Zina Suzanne Berry, PharmD

Organ transplant patients face unique challenges and can benefit from the support of a specialized pharmacy team.

	Patients whose lives depend on receiving a new heart, kidney, liver, or other organ face a difficult journey. After months or even years of waiting for an organ, patients who undergo transplant surgery must adhere to a challenging health regimen that includes taking as many as 20 medications a day to prevent rejection.

 Successfully supporting transplant patients as they transition from hospital to home is of critical importance.

	To help transplant patients manage the complex medication regimens, Walgreens Specialty Pharmacy developed a network of Walgreens pharmacies with pharmacists who have an expertise and specialized training in transplant-related care. These 53 pharmacies are located in hospitals and health systems, as well as in Walgreens retail stores and community-based specialty pharmacies. Taking an individualized approach to patient care along with program customization to meet the unique needs of each transplant center, the network of Walgreens transplant-specialized pharmacies provides support to give patients the best opportunity for a good quality of life.

MEDICATION MANAGEMENT: A CHALLENGE FOR PATIENTS

	New medication options have helped increase the success of organ transplantation—an estimated 74% of heart transplant patients and more than 86% of liver patients are still alive 5 years after the procedure, compared with 69% of heart patients and 73% of liver patients in 1990.

 Pharmacists play a crucial role in helping patients manage these medications.

	Management of transplant patients is a delicate balancing act. Unfortunately, the same medications that help improve transplant outcomes may cause or contribute adversely to other health conditions, such as diabetes.

	Complicating matters further, patients often fail to adhere to their lifesaving immunosuppressant therapy. It is estimated that up to 70% of transplant patients do not take their medications correctly, for many reasons—including difficulty keeping track of the medication regimen and the high cost of the medications.

 Non-compliance can lead to an increased risk of acute rejection, chronic rejection graft loss, and death.

INDIVIDUALIZED PATIENT CARE AND EDUCATION

	For the post transplant patient, pharmaceutical care begins prior to discharge from the hospital. A pharmacist or member of the transplant team educates the patient about the prescribed medications—explaining what the medications do and why they are important&mdash;and provides guidance on how and when to take them. Care teams also offer suggestions to help identify and cope with side effects. To complement this education, some transplant care professionals want patients to have the medications in hand when discharged from the hospital. Walgreens can ensure that this is the case by delivering these medications to the transplant center at locations where such delivery is available.

	Once discharged from the hospital, the patient begins the long road to recovery. A Walgreens pharmacist contacts the patient or caregiver within 24 to 48 hours of discharge. During this call, the pharmacist answers any immediate questions and provides counseling on the importance of adherence to the prescribed regimen, preventing infection, and how to contact them with any concerns. Patients are assured that a Walgreens pharmacist will take their calls 24 hours a day, 7 days a week.

	Within 7 days of discharge, a Walgreens pharmacist will make another care call to make sure the patient is doing well and is not experiencing any signs of early infection, organ rejection, or medication side effects. Pharmacists will encourage patients to report any problems directly to their physician or transplant coordinator, but will also forward any concerns to the patient’s physician. Coordinated care through the pharmacy allows for the early identification of problems so that appropriate medical attention can be provided early.

	Since a missed dose can have dire consequences, Walgreens provides transplant patients with convenient, easy access to medications through monthly proactive refill reminders and home delivery. If there are any changes to the patient’s medication regimen, pharmacists will monitor for any signs of infection, early rejection, or side effects.

	Transplant patients often require additional pharmacy support because their anti-rejection medications can cause or worsen existing health problems, such as diabetes, hyperlipidemia, and osteoporosis. Managing comorbid disease states in addition to monitoring transplant medication issues can be overwhelming for a patient.

 Walgreens’ extensive pharmacy network and specialized services provide patients convenient support and access to care for these health conditions.

	For example, Walgreens offers extensive home infusion services, such as immunoglobulin therapy, antimicrobials, antifungals and total parenteral nutrition, and tube feeding, just to name a few. Walgreens also offers a program specifically designed for stage D heart failure patients who require inotropic infusion while waiting for a transplant or in those rare instances when inotropic therapy is required post transplant.

	The high cost of transplant medication is a considerable barrier for many patients. Immunosuppressant therapy alone can cost more than $34,000 per year.

 To help ease the burden for patients, the Walgreens Specialty Pharmacy Care Team confirms health insurance coverage and provides assistance with prior authorization for medications that require additional insurance approval. In addition, Walgreens Specialty Pharmacy also coordinates with financial assistance organizations that provide funding for medications.

	Walgreens understands that each transplant program is unique and works with each center to ensure individual program needs are met and consistent messages are conveyed to patients. The Walgreens pharmacy team coordinates with the transplant center team to help reinforce education about the prescribed medications and the importance of adherence.

	Pharmacists with specialized training in transplant medications can play a key role in the care team, helping to increase medication adherence, reduce hospital readmissions, and improve patient outcomes. 

Organ transplantation: the process. US Department of Health & Human Services. http://organdonor.gov/about/transplantationprocess.html. Accessed August 16, 2013.

Anderson R. Education, adherence to medical regimen increase survival following heart transplant. Northwestern University Feinberg School of Medicine website. www.feinberg.northwestern.edu/news/2013/04/heart_transplantation_survival.html. Published April 16, 2013. Accessed August 16, 2013: 

Survival rate data tables. US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients 2009 Annual Report. US Department of Health & Human Services website. www.ustransplant.org/annual_reports/current/survival_rates.htm. Accessed August 22, 2013.

Diabetes and organ transplant. WebMD. http://diabetes.webmd.com/life-after-transplant-post-transplant-diabetes. Published June 15, 2012. Accessed August 20, 2013.

Tschida S, Aslam S, Khan TT, Sahli B, Shrank WH, Lal LS. J Managed Care Pharm. 

		2013;19(1):26-41. www.ncbi.nlm.nih.gov/pubmed/23383705.

Costs. United Network for Organ Sharing. TransplantLiving.com. www.transplantliving.org/before-the-transplant/financing-a-transplant/the-costs.  Accessed August 20, 2013.

Zina Suzanne Berry, PharmD, is director of strategic integration for Walgreens Specialty Pharmacy and Infusion Services. She has more than 20 years of experience in pharmacy practice and health care management, including implementation of clinical programs across the country. In her current role, she is responsible for the Walgreens Transplant Specialty Network, which comprises 53 hospital and health system—based specialized Walgreens pharmacies. Berry manages services and advocacy programs and develops standardized processes, clinical education, and monitoring to help pharmacists drive medication adherence.

She earned her doctor of pharmacy from the University of Arizona College of Pharmacy and is a member of the American Society of Transplantation.

Zina Suzanne Berry, PharmD

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