Ambulatory Care Ambulatory Care Pharmaceutical Services Pharmaceutical Services Pharmacy 492 Pharmacy 492 February 2007 February 2007 Katie Lai, PharmD., BCPS Katie Lai, PharmD., BCPS
QUESTIONS QUESTIONS � Where Where: : Is my practice site? Is my practice site? � � What What: : Is my job description? Is my job description? � � Why Why: : Is it important? Is it important? � � Fun Fun: : Is it interesting and stimulating? Is it interesting and stimulating? � � Not fun Not fun: : What are the challenges? What are the challenges? �
Where Where th Senior Care Clinic (SCC) is located on the 4 th � Senior Care Clinic (SCC) is located on the 4 � floor of Harborview Medical Center (HMC) floor of Harborview Medical Center (HMC) Hospital ambulatory care tower Hospital ambulatory care tower � The setting is an outpatient clinical practice The setting is an outpatient clinical practice � � The site is both primary care (SCC) and The site is both primary care (SCC) and � specialty care services (cardiology and specialty care services (cardiology and neurology) neurology)
Living facilities Health Care Facilities Independent Living/ Ambulatory Homes Clinics Hospital Outpatient Inpatient Clinical Clinical Retail Assisted Living Pharmacy Inpatient Outpatient Dispense Dispense LTC Rehab
Primary Care Clinics Primary Care Clinics Vs. Vs. Ambulatory Care Clinics Ambulatory Care Clinics Vs. Vs. Specialty Care Clinics Specialty Care Clinics
HMC Ambulatory Care Clinics HMC Ambulatory Care Clinics Primary Care Clinics Specialty Clinics Primary Care Clinics Specialty Clinics � Senior Care Senior Care � Cardiology Cardiology � � � Family Medicine Family Medicine � Neurology Neurology � � � Adult Medicine Adult Medicine � Ophthalmology Ophthalmology � � � Pioneer Square Pioneer Square � Renal Renal � � � International Medicine International Medicine � Diabetes Diabetes � � � HIV HIV � � Rheumatology Rheumatology � � Podiatry Podiatry � � Orthopedics Orthopedics �
Clinical Versus Distribution Clinical Versus Distribution � Distribution Distribution � � Dispensing medications Dispensing medications � � Retrospective evaluation Retrospective evaluation— —Fix problems Fix problems � � Clarification of orders Clarification of orders � � Clinical Clinical � � Monitoring medications Monitoring medications— —labs, side effects labs, side effects � � Prospective evaluation Prospective evaluation— —Anticipate problems Anticipate problems � � Writing the orders Writing the orders— —prescriptive authority prescriptive authority �
What What � Clinical services development in Senior Care Clinic Clinical services development in Senior Care Clinic � � See 4 See 4- -12 patients per day, each for 30 12 patients per day, each for 30- -60 minutes 60 minutes � � Pharmacy staff development Pharmacy staff development � � Provide educational services Provide educational services � � Interns, medical + pharmacy residents Interns, medical + pharmacy residents � � Support UW Pharmacy School: didactic and rotations Support UW Pharmacy School: didactic and rotations � � Drug information to 4west clinics staff Drug information to 4west clinics staff �
Clinical Services Clinical Services � Disease States Management in SCC Disease States Management in SCC � � Diabetes Diabetes � � Hypertension Hypertension � � Hyperlipidemia Hyperlipidemia � � Congestive heart failure Congestive heart failure � � Anticoagulation management Anticoagulation management � � Glucometer Education Glucometer Education � � Coordination of Care Coordination of Care � � Medication Evaluation Medication Evaluation— —poly poly- -pharmacy pharmacy �
Why Is It Important? Why Is It Important? � Assist in medication adjustments Assist in medication adjustments � � Assess how pt is using the medications Assess how pt is using the medications � � Evaluate appropriate medication prescribing Evaluate appropriate medication prescribing � � Educate patient on various disease states Educate patient on various disease states � � Monitor lab values Monitor lab values � � Individualize therapy for patients Individualize therapy for patients � � Problem solve medication issues Problem solve medication issues �
FUN FUN � Direct patient care Direct patient care � � Ability to tailor medications and individualize Ability to tailor medications and individualize � therapy for patients therapy for patients � Plenty of opportunities for patient education Plenty of opportunities for patient education � � Prevent problems Prevent problems— —anticipate meds that could anticipate meds that could � cause falls and side effects cause falls and side effects � Pharmaceutical care: allows follow Pharmaceutical care: allows follow- -up and up and � outcome evaluations outcome evaluations
NOT FUN NOT FUN � Documentation of interactions Documentation of interactions � � Time consuming Time consuming � � Paperwork Paperwork � � Billing Billing � � Multi Multi- -tasking tasking � � Constant interruptions Constant interruptions � � Liability Liability � � Must keep up with current drug studies Must keep up with current drug studies �
Typical day in Typical day in Senior Care Clinic Senior Care Clinic
71 Year Old Female 71 Year Old Female � Was hospitalized 6 times in 2005 Was hospitalized 6 times in 2005 � � Recently discharged from HMC Hospital Recently discharged from HMC Hospital � � Has rapid heart rate Has rapid heart rate— —was prescribed warfarin was prescribed warfarin � � Seeing pharmacists for: Seeing pharmacists for: � � Warfarin management Warfarin management � Medication monitoring � Medication monitoring � � Asthma and diabetes education & management Asthma and diabetes education & management � � Medication assessment of appropriate prescribing Medication assessment of appropriate prescribing �
Medication Assessment: 27 Meds Medication Assessment: 27 Meds Medical Problems Medications Medical Problems Medications Asthma Asthma 4 different breathing inhalers 4 different breathing inhalers � � � � Hypertension Montelukast Hypertension Montelukast � � � � Hx of heart attack 2002 Nasal spray Hx of heart attack 2002 Nasal spray � � � � Atrial Fibrillation Atrial Fibrillation Lisinopril Lisinopril � � � � Hyperlipidemia Diltiazem Hyperlipidemia Diltiazem � � � � Diabetes Diabetes Bumetamide Bumetamide � � � � Anxiety & depression Digoxin Anxiety & depression Digoxin � � � � Insomnia Warfarin Insomnia Warfarin � � � � Osteoporosis Osteoporosis Atorvastatin Atorvastatin � � � � Gout Lispro insulin Gout Lispro insulin � � � � Osteoarthritis— —pain pain Diazepam, Trazodone Osteoarthritis Diazepam, Trazodone � � � � Psoriatic dermatitis Venlafaxine Psoriatic dermatitis Venlafaxine � � � � Decreased hearing Pantoprazole Decreased hearing Pantoprazole � � � � Right eye cataract surgery 2005 Right eye cataract surgery 2005 Alendronate, Tylenol Alendronate, Tylenol � � � � Calcium carbonate Calcium carbonate � � Docusate, multivitamin, Senna Docusate, multivitamin, Senna � � Prednisone Prednisone � �
What Do You Do First? What Do You Do First? � Geriatric considerations? Geriatric considerations? � � Falls assessment Falls assessment � Sleep regimen � Sleep regimen � � Does disease states match with medication list? Does disease states match with medication list? � � Compliance issues: caregivers? Compliance issues: caregivers? � � Can we minimize the number of meds needed? Can we minimize the number of meds needed? � � Level of education needed? Level of education needed? � � Consider pt Consider pt’ ’s hearing and cognition ability s hearing and cognition ability �
Questions Questions
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