UI-trained pharmacists on the front lines

In the late 1980s, a Cedar Rapids–based pharmacist got a call from a Midwestern physician he had helped train many years before. During the call, the physician described his experience with an older woman who had come to his hospital.

“The physician told me the woman had come in quite ill and confused. While medically she improved, she had remained confused, and she was likely going to a nursing home,” recalls Jay Currie, an alumnus of the University of Iowa College of Pharmacy. “But then he said he remembered some things I had taught him. He took her off of two medications, and she just ‘came right back’ and went home.”

Currie—now head of the Department of Pharmacy Practice and Science in the UI College of Pharmacy—held a unique position at the time. He was working in a family medicine clinic in Cedar Rapids training resident physicians how to prescribe medication while also working directly with patients.

Today, University of Iowa–trained pharmacists continue to fill this role across Iowa.

In 1974, an outreach office of the UI Carver College of Medicine established a network of community-based medical education clinics across the state. The UI College of Pharmacy formed unique partnerships with six of the eight family medicine clinics in the network that have pharmacists in them. Each clinic still houses a practicing pharmacist who is also a faculty member at the UI College of Pharmacy, in the applied clinical sciences division within the Department of Pharmacy Practice and Science.

The UI College of Pharmacy and Carver College of Medicine financially support these statewide clinics, ensuring that pharmacists “have an opportunity to directly shape the education of tomorrow’s doctors, and promote the safe and effective use of medications in our patients,” says Michael E. Ernst, a pharmacist and College of Pharmacy faculty member at UI Hospitals & Clinics, one of the six aforementioned sites. The arrangement also ensures that patients in Iowa and beyond continue to benefit from having clinical pharmacists on their family medicine care team along with their doctors, nurses, and others.

Because each of the six applied clinical sciences faculty members at the family medicine clinics across Iowa operate under unique partnerships, they are able to push the status quo.

James Hoehns heads up the applied clinical sciences division and has been one of its faculty-practitioners in the field since 1995. He was the first full-time pharmacist to join the Northeast Iowa Family Practice Center in Waterloo.

“When I was a student, and a clinical faculty member visited the classroom, I always savored that,” says Hoehns. “Clinical faculty will frequently bring back the information they learn from patient encounters. It was a rich experience to learn how certain events transpired halfway across the state.

“I enjoy the variety of work and the outstanding degree of collegiality from the family medicine doctors,” Hoehns adds. “Much of the time we are able to evaluate and care for patients with our team of 24 physicians, 12 nurses, three pharmacists, two behavioral health counselors, one social worker, and one health coach.”

Hoehns works in the areas of cardiology and therapeutics, and manages anticoagulation patients. He rounds with physicians at the hospital, and collaborates with UI researchers and others—including surrounding community pharmacies—to further advance health care.

“A unique thing we do in Waterloo is participate in a number of large, phase three, multicenter clinical trials,” Hoehns said. “There are usually six to 10 active studies running at a time.”

Sara Wiedenfeld is another applied clinical sciences faculty-practitioner, based at Siouxland Medical Education Foundation in Sioux City, Iowa, where she runs a new, pioneering health service. Each week, Siouxland pharmacists lead annual wellness visits for Medicare recipients at the family medicine clinic. They identify drug therapy problems and refer patients for additional health care services.

“Before the project began, most Medicare beneficiaries at the clinic did not receive an annual wellness visit,” Wiedenfeld said. “Pharmacists are the ideal health care provider to perform this service, because a key component is medication reconciliation, and we are well-trained to counsel patients about lifestyle changes and smoking cessation. This program has connected patients with needed services, brought in significant revenue, and improved our clinic’s quality metrics. Our relationships with our physician partners are stronger. Now they can practice at the highest level of their scope of practice as well.”

Wiedenfeld also works with patients who have a high risk for being readmitted to the hospital soon after they are discharged. She does some hospital rounds and sees anticoagulation patients in a clinic.

“Not only is there geographical diversity in where we practice, but also the types of settings differ,” Hoehns said. Faculty members with the college work with patients from a variety of backgrounds and income levels, in both inpatient and outpatient hospitals and clinics.

In Mason City, Iowa, John Swegle is the pharmacist on faculty with the MercyOne Family Medicine Residency. In this role, he rounds with the medical team on the inpatient service, goes with them on nursing home rounds, and is also in the clinic.

Other family medicine clinics that are part of the College of Pharmacy faculty-affiliated practices are Broadlawns Medical Center in Des Moines (Emily Beckett) and Iowa Lutheran Hospital/UnityPoint Family Medicine at East Des Moines, Des Moines, Iowa (Morgan Sayler). The two other family medicine training programs in the state—in Cedar Rapids and Davenport—have pharmacists who trained at Iowa and provide care and similar interprofessional education in those practices.

As the College of Pharmacy keeps pushing the envelope on job roles for pharmacists, progress becomes both exponential and harder to measure. Some of the statewide centers that host applied clinical sciences faculty-practitioners have hired additional pharmacists to fill the growing need for the modern roles that the college’s faculty-practitioners have modeled so well.

“Whether in family medicine or other settings, UI pharmacy students rotate throughout the state, caring for Iowans while learning from preceptors who are their pharmacists,” says Currie. “There is probably one near you if you live in Iowa. In addition, we probably trained a pharmacist who works near you.”