This week I am talking to Sadé Osotimehin, an Advanced Practice Pharmacist at the University of Maryland School of Pharmacy (@umsop). Sade found her passion in chemistry and developed her career around this following a path into pharmacy school and beyond.
Sade discusses her journey into the field of pharmacy and her passion for chemistry and explains how she chose pharmacy as a way to help people while utilizing her knowledge and skills. After spending time in retail pharmacy and later taking on a role in retail clinical services, where she implemented various programs and services to improve patient care. Currently, Sade leads a telehealth center at the Center for Innovative Pharmacy Solutions at the University of Maryland
We discuss the importance of pharmacists as clinical professionals who can contribute to medication therapy management and collaborate with other healthcare providers to deliver holistic care, especially as pharmacists can have closer relationships with patients, as they often have extended interactions during pharmacy visits.
Listen in to hear us discuss the way they have leveraged the accessibility of pharmacists and utilize them as a point of contact for patient care, particularly in managing chronic diseases with their integrated healthcare program and share the amazing results they have achieved with patients with chronic heart disease and lung disease being more likely to fill their prescriptions when enrolled in a Mobile Integrated Healthcare and Community Paramedicine (MIH-CP) program after hospital discharge according to a new study by the University of Maryland just published this month.
The patient’s prescription first-fill rates increased by nearly 20% for patients with congestive heart failure (CHF) and 25% for patients with chronic obstructive pulmonary disease (COPD) in the first 30 days after enrollment. The six-month pilot also improved medication adherence by 8% to 14% in the 60 days after a pharmacist-led intervention.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Shadi or shortbow. Mei when she is an advanced practice pharmacist at the University of Maryland School of Pharmacy. Shadi, thanks for joining me.
Sade Osotimehin
Thank you for having me, Dr. Nick, appreciate the opportunity.
Nick van Terheyden
So if you would, for the benefit of our listeners, I think it’s always important to get a little bit of historical context, how did you arrive at this point? What was your journey to this place in your career? And, you know, include some of the highlights if you would?
Sade Osotimehin
Absolutely. Thank you so much. So I think, to start at the very beginning of my journey, and how I got here, my favorite subject in high school was chemistry. And so just trying to figure out what am I going to do with chemistry. And so two thoughts came to mind. One was pharmacy and the other was Industrial Chemistry, very divergent fields. But I knew that I wanted to be in the healthcare field, I wanted to help people. Matter of fact, my father wanted me to be a medical doctor. But I wasn’t having any of those, you know, I couldn’t stand the sight of cutting people off. And so I’m sorry, I’m sorry, dad to break your heart, but it’s not gonna happen. So I think going from wanting to be in the healthcare field, and really enjoying chemistry, I figured I would go into the field of pharmacy and still be able to help people with my knowledge and my skill set. So as far as my undergrad, it’s pretty much my life has been about pharmacy, right for after high school. I did get my Bachelor of Pharmacy from University of Ibadan in Nigeria. It was a five year program with a lot of tears, very rigorous pharmacy background, very intense, certainly under the British curriculum. But it did serve me with a really great foundation in pharmacy. Fast forward after that, I relocated to the United States and pursued my doctor pharmacy degree in Albany College of Pharmacy. And that sort of like layered more of the patient care clinical pharmacy, built on the pharmacology from from Nigeria, and really went into pharmacotherapy favorite aspect was definitely cardiology, that was my favorite aspect. I thought that I was going to do a residency and really going to clinical pharmacy, but sometimes life throws your curveball. So I ended up in retail pharmacy, with Walgreens where I spent the first 15 years of my career. First half was really just working as a retail pharmacist helping patients with their medications. And the second half, I wanted to do something a little different. And so I started taking classes in US School of Nursing certificate programs, in disease state management. And from that point, I was sort of put in charge of all the retail clinical services, so medication therapy, management, immunizations, point of care, health testing, all of that fell on my lap, go figure it out, make it work. And, you know, I that was really, really successful, not only on the district level, but even on the regional level. So I was working with other pharmacists in the same position. Subsequent to that, I got a text that said, hey, you know, I have an interesting position and wondering where you’re sort of ad right now. And it the text text came from my current boss. And she said, You