Other Amb care specialties

[MdBrndPhrmcst]

Advertisement - Members don't see this ad

So we all know that many retail chains are thinking of implementing chronic disease managment clinics. So far they mostly deal with HTN, Dyslip and DM. What other disease do you see pharmacists managing chronically in the clinic setting? I know we can do many.. but what do you think will become prevalent?

 

[UTCPharm]

From what I hear asthma might be another one.

 

[KARM12]

Anticoagulation-almost all the amb. profs at my school are connected to this type of clinic.
Osteoporosis- gotta love those foot scanners

 

[MdBrndPhrmcst]

yeah asthma and osteoporosis are definet possibilities... i know lots of pharmacists work in anticoag clinics.. you really think a place like walgreens would start one? hmm i wonder if the liabiltywould scare them off...

 

[KARM12]

yeah asthma and osteoporosis are definet possibilities... i know lots of pharmacists work in anticoag clinics.. you really think a place like walgreens would start one? hmm i wonder if the liabiltywould scare them off...

I read something in one of those free magazines that they send to the pharmacy about an anticoag clinic in a community pharmacy. I think it was at a KMart somewhere.

 

[MdBrndPhrmcst]

sounds kool.. my ideal job would be to work as a primary care specialist dealing with several not one disease states in the community setting..(of course with the retail pharmacists salary) ;-)

 

[rxlynn]

So we all know that many retail chains are thinking of implementing chronic disease managment clinics. So far they mostly deal with HTN, Dyslip and DM. What other disease do you see pharmacists managing chronically in the clinic setting? I know we can do many.. but what do you think will become prevalent?

You might want to check out some of the things that Kerr Drugs is doing. They are a regional chain mostly in NC, and they opened a store (I think in Lenoir) that is focused on the health care side of the drug store business - more DME, room for counseling and health-related education, clinical pharmacists, etc.

 

[Sosumi]

sounds kool.. my ideal job would be to work as a primary care specialist dealing with several not one disease states in the community setting..(of course with the retail pharmacists salary) ;-)

Did you do the rotation at Happy Harry's (now owned by Walgreens) with Hoai An? He's doing clinical activities, screenings, etc. and being paid as much as a dispensing staff pharmacist without having to do any dispensing.

 

[MdBrndPhrmcst]

yes i did.. its still in its incipient stages.. they've got a ways to go.. but exciting nonetheless....who r you btw?

 

[ZpackSux]

I did anticoag...and asthma clinics before. It's boring... same chit over and over and over... to me, it's more boring than processing inpatient orders.. where you see different disease state and drugs.

 

[Sosumi]

I did anticoag...and asthma clinics before. It's boring... same chit over and over and over... to me, it's more boring than processing inpatient orders.. where you see different disease state and drugs.

I've done a few days of AC clinic last year, and it was really is repetitive and boring. Asking the same questions over and over...

Luckily, I got assigned a medication management clinic at the VA hospital this year which is a lot less repetitive. I view this clinic as where MTM foresees itself in the future. However, we get the big benefit of access to patient's records, progress notes, pharmacy profile, labs, consults, vitals, etc. all at the click of a few buttons. These patients are all on so many medications with complicated chronic conditions that it feels more challenging. It's also cool that my preceptor has prescriptive power and the ability to order labs since pharmacists have more privileges in the federal system. Thus it feels like we're making our own impact on the patient while still not overstepping our boundaries and expertise.

 

[MdBrndPhrmcst]

I did anticoag...and asthma clinics before. It's boring... same chit over and over and over... to me, it's more boring than processing inpatient orders.. where you see different disease state and drugs.

yeah I think that dealing with only one disease state truly could be boring.. I'm hoping I can find a job where I can deal with several disease states..I wonder if they have any hospitals where amb care pharmacists can rotate through different clinics throughout the week much like residents do. (ex: monday: anticoag tuesday: asthma wednesday: endocrine)

 

[MdBrndPhrmcst]

I've done a few days of AC clinic last year, and it was really is repetitive and boring. Asking the same questions over and over...

Luckily, I got assigned a medication management clinic at the VA hospital this year which is a lot less repetitive. I view this clinic as where MTM foresees itself in the future. However, we get the big benefit of access to patient's records, progress notes, pharmacy profile, labs, consults, vitals, etc. all at the click of a few buttons. These patients are all on so many medications with complicated chronic conditions that it feels more challenging. It's also cool that my preceptor has prescriptive power and the ability to order labs since pharmacists have more privileges in the federal system. Thus it feels like we're making our own impact on the patient while still not overstepping our boundaries and expertise.

Thats sounds awesome was it a phase 6 or a phase 4a? how often did you make interventions? what type were they? and how did the MD's take your suggestions?

 

[Sosumi]

Thats sounds awesome was it a phase 6 or a phase 4a? how often did you make interventions? what type were they? and how did the MD's take your suggestions?

It's a phase 4a. First you just check out what patients will be coming that day then look up their progress notes, labs, vitals, and medication profile since the last visit. Then you basically go over the patient's medications at each visit, see how adherent they are, teach them about their medications, how to recognize adverse effects (i.e. recognizing the symptoms of hypoglycemia and what to do), review any medication problems (i.e. drug without indication, improper dosage, etc.), take a problem oriented history, and take their blood pressure and pulse, check their heart and breath sounds if appropriate, and examine for edema, etc. Then you present to your preceptor your SOAP. She decides if there's anything else you missed, what medications need to be ordered and labs need to be done (i.e. HbA1c). She then prescribes the medication for the outpatient VA pharmacy to be picked up or mailed to the patient. Then you type up your progress note on CPRS for her to review and electronically sign.

Most of the time, the patients are on so many medications that they're confused about how to take them, what they're for, how to check their blood glucose, or why they're taking them. There have been many opportunities where we have intervened, such as an allergic reaction to penicillin that another provider had assumed was a fungal infection, a physician discontinuing metoprolol without the patient or other providers realizing it, a patient not realizing that he shouldn't just go to bed when his blood sugar is less than 50, etc. The best part is that our preceptor doesn't have to bug the physician to have a medication ordered, although we usually defer if it's something that's beyond our scope. Our SOAP is added in the progress notes for other providers to read if they feel like it.

 

[sdn1977]

I did anticoag...and asthma clinics before. It's boring... same chit over and over and over... to me, it's more boring than processing inpatient orders.. where you see different disease state and drugs.

👍 yep...boring! Which is why it is a "cookbook"

IMO - the issue is the pharmacist who is not in a clinic setting - like the VA or Kaiser who has the resources to dedicate to detailed interventions as Sosumi noted....

What can you offer as a regular retail outpatient (& clinical - don't forget clincal!!!) pharmacist????

Can you offer some interventions which allow the pt to use their medication wisely & with proper consideration to side effects & decreased efficacy??