Clinical Aspects of Pharmacy Education: Focus on Advanced Pharmacy Practice Experience Mort Goldman,...

Clinical Aspects of Clinical Aspects of Pharmacy Education: Pharmacy Education:

Focus on Advanced Pharmacy Focus on Advanced Pharmacy Practice ExperiencePractice Experience

Clinical Aspects of Clinical Aspects of Pharmacy Education: Pharmacy Education:

Focus on Advanced Pharmacy Focus on Advanced Pharmacy Practice ExperiencePractice Experience

Mort Goldman, Pharm.D., BCPSMort Goldman, Pharm.D., BCPSDirector, Pharmacotherapy ServicesDirector, Pharmacotherapy Services

Department of PharmacyDepartment of PharmacyCleveland Clinic, Cleveland, Ohio USACleveland Clinic, Cleveland, Ohio USA

ObjectivesObjectivesObjectivesObjectives

• Cleveland Clinic and Department of Cleveland Clinic and Department of Pharmacy overviewPharmacy overview

• Standards for clinical education and for Standards for clinical education and for Advanced Pharmacy Practice Advanced Pharmacy Practice Experiences (APPEs)Experiences (APPEs)

• Community and ambulatory care APPEsCommunity and ambulatory care APPEs

• Evidence that pharmacists make a Evidence that pharmacists make a differencedifference

• Future directions for community Future directions for community pharmacypharmacy

http://www.mapsofworld.com/usa/states/ohio/ohio-map.html

Established Feb 21, 1921- Four Physicians- MD Group Practice

Physician Led Non-Profit Organization-Group Practice Hospital / Clinics

- Bring together diverse specialists to “think and act as a unit”

Mission: “…care of the sick, investigation of their problems, and further education of those who serve.”

Staff1,799 physicians and researchers

17,000 employees (main campus)(36,000 CCHS total)

120 specialties and sub-specialties

1,388 available beds; 94 operating rooms

Patient Care

Total Admits 52,561

Surgical Cases 73,986

Total OP Visits >3.2M

EducationEducation

- >1,000>1,000 Residents and Fellows in Residents and Fellows in TrainingTraining

• 59 accredited residency programs59 accredited residency programs

- Lerner College of Medicine Lerner College of Medicine

ResearchResearch

- >$144.3 M Grants Awarded>$144.3 M Grants Awarded

• Federal, State, Private Federal, State, Private

• 33rdrd highest NIH funding highest NIH funding

FHCFHC

Elyria FamilyHealth Center

Westlake FamilyHealth Center

FHCFHC

Lorain Family HealthAnd Surgery Center

FHCFHCLakewood

Family HealthCenter

FHCFHC

Strongsville Family Health and Surgery Center

FHCFHC

Brunswick FamilyHealth Center

FHCFHC

Wooster FamilyHealth Center

FHCFHC

Independence FamilyHealth Center

FHCFHCSolon FamilyHealth Center

FHCFHC

Chagrin Falls FamilyHealth Center

FHCFHC

Beachwood FamilyHealth and Surgery Center

FHCFHC

Willoughby HillsFamily Health Center

FHCFHC

HHFairview Hospital

Lakewood Hospital

HH

Lutheran Hospital

HH

Ashtabula County Medical Center

HH

Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH

South PointeHospital

HH

Marymount Hospital

HH

ClevelandClinic

Integrated Health Systemserving 5.1 million patients

Cleveland Clinic Abu Dhabi, UAE

-Sheikh Khalifa Medical City (Abu Dhabi, UAE)

- Toronto Health & Wellness Center

The Department of Pharmacy is a The Department of Pharmacy is a clinical care clinical care departmentdepartment whose mission is to: whose mission is to:

• ensure the provision of safe and optimal ensure the provision of safe and optimal drug therapy outcomes in patients drug therapy outcomes in patients

• educate patients, healthcare practitioners educate patients, healthcare practitioners and students about optimal drug therapy and students about optimal drug therapy

