It’s my responsibility as a clinical pediatric pharmacist to make sure the right drugs are being prescribed in the right amounts and that patients are following their medication schedules appropriately.”
Access to Medication Therapies
Dr. Zobell meets with each clinic patient at least four times a year, as recommended by the CF Foundation. During these in-person or telehealth sessions, he reviews all their current and past medications, allergies, and drug interactions. When a new medication is prescribed, he explains the role of the medication in the patient’s overall care to make sure they understand its importance.
He encourages his patients and their families to advocate for themselves by asking questions and engaging with him and other members of the care team. Honesty, he said, is the best policy, especially when it comes to medication adherence.
“I work with patients to make sure they’re taking their medications as prescribed,” he said. “If they aren’t, I work with them to find out why and solve any problems relating to access.”
Dr. Zobell said the biggest barrier to complying with CF medication protocols is cost; some of the gene therapies carry a $300,000 annual price tag. He works regularly with Charitable Patient Assistance Programs (CPAPs) such as the HealthWell Foundation, which sponsors Real World Health Care and has grant programs to help patients afford out-of-pocket costs associated with CF Treatments and CF Vitamins and Supplements.
“The need for such programs has increased dramatically during the COVID-19 pandemic as families have faced job cuts, job losses and changes in or loss of insurance,” he said. “I make sure patients are enrolled in these CPAP programs and are using their grants fully and appropriately.”
Another barrier to CF medication adherence is the number of specialty pharmacies patients must go through to get their various prescriptions filled. With many specialty pharmacies delivering medications by mail, this barrier has become even more of an obstacle as the U.S. Postal Service has experienced delivery delays in recent months.
“When I started at the clinic, it wasn’t uncommon for families to tell me they were working through five or more specialty pharmacies to get their scripts filled, which can be incredibly cumbersome to manage,” he said. “I help them consolidate that and have developed relationships with most of the large specialty pharmacies so I can resolve issues quickly to get them their medications in a timely fashion.”
Pediatric Pharmacists Provide Highly Specialized Services
Dr. Zobell was quick to point out that pediatric pharmacists are vital to ensuring that children receive appropriate care. It takes years of training, including post-graduate residency programs, to become a medication-use expert for children.
“Pediatric patients are different than adult patients,” he said. “You can’t just cut an adult dose in half for a child because their biology is unique, and drugs can interact differently in them. One-size dose does not fit all.”
The pediatric pharmacy profession is supported by the Pediatric Pharmacy Association (PPA), of which Dr. Zobell is a member. The PPA’s mission is “to promote safe and effective medication use in children through collaboration, advocacy, research and education.” According to Dr. Zobell, one of the group’s goals is to encourage pharmaceutical companies and the U.S. Food and Drug Administration to place more focus on children and pediatric dosing when developing new treatments.
“I’m incredibly motivated to help my patients, and I’m pleased to see that other organizations are recognizing the importance of pediatric pharmacists,” he concluded, adding that the CF Foundation included dedicated, in-clinic pharmacists to its list of recommended CF care team providers in 2015.