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Shubha Bhat, PharmD joins the Butts & Guts podcast to discuss Cleveland Clinic's unique inflammatory bowel disease (IBD) patient-centered medical home and how a clinical pharmacist collaborates with a team of gastroenterologists, surgeons, nutritionists, dietitians, nurses, nurse practitioners and psychologists to capture the needs of a patient dealing with this condition.

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The Role of a Pharmacist in Cleveland Clinic's IBD Medical Home

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi everybody, and welcome to another episode of Buts & Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And I'm super excited today, because we're going to have somebody on that we have not actually had this role on before, and that's Dr. Shubha Bhat, who is a PharmD gastroenterology clinical pharmacist here at the Cleveland clinic. Dr. Bhat, thanks for joining us.

Dr. Shubha Bhat: Happy to be here. Thank you for having me.

Dr. Scott Steele: Great, so we're going to talk a little bit today about the role of the clinical pharmacist in Cleveland Clinic's IBD Medical Home, something that that's been very unique and is a critical aspect to the care of these patients. Before we go down there, some people out there may say, " I think I know what a pharmacist is, but what's a clinical pharmacist and a PharmD and all this stuff?" So tell us a little bit about yourself, your background, and how did it come to the point that you're here at the Cleveland Clinic?

Dr. Shubha Bhat: Just to define, a PharmD is a doctorate on pharmacy degree. Basically this is a area of medicine, if you will, where we really tend to specialize primarily on medication, so anything related to medication, the pharmacist is going to be your go-to person to help in terms of dosing, side effects management, etc. In the clinical pharmacy space, that's kind of a newer area of pharmacy, if most people want to know. Traditionally pharmacists tend to be practicing more in a community setting, so a lot of people tend to be familiar with CVS, Walgreens, like basically pharmacists in that setting.

However, the world of the clinical pharmacist has recently evolved, that more we're being embedded in the hospital and in clinic than we're participating on patient care team, and really contributing from a medication perspective and making sure that we optimize medication-related outcome and hoping that that will include and drive and optimize patient outcome in turn.

Dr. Scott Steele: That's fantastic, and so today we're going to talk about the role in IBD medical home. And so for all the listeners out there, I encourage everybody to go back and take a look at some of our back views on IBD, but just as a broad overview, remember, IBD is the inflammatory bowel disease. It's composed oftentimes of ulcerative colitis and Crohn's disease, and then there's some patients with a little bit of crossover in terms of indeterminate colitis, and it involves a multidisciplinary approach. We've had great talks on it in the past. We have some of the world's leaders here at the Cleveland Clinic, and we're going to talk a little bit about some of the expansion more recently, and that's the role of the medical home, so let's dive right into Cleveland Clinic's medical home. So what is a medical home and what are some of the objectives that these patient-centered care teams aim to achieve?

Dr. Shubha Bhat: The concept of the medical home is essentially that we want to bring the care to the patient and that the care is going to surround the patient. Basically we want to bring comprehensive care, and that includes meeting with the gastroenterologist, a psychologist, the nurse, the pharmacist, a dietician, so really making sure, even like a surgeon, and making sure that we're really providing comprehensive care to the patient. And so the ultimate objective is that we basically want to optimize patient-centered outcome because we're comprehensively caring for the patient as a whole.

Dr. Scott Steele: So how does the pharmacist, and specifically the clinical pharmacist, what is your role in this medical home?

Dr. Shubha Bhat: When we talk about treatment for inflammatory bowel disease, it can be a complex thing depending on where the patient is in terms of their diagnosis. If it's a new concept, then the concept of being particularly on medication that's biologic can be really overwhelming. In that sense, the pharmacist is well equipped to come in and provide education and reassurance that this is a medication that potentially will hopefully help treat and control the inflammatory bowel disease. For patients that are already on medication, the role of the pharmacist, really, is to make sure that we're optimizing the safety and efficacy of the medication and making sure that we're keeping patients in remission and our optimizing the dose and frequency as needed.

And then lastly, the pharmacist can actually play a great role in terms of health maintenance, so making sure that the health maintenance needs of being on these medications is being... So whether that means that they see a dermatologist and do a skin exam, whether it is getting a bone scan, so making sure that all of the components, including vaccinations are up to date to keep the patients healthy. And then lastly, there's a lot of financial taxes to be involved with these medications, they can be really expensive, and navigating this budgetary pharmacy landscape is really complex, so the clinical pharmacist is well equipped to help and step in and help in with that role.

Dr. Scott Steele: Yeah, and for all the listeners out there, I can tell you, it goes without saying that inflammatory bowel disease really runs the spectrum of some people need just a few medications, or in even some cases, no medications. The others, as Dr. Bhat says, that can be involved in a lot of medications and they can be really time consuming, and they can be expensive and they can be confusing, and you got other medications. So this idea of the clinical pharmacist being able to help sort all this out is wonderful in that. And I'm going to ask you a completely... And feel free to be biased here, but how have you seen the medical home improve since pharmacists were added to the clinical team?

Dr. Shubha Bhat: Yeah, so definitely I'm having a little bit of bias here since that started. I feel that having me embedded in part of the team has really helped optimize medication education, so spending time with the patients to really explain the beginning, the middle or the end of medications, that they're really completely aware of what to expect and how to navigate that process. I think that vaccination rates have improved, so at this point going back and looking at the data, but I have been able to optimize vaccination rates within my population.