know, I have a really great position for you have heard about some of the things you’ve done at Walgreens, all this implementation on that you’ve done and I’m looking to open up a telehealth center. That’s going to be led by pharmacists. And I need someone to take it from scratch. And so that was for me, it was the next level. And that’s currently where I am. This is now at the Center for Innovative pharmacy solutions at the University of Maryland. And what we really do is we work with different organizations similar contract based on our grants. We really want to test innovative healthcare models that involve a pharmacist to try to undo Standard, what are some of the problems? Why is the health care system not functioning the way it’s supposed to? The infrastructure is there, the knowledge is there, the expertise is there. But when you compare the outcomes, patient outcomes to other developed countries, the United States healthcare system is sort of behind
Nick van Terheyden
sort of just, you know, being nice about it, you are very nice
Sade Osotimehin
in nice about it. And then when we talk about health care costs, you know, it’s like, astronomically, like a lot more. So why are we spending more, but the results are not as great. Anything that has been a really huge learning curve for me. And I continue to learn about it, and try to figure out, you know, what is it? What, Where did we get it wrong. Um, and really, I have learned that, you know, it’s really the simple things that were probably overlooked, I mean, we do really great work with acute care, a patient has an MI, you know, the number of deaths from a heart attack has really dropped, we do a fantastic job with that. But in terms of chronic care, um, and making sure you know, chronic diseases are not things that are being managed in the emergency room, not so much. So just taking time to understand that, and this has really given me this position has given me the opportunity to really learn, work with innovative grants. Currently, we have, under our belt, pharmacists, led remote patient monitoring, that we’re doing just a lot of just, you know, and we’re really working with, with patients who are, quote, unquote, have been left behind lots of health disparities, lots of social determinants of health barriers, and it’s been a very humbling and eye opening experience thus far.
Nick van Terheyden
So I, you know, great intro, you know, love, love the sort of history in the background, I’m going to go back to something at the beginning. And, you know, we’ll come back to some of the way you are currently. But I just want to go back to the chemistry for a second, because I gotta say, you know, in most instances, people don’t go I love chemistry, at least that wasn’t my expect. I mean, I did. And the fact that you did is kind of interesting to me. It’s not, it’s not that sort of Love Field, but you clearly did and that I didn’t have your passion.
Sade Osotimehin
I did. I it was like, my favorite subject of like, the textbook, from front to back. It was one of those, like, when I say that, I read the textbook, every single page, every equation in there, I could rewrite, I don’t know where it came from, but I just found it or maybe it found me. I don’t know. But yeah, it is odd. I agree. I
Nick van Terheyden
didn’t use that word. And I would not because I think what’s really interesting about it, and, you know, it’s, it’s always why I like to ask the question at the beginning, is, it’s what drives people and, you know, one of the things that, you know, our minds are just, you know, we’re, we have different approaches, we have different lenses, that’s what I’ve realized. And, you know, I realized that, you know, my lens is based on all of the things that I personally love, and that love or, you know, passion element really sort of helped drive. I think, sort of innovation and expression in sort of opportunities. It’s one of the reasons that, you know, they, they have a tendency to say, it seems a little bit flippant, but you know, find something that you love and do it for the rest of your life, and you’ll never work a day in your life. And, you know, it sounds like you’ve got that in some form, at least with pharmacy, because it is it’s about all of these molecules, essentially. And, you know, we’ve got lots of variations on those molecules from even, you know, a few years back, we’re sort of learning more and more so fascinating sort of experience that drives you. But now fast forward, you’ve sort of gone through this, you’ve gone through a retail experience, you’ve gone through a different country. So I imagine all sorts of experiences and exposures to different health systems. You’re incredibly generous in your reverence to how poorly we’re doing in the United States. I’m just going to call it as it is. It’s it’s a disgrace, quite frankly, given the outrageous amount of money that we spend and we’re not getting value for money. And here you are in a program. And I’m going to challenge you a little bit because I don’t think most people think of it in this term, but, you know, a pharmacist in a telehealth sort of circumstance as a clinician. Is that really, you know, how does that come about? You know, you, you, you just deal with molecules.
