Ambulatory Care Ambulatory Care Pharmaceutical Services - - PowerPoint PPT Presentation

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Ambulatory Care Ambulatory Care Pharmaceutical Services Pharmaceutical Services

Pharmacy 492 Pharmacy 492 February 2007 February 2007

Katie Lai, PharmD., BCPS Katie Lai, PharmD., BCPS

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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?

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Where Where

• Senior Care Clinic (SCC) is located on the 4

Senior Care Clinic (SCC) is located on the 4th

th

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)

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Independent Living/ Homes Assisted Living Ambulatory Clinics LTC

Retail Pharmacy

Hospital Rehab

Health Care Facilities Living facilities

Inpatient Clinical Inpatient Dispense Outpatient Clinical Outpatient Dispense

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Primary Care Clinics Primary Care Clinics Vs. Vs. Ambulatory Care Clinics Ambulatory Care Clinics Vs. Vs. Specialty Care Clinics Specialty Care Clinics

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HMC Ambulatory Care Clinics HMC Ambulatory Care Clinics

Primary Care Clinics Primary Care Clinics

• Senior Care

Senior Care

• Family Medicine

Family Medicine

• Adult Medicine

Adult Medicine

• Pioneer Square

Pioneer Square

• International Medicine

International Medicine

Specialty Clinics Specialty Clinics

• Cardiology

Cardiology

• Neurology

Neurology

• Ophthalmology

Ophthalmology

• Renal

Renal

• Diabetes

Diabetes

• HIV

HIV

• Rheumatology

Rheumatology

• Podiatry

Podiatry

• Orthopedics

Orthopedics

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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

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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

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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

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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

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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

• utcome evaluations
• utcome evaluations

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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

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Typical day in Typical day in Senior Care Clinic Senior Care Clinic

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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

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Medication Assessment: 27 Meds Medication Assessment: 27 Meds

Medical Problems Medical Problems

• Asthma

Asthma

• Hypertension

Hypertension

• Hx of heart attack 2002

Hx of heart attack 2002

• Atrial Fibrillation

Atrial Fibrillation

• Hyperlipidemia

Hyperlipidemia

• Diabetes

Diabetes

• Anxiety & depression

Anxiety & depression

• Insomnia

Insomnia

• Osteoporosis

Osteoporosis

• Gout

Gout

• Osteoarthritis

Osteoarthritis— —pain pain

• Psoriatic dermatitis

Psoriatic dermatitis

• Decreased hearing

Decreased hearing

• Right eye cataract surgery 2005

Right eye cataract surgery 2005

Medications Medications

• 4 different breathing inhalers

4 different breathing inhalers

• Montelukast

Montelukast

• Nasal spray

Nasal spray

• Lisinopril

Lisinopril

• Diltiazem

Diltiazem

• Bumetamide

Bumetamide

• Digoxin

Digoxin

• Warfarin

Warfarin

• Atorvastatin

Atorvastatin

• Lispro insulin

Lispro insulin

• Diazepam, Trazodone

Diazepam, Trazodone

• Venlafaxine

Venlafaxine

• Pantoprazole

Pantoprazole

• Alendronate, Tylenol

Alendronate, Tylenol

• Calcium carbonate

Calcium carbonate

• Docusate, multivitamin, Senna

Docusate, multivitamin, Senna

• Prednisone

Prednisone

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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

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Questions Questions