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By: Emily Ruiz Escobar

Clinical pharmacists, Dr. Jeremy Thomas and Dr. Alyssa Lee, are currently providing Comprehensive Medication Management (CMM) services via telehealth to patients with diabetes in eight clinics in rural and underserved areas of North Carolina and Arkansas. These services are being offered as part of the CMM in Telehealth project awarded to UNC CMO and UAMS Center for Implementation Science. The project aims to implement and evaluate remote delivery of CMM for complex patients with diabetes in rural communities. Learn more about the project in the overview blog post.

Jeremy Thomas, PharmD, is an Associate Professor in the Department of Pharmacy Practice at the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy. Working in the UAMS Center for Implementation Research, Dr. Thomas is exploring new ways to integrate pharmacists into rural primary care practices. Prior to this, he spent several years working with Arkansas Blue Cross Blue Shield to develop the patient centered medical home program in Arkansas.

Alyssa Lee, PharmD joined the UNC Eshelman School of Pharmacy in July 2020 as a Chronic Medication Management telepharmacist at the Center for Medication Optimization. She earned her Doctor of Pharmacy degree from Wingate University School of Pharmacy in Wingate, NC. Dr. Lee completed her post graduate training at Atrium Health Cabarrus PGY-1 residency in the Ambulatory Care Setting in Concord, NC where she focused on diabetes and other chronic care management.


Q: Tell us more about the services you provide and how it works.

Jeremy Thomas (JT): The services that we provide are collectively called Comprehensive Medication Management (CMM) and it is just really a stepwise process for providing a thorough review of a patient’s medications, conditions, and disease states, and then applying a pharmacist’s perspective to the treatment of those conditions.

Alyssa Lee (AL): We also focus part of the visit on their diabetes. We talk about diet, exercise, we go over what their diabetes medications are, and what future options we may be looking for. The patients really seem to love it and it is tailored to them.


Q: What are the impacts of these services? How do these services relate to the current COVID-19 pandemic?

AL: The impacts of these services are really to assist the doctors, give care and comfort to the patients, and give patients another way to connect with their healthcare system.

We have also expanded the services to provide answers, education, and resources concerning COVID-19 by screening patients for COVID needs and any social determinants of health. These services then allow us to more holistically address the patients’ concerns and health.

JT: It also provides patients with access to a pharmacist service that they may not have access to otherwise.

In light of COVID-19, we have seen a shift in where a lot of care is moving sometimes out of the traditional clinic/office setting and into the patient’s home. This is a great modality for patients that are high-risk because it allows them to access the CMM care without having to put themselves at risk.


Q: How do you think telehealth compares to providing these services in person?

AL: It makes it easier for the patients because just having to answer the phone gives them more flexibility of when they can do it. It’s very convenient for them in their home.

On the other side, if I need to show them how to start a new medication and it’s an injection, I can’t physically show them how to do it if we’re over the telephone, and I can’t physically look at their bottles and medications. Even when we do face-to-face telehealth platforms, we can show each other but it’s not quite the same as being hands-on.

JT: There are some barriers on communication, as it is a little easier to communicate while in the same room. However, those barriers are easily overcome once you get used to communicating with a patient in a different location. I’d say the advantages far outweigh the disadvantages because the services, level of care, and the interventions that a pharmacist would make would not occur otherwise.


Q: How are you collaborating with other members in the care team?

AL: I am currently working with, I think, 10 doctors across the four clinics. It has been a challenge at times to build that trust and camaraderie with them since we are remote, but everybody has been so open and so kind. Messaging back and forth has been really easy and we have an open line of communication where we can discuss things.

JT: Now we have to be a little more intentional about building those relationships with others on the care team. Much of our communication is done through electronic means and so we have to understand that different providers and staff have different comfort levels with digital electronic communication. We have to adjust how we operate in order to meet the needs of the patient and members of the care team.


Q: What has been your favorite part of offering these services?

AL: My favorite part is building a relationship with patients. I have a patient I see every week on Wednesdays. He will tell me, “BOY, Alyssa, just let me tell you what I ate this week, but again let me tell you what I skipped out on!” It’s great to build that relationship with them, and they look forward to your call and you look forward to talking with them.

I had a patient tell me, “I only did this because my doctor told me to. I didn’t think it was going to be beneficial and I didn’t think I was going to like it, but I really like you and I think this was really helpful.” So, I think those interactions are the most rewarding parts for me.

JT: I think my favorite part is being able to provide the services in exactly this format.

There was one instance where someone came by and said, “No, you’re drinking a whole lot more sweet tea than that. Tell them how much you really drink.” In another appointment, I was talking to this gentleman over the phone and he said he couldn’t look at his blood sugar at the time because he was driving. I said, “well we need to probably conduct this visit at another time because if you’re driving on the road, I don’t want to distract you.” He said, “No, we can continue talking! I’m not on the road I’m on the tractor.” He was actually out plowing a field while I was conducting the CMM visit.


Q: What advice would you give to pharmacists looking to provide these services through telehealth

AL: Make sure you are able to sound kind over the telephone and that your personality can come through telehealth. Express yourself with your voice or facial expressions.

It’s very important that the patient still gets that camaraderie with you and can understand that you are a person and not a robot.

JT: Understand that the process is a little different and a little slower than what we would normally do when we insert ourselves into a clinic. The relationship building with the providers and staff that is so key for a pharmacist service to be successful in primary care takes a little more intentionality, formality, and structure, and it takes a little more time to do that. It’s important to include the justification and rationale for the decisions that I am making and providing a little more detail in the record because that is my primary means of communication with the provider. I’d say that’s lesson number one.

Advice number two is understand that we are really, truly inserting ourselves into the patient’s life. We need to be flexible in doing that. They are allowing us to meet at times that are convenient for them, but they have a lot of things going on in their normal, everyday life and sometimes the services we are providing are occurring during those times. So, we have to be flexible.


Stay tuned to the CMO blog and twitter for more project updates.

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