Anticoagulation, diabetic clinics pharmacist

[konkan]

Looking for an information about this specialty. Can someone explain in details what do they do? What is their scope of autonomy? I've read somewhere that there are solely pharmacist or pharmacists-run ac or diabetic clinics. I guess, they must be pretty independent? When I do research online I constantly ran into articles how these clinics do a better job managing ac or diabetes than physicians, but there are not many of them yet. Why? Any predictions for the future?
Do one have to complete a residency for it (I would hate to do that)? And last, but not least - what's the pay?

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[sdn1977]

I'm off to work so I can't spend much time answering your question right now. But..I'll give you a quick overview.

Anticoag pharmacists are ususally employed by a clinic, physician group, university group, hospital (Kaiser/VA), etc..

You are given full autonomy within the scope of the protocol you are working. That means...you deal with "if,.....then" scenarios - pretty cookie cutter stuff.

You get the blood sample, run in thru the machine, take a history (should be a good history, but in my experience - it is a poor one at best) then tell the pt to stay with the dose,, up it or reduce it, write the rx & schedule the next appt.

Whether they control INR's better than physicians??? I, personally, don't think so. Yes - they have tight control of the INR....but these pharmacists I have known are generally young & don't have enough experience to see how easily things can influence the INR & that that blood sample is only one moment in time. Personally, I think it takes them too long to get stable. I have known more than one patient who was kept on weekly anticoag checks for 6-9 months with changing doses. It should be stabilized within a month, baring unusual circumstances - these were not.

So...good concept - except this is a case where pharmacists sometimes lose the "bigger" picture. You need to keep the INR 2-2.5 times normal, but you need to make sure these folks have a life as well.

The pay is that for any pharmacist - same in my area - mid-to high 50's/hr + benefits. A boring job though....just doing INR's.

Blood sugar monitoring is more interesting....more education involved. But, in my area, done more by nursing since they are less expensive to pay. Again you follow protocols. Few endocrinologists like this approach since they like really, really tight control. However, large group & family practice setting like this & will do group classes for teaching pumps, monitors, Byetta, etc...

Blood sugar testing is similar....however, you are looking over their own records & testing for Hb1Ac. You need to certified to be a diabetic educator - not a difficult process. Your pay will be again what pharmacists make, but again...many diabetic educators are nurses or dieticians.

Good luck!

 

[ZpackSux]

I started an anticoag clinic in 1998 for a county hospital. Basically, physicians refer their coumadin patients to the clinic. Then I would contact the patient and then follow their coumadin dosing.

They come to the clinic, I run the INR...and change coumadin dose accordingly....fairly mindless. No way I would do it full time.

 

[gsinccom]

I started an anticoag clinic in 1998 for a county hospital. Basically, physicians refer their coumadin patients to the clinic. Then I would contact the patient and then follow their coumadin dosing.

They come to the clinic, I run the INR...and change coumadin dose accordingly....fairly mindless. No way I would do it full time.

I just shadowed an anticoag pharmacist. she graduated 10 years ago from UCSF and did a one year residency too. she had a lot of autonomy in her work and although it is routine I thought it was a great way to interact with patients. I would certainly prefer that over working at the Wally-World front pharmacy counter.

 

[Twins fan]

I will be interviewing in a couple weeks for a position as a tech (and then pharmacy intern once school starts) in an anticoagulation pharmacy within a clinic. The position sounds extremely interesting...I guess this pharmacy does some work with diabetics as well as fill prescriptions written by doctors that work in the same clinic. I know that the pharmacists have limited prescribing rights at this clinic, which interests me (not that I want to be a doctor....I don't want this to become a "what should the pharmacist's role be?" thread).

I have 1.5 years of retail pharmacy tech experience and I've really enjoyed it. However, I'm looking forward to trying my hand in another area of pharmacy so I can better decide which career path I want to follow. Do any of you have any experience in an anticoag clinic? What did/do you think about it? Just looking for additional info.

