This longitudinal rotation is a broad ambulatory care experience which provides medication therapy management (MTM) services, management of chronic disease, and care transitions within an inter-professional healthcare environment. Catholic Health Systems seeks to meet quality measures while reducing the total cost of care for our patient population and this pharmacy service addresses all aspects of the Triple/Quadruple Aim. Additionally, these services will align with Catholic Health Systems values; reverence, compassion, justice and excellence. The pharmacist-led ambulatory care service within the Catholic Health System serves as an outpatient practice which focuses on medication safety and efficacy/outcomes, as well as cost management as they relate to transitions of care and disease management.
Residents will develop necessary knowledge and skills to provide quality, direct patient care, through pharmacist-led relationships and within a collaborative practice agreement within an adult medicine clinic. Residents will assess needs for patient education, lifestyle modification reinforcement, appropriate device use and technique, insulin titration or instruction and adherence with drug therapy plans. They will gain experience as a resource to clinicians by providing drug information, monitoring drug therapy, assessing adherence, considering cost comparisons, and making recommendations for to achieve optimal patient outcomes. Common disease states include (but not limited to); hypertension, hyperlipidemia, diabetes, asthma, heart failure, COPD, coagulopathy, obesity, and nicotine addiction.
Furthermore, the resident will act as a drug information resource for providers throughout the Catholic Health system. The resident may be asked to provide education for care to team members or patients. Residents will also interact with students (of many disciplines) to collaborate on (including but not limited to) medication reconciliation, literature review processes or disease state topic discussions.
This service requires interdisciplinary teamwork with primary care staff which include; nurses, care coordinators, medical assistants, social work, nutritionist and other physician office support staff to achieve the primary program goals. Residents must gain the ability to identify the different roles of team-members in order to refer and collaborate effectively. Pharmacy service goals include; reducing medication errors and hospital re-admissions; identifying and resolving drug therapy problems (DTPs); enhancing the patient's understanding of appropriate drug use; increasing adherence to medication therapy; and improving detection of adverse events.
The pharmacy resident (PGY-1) will be responsible for providing medication therapy management services – comprehensive medication therapy review and disease state management, identifying and resolving DTPs, communicating discrepancies along with recommended interventions to the healthcare team, and enhancing drug information communication. The resident will document discrepancies and outcomes related to medication reconciliation and DTPs. These activities will be documented in a tracking template which will track resident progress. The resident will be required to engage in research and data collection related to existing services for quality improvement and tracking of interventions.