Practitioner Profile: Somer Smith, PharmD

What got you interested in becoming a pharmacist who specializes in HIV?

In my last year of pharmacy school, I had the privilege of taking an International Medicine Elective in Kijabe, Kenya, Africa. The International Medicine Elective was a great opportunity to broaden my horizons and learn about pharmacy in a different perspective. The goals of this rotation were to enhance my knowledge about healthcare systems outside the country, compare and contrast the international pharmacy with the United States and to establish personal goals and responsibilities. My duties ranged from a wide variety of attending grand rounds and observing the prescribing and dosing as well as serving in the ICU and Women's Ward. There were many sick people with mostly illnesses pertaining to HIV and opportunistic infections. We treated HIV, tuberculosis, pneumocystis jirovenci pneumonia (PCP), toxoplasmic encephalitis, and cryptococcal meningitis. There was a large HIV positive pregnant population that we served and I had the opportunity to provide the antiretroviral (ARV) medications to these women and teach them about the risk of fetal transmission. The most rewarding part was the look on these women's faces when I explained to them that with the ARV medications and planned cesarean delivery, the risk of transmission to the newborn is almost zero. In the end I came back with a better knowledge of pharmacy and a confidence in my abilities as a pharmacist. I had a greater appreciation for the privilege of attending pharmacy school at Auburn University and having access to the highest quality of education as well as health care. After this experience, I knew without a doubt that I wanted to specialize in infectious disease and travel medicine, but most specifically HIV. This led me to focus my residency training on HIV outpatient care which ultimately led me to my current job.

Describe your current job duties

I provide treatment adherence counseling and education regarding antiretroviral medications to HIV/AIDS patients in an outpatient setting.

I provide education to patients who are starting medications for the first time, changing regimens, or having difficulty adhering to a currently prescribed regimen. Also, I work with patients to develop individual plans of action for medication adherence and monitor progress.

I provide assistance in procurement of medications for uninsured/under-insured clients through the Alabama Drug Assistance Program (ADAP) or pharmaceutical patient assistance programs, as applicable and design and implement specific time-limited continuous quality improvement projects

I create routine quarterly reports outlining performance on specific clinical indicators and presents findings at quarterly quality meetings and participate in program in-services and meetings designed to improve professional performance and enhance the quality of services provided to patients.

How did you get your current position?

I had the privilege of working at the outpatient Family Specialty Clinic as a resident and was offered the position after my residency.

What do the physicians you work with think about having a pharmacist as part of the team?

“It is great to have a pharmacist on board in the care of our patients. Pharmacists help patients understand their medications better and improve adherence. Having them on the team also brings out ideas on therapeutic options for patients. Somer brings great energy and enthusiasm in the care of our patients. She is willing to explore and try new interventions. And she has the passion to make a difference in everyone's lives.” Dr. Haidee Custodio, Department of Pediatric Infectious Diseases and University of South Alabama.

What is an average day like for you?

An average day is never the same. My job is exciting because the day comes with many different problems to solve and opportunities. Our program is covered under the Ryan White Grant and we see mostly women, adolescents and children who are HIV positive, or babies born to HIV positive women. We treat women throughout their pregnancies and up to their deliveries. Our clinics are held every first and third Monday of each month with pediatric clinics held on Tuesday and Thursday. Besides providing treatment adherence counseling and monitoring patient's response to the ARV medications, I manage the AIDS Drug Assistance Program (ADAP) medications, identify research opportunities and manage our quality assurance program. Our quality assurance program essentially focuses on our specific core measures and working to achieve these benchmarks. Right now we are focusing on patient retention and maximum viral load suppression.

Tell me about some projects you're working on

Right now we are working on the In+Care campaign. This is a national quality improvement effort by The Health Resources and Services Administration HIV/AIDS Bureau together with the National Quality Center (NQC). They have teamed up on a national retention campaign like no other; a campaign where you can have an immediate impact over the health and well-being of your HIV patients. We will be focusing on the simple idea that when patients stay in care they get the services that they need, leading to healthier people and stronger communities. We are working to improve our core measures of viral load suppression, patient medication adherence and retention rate. Check it out at http://www.incarecampaign.org/.

How are you balancing your patient care and research responsibilities?

Patients are not scheduled every day of the week. I spend about three days a week providing direct patient care and the other two days researching. Much of my research is involved with quality improvement measures. The research and patient care go hand-in-hand at our clinic. Quality improvement measures include viral load suppression, patient retention, and medication adherence. As a pharmacist, my primary role is providing anti-retroviral education and adherence assessment.