this may seem dumb to some but I was wondering if I could get some info. I am interested in pharmacy (I am 4th year undergrad so I dont know a lot and this will most likely change throughout pharmacy school) that deals with long term patient care. I have heard a general reference to something like this as clinic work, as opposed to retail and hospital "pill dispensing", or MTM or hospital outpatient work. While doing this sort of work as a pharmacist is there a lot of long term chronic patient management? I am interested in following a patient through adapting the treatment and getting to know the patient. Is this something that can be done with pharmacy? Would you need a post doc fellowship type experience to do this? Is it fairly common so that I would be able to do this in most areas (does every hospital have some?) any info or a link would help thanks
ribbit...I'm not sure exactly which patient you are interested in following...
Is it the geriatric broken hip who has 1 wk acute pre,post-op care, 1 week rehab & 4 wks home care?
Is it the long term convalescent pt - anything from the multiple head traum, quadriplegic, coma 23 yo MVA to the 86 yo stroke pt???
Well....there are varing levels of pt involvement in pharmacy with each type of setting.
With the first...the acute pharmacist will be involved....the warfaring, lovenox, pain meds, hbp meds, etc....all need to be monitored & restabilized with the post op time frame. Then they usually pass it off to the convalescent rx.....mostly warfarin & pain management, altho with some stroke, trauma victims...it can be seizure management. It also involves family interation at this point.
For the long term...you have monthly pharmacist visits....mostly to maintain compliance with standards. These pts don't change much clinically, however, sometimes the standards of care are not met to the letter....it needs pharmacy to maintain that - ie reasons for continuing an antiemetic or analgesic when there is no indication, etc...
Long term, hospital or institutional involvement is fragmented....unfortunately. However..community care can be fulfulling. However - it too can be limiting. When the COPD pt develops a "cold" & their Advair inhaler is no longer providing adequate ventilation...they won't call you!! They'll call their physician or go to the ER - as they should. We want to continue compliance with current tx & advise when tx is not maintaining the same level of health. We are not in a position to diagnose nor advise tx...we advise seeking out tx when the current regimen is no longer providing adquate care. I know lots and lots of pts very well. However...I never necessarily know when they have an acute issue which takes them to their physician nor ER. I did have a pts wife call me from the pts room about 30 min after the pt expired. She just wanted me to know since I had known him so long. He was a nice guy & just had one time too many of acute exacerbations of his pulmonary issues. I had known him for 7 years - not that long, but long enough to encourage him to continue his inhalers, exercise,lose weight, etc..
No...I don't think you need a fellowship...perhaps a residency....you need to decide what area you want to pursue. But...you need to develop a deep sense of empathy & understanding of the aging process. I'm not sure post graduate programs will give you that if you don't already have it.
When you talk to pts.....try to think of them as your parents, grandparents, sibs, children....what are their fears, misunderstandings, confusions???? Each changes with age & circumstance.
Does that help???
