Dr. Stephen Buksh, Northeast Tarrant Internal Medicine Associates in Texas (Part 1)

Contributors

In this new series from Stellus Rx, we’re exploring the perspectives and insights from our physician partners—healthcare providers who have dedicated their lives toward improving the lives of others. First in the series is Dr. Stephen Buksh, a physician at Northeast Tarrant Internal Medicine Associates (NETIMA), who has been in private practice in the Dallas-Fort Worth area for more than 25 years.

In part one of this two-part interview, Dr. Buksh shares some of the common challenges his patients face in their health journeys … how he and his practice have worked to deliver a more connected and relationship-driven care experience … and the value that he and his patients have seen in their collaborative work with the pharmacists at Stellus Rx.

Can you start by giving us a view of the type of care you aim to deliver at NETIMA?

Dr. Buksh: Internal medicine is all about taking care of the complex patient in a relational way. It’s important for me to make sure that patients take responsibility and get engaged and excited about getting better. Often, they’re bogged down and burdened by the complexity of their care. They have heart failure, COPD, a lot of complicated issues around their diet and exercise to maintain their diabetes, high blood pressure … they get lost.

Some patients literally get to the point where they just take their medicines, and they don’t realize how important it is to take care of their lifestyle, too. The only way you can impact that is through connection and relationships. And the only way you can manage that complexity is with a team.

So, I’m very proud of the fact that I’ve known people and cared for them for 20+ years, and in those relationships I’ve seen people change. Instead of just putting out fires and being reactive, we are taking care of folks and improving their health.

If we dive a little deeper into the needs of your patients, what are some of the most common concerns your patients face—especially among the areas that might otherwise sit outside of your control?

Dr. Buksh: There are a lot of unanswered questions in most of my patients when it comes to medications. Because many of my patients are taking multiple medications—often five or more—they just don’t grasp deeply what each of those medicines is doing.

And then there are a lot of challenges in filling prescriptions, managing the cost of medications, understanding side effects and possible adverse effects. Many times, they’re going to the Internet or to friends or family. Sometimes well-intentioned people are telling them not to take their statin, or not to take this or that medicine. They need a well-informed professional to be able to address those concerns.

Patients lose their prescriptions or suddenly find that the cost of a prescription is higher because of changes in coverage. These are patient needs and concerns, but they’re also physician needs and concerns … because without additional support, I wouldn’t have the time or knowledge to be able to fill those gaps in ways like Stellus Rx does.

So then turning to your experience with Stellus Rx, how have the pharmacists here impacted the way that you deliver care or the way that that care is delivered through your practice?

Dr. Buksh: Broadly, I’d say that it’s just invaluable for a physician to have a pharmacist side-by-side with them. I can only give examples of things that I had to manage myself, and they’re managed well now because I have the pharmacist help from Stellus Rx.

It’s often that I prescribe a script and I don’t know for sure if it’s covered on formulary, because every year the formulary changes. So, in January I’ll do a refill for a patient, and the patient’s formulary has changed. And even though the patient has been doing well on the medication, we need to change it.

I’ll send the patient to Stellus Rx, with the note that this patient has this type of insurance … and could you check if this is on formulary or recommend what’s on formulary to make this more affordable for the patient?

A dedicated Stellus Rx pharmacist will reach out to the patient, evaluate all their different medicines and find what’s on formulary. They’ll check for interactions. They’ll talk to the patient to make sure the patient is aware and agreeable to the change. Then they reach back out to me, and all I need to do is finalize the script. They make it so simple and easy for me.

Another example is when a patient has trouble filling their meds. I have no optics to know if they’re not picking up their prescription, and there’s a multitude of different things that can happen.

Sometimes they just dropped it from their routine, and they didn’t realize they weren’t taking it. Sometimes they miscommunicate with me. I tell them to add this medicine for blood pressure. They stop their old medicine for blood pressure but forget to add the new one. And then it could be three months, six months before I realize what has happened when they come back for their next appointment.

That doesn’t happen with my patients who work with Stellus Rx, because those patients connect monthly (or more) with their personal pharmacists. Right away, a Stellus Rx team member will reach out to me to let me know: “Did you know Mrs. Smith has not picked up her medicine in 15 days? Did you see it, or is there a problem? Can we help out?” They’ll call the patient to clarify that they’re supposed to be taking the medication and make sure the patient receives it.

What other “small but important” details stand out to you about the Stellus Rx experience for patients?

Dr. Buksh: The packaging that comes from Stellus Rx is really, really important. I have multiple stories of patients who previously could not take their medicines on their own.

Patients who have dementia. Patients who were too confused by their medication schedule. And the compliance is extremely important in those patients and quite dangerous if they don’t know if they’re taking the medicines properly or if they take them twice. So Stellus Rx takes that over, packing medicines in a way where patients just need to open up their morning or evening pre-packaged pouch and take their pills.

And if there’s a change to the medications, all I have to do is just send a new script to Stellus Rx and they take charge of that. They will work with patients’ family members to change those things out. It makes a complicated situation easy and creates a lot of satisfaction for my patients to be better able to manage their care, keep them out of the hospital, out of the emergency room, and away from harm that could easily happen under different circumstances.

Certainly there’s a wide spectrum of value in what Stellus Rx is able to provide for physicians and patients. Which patients have the greatest need for more support from a personal pharmacist?

Dr. Buksh: I think that if a patient is on five or more meds, it’s very, very difficult for a patient to understand what they’re doing with their pills. And you can think that they line them up and open them up one at a time to take them. But there is a good chance that they’re not taking them right and they won’t share that with their physician. So that’s where the importance of the pharmacist can really come into play … to touch base with patients and dig into whether patients are really taking their medications correctly.

A second patient type who sees a lot of value from pharmacist intervention is one who has a lot of questions—or maybe even suspicions—around medications. When these patients talk to their pharmacists, they can actually feel more comfortable than talking to their physician. As physicians, we can sometimes get a little defensive around the fact that we want you to take this pill, and you need to take it.

A lot of patients will go elsewhere for information instead of talking to their physicians about it. If a pharmacist is involved, the patients can feel more open about their concerns that a medicine might cause a problem. They can share what they’ve seen or heard with the pharmacist, who’s able to listen, empathize and then educate.

The listening part is crucial. Sometimes a patient needs a social work consultation, and you wouldn’t know it until they sit with their Stellus Rx pharmacist and talk about the fact that they’re having trouble paying for groceries this month.

And what about patients that have cost barriers that prevent them from taking their medications?

Dr. Buksh: Affordability is a significant barrier and one that Stellus Rx regularly helps my patients address. I can tell you all kinds of solutions that Stellus Rx has helped to find: Programs within the insurance companies that allow for zero-dollar copays because of a patient’s financial situation. Stellus Rx files those statements for me. They find ways to reduce out-of-pocket costs for patients as a standard course of business.

If it’s a medicine that requires a prior authorization or a formulary change, they support me on that as well. These are things that I could do possibly, but it would take a lot of time. To have a pharmacist do that for me, it’s just fantastic.
 

Published: April 3, 2024