Pharmacists in Family Medicine: a New Model in Teaching & Practice John E. Delzell, Jr, MD, MSPH L. Brian Cross, PharmD, CDE Michelle Hilaire, PharmD, CDE Oralia Bazaldua, PharmD John Tovar, PharmD Jeremy Thomas, PharmD Andrea Franks, PharmD, BCPS

Introductions John E. Delzell, Jr, MD, MSPH Department of Family Medicine Kansas University School of Medicine L. Brian Cross, PharmD, CDE Holston Medical Group University of Tennessee College of Pharmacy Michelle Hilaire, PharmD, CDE Fort Collins Family Medicine Residency University of Wyoming Oralia Bazaldua, PharmD & John Tovar, PharmD Department of Family & Community Medicine University of Texas Health Sciences Center at San Antonio Jeremy Thomas, PharmD & Andrea Franks, PharmD, BCPS Saint Francis Family Medicine Residency University of Tennessee College of Pharmacy

Outline for this Lecture-Discussion Survey Background Description of the speakers’ residency programs Curricular Elements Audience Discussion Financial Issues How are we funded? Audience Discussion Final thoughts

Audience Survey

Question #1 Does your hospital utilize clinical pharmacists? Question #2 Does your department or residency program utilize clinical pharmacists? Question #3 Have you worked with a pharmacist in the inpatient setting?

Audience Survey Question #4 Have you worked with a pharmacist in the outpatient setting? Question #5 Does your hospital pay for a clinical pharmacist? Question #6 Does your department or program pay for a clinical pharmacist?

Audience Survey Question #7 Can a PharmD see patients independently? Question #8 Can a PharmD bill independently for patient care? Question #9 Does your residency program have a formal curriculum for pharmacy teaching?

Audience Survey Question #10 Are PharmDs involved in teaching your residents or students? Bonus Question Are pharmacists taking over the WORLD?

Background

 Clinical pharmacist involvement in FP training programs first described in 1980’s  Increasing involvement as teachers since that time  Clinical pharmacists in FP residency programs:  Improve medication prescribing  Improve patient satisfaction  Improve patient outcomes 1. Geyman JP. J Fam Pract 1980;10:21-2; 2. Johnston TS, et al. J Fam Pract 1981;13: Robinson JD, et al. Postgrad Med 1982;71(1):97-103; 4. Carter BL, et al. DICP 1984;18: Helling DK, et al. Am J Hosp Pharm 1979;36:325-9; 6. Wilt DM, et al. Pharmacotherapy 1995;15(6):732-9.

 Clinical pharmacists in non-FP ambulatory settings have improved outcomes in:  Anticoagulation  Asthma  Diabetes  Heart Failure  Hypertension  These studies have helped to support the role of clinical pharmacists as both teachers & clinicians in FP residency programs Carter BL, et al. Ann Pharmacother 2000;34: Background

Dickerson LM, et al. Fam Med 2002;34(9):653-7.

Roles of Clinical Pharmacists in FP Residency Programs in the US  Survey of FPRPs to evaluate involvement of clinical pharmacists  579 programs identified  155 (27%) had a clinical pharmacist on faculty 56% in community-based programs 44% in university-based programs Dickerson LM, et al. Fam Med 2002;34(9):653-7.

Current State of Clinical Pharmacists in FP Residency Programs in the US  130 pharmacists responded to a web-based survey  Allocation of time/activities: 43%teaching 37%patient care 12%research 12% administration <5% drug distribution

Ables, AZ. Fam Med 2002;34(9):

Description of Precepting Activities by Clinical Pharmacist Types of Questions Asked Identification 3% Pregnancy/Lactation 2% Med Assistance Programs 2% Monitoring Therapy 2% Patient Education 1% Physician Education 1% Other 1% Drug Therapy46% Drug Information12% Dosing 9% Side Effects 8% Drug Interactions 6% Availability 4% Cost 3% Ables, AZ. Fam Med 2002;34(9):

Description of Precepting Activities by Clinical Pharmacist Questions by Post-Graduate Year n = 1,888 Ables, AZ. Fam Med 2002;34(9):

Other Clinical Pharmacist Responsibilities  Scholarly Activities  Clinical Research  Quality Improvement Projects  Publications  Administrative Activities  Resident recruitment  Residency committees  Library maintenance  Pharmaceutical representative interactions  Didactic / evaluative program coordination

Group-on Pharmacotherapy 2005 Curricular Recommendations for Pharmacotherapy education

Our Residency Programs University of Kansas Family Medicine John E. Delzell, Jr, MD, MSPH University-based department and residency program KU College of Pharmacy-located in Lawrence PharmDs work with residents in hospital Family Medicine (& other) service No formal curriculum PharmD salary paid by COP and hospital

Our Residency Programs Fort Collins Family Medicine Residency Michelle Hilaire, PharmD, CDE Community-based residency program University of Wyoming COP located in Laramie PharmD works with residents in FPC and another PharmD who works with residents in the hospital Incorporated into existing residency curriculum PharmD salary paid by University of Wyoming COP

Our Residency Programs University of Texas Health Sciences Center at San Antonio Oralia Bazaldua, PharmD & John M. Tovar, PharmD University-based department and residency University of TX COP located in Austin PharmDs work with residents in FPC & hospital There is a formal curriculum PharmD salaries paid by Hospital, FM Department & COP

Our Residency Programs UT / Saint Francis Family Medicine Residency Program Jeremy Thomas, PharmD &, Andrea Franks PharmD Community-based, University run residency program University of Tennessee COP located in Memphis PharmDs work with residents in FPC and hospital There is a formal rotation PharmDs salaries paid by COP

Round Table Discussion Curricular Elements Pharmacotherapy rotation Required or elective Didactics / conferences Precepting in Family Practice Center Journal Club Morning report Consultations Shadowing Other educational opportunities

Round Table Discussion What are the funding models that are out there? Hospital funding Department funding College of Pharmacy funding Joint arrangement LIMITED clinical revenue generated

Round Table Discussion Actual Pay Varies by institution Varies by experience of the pharmacist Varies by training (residency or fellowship training, advanced certification, etc)

Audience Discussion

Final thoughts? Thank you!