• conduct and support drug-related researchconduct and support drug-related research

Department of Pharmacy Department of Pharmacy MissionMission

Department of Pharmacy Department of Pharmacy MissionMission

The vision of the Department of Pharmacy is to:The vision of the Department of Pharmacy is to:

• be a valued member of the CC patient care teambe a valued member of the CC patient care team

• make a unique contribution to high quality, cost-make a unique contribution to high quality, cost-effective patient care, teaching and researcheffective patient care, teaching and research

• be known for our service excellence to all of our be known for our service excellence to all of our customer groupscustomer groups

• have a local, state, and national reputation and have a local, state, and national reputation and leadership role resulting from the outstanding leadership role resulting from the outstanding quality of our services and programsquality of our services and programs

Department of Pharmacy Department of Pharmacy VisionVision

Department of Pharmacy Department of Pharmacy VisionVision

Department of PharmacyDepartment of PharmacyDepartment of PharmacyDepartment of Pharmacy

FY 2008FY 2008• 319 full time 319 full time

employees employees (FTEs); (FTEs);

• $22 million $22 million salary expensesalary expense

• $127 million $127 million drug expensedrug expense


Inpatient Services Inpatient Services (2008)(2008)

- 238 FTEs budgeted238 FTEs budgeted- 2.23 million medication 2.23 million medication

orders annuallyorders annually- 6.94 million doses 6.94 million doses

prepared & dispensed prepared & dispensed annuallyannually

Hospital Outpatient Hospital Outpatient Clinics, FHCs & ASCs Clinics, FHCs & ASCs (2008)(2008)

- 40 FTE budgeted40 FTE budgeted- 633K main campus clinic 633K main campus clinic

doses annuallydoses annually


Ambulatory Pharmacies Ambulatory Pharmacies (2008)(2008)

- 57 FTE budgeted57 FTE budgeted- 386K prescriptions 386K prescriptions - 10 locations including 10 locations including

FloridaFlorida

Pharmaceutical Care Clinic Pharmaceutical Care Clinic (2008)(2008)

- 13 FTE budgeted13 FTE budgeted- >2,100 Active Patients >2,100 Active Patients - >40,000 INR’s monitored>40,000 INR’s monitored

Department of PharmacyDepartment of PharmacyDepartment of PharmacyDepartment of PharmacyResearch SectionResearch Section

- 5 dedicated FTEs Investigational 5 dedicated FTEs Investigational Drug ServiceDrug Service

• 350 total protocols 350 total protocols

• Manuf, NIH, SWOG, CCGManuf, NIH, SWOG, CCG

- Drug Outcomes ResearchDrug Outcomes Research

• collaboration and publication with collaboration and publication with multiple medical departments multiple medical departments

- Clinical and Practice ModelClinical and Practice Model

• outcome evaluation studiesoutcome evaluation studies

Pharmacotherapy SectionPharmacotherapy Section

• Acute Care Clinical SpecialistsAcute Care Clinical Specialists

• Pharmaceutical Care ClinicPharmaceutical Care Clinic

• Drug InformationDrug Information

• Research/Investigational DrugsResearch/Investigational Drugs

• EducationEducation

• 45+ employees including Pharm.D., R.Ph., RN, 45+ employees including Pharm.D., R.Ph., RN, technical, clerical, and magnificent secretarytechnical, clerical, and magnificent secretary

Acute Care Clinical Acute Care Clinical SpecialistsSpecialists

• Cardiology X2Cardiology X2

• Cardiothoracic ICUCardiothoracic ICU

• SICU SICU

• MICU X2MICU X2

• NeuroICUNeuroICU

• Hematology/ Hematology/ OncologyX2OncologyX2

• Infectious Diseases Infectious Diseases X2X2

• Internal MedicineInternal Medicine

• Nutrition SupportNutrition Support

• Pediatrics X3Pediatrics X3

• Transplantation X4Transplantation X4

Department of PharmacyDepartment of PharmacyDepartment of PharmacyDepartment of PharmacyEducation Education (2008)(2008)

