HJNO Jan/Feb 2025

As the number of outpatient referrals grew, I recognized an opportunity to expand our reach by streamlining initial treatment option discussions and the medical monitoring of the complex advanced pharmacotherapies by involving pharmacists to work within our IBD clinic. We hired the first clinic-based pharma- cist, Estela Lajthia, PharmD, in the Ochsner Health system in 2021 and expanded with a second pharmacist in 2024, Alison LeBon, PharmD. This has allowed the IBD physicians to offload many of these important discus- sions and follow-up visits to our well-qualified pharmacists. They essentially function as our expert physician extenders, performing medi- cation therapy management and have allowed the IBD physicians to reach more new patients in need of their services. They are now a key component of our IBD-focused care team. Our team has a shared goal of trying to reach more patients and to optimize their medical care. Amidst a national shortage of gastroenterologists, which may be further pro- nounced in Louisiana, this is likely to remain a challenge. We have tried to think differ- ently about care teams and expansion locally and outside of our system and have thereby been able to reach more patients. Nothing would be possible without a collaborative team. Talent wins, but teamwork is essential to offer patients the quality care they deserve. Estela Lajthia, PharmD, and Matthew Malachowski, PharmD The global burden of disease for those af- fected by Crohn’s and colitis is increasing, with the highest age-standardized prevalence and incidence rates occurring in North America. 2 This increase is in tandem with the number of new advanced treatments available for pa- tients with inflammatory bowel disease (IBD). For context, only seven advanced therapies were approved for IBD from 1998 to 2019, but 13 therapies were approved from 2021 to 2024 with a robust future pipeline of new products already in stages of development. While ben- eficial for patients with treatment-resistant IBD, this has increased the complexity of caring for these patients and changed the way clinicians must think about the multidisciplinary team approach. Even though clinical pharmacists have been included in the multi-disciplinary team model in other disease states, adoption has been slower in IBD. Over the last year or two, several sister organizations have also de- ployed pharmacists as members of the IBD multidisciplinary team. Shah identified the need and benefit that this skillset could pro- vide to her patients and clinic and was an early adopter of our version of workflow integra- tion. While other health systems may deploy pharmacy resources to support prescription navigation, our mission has been to increase throughput for the clinic and improve access to our physician specialists for our communities. Traditional didactic education often struggles with novel or rapidly changing therapeutic ar- eas such as health system specialty clinics. Inte- grating with these clinics and adding our pro- fession’s unique skill sets to those of our fellow clinicians is both exciting and challenging, but when seamless, the whole becomes greater than the sum of the parts. Clinic-based phar- macists provide the team with both clinical and operational opportunities for solving patient care issues, which adds flexibility and resiliency to the team. Specific tasks include medication education, prescription and infusion order navi- gation, insight into patient formulary utilization management, medication reconciliation, and general patient support. This helps decrease the workload of the physicians as well as the support staff. As I’ve built trust in my provid- ers — Shah and Gaspard — and created strong collaborations with other pharmacy infrastruc- ture within our CMS-designated accountable care organization (ACO), such as our specialty pharmacy and infusion centers, we’ve been able to further grow and expand our program. One of the greatest needs affecting our pa- tients had been increasing access to specialist services for IBD care. Like all health systems, resources are finite, and we refuse to compro- mise the quality of care. Through implement- ing policies and protocols, we’ve been able to allow the clinic-based pharmacist to practice at the top of their license by performing medica- tion therapy management for our patients and acting as an extender of the physician. The role of the pharmacist now includes medication evaluation for clinical appropriateness, patient education, and appropriate monitoring and op- timization of therapy once treatment is started. The clinic-based pharmacist has a symbiotic re- lationship with the Ochsner specialty pharmacy and infusion centers, who provide additional support to help improve medication outcomes. “Clinic-based pharmacists provide the teamwith both clinical and operational opportunities for solving patient care issues, which adds flexibility and resiliency to the team. Specific tasks include medication education, prescription and infusion order navigation, insight into patient formulary utilization management, medication reconciliation, and general patient support.”