Introduction: Medical Science Liaisons (MSLs) thrive on meaningful work that addresses patient care decision-making as supported by scientific data and published literature. Below, we demonstrate this impact and how a field-based inquiry evolved into a large-scale project with multiple engagement points and broad utilization.
The Need: Despite a health care professional’s (HCP) vested interest in the wellbeing of their rare disease patients, any HCP can have a difficult time staying up-to-date on the latest literature and emerging science around a particular rare disease. HCPs at large, multi-center practices may have the advantage of an “in-house” thought leader (TL) in the rare condition to provide guidance and advice. However, smaller practice settings may not have this opportunity, and even in-house experts may lack the bandwidth to consult on a colleague’s patient. This highlights the need for a ready and up-to-date reference on patient care decisions along the disease trajectory.
The Ask: Our MSL team recently noticed an uptick in requests from TLs for resources that could help them build a patient care algorithm within their multi-center healthcare systems to articulate and update the HCP on a particular rare disease. One such TL reflected that they wanted to ensure any patient treated at any site would receive the same caliber of care as those treated by an expert. Despite medical society guidelines, often seen as an essential cornerstone to treatment decision-making, there seemed to be a greater need for an up-to-date, comprehensive literature review to build such an educational tool that could provide considerations for such an algorithm or pathway.
A Resource Is Born: We saw this as an opportunity to provide TLs with a “one-stop-shop” of literature. Specifically, we envisioned a single packet comprised of up-to-date manuscripts, guidelines, and prescribing information relevant to clinical decision-making. With support from leadership, a team was born to bring this vision to life, including two MSLs (PhD and DNP) and the Director of Medical Information. The three of us divided the project and played to our strengths. With experience in research, the PhD found primary research literature highlighting new developments in risk stratification. The DNP, with expertise in clinical practice, found literature that supported the use of a consensus-driven care pathway and ensured we addressed most aspects of patient care. We wanted this resource to be thoughtful and intentional, so we decided to structure the document into sections such as Medical Society Guidelines, New Goals for Risk Stratification, and Topics to Consider in an Algorithm. Our Medical Information colleague organized all this into a Resource Document by including an executive summary and additional context to orient the audience (our TLs) to the importance of each selected reference.
Although the Resource Document was a powerful tool, our VP of US Medical Affairs saw an opportunity to take this project further. We needed to utilize our resources to develop an educational tool that provides a non-exhaustive description of potential care options in PBC based on peer-reviewed literature.
To address this, we ‘distilled’ the literature into simplified decision points. For example: how does an HCP decide whether a patient is at low or high risk of progression? Sometimes one single answer is unanimously supported by the literature. Other times, an HCP will need to consider many options or other variables. As it would not be appropriate for us to guide clinical decision-making, we presented scientifically-supported care options for each physician/patient touchpoint in the disease pathway. Ultimately, the resource took the shape of an interactive slide deck: a TL could essentially click, choose, and tailor a pathway best suited for their practice and patient population.
We made sure the document is for educational purposes only and provides a non-exhaustive description of potential care options in PBC. The content is based on information from approved product prescribing information, published guidelines, and peer-reviewed literature. We made it clear that HCPs should exercise their independent clinical judgment when managing patients with PBC. In addition, we wanted to avoid bias or the promotion of one treatment option over another. Further, it would be impossible to accumulate all potential care options and create an entirely inclusive resource. Close collaboration and communication with colleagues on our legal, regulatory, and medical review committee were key. They helped us create a resource that was transparent and balanced.
Collaboration of MSLs: Our MSL team comes from various backgrounds with unique experiences. We’re comprised of PhDs, DNPs, NPs, PAs, MDs, and PharmDs. It is always interesting to see how each discipline thinks, bringing different strengths and information to the team. With this Pathway tool, a PhD and DNP worked closely to bring this resource forward. The PhD is extremely focused on data and literature. She worked to make sure all the resources were relevant, balanced, and scientifically rigorous. The DNP, wanted to make sure the flow of the pathway was clinically sound: does the data directly impact clinical practice? Is each test commercially available? How can this tool be utilized in clinical practice? With this collaboration, we exhausted many resources and avenues of practice.
After our initial draft was completed, we held 3 Advisory Boards including community HCPs, Academic HCPs, and Advanced Practice Providers (APP). These Advisory Boards gave us the necessary feedback to improve the Care Pathway and bring the resource to fruition for improved patient care.
Results to Date: Once completed, a ‘vanguard’ group of MSLs premiered the resource to TLs in their respective territories to collect further feedback about usability in their practice. Today, our entire MSL team utilizes the resource in TL engagements, and Medical Information has received 82 unsolicited requests for the resource in four months. From our field feedback, it’s apparent we built a valued educational resource with considerations for building care pathways, and for teaching fellows, new physicians, and APPs. Not only is this a point of engagement for the MSL team, but our Market Access team utilizes the resource for Systems of Care, and the Commercial Team uses an abbreviated version for talking points during their meetings.
Conclusions: As MSLs we want to make a difference in healthcare on a large scale. To be able to develop a tool that is being utilized throughout the company speaks volumes to the need and value of this project. As we, DNP and PhD, worked on this project, we learned how each other thinks and our strengths. We have also formed a bond that also improves job satisfaction. This project is an excellent example of how Field Medical can lead resource creation. MSLs have the closest finger on the pulse of TL needs and we can bring value to our TLs and create a strategic tool leveraged by many departments within our organization.
Stephanie M. Kyle, PhD
Stephanie Kyle, PhD is a Rare Disease/Hepatology Medical Science Liaison at Intercept Pharmaceuticals. Stephanie earned her PhD in Molecular and Human Genetics from Baylor College of Medicine in 2016, followed by a Postdoctoral Fellowship at Emory University. Her research has focused on understanding epigenetic mechanisms that contribute to fatty liver disease, and neurodegenerative and neurodevelopmental disease. One of her favorite things about being an MSL is that no two days are ever the same, and no two field conversations are the same. She lives in the Tampa area and enjoys hanging out with her family and dog, gardening, boating, fishing, and interior decorating.
Tenita P. Foston, DNP, APRN, FNP-C
I am an Executive Medical Science Liaison at Intercept Pharmaceuticals currently mentoring several colleagues and serving on multiple leadership committees. I have been in the Pharmaceutical Industry since 2011 and initially worked as an HCV Treatment Educator, then a Sales Representative, then Medical Science Liaison. I have won multiple excellence awards for Integrity and Commitment to Patient Care. Prior to coming into the pharmaceutical industry, I worked as an emergency room nurse, a Family Nurse Practitioner, and a Hepatology Nurse Practitioner. I continue to practice clinically by helping with COVID screening, Urgent Care Nurse Practitioner, and Outpatient Hospice Nurse Practitioner. I enjoy swimming, cooking, and family time that includes my 3 geriatric dogs.