- 2 dedicated FTEs 2 dedicated FTEs

- >350 CCF presentations/ >350 CCF presentations/ inservices inservices per year per year

- College Curriculum FacultyCollege Curriculum Faculty• Lerner College of Medicine Lerner College of Medicine • School of PodiatrySchool of Podiatry

- ASHP Accredited ResidenciesASHP Accredited Residencies

- Pharmacy Student RotationsPharmacy Student Rotations• Univ of Toledo, Ohio Northern, Univ of Toledo, Ohio Northern,

NEOUCOPNEOUCOP• High School Students High School Students

Residencies at Cleveland ClinicResidencies at Cleveland ClinicResidencies at Cleveland ClinicResidencies at Cleveland Clinic

• Pharmacy Practice (PGY1)Pharmacy Practice (PGY1)

• Pharmacotherapy (PGY1/PGY2)Pharmacotherapy (PGY1/PGY2)

• Infectious Diseases (PGY2)Infectious Diseases (PGY2)

• Critical Care (PGY2)Critical Care (PGY2)

• Hematology/Oncology (PGY2)Hematology/Oncology (PGY2)

• Drug Information (PGY2)Drug Information (PGY2)

• ????Community Pharmacy Residency ????Community Pharmacy Residency (PGY1)(PGY1)

• Pharmacists should be the health care Pharmacists should be the health care professionals responsible for providing professionals responsible for providing patient care that ensures optimal patient care that ensures optimal medication therapy outcomes;medication therapy outcomes; and the and the key element required to move the key element required to move the toward this goal is clinical educationtoward this goal is clinical education

• Automation and pharmacy technicians Automation and pharmacy technicians should be performing most if not all should be performing most if not all technical functions of drug dispensingtechnical functions of drug dispensing

• Pharmacists contributions to patient Pharmacists contributions to patient care have been shown to be essential in care have been shown to be essential in hospitals and in the community and are hospitals and in the community and are cost effective (even profitable)cost effective (even profitable)

• Pharmacists are the drug expertsPharmacists are the drug experts

• Pharmacy colleges must provide a Pharmacy colleges must provide a robust clinical curriculum to assure that robust clinical curriculum to assure that pharmacists have the skill necessary to pharmacists have the skill necessary to take care of patientstake care of patients

• Pharmacists must take personal Pharmacists must take personal responsibility to enhance their clinical responsibility to enhance their clinical skills; Pharmacy organizations and skills; Pharmacy organizations and colleges should provide continuing colleges should provide continuing education to support this goaleducation to support this goal

• Pharmacy is a life-long learning process Pharmacy is a life-long learning process

Clinical EducationClinical EducationACPE StandardsACPE Standards

Clinical EducationClinical EducationACPE StandardsACPE Standards

• Provide patient careProvide patient care

• Promote health improvement, Promote health improvement, wellness, and disease preventionwellness, and disease prevention

• Design, implement, monitor, Design, implement, monitor, evaluate, and adjust pharmacy care evaluate, and adjust pharmacy care plans that are patient-specificplans that are patient-specific

• Provide population-based careProvide population-based care

ACPE Guidelines for ACPE Guidelines for Pharmacotherapy CurriculumPharmacotherapy Curriculum


• Begins to translate the basic sciences to Begins to translate the basic sciences to patients patients

- Principles of clinical practice guidelines Principles of clinical practice guidelines

- Integration of scientific knowledge in Integration of scientific knowledge in patient care decisionspatient care decisions

- Application of evidence-based decision Application of evidence-based decision making to patient care making to patient care

- Pain management and palliative carePain management and palliative care



- Wellness and disease prevention Wellness and disease prevention

- Drug monitoring for positive and negative Drug monitoring for positive and negative outcomes and disease monitoring outcomes and disease monitoring

