What coordinated care actually looks like
Last month, I sat across from a 31-old man in our consulting room. He has sickle cell disease. Two years ago, he was in crisis every six to eight weeks. Emergency room visits. Missed work. A wife who had begun to dread Sunday nights because she could hear his breathing change. When we met, he had not had a major crisis in seven months. He was back at his job. His wife had stopped crying on Sundays.
I want to be very clear about what changed for him. He did not get a new drug. The molecule he is on, hydroxyurea, has been around for decades. What changed was the system around the molecule.
This is what coordinated care actually means, and it is what last month’s column promised to unpack. Not a buzzword. A specific operating model.
Let me put it plainly. Coordinated care is what happens when somebody owns the patient’s outcome, not just the prescription. In our model, when a patient enters one of our chronic programmes, a clinical pharmacist is assigned to them. That pharmacist is responsible for adherence, education, dose adjustments in consultation with the physician, refill timing, side-effect management, lab follow-up, and crisis escalation. Everything that happens between the prescription pad and the patient’s bloodstream becomes somebody’s job. In the old model, that space was a void. Patients fell into it. Many never climbed out.
Three programmes have taught me how this works in practice.
In our sickle cell programme, the bottleneck was never the medicine. It was hydroxyurea titration, hydration discipline, infection vigilance, and the psychology of a young person told they must take a tablet every day for the rest of their life. We built a model around weekly check-ins for the first month, then biweekly, then monthly. A WhatsApp line that gets answered. Lab reminders. A clinical pharmacist who knows the patient by name and by trigger. Crisis frequency among our SCD patients has dropped by more than half. Hospital admissions have dropped further.
In our hepatitis C programme, the challenge was different. The disease is curable. The drugs are expensive but available. The real barrier is the twelve-week regimen and the fact that most patients feel fine three weeks in and stop taking the medicine. Coordinated care means we know on day eighty when a patient has fallen off. We know because we are counting. Cure rates in our programme run at over 90 per cent, comparable to American specialty pharmacy outcomes, in a Lagos clinic.
In our oncology programme, coordination is everything. Patients are managing four to seven concomitant medications. They are missing appointments because of fatigue. They are skipping doses because the side effects scare them. Without a coordinator, they fall apart. With one, they finish protocols.
Across all 5,100 patients in our care, adherence has improved by 42 per cent and satisfaction sits at 92 per cent. These two numbers tell the whole story. When somebody owns the outcome, outcomes change.
Now, this is the part I want every pharmacist reading this to sit with. None of what I have described requires HubPharm. None of it requires venture capital, a fancy app, or an AI companion (though those help). What it requires is a decision: that you, the pharmacist, will own the patient’s outcome past the counter. That the relationship begins, not ends, at dispensing.
A community pharmacist in Surulere can do this. A hospital pharmacist in UCH can do this. A locum in Kano can do this. The tools are simple. A patient register. A follow-up cadence. A WhatsApp line. A relationship with the prescribing physician. A discipline of asking, every time, “Has this medicine worked the way it was supposed to?”
What changes is not the qualification. What changes is the posture.
This is also where the economics start to make sense again. Patients who feel cared for refill at your pharmacy. Their family members come to you. HMOs pay more for documented adherence outcomes. Donors fund programmes that measure impact, not transactions. The coordinated care pharmacist is not poorer than the dispensing pharmacist, she is paid for a different kind of work. Better work. Work that matches what we trained for.
Next month, in the final part of this series, I will give you the practical playbook for moving any pharmacy, any practice, any career from dispensing to coordination. We will talk about structures, technologies, partnerships and revenue models. We will be specific.
For now, hold this in your mind: the patient does not need another bottle. The patient needs somebody to call her on Tuesday to ask if she took the dose on Monday. Be that somebody.
Sesan Kareem is the founder and president of HubPharm Africa, a speciality pharmacy and coordinated care platform based in Lagos. He writes on health access, health systems, and the business of chronic care.
