February 2024 ACCP Member Spotlight: Sherry (Sharon) K. Milfred-LaForest

LaForest

Sherry (Sharon) K.M. LaForest, Pharm.D., FCCP, BCCP, is a clinical pharmacy specialist in cardiology and solid organ transplantation at the VA Northeast Ohio Healthcare System (VANEOHS) in Shaker Heights, Ohio.

LaForest received both her B.S. degree in pharmacy (1991) and her Pharm.D. degree (1992) from the University of Minnesota. She then completed a fellowship in cardiothoracic transplantation at Abbott Northwestern Hospital in Minneapolis, Minnesota. Subsequently, LaForest held clinical and academic positions in heart failure, heart transplantation, and multiorgan transplantation at Temple University in Philadelphia, Pennsylvania; Methodist Hospital in Indianapolis, Indiana; and UH Cleveland Medical Center in Cleveland, Ohio.

In her current position as a clinical pharmacy specialist, LaForest practices in the Heart Failure Shared Medical Appointment interdisciplinary group clinic, the Heart Failure Transitional Care Clinic, and the Heart Failure Medication Titration Clinic. In addition, she is a consultant for antiarrhythmic drug monitoring, outpatient general cardiology, and solid organ transplant services at the hospital where she has her practice. She also serves on several institutional committees, including as a pharmacy representative to the VANEOHS Research and Development Committee and the Advanced Heart Failure Committee and co-chair of the PHASER Pharmacogenomics Implementation Steering Committee. Her academic contributions include serving on a pharmacy residency project committee and serving as a preceptor for pharmacy residents and students in cardiology rotations. She has contributed to several professional publications through writing book chapters and research articles and has delivered many invited lectures on pharmacotherapy and the role of the pharmacist in heart failure, organ transplantation, and transitions of care. She has been a co-investigator on VA-funded research grants examining methods to optimize heart failure pharmacotherapy. She has active research interests in these areas as well as in transitions of care, the pharmacist’s role on interdisciplinary teams, and the impact of psychosocial factors on the effectiveness of heart failure pharmacotherapy.

From an early age, LaForest knew she wanted to be in a medical profession and was motivated by her mother, who practiced as a nurse. She has always gravitated toward science, particularly chemistry. In high school, she volunteered at a local hospital and was assigned to work in the pharmacy department. She decided then that “this would be a career to investigate further as it seemed like a perfect balance of science and direct patient care.” The research experience as both an undergraduate and in pharmacy school led her to pursue fellowship training. Cardiology was always an interest of hers and was one of the specialties that offered a balance of clinical and research fellowships at that time. This led to her decision to pursue a fellowship in cardiac transplantation. Her fellowship director, Dr. Kathleen Lake, had a tremendous influence on LaForest’s early career. Lake was very active in ACCP and other professional organizations. She demonstrated the value of sharing scientific findings and networking at these professional society meetings, including interprofessional organizations, such as transplantation. ACCP has been LaForest’s “professional home” ever since she was introduced to the organization. At ACCP meetings, she gained new knowledge from the didactic, high-quality scientific presentations, not all of which were related to cardiology or transplantation but were related to core topics in pharmacotherapy. She found value in these meetings, especially as a young clinician developing her own practice. ACCP became a forum to advance her own research and clinical skills as well as present scholarly work. When she moved on to her first post-fellowship position, she immediately gravitated to the strong local ACCP chapter and became very involved, developing leadership skills as a chapter officer. She was able to develop manuscript peer review skills and gain writing experience through ACCP and publications like PSAP. Pharmacotherapy and JACCP have always been a relevant source of new information in her day-to-day clinical work and served as an example of strong clinical research. Subsequently, she used these opportunities for submitting her scholarly work(s) for publication. These publication opportunities, as well as the valuable networking contacts the meetings offered, led to additional opportunities for participation on national committees and invited presentations. To this day, ACCP remains an important part of her professional life, and she continues to value the content presented in both print material and live meetings of this reputable organization.

Often, students and residents ask her why she chose to be so involved in professional organizations and in activities like writing, manuscript review, research, and external presentations, which are not necessarily part of her day-to-day job description. Laforest responds by noting the great emphasis placed on burnout and clinician apathy today. As such, she often advises students to find what excites them, kindles their passion in their chosen profession, and gets their creative juices flowing because this is what prevents burnout, from her point of view. For LaForest, scholarly work has always been her passion, even if it is outside her normal 8-hour workday: “Learning about new concepts, new pharmacologic mechanisms, new roles for a clinical pharmacist is what has propelled our profession forward.” For LaForest, being open to new roles, developing skills as direct patient care providers, and leading on drug therapy optimization tools – whether in pharmacokinetics, pharmacology, pharmacogenomics, or advancing equitable access to modern pharmacotherapy – have helped maintain clinical pharmacy within the multidisciplinary health care team. The clinical pharmacist offers a unique perspective on these aspects of clinical care, thus contributing to the ability of the medical team to provide equitable care for all patients. According to LaForest, “This is how clinical pharmacy as a profession has established and sustained the value of our role in the health care system.” To maintain this value as well as for their growth, pharmacists need to continue to share their new research and practice skills in the multidisciplinary team.

LaForest notes that the care of patients with heart failure and undergoing transplantation is a team sport. She started as the first pharmacist on the heart transplant or heart failure team at almost every institution where she took a new position. To prove her skills, she decided to address the difficult pharmacotherapy questions from all team members and advocated for her medical/nursing team members on pharmacy policy while interweaving unsolicited information to achieve optimized patient-specific drug therapy. For LaForest, it is very important that all members of the multidisciplinary team – from the leaders (often physicians or advanced practice nurses/physician assistants) to the staff nurses, allied health professionals, and support staff – believe their role is respected and valued. As a clinical pharmacist, she has tried to model that respect and deference to expertise while learning new skills from her colleagues. She has learned motivational interviewing skills from her psychologist colleagues, patient-centric dietary barriers from dietitian colleagues, and medical history and physical examination tips from medical colleagues. Every professional sharing their skill set elevates an interdisciplinary team, and this has made her a better clinical pharmacy provider.

The VA has long been a pioneer for effective multidisciplinary care and collaborative teams. Many early publications demonstrating the benefit associated with clinical pharmacy providers came from the VA system. LaForest acknowledges that she has been fortunate to practice at the top of her license as a provider with a scope of practice directly interacting with patients in the VA system during the past 15 years of her career. She adds that clinical pharmacists are currently training the next generation to have the skills needed to be comprehensive medication management (CMM) providers. Concurrently, she states that advocacy for provider status is required: “Advocacy for federal provider status for pharmacists to be compensated for delivering CMM is an important focus area for our profession since provider status is not universal.” As these newly credentialed CMM providers move into new institutions and new positions, demonstrating a high level of competency in partnering with their medical and nursing colleagues, they will model the benefit of clinical pharmacy providers locally. At that point, state regulatory barriers and reimbursement questions will still need to be addressed. In addition to advocacy at the state and federal levels, benefit can be demonstrated by creating peer-reviewed publications of CMM in clinical pharmacy settings. Research, quality improvement projects, and organizational position papers are all valuable additions to this effort. She does not think results need to be earth-shattering; they just need to be available to those who advocate for provider status. Finally, LaForest challenges clinical pharmacists as a profession to “get our voice outside of our institutions to be heard toward these higher goals of national provider status and CMM reimbursement.”