Drysdale sees team-based patient care as essential

Mark Dastrup

Troy Drysdale, PharmD

Troy Drysdale, PharmD ’08

Scripps Memorial Hospital La Jolla, San Diego
Clinical Pharmacy Manager

Beyond the PharmD: Year-long pharmacy residency at University of Washington Medical Center; then internal medicine pharmacist at Zuckerberg SF General Hospital

Expertise: Acute and transitional care medication management

Troy on Medicare Part D Outreach: “These outreach experiences really opened my eyes and actually gave me a passion and a heart for thinking about the [hospital to home] care transition process.”

An expansive role for pharmacists

“What really got me into pharmacy,” says Troy Drysdale, “was when I realized the role of the pharmacist was bigger and more expansive than anything I’d ever experienced personally.”

As an undergraduate, he had a mentor with a medical degree who’d had such a good experience interacting with pharmacists during his training that he recommended the field.

Soon, Drysdale came across the website for the UC San Francisco post-graduate pharmacy residency programs, describing pharmacy specialties in pediatrics, critical care, organ transplant, informatics and technology, oncology, infectious disease, and more. “I was dumbfounded that pharmacists were active in all these different roles and types of care settings. I’d just had no idea,” he remembers.

Student pharmacists leading the way

In 2006, Drysdale was one of three second-year student pharmacists who co-founded what became the dual Medicare Part D Outreach and Peer Educator Program at UCSF, in response to the then-new Medicare Part D drug benefit. “The motivation [for] that first grassroots presentation was just… the realization of a need, and understanding that our role is to take care of patients—and not to let pharmacy tradition limit our scope of how we do that.

“We just realized that … we’ve got to make sure we know about it and understand it [the Part D drug coverage], because people are going to ask—our family members, our patients, our colleagues such as physicians and nurses. This is a huge issue, and we need to step up to help fill that void. And who is better suited to do so than pharmacists-in-training?”

After delivering a lunchtime presentation to their classmates on the subject, those student pioneers reached out to School faculty members with health policy expertise. The latter mentored a pilot outreach program in which nearly 100 students, trained in navigating the Medicare web site, helped hundreds of underserved seniors select the most affordable plan that fit their medication needs.

“What really empowered the community outreach,” says Drysdale, “was that we were students. We didn’t have anything to gain by steering people in any direction. We were able to provide an objective eye” for patients who could be overwhelmed by the new benefit’s complexity.

Advising peers on Medicare Part D

Drysdale also became one of the first Peer Educators—student volunteers who, with further faculty preparation, taught other health professional students and clinicians about the Part D drug benefit. The lectures were delivered in campus venues such as health policy courses and medical center resident conferences. This program later traveled nationally and evolved beyond its initial Part D focus to include an array of strategies for providers to help patients afford their prescribed medications.

© 2017 Mark Dastrup Photography

Drysdale had already enjoyed an interdisciplinary educational environment at UCSF, taking classes and interacting with medical and nursing peers. But the experiences making presentations to peers were still eye opening.

“I was just blown away by how, afterward, we’d have handfuls of students stick around to talk and ask questions. I was very pleasantly surprised at how respected we felt by our peers in other health disciplines,” says Drysdale.

“We started to realize the truth in what UCSF had always ingrained in us—that we do have this specific subset of knowledge and expertise with respect to medication use and, when coupled with other professionals with different kinds of expertise, we could get a lot done for patients.”

Reaching out to the community

While Peer Educator lectures may have helped foster future collaborations with fellow providers, it was Drysdale’s experiences doing Medicare Part D Outreach that most influenced his own professional outlook.

He recalls in one instance finding he could save an elderly, limited-income resident of an assisted living home more than $1,000 a year, just by “recommending that he change to a plan that actually covered his medications” and by switching one of the prescriptions to a generic version.

“These outreach experiences really opened my eyes and actually gave me a passion and a heart for thinking about the care transition process,” says Drysdale. “Anyone who does inpatient acute care [knows that we] can do all the interventions in the world, but if we can’t get patients to a place where they can care for themselves and take their meds outside, they’re just going to end up right back in the hospital. So it gave me an appreciation for that piece of what we do in the hospital and to not take it lightly or for granted.”

Beyond the PharmD

After receiving his PharmD degree, Drysdale completed a year of residency training at the University of Washington Medical Center, and then joined the staff of Zuckerberg San Francisco General Hospital (ZSFGH) as an internal medicine pharmacist.

There, he went on daily rounds with inpatient teams, consulting on drug therapies. But Peer Educator’s focus on affordability to ensure patient adherence also routinely came into play at ZSFGH, a public hospital that serves many uninsured and underinsured patients.

© 2017 Mark Dastrup Photography

While Drysdale worked to develop medication plans for hospitalized patients, another key aspect was “helping make sure that a patient could be discharged safely, making sure that home medications were restarted, and if a patient was started on new medications, that they could afford them.”

“It was kind of like Partners in D [aka Medicare Part D Outreach] played out in everyday practice,” he says, “trying to figure out what was immediately needed for a particular patient before they got discharged … It was almost overwhelming at times, because there was such a need for it.”

He recalls an instance when a patient with a bone infection was discharged from the hospital with a prescription for linezolid, a relatively expensive “big gun” antibiotic used to treat otherwise resistant bacteria. The patient had returned to the nursing unit where she’d been treated to report that the pharmacy down the street couldn’t fill the prescription using her Medi-Cal (California Medicaid) insurance, and she couldn’t afford to pay for it.

Drysdale happened to be on duty and determined that the patient’s insurance plan required prior authorization (essentially detailed clinical justification) to be sent to the pharmacy for this drug by the treating physician.

As with Peer Educator, this was an opportunity to offer a collegial reminder that pharmacists are available as a resource. “The general sense was, ‘Hey, don’t forget to run the med lists by me,’ ” Drysdale recalls. “ ‘Loop me in on a plan and I can help you identify these roadblocks.’”

Pharmacy manager and collaborative professional

In his current position as clinical pharmacy manager at Scripps Memorial Hospital La Jolla (in San Diego), Drysdale oversees a staff of pharmacists who round in teams with physicians as he did.

“I actually see some attitude adjustment, even within the pharmacy profession,” he says. “Because we have a lot of very highly skilled acute care practitioners who may not have historically paid a lot of attention to transitions of care [from hospital to home] or affordability issues….

“I’ve got to continually instill the attitude that you’re not just here to fix doses or to consult with physicians while the patient’s in the hospital… You need to think about: ‘What can keep patients out of the hospital? Are they going to be able to afford their meds? And can we [help the patient] by switching them to a generic or a drug that their insurance is going to cover and that also meets their medical needs?’ ”

Overall, Drysdale sees that hospital-based providers are increasingly aware of the problem of post-discharge medication affordability.

In part, this is driven by financial penalties for hospital readmissions enacted in recent years under Medicare reforms and the Affordable Care Act (aka Obamacare). But Drysdale thinks that such concerns are also being brought to the forefront by the increasing presence of pharmacists on interdisciplinary care teams, including at community hospitals like Scripps Memorial. In that role, they can infuse the health care system with their expertise on drug access and affordability issues and continue being peer educators.

“As I told pharmacy students when I was still a student myself: ‘It’s seeing yourself as a practitioner out in front of the counter…’ And really doing that: not as the exception, but as the rule. Inserting ourselves into the interdisciplinary sphere has to be where we start from and it’s got to be conveyed as just the way of the profession, not as a niche of the profession.”