1. Clinical Pharmacists: Enhancing Learning and Clinical Care STFM 41 st Annual Spring Conference Allen Last, MD, MPH Beth Musil, PharmD Jonathan Ference, PharmD, BCPS Trish Klatt, PharmD, BCPS Stephen A. Wilson, MD, MPH

3. Objectives  Identify patient populations that may benefit from involvement of clinical pharmacists in their care  Recognize the value of collaboration with clinical pharmacists for family medicine residents  Describe at least 3 models of collaboration with clinical pharmacists to enhance the education of family medicine residents  Discuss the relative advantages of each of these various models.

4. Today…  Introduction  Model A  Model B  Model C  Physician perspectives on collaboration  Discussion/Questions

5. Clinical Pharmacy Specialists in FM Residencies  Clinical Pharmacy Specialists are increasingly prevalent in family medicine residencies.  In 2006 28% of Family Medicine Residencies had a pharmacist on faculty. *  Clinical and educational benefits. *Beth Musil PharmD and Melly Goodell MD. Identification of Barriers to the Incorporation of Pharmacists into Family Medicine Education. Poster Presentation. Medical College of Pharmacists into Family Medicine Education. Poster Presentation. Medical College of Wisconsin 2006 Research Day

6. Pharmacists Roles Dickerson, L, et al, Fam Med 2000

7. Clinical Activities  Demonstrated clinical benefits  Anticoagulation  Hypertension  Diabetes  Congestive heart failure  Asthma  Lipids  Depression  HIV  Epilepsy  Inpatient care  Smoking cessation

8. Educational Activities: Admin Pharmacists involved with:  Committees33-48%  Dealing with pharm reps21-60%  Meds for indigent pts19-43%  Managing samples14-49%  Resident Recruitment14%  Research74%  Fam Med 2002;34(9);658-62  Beth Musil PharmD and Melly Goodell MD. Poster Presentation. MCW 2006 Research Day

9. Educational Activities: Teaching Percent of pharmacists teaching at/with:  Point of Care45-93%  Didactics23-96%  EBM updates83%  Round with residents62%  Consultation/chart review37-61%  Newsletters10%  Fam Med 2002;34(9);658-62  Beth Musil PharmD and Melly Goodell MD. Poster Presentation. MCW 2006 Research Day

10. 3 Models  Beth Musil, PharmD  Racine Family Medicine Residency  Com Based, University Affiliated  6-6-6  Jonathan Ference, PharmD, BCPS  University of Oklahoma Family Medicine Residency  Community-based, University Administered  12-12-12  Patricia Klatt, PharmD, BCPS  UPMC St. Margaret FMR  Community-based, University Affiliated  12-12-12

11. Beth Musil, PharmD Racine Family Medicine Residency Program

12. Resident Education  Co-precept in clinic:  Drug information at point of care  Utilization of drug resources  Assistance w/pt access to medications  Appropriate med monitoring & pt education  Med reviews (chart reviews) on request with written feedback

13. Details of types of Pharmacist Consultations

14. Resident Education: Curriculum  Longitudinal Pharmacotherapy Curriculum  ACGME competency based  Multiple instructional methods  Evidence based  Modeled and reinforce by core faculty  Evaluation – multiple methods Curriculum available on MedEdportal at: http://services.aamc.org/jsp/mededportal/retrieveSubmissionDetailById.do?subId=587 http://services.aamc.org/jsp/mededportal/retrieveSubmissionDetailById.do?subId=587

15. Resident Education: Curriculum  Others:  Information Mastery Curriculum (w/ Dr. Last)  Pharmaceutical Rep Counter Detailing  Community Medicine  Pain  Complementary/Alternative Medicine  Infectious Dz Curriculum available on MedEdportal at: http://services.aamc.org/jsp/mededportal/retrieveSubmissionDetailById.do?subId=587 http://services.aamc.org/jsp/mededportal/retrieveSubmissionDetailById.do?subId=587

16. Resident Education: Rotational  Clinical Rotations:  For residents:  Intern Ambulatory Care training  Pharmacotherapy Elective  Home Study  Medical Students:  M4 pharmacotherapy selective  Pharmacy Students:  4 th year PharmD students: UW, UI,

17. Direct Patient Care Chronic disease state education & management  via MD referral  DM  Asthma  Smoking Cessation  Non-compliance  Poly-pharmacy, med management med management  Med Access

18. Administrative  Recruitment  Curriculum development  Didactic block coordinator  Resident Education Committee lead  Sample cabinet/PAPs  Quality Improvement Projects  Conference attendance and presentations

19. Jonathan Ference PharmD, BCPS University of Oklahoma Family Medicine Residency Program

20. Patricia Klatt, PharmD, BCPS UPMC St. Margaret Family Medicine Residency Program

21. UPMC St. Margaret  Located in Pittsburgh, PA  ~ 7 miles from UPMC main facility  Family Medicine residency unopposed  12-12-12  Specialty residents “visit”

22. UPMC St. Margaret: Pharmacy Dep’t Timeline of Events  2002  No clinical pharmacists through the dept  1 FTE FM pharmacist through FM residency  2003  ICU pharmacist position approved/filled  Pharmacy residency started (FM specialty)  2004  Surgical Services pharmacist position filled

23. UPMC St. Margaret: Pharmacy Dep’t Timeline of Events  2006  ID and Inpt FM/Out pt geriatrics clinical specialists hired  Approval to expand residency from 1 to 4 positions  2007  Recruit 2 pharmacy residents  Add 2 “casual” clinical pharmacists  2008  Recruit 3 pharmacy residents  Graduate 1 st PGY-1 only resident

24. Resident exposure to Pharmacists  ICU  2 nd year  Intern  Daily rounds  Surgical Team  1 st year  Daily rounds  ID  Inpt consults

25. Resident exposure to Pharmacists  Inpatient FM  3 rd year  1 st year  Daily rounds  Outpatient geriatrics  Office visits on geriatric rotation

26. Resident exposure to Pharmacists  Outpatient Family Medicine  Precepting at 3 health centers  Rotation for 2 nd years “Medication Management”  5-6 half days/week of time seeing patients with pharmacists  2 nd Thursday every month 15 minute Rx Update  4 1-hr lectures a year  Field trips

27. Other exposure  Decentralized pharmacy model  Various hospital initiatives led by pharmacists that involve residents

28. Stephen A.Wilson MD, MPH Physician Perspectives on Collaborating with Pharmacists

29. Nothing to fear

30.  Member of the faculty team  Special & different skills, perspectives, abilities  Input valued and sought  Promotional meeting

31.  Model collaboration  Precepting  Lectures  Seek input…publicly

32. Cut them loose; Set them free  Pharm Yard  Med Mgt Rotation  DM education  DM Group Visits  School Health Activities (Asthma)  Community Medicine Projects  Pharm D Residency  Augment Faculty Development Fellowship  Models for future teachers; cycle continues

33. They can spoil it for others Raise expectations of what to expect from pharmacist

34. Funding  Racine  Oklahoma  UPMC St. Margaret

35. Questions/Comments…?