- Nonprescription drugs and dietary Nonprescription drugs and dietary supplements supplements

- Design of patient-centered treatment plans Design of patient-centered treatment plans

- Identification of drug-induced diseases Identification of drug-induced diseases

ACPE Guidelines Advanced Pharmacy ACPE Guidelines Advanced Pharmacy Practice Experience (APPE)Practice Experience (APPE)

ACPE Guidelines Advanced Pharmacy ACPE Guidelines Advanced Pharmacy Practice Experience (APPE)Practice Experience (APPE)

• The true application of the pharmaco- The true application of the pharmacotherapy and basic science curriculumtherapy and basic science curriculum

• From book to bedsideFrom book to bedside

• Practicing as a member of an inter-Practicing as a member of an inter-professional teamprofessional team

• Providing pharmacist-delivered Providing pharmacist-delivered patient carepatient care

Clinical Education at Clinical Education at Cleveland ClinicCleveland Clinic

Clinical Education at Clinical Education at Cleveland ClinicCleveland Clinic

• Provide advanced pharmacy practice Provide advanced pharmacy practice experiences in hospital pharmacy, acute experiences in hospital pharmacy, acute care clinical services, community care clinical services, community pharmacy and ambulatory care for pharmacy and ambulatory care for students at several Ohio collegesstudents at several Ohio colleges

• Typically one month rotations with Typically one month rotations with pass/fail grading systempass/fail grading system

• University of University of Toledo (UT)Toledo (UT)

• Ohio Northern Ohio Northern University (ONU)University (ONU)

• Northeastern Ohio Northeastern Ohio Universities Universities College of College of Pharmacy Pharmacy (NEOUCOP)(NEOUCOP)

..

http://www.mapsofworld.com/usa/states/ohio/ohio-map.html

Student Experiences Student Experiences offered at Cleveland Clinicoffered at Cleveland Clinic

Student Experiences Student Experiences offered at Cleveland Clinicoffered at Cleveland Clinic

• Advanced CommunityAdvanced Community

• Advanced HospitalAdvanced Hospital

• Ambulatory CareAmbulatory Care

• Internal MedicineInternal Medicine

• CardiologyCardiology

• ICUICU

- Medical, surgical, Medical, surgical, cardiothroacic, cardiothroacic, neurological, cardiac, neurological, cardiac, pediatric, neonatalpediatric, neonatal

• TransplantTransplant

- Liver, lung, heart, Liver, lung, heart, kidneykidney

• Infectious DiseasesInfectious Diseases

• Nutrition SupportNutrition Support

• Drug Information Drug Information

• Investigational drugsInvestigational drugs

• Pharmacoeconomics and Pharmacoeconomics and Outcomes researchOutcomes research

Community Pharmacy:Community Pharmacy:Why is Clinical Education so Important?Why is Clinical Education so Important?

Community Pharmacy:Community Pharmacy:Why is Clinical Education so Important?Why is Clinical Education so Important?

• Pharmacists should be the health care Pharmacists should be the health care professionals responsible for providing professionals responsible for providing patient care that ensures optimal patient care that ensures optimal medication therapy outcomes;medication therapy outcomes; and the key and the key element required to move the toward this element required to move the toward this goal is clinical education goal is clinical education - Too many drugs and data for physicians to keep Too many drugs and data for physicians to keep

up withup with

- Pharmacists are the Drug Experts!!Pharmacists are the Drug Experts!!

- Patients are in the community!Patients are in the community!

