As clinicians, we must first understand the unique challenges that a patient is facing and then tailor our support to address their specific needs.
The coronavirus disease 2019 (COVID-19) pandemic is strongly impacting the health care system, interrupting the ability to receive or provide care. Some patients with cancer or rare diseases are not only coping with the difficulties of their disease but undergoing transitional care, giving them unique challenges in their fight for health. Fortunately, specialty pharmacies can play an integral part in supporting patients during these times of uncertainty.
Transitional care comprehensively supports patients as they move through health care settings, providers, disease states, and therapies. Delivering this type of care can be difficult when patients have to navigate a fragmented health care system and visit multiple providers. COVID-19 disrupts transitional care even further, creating new challenges including reduced care and communication, isolation from support, and adherence risk.
Reduced Care and Communication
Some practices are closed or have limited hours, which impacts patients’ ability to communicate with their health care team. While a number of the practices that remain open have transitioned to telemedicine to keep regularly scheduled appointments, the change in format impacts the normal communication that would occur during an office visit. It can even cause patients to miss visits because they aren’t able to connect virtually.
Additionally, some patients are hesitant to seek the extra care and support they need during this time. They may feel less comfortable reporting changes in health between appointments as they don’t want to burden their providers, whom they see as part of the health care system overwhelmed by COVID-19.
Isolation From Support
Not only has normal interaction with providers been disrupted but, due to social distancing recommendations, so has much routine support from caregivers and support persons. Some patients need a caregiver to accompany them during their provider visits to help ask questions or provide details the patient may not be able to. Illness or medications can impact cognition as well, which is difficult to self-report and is typically noticed by a caregiver first.
COVID-19 is also taking an emotional toll on these high-risk patients. Many patients need to have their questions and concerns about the impact of this virus addressed, such as medication availability and whether they can maintain normal self-care activities. Others miss the comfort of a friendly visit and a warm smile on days when adverse effects or fears are intense. Their chances for success diminish without people to help support them.
Having a support system impacts patients’ adherence to therapy, too. Remembering when to take medication may be challenging for patients who are managing their therapy independently for the first time. Additionally, new adverse effects could become a significant problem, especially if patients do not report them. This could cause them to stop taking their therapy to find relief. Additionally, they may no longer be able to afford their therapy due to an employment layoff related to COVID-19.
Support Transitional Care Patients
When specialty patients are struggling with reduced care, isolation from support, and adherence risk— on top of going through transition of care during a pandemic—their chances for a positive outcome are severely impacted. Specialty pharmacies can step in to help fill the gaps in care and give patients a real chance for success.
“Specialty pharmacies follow the patient from provider to provider, inpatient to skilled nursing to home, and from therapy to therapy,” said Michelle Hendricks, BSN, RN, clinical case educator for Biologics by McKesson. “Specialty pharmacy care teams can be a constant for the patient.”
Ensure That Care Teams Are Contacting Patients
It is important for specialty pharmacies’ clinical care teams to proactively reach out to patients to ensure that they receive the amount of care and communication they need. A pharmacist or nurse should regularly call patients to check on their status and to help them mitigate potential adverse effects or suggest supportive therapies. If the clinical team cannot solve an issue without the assistance of the provider, they should call the provider on behalf of the patient.
Empower Care Teams to Provide More Support
Patients who are isolated and under stress do not manage as well as patients with a strong support system. Even if some patients do have a support system, a specialty pharmacy’s care team can supplement support. Care teams should be empowered to reach out to patients who need extra support and encouraged to take more time on the phone with those who need to vent their fears and frustrations.
“Many patients need to understand how their treatments can increase their risk for getting COVID-19,” said Hendricks. “They fear exposure during necessary appointments, and they fear how their therapy may compromise their immune system. They want to know if they should continue or pause treatment temporarily. Take time to answer their questions and educate them on how to best protect their health.”
Pharmacists should acknowledge that patients may also be experiencing fears around whether COVID-19 is affecting their therapy’s supply chain. Patients may be wondering where their drug is made, if the pharmacy has enough supply in stock, whether they can get more than a 30-day supply, and what will happen if the pharmacy has to shut down temporarily. Specialty pharmacies can alleviate patients’ concerns by providing their care teams with talking points that address these topics, including business continuity plans and what is being done to protect their essential workers.
Clinical staff should be trained to be active and engaged listeners, to ask open-ended questions that assess the patient’s current health and situational challenges, and to know when someone just needs to talk. They should be encouraged to listen for more than just clinical information—such as tone of voice, speech cadence, and certain offhand remarks. These can be subtle indicators that a patient needs increased support.
Members of care teams should trust their clinical judgment regarding the appropriate level of support a patient may need. Having a team member communicate concerns to a provider’s office can also facilitate further follow-up from the provider’s staff, who may have access to additional resources for the patient. Reporting emotional symptoms, such as a change in a patient’s mood, can be as significant as reporting physical symptoms and could make all the difference in someone’s life and treatment.
“Providing holistic support means meeting patients wherever they are in their treatment journey,” said Ashleigh Burdette, MSN, RN, senior director of clinical innovation at Biologics by McKesson. “As clinicians, we must first understand the unique challenges that a patient is facing and then tailor our support to address their specific needs. Having this approach helps patients overcome barriers and ensures a positive patient experience.”
Provide the Tools for Adherence
Small gestures can go a long way in improving adherence during transitional care. Having a robust solution set is a key to success. For a specialty pharmacy, the road to patient success begins as soon as a referral is sent by the provider. A pharmacist should contact patients prior to first fill.
During this initial call, the pharmacist should thoroughly educate a patient on their treatment and conduct a risk assessment. This will help determine whether a patient needs to follow a traditional care plan or may require a customized care plan with additional touchpoints. The results of a 2017 study showed that patients stay on therapy 2 months longer and live 5 months longer when they have access to a nurse to whom they can report their symptoms and get help managing them.1
Access to therapy can also affect medication adherence. Specialty pharmacies can help guide patients to alternate financial resources when needed and can prevent patients from discontinuing therapy. Care teams should include staff members dedicated to financial aid. This assistance is critical in finding funding via co-pay cards or grants to help cover costs of therapy, or in enrolling a patient into a free drug program.
Additionally, providers’ offices may be working with decreased staff. Having a team who can help with prior authorization support is critical.
Trying to navigate a complex health care system while managing a life-threatening disease, transitioning care, and surviving a pandemic can be tough for patients to handle. Support needs to come from all angles. Patients should be assured that help is only a phone call away if needed, and that resources are available to help them through their treatment journey.
“Guiding patients on where and how to access the resources and education they need is a critical component of supporting patients during COVID-19,” said Hendricks.
Make a Difference
Specialty pharmacies are extensions of the care teams surrounding patients. As patients experience transitions in care during COVID-19, they struggle with getting the level of care they need, potentially losing their support system and threatening their adherence to therapy. It is the responsibility of specialty pharmacies to fill in the gaps wherever they can to help high-risk patients transition well throughout their care journey.
“COVID-19 has forced a rapid evolution of health care delivery, and it will continue to demand flexibility and innovation in the industry moving forward,” said Burdette. “Specialty pharmacies have a unique opportunity to support patients during this difficult time by engaging with them proactively and providing holistic, meaningful support.”
By providing this additional care and support, including having greater outreach, empowering clinical teams to listen, and having the right adherence tools on hand, pharmacies can help give patients a real fighting chance.
BRANDON TOM, PHARMD, is general manager of Biologics by McKesson, overseeing the company’s operations, quality, payer relations, sales and marketing, account management, IT, and culture.
Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156