I'm definitely helping patients navigate the specialty pharmacy landscape, so making sure we do a lot of care and making sure that infusion appointments are scheduled, that they're getting their medications on time, and basically navigating any insurance failures or hurdle. So having a pharmacist that's really able to... I think it's just another resource for the team to have when it comes to managing any medication-related needs, which can be sometimes complicated and time intensive.

Dr. Scott Steele: You do more than just that. You're probably doing some research and everything, so what types of research are you or your team conducting, in either medications or medical management to better treat IBD?

Dr. Shubha Bhat: One area that I know that we're definitely interested in his petition medicine. We know that with inflammatory bowel disease and the medications that we use, one of the particular downside is that over time, patients may not respond to treatment, or they might not even have an initial response to treatment. And so one of the research area that we're really interested in is how do we identify specific medication targets, or how do we identify specific genes that may be predictive of patient response to biologic treatment, particularly?

We're hoping that that will be a therapeutic advance in the future, that we can actually pinpoint precise factors that will actually help us determine ahead of time what treatment patients are going to respond to, so that we can really optimize outcomes, and that patients are not necessarily suffering or having symptoms for a prolonged period of time while we do the classic assessment of making sure if the medication is working. And that involved doing a colonoscopy, but we always have to give that medication time, so imagine living with symptom for three to six months until we finally decide that the medication is not working. So hoping we invent that area, we're able to identify right up ahead, even at a better time frame when a medication is going to be effective, and if it's the best one for the patient.

Dr. Scott Steele: That's extremely exciting, and I wish us well, because I think that's going to be a huge improvement in the care of our patients. Tell me, where do you see this IBD home in the future? Where do you see it happening? How's it going to advance?

Dr. Shubha Bhat: I think that the main thing is really having comprehensive embedded care, so really having a linked network. When it comes to extracting, like getting information from outside hospitals, we're hoping that it'll be a little bit more integrated. But if anything, I think if we think about when it comes to integration of care. But beyond that, I think an addition, and I think that the team just growing, so having more specialists, having more comprehensive care, having access to a dermatologist and rheumatologist to help manage all the extra intestinal manifestations. So really again, the main point again, is that the patient is at the center of the care model, and so how do we optimize that model so that we're basically making sure that it's one step care for all?

Dr. Scott Steele: And I want to take a step back from IBD and medical home today. A lot of people, again, are a little confused about the exact role. What's the doctor, what's the nurse, what's the pharmacist in there. So what's the overall importance of having a pharmacist as a part of a patient's care for any type of treatment?

Dr. Shubha Bhat: The main point, again, though, being that we are considered medication experts, so the importance of having a pharmacist that's part of a patient's care team is that we are really focused on medication. We're focus on the dose, we're focus on the frequency, we're looking at labs, we're looking at outcomes and we're really ensuring that the medication is appropriately being utilized, and that it's the best choice for the patient. So really, the main overall importance is that we just want to make sure that pharmacists are really contributing from a medication perspective so that we can get the patient healthy, in remission, and basically get them feeling well.

Dr. Scott Steele: We'd like to end up with a few quick hitters for all of our guests to get to know you a little bit better, so what's your favorite food?

Dr. Shubha Bhat: I'm a little biased. I'm Indian, so anytime we go with Indian food, you can't go wrong.

Dr. Scott Steele: Amen to that. What's your favorite sport?

Dr. Shubha Bhat: Football. Definitely like football.

Dr. Scott Steele: Go Browns and Packers. And finally, tell us something that you like here about Northeast Ohio.

Dr. Shubha Bhat: I'm not an Ohio native. I've kind of lived around everywhere in terms of like Denver, Colorado, Boston. I'd say that Northeast Ohio is a little bit more a smaller city deal. They're really like a little bit more homey, and I'm really getting to enjoy the lot of small gems and hidden perk that's there that a lot of people just might not actually think about. And really it's a great city, just in case people haven't been.

Dr. Scott Steele: Great. Well, that's good to hear. We're glad you like it. So what's a final take home message for our listeners regarding just either pharmacy in general, or the IBD medical home, or the adjustments? What's with your take home.

Dr. Shubha Bhat: I know there's a lot of IBD medical homes that are becoming more integrated. I think that people are realizing that there's value to having a medical home, and when it comes to optimizing patient care and optimizing patient outcome. I think that it would be great if we could embed more clinical pharmacists in general, whether it's irrespective in which practice setting. There's definitely a wealth of clinical pharmacist in every capacity to help really focus on the medication component of the care, so I think that if anything, I hope that this is a space that continues to expand, and I really hope that there'll be more pharmacists practicing in inflammatory bowel disease, given that we're having a lot of exciting therapeutic advances. But some of these advances are very complex when it comes to management and monitoring, and that this would be a great space to have a pharmacist be involved in.

Dr. Scott Steele: That's fantastic. And to learn more about IBD treatment at the 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.

And finally, please remember it's important for you and your family to continue to receive medical care and stay up to date on health screenings. Rest assured here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers. Dr. Bhat, thank you so much for joining us on Butts & Guts.

Dr. Shubha Bhat: Thank you. I appreciate the opportunity.

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

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Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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