From Medications to Meaningful Care in IBD

Podcast Transcript

Dr. Scott Steele:

Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end. Hi again, everyone, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, president of Main Campus, colorectal surgeon here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today I am extremely pleased to have Dr. Shubha Bhat, who is a clinical pharmacist in gastroenterology specializing in IBD here at the Cleveland Clinic. Shubha, welcome to Butts & Guts.

Dr. Shubha Bhat:

Thank you, Scott. I'm excited to be here.

Dr. Scott Steele:

So today, what's the role of pharmacists in IBD? But before we go into that, for those of you who maybe this is the first podcast they've ever listened to regarding a pharmacist, give us a little bit about your background, where you're from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic?

Dr. Shubha Bhat:

Certainly. So I grew up in Philadelphia and I earned my PharmD degree at Northeastern University in Boston. And during my training, I had the opportunity to work at several institutions in Boston, Chicago and Denver. And all of these experiences gave me a broad perspective on patient care. So about seven years ago, I transitioned to providing clinical pharmacy services in a GI and hepatology clinic. And for the past five years, I have been embedded as a clinical pharmacist in the Digestive Disease Institute at the Cleveland Clinic. It's been an incredible experience and I'm really passionate about being part of the multidisciplinary team and helping patients manage complex conditions such as inflammatory bowel disease.

Dr. Scott Steele:

So again, before we jump into the topic, can you give us a little bit more background about what's the difference between a clinical pharmacist and maybe one that you might see, for many of our listeners, at a local pharmacy?

Dr. Shubha Bhat:

Yeah, that's a great question, Scott. So basically a clinical pharmacist has the extra additional training. So we do have the option of doing a residency and that can be specialized in certain therapeutic areas as well. But the main differentiation here primarily is that a clinical pharmacist is more involved in the patient care component side of things and not necessarily the dispensing capability within the community pharmacy. Those pharmacists are definitely a lot more accessible too. But they're going to be more involved in focusing on the medication dispensing component and making sure that there's no drug interaction or anything of that capability. As we talk further, Scott, you'll see that I do have a little bit more of a higher role in touching on other components of IBD care. So that also gives another unique aspect of clinical pharmacy is to be further more involved in the patient care and be part of a multidisciplinary team.

Dr. Scott Steele:

So let's jump right in there. So can you give our listeners a little bit of a high level overview of something that you must feel passionate about? And that's inflammatory bowel disease or IBD. What makes it unique and why were you interested in going into it?

Dr. Shubha Bhat:

So IBD is an umbrella term for chronic autoimmune inflammatory conditions that cause inflammation in the gastrointestinal tract. And it primarily consists of Crohn's disease and ulcerative colitis. Crohn's can affect any part of the GI tract while ulcerative colitis is limited to the colon and the rectum. What makes IBD unique is the fact that it's a lifelong nature and systemic impact. It's not just about the gut. Patients can experience joint pain, skin issues, eye inflammation and even mental health challenges. There's currently no cure for IBD, but current treatments aim to control inflammation, achieve remission, and improve quality of life.

Dr. Scott Steele:

Okay. So let's dig in a little bit further right there. So complex disease process, no question. Can you give our listeners a high level overview about the medications that are specifically used for the treatment of IBD?

Dr. Shubha Bhat:

Yeah, absolutely. So in general, IBD treatment is guided by two key factors, disease severity and location. Our primary goal is to induce remission and maintain this effectively and safely over time. So to achieve that, we have a range of options including aminosalicylate, immunomodulators, and corticosteroids, which are more intended for short-term use to control inflammation. And for our more moderate to severe disease, we utilize biologics and small molecules. If you're interested in learning more about the advanced therapies, I would highly recommend checking out Dr. Cohen's excellent podcast episode from July 2025. This provides a great deeper dive into this topic. One important point though to note is that these advanced therapies are often high cost specialty medication, which is why having pharmacists on the care team is so critical. Pharmacists can help optimize treatment access, affordability and outcomes.

Dr. Scott Steele:

Okay. So you just said complex high cost specialty medications. There's a lot when you break that down. So give us a little bit more there. What exactly does that mean?

