Pharmacists in Family Medicine 4.26.06

1. Pharmacists in Family Medicine: a New Model in Teaching & Practice

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

2. 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

3. 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

4. Audience Survey

5. 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?

6. 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?

7. 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?

8. Audience Survey

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

9. Background

10. 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;13:91-4.
3. Robinson JD, et al. Postgrad Med 1982;71(1):97-103; 4. Carter BL, et al. DICP 1984;18:817-21.
5. Helling DK, et al. Am J Hosp Pharm 1979;36:325-9; 6. Wilt DM, et al. Pharmacotherapy 1995;15(6):732-9.

11. Background

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;34:772-86.

12.

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

13. 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.

14. 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

15.

Ables, AZ. Fam Med 2002;34(9):658-62.

16. Description of Precepting Activities by Clinical Pharmacist Types of Questions Asked

Drug Therapy
Drug Information
Dosing
Side Effects
Drug Interactions
Availability
Cost
Ables, AZ. Fam Med 2002;34(9):658-62.
46%
12%
9%
8%
6%
4%
3%
Identification
Pregnancy/Lactation
Med Assistance Programs
Monitoring Therapy
Patient Education
Physician Education
Other
3%
2%
2%
2%
1%
1%
1%

17. Description of Precepting Activities by Clinical Pharmacist Questions by Post-Graduate Year

Number of questions
1200
1000
800
600
400
200
0
1
2
Resident Post-Graduate Year
Ables, AZ. Fam Med 2002;34(9):658-62.
3
n = 1,888

18. 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

19. Group-on Pharmacotherapy

• 2005 Curricular Recommendations for
Pharmacotherapy education

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Round Table Discussion

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

27. Audience Discussion

28. Final thoughts?

Thank you!