Sade Osotimehin
Absolutely. And I think that that’s a fantastic challenge and Challenge accepted. So, and I think that you certainly have sort of opened a door that I definitely want to dive down that rabbit hole, and explain that, you know, a lot of times when you say pharmacist, the idea that comes in people’s minds, and I’m happy that it has changed from the druggist or the chemist with the you know, exactly, I’m happy that it’s moved away from there, where it’s, you know, these bottles that are amber colored glass bottles, like mixing things together. And now it’s more that person behind the counter counting pills by five. Certainly, pharmacy has really, really evolved from there. And I think, as at the time that I went to pharmacy school for, for my doctor, pharmacy degree, it was a lot of information, the level of training was impeccable, it was really intense. And the the value that pharmacists can really bring to the table. It’s astronomical, and to think about the fact that majority of chronic disease states are being managed with some type of medication. And we spend at least six years of our lives, thinking and breathing nothing but medications. I feel like there’s certainly like a lot of value that a pharmacist can bring to medication therapy management of chronic disease states. So definitely, we’re no longer the pharmacist that’s counting by five, we are definitely the professional that’s working with collaborating with other health care professionals, whether it’s a medical doctor, an NP, a social worker, a community health worker, and just bringing our our, like you said, our lens and our piece of the puzzle to complete that holistic, whole person healthcare that’s been delivered to the to the patients. So yes, we’re no longer the No, we have a lot more. We’ve definitely advanced and there’s a lot more to that we we are contributing and would still love to contribute to improving healthcare in the United States. Absolutely.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to shadow or Shoto. May hen she is a Advanced Practice pharmacist at the University of Maryland School of Pharmacy, I was just challenging her and saying, Well, you know, pharmacist, as, as you rightly pointed out, I truly forgotten him. I think it may actually be a British ism. They were the chemist. I don’t know if that was true in the United States. But you know, in fact, I think people still talk and, you know, generationally, they’ll talk about I’m going to the chemist, and you know, I think Americans would go What, what, that’s the pharmacist to be clear. But the other thing that’s, you know, I think you didn’t highlight, but it’s abundantly clear to anybody that sort of interacts with the system is you have this relatively short interaction with some clinician, and then you’ll go to the pharmacy experience, and it can be an extended experience. And in fact, I had this with my own mother in law. And we were having all sorts of challenges with medications as she was being discharged. And I was in the pharmacy four times in one day. Interacting got to know the pharmacist a whole experience. And this was me as I was a seagull in this particular instance, I flew in, did my little thing and then flew back out again. So I wasn’t continuously involved. yet. I got to know that of all the people I got to know it was the pharmacist and I think that’s one of the areas that gets lost in some of these discussions is that they’re, you know, not only do they have that extent So clinical skill set. And as you point out, you know, a big component of the treatments that we deliver to patients, especially in chronic disease, we’re managing with medications in many instances, in fact, those are the preferred terms. For many, not all, but they have this much closer relationship and I think potentially understand the patient a little bit better.
Sade Osotimehin
Absolutely. And and I think that what you’re getting at is that the pharmacist is possibly the most accessible healthcare professional,
Nick van Terheyden
again, you’re being generous, it’s not possibly.
Sade Osotimehin
Okay, if you’re generous, okay? Because in your rate, if you think about it, you know, a patient would have appointments with their provider, once in three months, four months, sometimes once a year. While like you mentioned, in the span of a month, you were there four times, no, one day, one day, in one day, you were there for 24. And I think that the healthcare system really needs to start to think about the pharmacist as a point of access into the healthcare system. Let’s not wait until the patient is so broken. And the cost of management is further down. Let’s use the pharmacy, especially in the ambulatory care setting, as a point of contact with pharmacists or in the community, it’s easier to identify patients who are not doing very well, connecting those patients to care, as opposed to patients showing up when they’re symptomatic, things are broken complications are in place, sometimes irreversible, and the cost is astronomical. Right.
Nick van Terheyden
And, you know, I think it’s important here, because one of the push backs that, you know, frequently get is well shows, as I would say the proof is in the pudding, and in this case in the data. And I think in this particular instance, you can actually demonstrate the value proposition, not just from, you know, anecdotal stories that I can relate, and you can obviously tell, but you actually have data that demonstrates this, right?