Dr. Shubha Bhat:

Specialty medications are high cost medications that are used to treat complex conditions like IBD. They often require special handling, storage and administration, but they're often given as an injection or an infusion. And they also require close patient monitoring by the healthcare team to optimize efficacy and safety. Examples include advanced therapy, such as infliximab, vedolizumab, ustekinumab, and upadacitinib to name a few. These medications can also cost several thousands of dollars annually, and so as a result, treatment assets can be challenging to navigate as this includes prior authorizations and use of specialty pharmacies and/or infusion centers. The pharmacists play a significant role in helping patients navigate the insurance and affordability piece while again, optimizing treatment efficacy and safety.

Dr. Scott Steele:

I'll absolutely claim that I'm biased here, but I think we are the world's leaders in the care of the patient with IBD. And part of the reason that is we have the IBD Medical Home and we've had podcasts around that as well as having a lot of wraparound services for the patient that has inflammatory bowel disease. So tell us about the specific role of the pharmacist within that Medical Home and within IBD care.

Dr. Shubha Bhat:

So Scott, I also think I might be a little biased here, but I think that this is such an important question. So pharmacists are really truly essential members of the IBD care team and we can be integrated in many different settings. So whether that is a specialty pharmacy, an infusion center, or right in the GI clinic. So in my case, I'm embedded in the clinic that work side-by-side along with the gastroenterologist, our advanced practice providers, a care coordinator, dietician and psychologist to really optimize patient's experience and outcome with medication. My role includes educating patients about their treatment, monitoring for efficacy and safety, and this could include drug therapeutic monitoring when applicable, and also managing side effects. I also help patients navigate the financial and access challenges that come with these therapies, connecting them with the appropriate assistance program and working through insurance barriers as well. So in short, pharmacists in IBD care can make sure that patients can access and afford their treatment and make sure that they're achieving their therapeutic goals effectively and safely.

Dr. Scott Steele:

Yeah, it's pretty amazing. I would ask our listeners to think about the last time you went to a doctor's appointment and saw a pharmacist working with a social worker and an APP and a physician at the same time. So pretty ingenuitis care there. So pharmacists in the past have been referred to as the Jack-of-all-trades. How do you feel this translates to patient care?

Dr. Shubha Bhat:

A pharmacist can definitely wear many hats. We can be a clinician, we can be an educator, we can advocate, we can serve as a coordinator, and really our role can go beyond medication. So for example, in the context of IBD, we often help with smoking cessation. And you know this directly, though smoking is associated with many negative outcomes, so like in the realm of surgery, we know that that can impair healing, it can increase the risk of complication. We also know that smoking can potentially reduce the treatment effectiveness. So when patients are motivated to quit, pharmacists are well-equipped to help guide them through that process. We also focus on health maintenance. So patients on immunosuppressive therapies need to stay up-to-date on vaccines and certain screening. And pharmacists play a key role in making sure that those recommendations are communicated and implemented. Finally, I would say that pharmacists provide a little bit of a unique perspective because we understand both the clinical and operational side of healthcare. So that means that we're not just making treatment recommendation, we're also ensuring that those recommendations can actually be put in the practice.

Dr. Scott Steele:

So Dr. Bhat, you're also involved in research that's ongoing. And so can you tell our listening audience a little bit about the type of projects that you're working on? And specifically, are there any new treatment options, medications, other kind of therapeutic challenges you're trying to overcome that are on the horizon for IBD?

Dr. Shubha Bhat:

Yeah, so research is something I'm definitely very passionate about. And my focus so far has been on advancing the role of IBD pharmacists and integrating us more fully on the care team as well as improving medication outcomes and access. So for example, one of the projects that I'm working on is actually evaluating the best educational approaches to help patients feel confident about biosimilars. So this has been something disruptive in the IBD space. The biosimilars are biologic medications that are highly similar to a biologic medication that has already been approved by the FDA or is considered the original biologic medication. There's a lot of concerns or hesitancy around the treatment. And a lot of the time we're using it generally in a situation of where it's being enforced or mandated by the insurance company. So there's a lot of patient issues of hesitation with this category of medication. So we're really in the realm of what I'm doing research-wise. And by far for new treatment, the pipeline looks exciting. One area that's been generating a lot of buzz recently is the TL1A inhibitors. TL1A standing for tumor necrosis factor-like cytokine 1a. We have identified that this is a target involved in both inflammation and fibrosis. And there's also growing interest in combination therapies because we know that using multiple mechanisms together can actually be more effective at controlling inflammation and achieving remission. That being said though, Scott, we do need more studies to figure out the best combination than where they fit in the treatment pathway.

