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The Right Dose

Toward the end of her biochemistry studies at Albright, Jeanette C. Roberts, Ph.D., M.P.H. ’79 landed the chance to conduct research at the Argonne National Laboratory in Illinois. That’s where she was introduced to the field of medicinal chemistry. She went on to a doctorate in medicinal chemistry at the University of Minnesota, a master’s degree in public health, teaching positions at the universities of Utah and Wisconsin, and 11 years as dean of the School of Pharmacy at Wisconsin. Roberts spoke with us about her work and how pharmacists can help patients stay healthy.

Albright Reporter: Could you summarize what you’re doing at the University of Wisconsin now?

Jeanette RobertsJeanette Roberts: One thing that was a priority for me as dean was to expand the international rotation sites for our pharmacy students, to give them a worldwide experience and compare different health care systems. We expanded all over the world, including a site in South Africa. We wanted to take that up a notch and proposed to create a joint pharmacy fellowship training program, which is a post-graduate research-focused experience, as opposed to a residency that’s clinical practice-focused. I spent a total of four months in South Africa over the past academic year. We have launched a two-year fellowship program. We selected one of our UW grads to become our inaugural fellow.

In the meantime, I applied for several fellowships in Washington, D.C., which is something I’ve always wanted to do. I’ll be starting in September a one-year Robert Wood Johnson Foundation health policy fellowship. I’m really interested in the politics of health care and policy work.

Throughout my years as dean I was kind of a champion of interprofessional education, where health care students come together and learn from and with each other, because they have to be able to practice in teams these days. I’ll be preparing to be the director of the fledgling center for interprofessional education while I’m in Washington.

AR How does international expansion benefit students and the patients they’re going to serve?

JR You’re never truly educated unless you get out of your comfort zone. The patient population our graduates are interacting with is increasingly diverse, from everywhere in the universe. You’re not going to know everything about everybody, but you’re going to have some sense about how to interact with people you’re not familiar with and be sensitive to their needs and cultural features.

AR This touches on the importance of interprofessional education.

JRAt least in the hospital sector, the hospital administrators expect pharmacists, nurses and physicians primarily, but also physicians’ assistants, social workers, psychologists—there’s a whole array of people—to have a team-based care approach. Everyone has their own areas of expertise. The sense is that patient care has improved.

There’s so much to the drug regimen for any patient these days. Especially as you’re aging, you have multiple chronic conditions. It really is the pharmacist’s job to be the medication manager for the patients.

ARWhat do you think is most important for the public to know about how to use medicines responsibly?

JR People do not utilize their pharmacists to their fullest capacity. We don’t train students to put pills in bottles. We train them to be the drug information experts. The way that community pharmacies are still set up—although it’s starting to change—they’re paid for filling prescriptions.

Consumers really need to demand more of their pharmacists. Things get so complicated, with multiple medications, interactions with over-the-counter, with herbals. The pharmacists know how to manage these things. We have to free up more of their time for direct patient care. It certainly happens in the inpatient settings.

So number one is to utilize your pharmacist much more than anybody is probably doing right now. They can help you with any kind of question.

Herbal medications are actually a hobby of mine. There’s so little good evidence for many. There is some good evidence for some, but the way the law regulating herbal medicines is written is not helpful. You just have to kind of be your own consumer-protection person in that sphere, but certainly the pharmacist can assist with the range of options.

AR What can customers ask their pharmacists?

JR Many pharmacies now can do a number of clinical assessments. For example, blood pressure monitoring can be done by the pharmacist with adjustments made to the medications in real time. The fact is that your community pharmacist is the most accessible of the health care team. You don’t need an appointment. You can walk in and say, “I’m not feeling right. Somebody switched my blood pressure medication. Can you tell me about the differences? Can you monitor my blood pressure?” And they can go through a whole checklist of questions and issues that patients should be worried about.

They’re doing more glucose monitoring. Immunizations are a huge thing now. Even bone density scanning. All these things you don’t need a physician’s office to accomplish. You can get much more frequent measurements and closer monitoring if you work through your pharmacist. Embedded in all that is the constant ability to address questions and concerns about the medications in particular. We need to see patients more often than doctors do.

AR How is it possible to change that?

JR It goes, first and foremost, back to the financial model. If pharmacies and pharmacists are paid to put pills in a bottle, that’s what they’re going to worry about. But with more and more robotics, more and more pharmacy technicians doing that sort of work, that frees them up to have more patient interactions. But the fact is that in most states—we’re in the middle of changing this now—pharmacists are not considered providers. That term is essential to be reimbursed for what services you’re providing.

The ideal situation is, you spend a half an hour with a patient. They bring in their brown bag full of pill bottles and you go through the review and you make suggestions. Ultimately, the insurance companies, and the government, need to pay pharmacists for that work, not for putting the pills in the bottle. We’re finally making headway with that idea and it’s going to change the world.

AR This fellowship with the Robert Wood Johnson Foundation is something you’ve wanted to do for a long time.

JR I’m particularly interested in spending my fellowship year in Congress, learning the legislative process, doing policy development analysis and assessment. One option is to identify a member of Congress and be their main health policy person. You can also end up staffing the Senate Finance Committee, which of course deals with a lot of health funding. I’m trying to go into it with an open mind, but I really do want to end up in Congress.

It’s really the policy legislative process, the nuts and bolts of that. What influences legislators, influences policy development, especially in health care? I just would find that absolutely fascinating. Especially now with all the Affordable Care Act stuff going on, and it’s a presidential election year. It’s going to be the perfect place to be this year.

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