Mayo Clinic Oncology Pharmacist Discusses Bridging Clinical Research and Pharmacy Practice

Scott Soefje, PharmD, BCOP, FCCP, FHOPA, MBA, director of pharmacy cancer care at Mayo Clinic, offers insights into the evolving landscape of clinical research and pharmacy practice. He discusses the pivotal role of oncology pharmacists and Mayo Clinic's unique approach to integrating pharmacists within the health care team. Through his perspective, he highlights the transformative potential of pharmacists in shaping patient-centered care and driving innovation in clinical research.

Pharmacy Times: What makes the Mayo Clinic oncology pharmacy unique?

Soefje: People always ask, what's the secret sauce of Mayo Clinic? The secret sauce of Mayo Clinic is teamwork. When we convince the practice that they need the pharmacist in their team, then they become part of the team and are embraced as such. When that happens, they're part of the family. And I don't think we have an identity crisis. Everyone knows what the pharmacist is going to be doing, what the nurses are going to be doing, what the advanced practice providers are doing, and what the physicians are doing. Now, when we put the pharmacists in there, it shifts some of those roles a little bit. But what it does is it allows everybody to focus on what they do best. One of the things Mayo Clinic is always looking at is how to get our people into roles in which they are doing what they're trained to do, and they are doing their best work at the best time for the patient. And again, because this all comes back to what's in the best interest of the patient, it's easy to begin to focus on that; there's a patient at the center of everything, and we're the circle around them that's helping them get better.

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Pharmacy Times: In what ways does the layout and design of the Mayo Clinic facility influence your approach to patient care and its overall quality?

Soefje: Part of the Mayo culture is to think about how we use the space to improve the overall patient care. And that's leading to our future new construction. We have a pretty significant project coming over the next five or six years. And I'm being asked questions like, what will pharmacy practice look like in 2060? And we're starting to have to think about this because the idea is to build the building, such that maybe the technology doesn't exist now. But when it does exist, that buildings ready to adapt it ready, it's flexible enough to bring it in. And then in 2016, we're practicing the way we think we're going to be.

Pharmacy Times: How has the integration of pharmacists into the three shields model at Mayo Clinic contributed to its shared practices with other institutions, and what benefits have been observed as a result?

Soefje: Yes, everything we do at Mayo Clinic revolves around those three shields (ie, clinical practice, education, and research). Now, the reality of the world is, if I take an individual pharmacist, they may be focused more on practice, or they may be involved in research, or they may be involved in education. But as a department, we have people doing all of them. And then when we talk to people, we want them to start thinking about how to incorporate all three shells. How do you integrate research into your daily practice? And sometimes, it depends on the definition of research. A quality improvement project can be considered research. So, how do you integrate quality improvement into your day-to-day practice? How do you make that part of your thought pattern? One of the things I tell the pharmacists when we send them out into the clinic is it's my expectation that they know the priority trials for their area. And then, as they're seeing patients, maybe they're doing something as simple as whispering in the provider's ear, saying, "Have you considered this trial for the patient?" And if we just accrue one or 2 or 3 more patients every year because of that, that's a big deal for an institution of our size. When you think about it, if we have 15 pharmacists or 20 pharmacists in the clinic, and each one adds three more patients, it's a pretty significant accrual over time

Pharmacy Times: What is your perspective on the pivotal role of pharmacists in clinical research, particularly in engaging patients and facilitating enrollment in clinical trials?

Soefje: So, when we're looking to go into the clinics for the first time, I come from a background where I've worked in institutions that have always had to justify and show the value of people going in. My initial thought was, how do I show the value of the pharmacist being in the clinic? So, we ask the question, what revenue does a new patient bring to Mayo Clinic? How much revenue does a new patient bring? Have the claims and finance people figure that out for us. Then I asked the question, how many new patients does a pharmacist have to help bring in every year to offset the cost of a pharmacist? And in our medical oncology clinic, it turned out to be one patient a week. Then we switch the question, what can the pharmacists do in the clinic to help the clinic see one more new patient every day? Thinking that a portion of those will get chemotherapy here, some won't, some will go back home. But some would get chemotherapy here. And we would be somewhere between paying for the pharmacists up to five times return on investment for that pharmacist. We sit down with a care team and say, “What are the medication management tasks that you don't like doing that we can take off your plate, that would be beneficial to us?” And we started building out a scope of practice. And what we have is a list of tasks that a pharmacist can do. We're very adamant that they can't do everything for every patient because there's just not enough of us to do that. Then we send the pharmacists into the clinic saying, work with your team to find out what you can do to help them see more patients. And as the financial pressures on the institution start coming in, and the institution now is telling the practice they have to see more patients, it just falls right into our natural what we're doing already.

Pharmacy Times: What is your perspective on the distinctive role pharmacists play in clinical research and how do you view the opportunities for pharmacists to facilitate patient enrollment in clinical trials?

Soefje: Pharmacy involvement in clinical research expands the gamut, and we have that here. So, we have a group of pharmacists that are involved in protocol development. When a protocol comes in, they review it and assess its logistical feasibility. They develop the protocol, help develop the orders, treatment plans, and all related aspects. We have another group that dispenses the drugs and ensures that agents are administered correctly and at the right time. Then we have pharmacists in the clinic who serve as an interface. As I mentioned before, we want our pharmacists to know the priority trials and promote them. They look for eligible patients and keep track of what's going on. We hear stories about patients seeking reassurance about their medication from pharmacists, which can also include discussions about research trials. Our pharmacists are freely available to provide this kind of support. The final step we're working on involves recent changes by the NCI. Pharmacists can now sign chemo orders. We're working on getting pharmacists listed as co-principal investigators on some clinical trials and obtaining the proper documentation so they can sign the chemo orders. Every institution can tell you the number of times a patient shows up at the infusion center and someone forgot to sign the order and can't find the doctor. Well, if the pharmacist is right there, we can just do it. Because we're principal investigators, we know the patient, we're part of the team. We know the patient is getting what they need. It just flows and makes the whole process work.

Pharmacy Times: Do you see pharmacist involvement affecting patient enrollment in clinical trials, and do you think this model could enhance clinical trial enrollment in community settings?

Soefje: I do. Community settings often have more patients than they have doctors, and there's a doctor shortage looming. There's a health care shortage coming. So engaging pharmacy in those types of roles could be huge for a community practice to get involved in research. And it may not be like us, where we have 600 open trials. Maybe it's a smaller number of trials that they feel comfortable with, but pharmacists can help manage that. Additionally, pharmacists can ensure that accountability is done correctly, all regulatory requirements are met, and other necessary tasks are completed. This really helps ensure that clinical research is conducted correctly.