A unicorn example of seamless physician-pharmacist collaboration gives other organization clues

The push for enhanced collaboration between healthcare professionals continues building momentum. This initiative is driven by a combination of the continued overhaul of the healthcare system as well as competition between institutions¹. While some healthcare organizations continue to wrestle with the lack of unity in interdisciplinary practice, one organization has made major strides in efforts to enhance the synergy between the two professions.

“I think physicians and pharmacists don’t visualize the synergism of pharmacist-physician collaboration,” says Michael Schuh, BS, PharmD, BMA, FAPhA, clinical pharmacist and assistant professor of family and palliative medicine at the Mayo Clinic in Jacksonville, FL. “Working together is the perfect storm of patient care and very powerful for the patient.”

The routine processes in place at Schuh’s practice illustrate one example of how collaborations between physicians and pharmacists can amplify the quality of care.

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“There are several ways that I collaborate with pharmacy,” says Molly Kilpatrick, MD, a palliative medicine physician who provides both inpatient and outpatient care at the Mayo Clinic. 

The institution runs weekly interdisciplinary team meetings for the palliative team and parties who have expressed an interest in palliative care. Pharmacists and pharmacy students are present, along with other non-physician healthcare professionals. An integral part of the organization’s didactics, the meetings entail round table discussions in which clinicians review a few patients’ cases. The team encourages student pharmacists to become engaged and take on active roles in helping to tailor therapy-a feature Kilpatrick says often triggers follow-up presentations by pharmacy students to the group at IDT meetings to review new medications and updates.  

The pharmacy staff contributes e-consults and outpatient pharmacy consult orders in which pharmacists review patients' charts or conduct face-to-face patient consultations. Examples of outcomes of pertinent interactions include providing patient education to improve adherence, to enhance deprescribing, and contain drug-related costs due to issues such as prescribing cascades, duplicate or inappropriate therapies, and drug interactions. Kilpatrick also relies on pharmacists to provide a quality check, citing a case in which a patient presents to the outpatient clinic with akathisia as an example. 

“[I rely on pharmacists] to review and double-check my plan," Kilpatrick says. She also appreciates having a pharmacist's input on discontinuing contributing or precipitating drugs as well as identifying additional potential contributors.

As Kilpatrick’s colleague, Schuh collaborates with Kilpatrick and other physicians to solve these and other medication problems. While he says the majority of these interactions occur via phone, email, and electronic medical record documentation, he also engages with patients physicians refer to him for pharmacology and medication management consultations. However, Kilpatrick also relies on pharmacists for a wide variety of additional interventions such as:

• Checking drug availability and cost for uncommon prescriptions

• Engaging pharmacists to consult on pre-transplantation medication optimization (e.g., evaluating a patient’s medications for the potential of serotonin syndrome),

• Assisting with quality improvement projects in efforts to tweak inpatient order

• Working with physicians to create higher-concentration medications for lower volume drips tailored to specific inpatient needs

• Collaborating with physicians to contribute written content, such as medication-related “fast facts” for palliative care

The concept of tapping into pharmacists’ specialized skill set to optimize patient care is nothing new. More institutions across the nation are incorporating practices into their plans. A growing body of evidence shows interdisciplinary practice is beneficial for a variety of conditions, including Alzheimer's disease, pain management, diabetes, and heart disease along with a host of other chronic illnesses and patient circumstances. Additionally, these collaborations include professionals from many health backgrounds other than medicine and pharmacy, such as nurses, case managers, social workers, physical therapists, occupational speech pathologists, and more. 

Despite the purported boons, Schuh and Kilpatrick recognize that the degree of professional intimacy physicians and pharmacists on their team share is a rarity.

“There are no big hurdles in my organization since it has been historically set up for the team," Schuh says. "The fact that there are very few silos is one major difference between my place of work and others." 

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Kilpatrick agrees. “We have a very collaborative environment, but I think there is a lot of underutilization of collaboration [in other organizations].”

She offers physicians the following tips to help organizations seeking to improve physician-pharmacist collaborations:

Recognize that clinicians’ and business needs may vary depending on the practice and adjust accordingly.

• Get to know the pharmacists within one’s organization

• Be proactive in communications with pharmacists. “Anticipate if a prescription may trigger a question form the pharmacists and give them a heads up in advance.”

• Utilize available electronic or in-person pharmacy consultations.

• Get creative: Think of interesting ways to incorporate teaching to your group to improve quality and workflow.

References:

Siedlock F, Hibbert P, Sillence J. from practice to collaborative community in interdisciplinary research contexts. 2015 Feb; 44(1)97-107. DOI:10.1016/respol.2014.07.018