New Processes May Stick Around After the Pandemic: Q&A with Wendy Ramey, BSPharm, RPh, CSP

Wendy Ramey, BSPharm, RPh, CSP

How are COVID-19 and physical distancing restrictions at work affecting rheumatology professionals? The Rheumatologist interviewed clinical pharmacist Wendy Ramey, BSPharm, RPh, CSP, to discuss how the pandemic has changed the way her staff supports rheumatologists at the University of Kentucky Specialty Pharmacy and Infusion Services, Lexington. Ms. Ramey describes how these unprecedented times affect patients, pharmacists and life outside the office.

Q: How are you and your staff adapting to restrictions related to the COVID-19 pandemic? Has your pharmacy changed its work routine to keep your staff safe?
The specialty pharmacy staff are ‘platooning.’ Most pharmacists and techs are working from home to set up refill shipments and assess patient adherence, outcomes and adverse effects of medications. We have our clinic-based pharmacists working from home reviewing lab reports, calling patients to discuss their regimens and what precautions to take. [They are also] supporting the rheumatologists, who are conducting patient visits via telemedicine.

The dispensing team is working in the pharmacy, trying to maintain a six-foot distance from each other. If the dispensing team needs help or someone becomes sick, then one of the platoons can come into the pharmacy to relieve that team member.

All meetings are now virtual. We continue to have our regular employee training [sessions], but they’re online. We have lost the ability to precept pharmacy students, who found alternate rotations in the hospital or in retail pharmacies, where they’re working with pharmacists on the front lines.

Q: How does the specialty pharmacy use technology to continue its work?
Because our staff is mostly working from home, it was necessary to set up VPNs [virtual private networks] for everyone, [ensuring everyone has] server access, desktops with dual monitors and soft phone service for access to the call center. This [approach] has forced us to be [mostly] paperless. We’re using a fax application to send and receive paperwork to each other, insurers and financial assistance programs. We also rely much more on electronic health records and updating information in the program instead of discussing cases verbally. These are all good practices anyway. I hope to continue many of these processes when we return to our regular environment.

Q: What are your patients’ chief concerns right now?
Patients are worried about running out of their medications. We have several shortages already, including hydroxychloroquine, but also sulfasalazine and sarilumab. Soon, we anticipate that tocilizumab will be hard to get.

The Kentucky Board of Pharmacy is requiring prescribers to send new prescriptions for every hydroxychloroquine patient. It must have the diagnosis attached, and it can only be dispensed for a 30-day supply. It’s meant to keep patients from hoarding, but it also means a lot more work to send over 1,000 new prescriptions this month.

Many patients call seeking advice for dealing with their increased infection risk. The changing landscape of the pandemic is making us re-evaluate our recommendations. Right now, we aim to keep patients’ disease under control and opt to continue most regimens unless symptoms of COVID-19 surface. Next week, we may be telling them something else. We have reiterated to patients that they have an increased infection risk, so they won’t keep taking their immune-modulating regimens during bacterial infections. [By doing so,] we have unintentionally created an increased fear of this pandemic. It does give us a chance to educate patients on how scientists believe the COVID-19 viral infection progresses and why and how they need to be concerned.

Another problem is getting lab results when we cancel live appointments and reschedule them for a later date or conduct them through telemedicine. Patients either can’t find a lab open near their home, or they’re justifiably afraid to have labs drawn. Because many conventional treatments for rheumatic diseases, a few biologics and all JAK inhibitors can cause serious systemic side effects, we are pondering how to safely prescribe and manage these medications blindly.

Q: How is the current crisis affecting you or your family? Can you share any coping tips?
My husband and I are both working from home. He’s always had some flexibility because he’s an outside sales representative, but it’s new to me. I’m busier at home than I was on most days in the clinic. There are more patient problems, more provider collaborations and new processes to create. I miss people and hands-on education. I enjoy my new commute and comfy work wardrobe, but I’m fearful for my patients and co-workers. I stress when I think about this going on for months and months.

In the evenings, our family watches new movies and TV series to unwind and take our mind off the pandemic. We’re cooking more together and sitting outside to enjoy the fresh air.

Susan Bernstein is a freelance journalist based in Atlanta.