Sade Osotimehin
Absolutely. We have a lot of data. We’re still gathering data as we speak. We’re still publishing data as we speak. And we certainly even recently put out a manuscript of some of the work that we did in collaboration with paramedics, in this in Baltimore City, the fire department, really innovative healthcare model, really just trying to work with a population. That’s just really just high levels of disparity, such a lot of healthcare burden. And it’s a it’s a population that because if you go to Baltimore City, there’s just a lot of lots of hospitals, lots of schools, Johns Hopkins is there University of Maryland is there University of Maryland medical centers there, Johns Hopkins Hospital is there. But these patients are right smack in the in the middle of all that knowledge, and they’re doing so poorly. And there’s been over decades attempts at how do we help the patients in this particular zip code in Baltimore City. And so this particular innovative healthcare model came about between the doctors at University of Maryland medical center, specifically Dr. Mike cozy, and the Baltimore County Fire Department. And the thought was, for the patients who are high utilizers of the ER or frequently calling 911. For chronic disease states, how do we deploy the paramedic team to the home to figure out first off, is this care that we could give to you right in your home? And if you even made it into the ER got admitted? How do we come to your home and figure out what was broken in terms of your chronic health care management? And how can we fix that so that you start to seek care from the primary care practices as opposed to coming as opposed to coming to the hospital, which is more expensive. So the team involved the paramedic community health workers, definitely our team pharmacists, and either a nurse practitioner or a medical doctor Okay, so in this space, what we really did, and what we really focused on since our area is really medication management was, you know, when patients are going from the hospital to the home, we know there’s a lot of changes in the hospital. One, do the patients even understand what those changes are. And to when they do go home, I mean, so your furosemide was changed to torsemide. These are patients with, again, low health literacy levels, they’re not sure you know, if it’s in their home, they’re going to take it. So you’ll find the patient going home, taking torsemide and furious and light together, because they’re both in the home. And then that’s acute kidney injury, right back in the hospital. So that’s sort of like where we come into the picture. So you come home, we want to know, what were the medications you were discharged home with? And have you been able to obtain those medications? And if you’ve been able to obtain those medications, are there barriers? With taking your meds, organizing your meds, what was discontinued? Do we need to make sure that you need to follow up with the PCP for medication that was put on hold. And I would also really like to emphasize the role that doctor first really played because they were sort of like, helping us connect all the dots as far as what are the patients doing with their meds? And are they even adhering to their meds? We found that in our intervention, 20% of patients who had CHF improved with their medication adherence, and 25% of those who had COPD, improved on their medication adherence in that particular study.
Nick van Terheyden
I think most most places would dream of getting drugs that give you that much of a positive impact or, you know, counter to disease process. So obviously, highly impressive results. In in the time that we have left remaining. You mentioned a little bit about SDOH. And the challenges, share a little bit of your thoughts around that and where that comes in and what you’ve seen, as you know, as part of your practice.
Sade Osotimehin
Absolutely. Thank you, doctor, for that question. So for example, again, I can go right back to this particular group of patients, and we’ll find that some patients are discharged home, when we call as a pharmacist to do a medication reconciliation, making sure what the patient was discharged with is what they’re taking, and making sure we’re taking away medications that have been discontinued, we’ll find that patients for our apps, we’re calling on day six, they still don’t have their meds that were written for after discharge used. And when you ask the patient, it’s things as I don’t have transportation to get to the pharmacy. And so some of what we’ve started to do is let’s identify pharmacies that are able to deliver medications to the patient at home, and will work with the patient, are you okay with us switching your pharmacy so that you can get the you can go to the pharmacy, the pharmacy can come to you type of situation. So those are some of the things that we’ve done to work with the patient. Sometimes it’s the cost. And we’re either working to find a cheap alternative, or we’re trying to find some type of patient assistance program that’s going to support the patient. But either way, we want to make sure the solution is long term, not a 30 day bandaid, because then they’re gonna go right back to you know, so we really want to fix whatever the barriers are, if it’s beyond our scope, then we would pull in like a community health worker to help connect the patient to resources because the resources are there, it’s just that the demand for the resources and the supply of the resources are not connecting. So we make sure that we’re also doing care coordination to other E, whether it’s a social worker, could be health worker to help with those types of barriers, barriers.
Nick van Terheyden
Again, you know, as I listened to that, it’s the sort of, it’s the element of being there seeing things being on the ground, being connected, and having the time as much as anything and, you know, all due respect to the other folks that are delivering care. They’re driven by systems that don’t allow for that, that perhaps used to happen in the past, but not so much. And, you know, here’s an opportunity to really drive this in ways that are clearly delivering benefits as you demonstrated, unfortunately, as we do each and Every week we’ve run out of time so it just remains for me to thank you shot a for joining me negozi
Sade Osotimehin
thank you so much for Dr Nick for having me it’s been a pleasure