Thanks!

 

[aphistis]

My hospital (VA) has pharmacists running the coumadin clinic. I've had several patients whose anticoagulation wasn't being managed very well, but I've never thought to check on whether physicians or pharmacists consistently manage INR's better than the other.

 

[All4MyDaughter]

I worked at the anti-coag clinic at my VA last summer. I was pretty impressed with the quality of patient history taken and the level of patient care. Of course, the pharmacist I shadowed had twenty years of experience under his belt and was extremely diligent. I learned a lot.

 

[SpirivaSunrise]

Haha! That's pretty funny. I can imagine going into the physicians' forum and saying that I've noticed prescribers incorrectly managing/dosing patients on drugs A, B and C. Wonder if pharmacists could do it better. I bet that would go over real well.

 

[Twins fan]

I worked at the anti-coag clinic at my VA last summer. I was pretty impressed with the quality of patient history taken and the level of patient care. Of course, the pharmacist I shadowed had twenty years of experience under his belt and was extremely diligent. I learned a lot.

What did a typical day entail for you All4MyDaughter? I would really appreciate it!

Oh, I was thinking the same thing Spiriva...wowsa. Some people's kids!

 

[SpirivaSunrise]

What did a typical day entail for you All4MyDaughter? I would really appreciate it!

Oh, I was thinking the same thing Spiriva...wowsa. Some people's kids!

This was the basic day at the anti-coag clinic I've worked at (not sure how it'll compare to the VA). Patient history included (if they were a repeat patient), asking them what their current regimen was (you wanted to compare what they were actually taking vs. what they'd been instructed to take); this varied from a simple "1 peach tablet daily" to "1 1/2 tablets MWF, 1 tablet TRSatSun", etc. Did they miss any doses since you last saw them? Have they experienced any bruising/bleeding? Any changes in their meds (OTCs, herbals, Rx)? Any changes in their diet, vitamin K, etc.? How many alcoholoc beverages in a week? How have they been feeling lately? Based on these questions, oftentimes you could already guess what the INR was going to be. You'd then proceed to obtain a PT/INR from a small blood sample. Based on the protocol set, the pharmacist would either increase/decrease or keep their regimen the same and write a new Rx. The time to the next appointment would depend on how stable said patient was and how new they were to you.

If they were a new patient on coumadin this would obviously go even more in depth...from why they're on warfarin, what to expect, perhaps start them on a diet log initially, what's normal when they're on the drug, what's not normal, importance of the drug, what we'll be measuring, etc.

Then do this 20 more times a day, or however many patients the clinic sees, and that's it! From what I've experienced, it's very laid back and conversational. You really get to know your patients and you'll be talking about everything from how many spinach salads they ate that week, to their daughter's wedding. Some people may find it a little monotonous day in/out, but if you enjoy conversing with patients and working within the protocol, it can be enjoyable! I think it would be great for you to branch out from retail, and the fact that the clinic deals with diabetic patients too...will allow you to see even more. Good luck!!!

 

[Twins fan]

Thank you so much for the reply...that does sound very interesting. Patient contact...what?!?! We don't see much of that 'round the Wal-Mart parts...we just have a lot of 'costumer contact'.

I was pretty much offered the job at the anticoag pharmacy over the phone, but I have to go in for an "official" interview yet. The clinic is affiliated with my pharmacy school and this particular clinic only takes one incoming student per year, so I was pretty excited to have this opportunity. Just want to learn a bit more about it before my interview though.

And one of the best parts....not open Sundays, open only from 8-12 on Saturdays, close at 7 on M, Tu, Th, and close at 5 on W and F! No holidays! I can get 40 hours a week in during the summer, but once school starts I basically can work as much as I want. Also, my would-be boss said she has season Husker football tickets that might given away at times

I've done my time at Wal-Mart....time to broaden my horizons Thanks again for the reply Sprivia!

If anyone else has any input on anticoag clinics, positive or negative, feel free to let 'er rip.