Dr. Scott Steele:

I want to go back to a little bit about this IBD home. And this model of the pharmacist and other ancillary services being truly an integral part of the patient's care team. Can it be implemented for any GI or hepatology condition? And what advice would you give to maybe other institutions who are considering adding pharmacists to their multidisciplinary care teams?

Dr. Shubha Bhat:

Absolutely. So in addition to IBD, I'm also providing clinical services for patients with other GI and liver condition, such as eosinophilic esophagitis, so EoE, and metabolic dysfunction associated with steatohepatitis or MASH. So conditions such as hepatitis C, cirrhosis, H. Pylori, and even transplant can greatly benefit from pharmacist involvement. For institutions that are considering this model, my advice would be to highlight the value that pharmacist bring to not just in improving patient outcome, but also when driving prescriptions to internal pharmacy and contributing to major cost savings initiative. And by optimizing therapy, we can reduce hospitalization. Once the pharmacist is onboard the part of the team, it's important to establish collaborative practice agreements that clearly define the scope of patient care. And don't forget to track outcomes as we know that cost savings and improved adherence will provide strong justification for keeping the pharmacist as part of the care team.

Dr. Scott Steele:

That's fantastic. And I would just like to remind all the listeners that each of the different conditions that Dr. Bhat just mentioned in the beginning of that last answer is available on podcasts here at Butts & Guts, so please look for them. So now it's time for our quick hitters, a chance to get to know our guests a little bit better. So first of all, what was the favorite place you've ever traveled to?

Dr. Shubha Bhat:

That's a tough one. Favorite place. But perhaps my favorite place might maybe be Alberta or Banff in Canada, deeply beautiful landscape. Would love to live there if there's an opportunity for that.

Dr. Scott Steele:

Yeah, absolutely. I've seen moose walking right downtown in Banff. Very, very beautiful, a little bit cold. But what was your first car?

Dr. Shubha Bhat:

So interestingly, given that I've trained in a lot of cities, I actually never owned a car until I moved to Cleveland. And being a dog lover, I had to invest in buying a Subaru, so I have a Subaru Forester.

Dr. Scott Steele:

Fantastic. We've just come through the holiday season here. What is your favorite holiday?

Dr. Shubha Bhat:

So probably the favorite holiday may be around Thanksgiving and Christmas. I just love how everything slows down. There's a moment to just take in everything that's happened in the past year, celebrate all the victory, all the gains, all the wins and reflect on what you want to do with the new year coming in. So would say that November, December time would be my best favorite holiday time.

Dr. Scott Steele:

That's awesome. And so what advice would you give to maybe some of our listeners who are maybe considering pharmacy as a career or wanting to get to know their pharmacists a little bit better?

Dr. Shubha Bhat:

Yeah, so definitely would say pharmacists, I think we rank as one of the top accessible healthcare providers. So we're out in the community setting. You'll hopefully see us in the doctor's office a little bit more frequently now, just really all over. So just asking the pharmacist as part of the care team and if you can have a chance to meet them. And if not, then definitely getting to know the pharmacist at the community setting and just talking to them about what their day-to-day job is like, what's the extent of education, what opportunities they are to get involved. And really, I think all of us in general are just a super friendly bunch. So always happy to connect with anyone that might be interested in the career path.

Dr. Scott Steele:

Fantastic. And so give us a final take-home message to our listeners with regards to medication specifically or pharmacy regarding IBD.

Dr. Shubha Bhat:

Yeah. So I think in general, Scott, IDB is a complex and lifelong condition. But I think with a strong team-based approach, patients can do really well. We know that medications are evolving rapidly and pharmacists are key partners in improving outcomes, assets and affordability. So I think in general, collaboration truly makes the difference. And when pharmacists are part of the care team, everyone will benefit.

Dr. Scott Steele:

Great points. And so to learn more about IBD treatment at Cleveland Clinic and to download a free guide, please visit clevelandclinic.org/ibd. That's clevelandclinic.org/ibd. And for more information on Cleveland Clinic pharmacy locations and services, please visit clevelandclinic.org/pharmacy. That's clevelandclinic.org/pharmacy. Dr. Bhat, thanks so much for joining us on Butts & Guts.

Dr. Shubha Bhat:

Thank you.

Dr. Scott Steele:

That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.