Community/Ambulatory Clinical Community/Ambulatory Clinical Education at Cleveland ClinicEducation at Cleveland Clinic

Community/Ambulatory Clinical Community/Ambulatory Clinical Education at Cleveland ClinicEducation at Cleveland Clinic

• Community Pharmacy experiences allow Community Pharmacy experiences allow significant patient counseling, and some significant patient counseling, and some directed disease state managementdirected disease state management

• Ambulatory care experiences allow direct Ambulatory care experiences allow direct patient care in the outpatient clinic settingpatient care in the outpatient clinic setting

- Anticoagulation monitoringAnticoagulation monitoring

- Diabetes careDiabetes care

- Hypertension and lipid managementHypertension and lipid management

- General mediation therapy General mediation therapy managementmanagement

Community APPE ExperienceCommunity APPE ExperiencePractices at Cleveland Clinic (ONU, UT) Practices at Cleveland Clinic (ONU, UT)

and NEOUCP sitesand NEOUCP sites

Community APPE ExperienceCommunity APPE ExperiencePractices at Cleveland Clinic (ONU, UT) Practices at Cleveland Clinic (ONU, UT)

and NEOUCP sitesand NEOUCP sites

• Patient counselingPatient counseling

- OTC consultationOTC consultation

• Specialized servicesSpecialized services- Immunizations – all Immunizations – all

Ohio Colleges train Ohio Colleges train students in vaccination students in vaccination technique (they are technique (they are permitted by law to permitted by law to administer particular administer particular agents to adults)agents to adults)

- Medication Therapy Medication Therapy Management Management

Medication Therapy Medication Therapy Management: DefinitionManagement: Definition


• Continuity of pharmaceutical care Continuity of pharmaceutical care

• Assessment of health statusAssessment of health status

• Formulating a medication treatment planFormulating a medication treatment plan

• Selecting initiating modifying therapySelecting initiating modifying therapy

• Monitoring and evaluating response to Monitoring and evaluating response to therapy including safety and effectivenesstherapy including safety and effectiveness



• Performing medication review to identify Performing medication review to identify resolve and prevent drug related resolve and prevent drug related problems problems

• Documenting and communicating to Documenting and communicating to patients other primary care providerspatients other primary care providers

• Providing patient education and training Providing patient education and training

• Providing support to enhance adherence Providing support to enhance adherence

• Coordinating medication therapy Coordinating medication therapy management servicesmanagement services

Community Pharmacy Community Pharmacy APPE ExperienceAPPE Experience

Community Pharmacy Community Pharmacy APPE ExperienceAPPE Experience

• Medication histories, Medication histories, independently or part of independently or part of MTM, OTC consults, etcMTM, OTC consults, etc

• Antibiotic call-back Antibiotic call-back program (NEOUCOP)program (NEOUCOP)

• Drug Use ReviewDrug Use Review

- Review dosing, drug Review dosing, drug interactions, etc. and interactions, etc. and make make recommendations to recommendations to physiciansphysicians

• Answer drug information Answer drug information questions from patients questions from patients and physiciansand physicians

Challenges in Community Challenges in Community PharmacyPharmacy

Challenges in Community Challenges in Community PharmacyPharmacy

• Availability of medical informationAvailability of medical information

- Continuity at the time of admission or Continuity at the time of admission or discharge from the hospitaldischarge from the hospital

• Ability to document interventions or Ability to document interventions or medication changes in the medical recordmedication changes in the medical record

• Marketing – the public and professionals Marketing – the public and professionals don’t know what we can do!don’t know what we can do!

What we can do in the Community:What we can do in the Community:The Ashville ProjectThe Ashville Project


• To assess the clinical, economic, and To assess the clinical, economic, and humanistic outcomes of pharmaceutical humanistic outcomes of pharmaceutical care services provided in care services provided in community community pharmaciespharmacies for patients with diabetes for patients with diabetes

• Pharmacists served as care providersPharmacists served as care providers

• Patient appointments included initial Patient appointments included initial history, needs assessment and goal history, needs assessment and goal setting followed by monitoring, training setting followed by monitoring, training and goal re-evaluationand goal re-evaluation



• HbA1C in range was 33% at base line and 85% HbA1C in range was 33% at base line and 85% in 14 monthsin 14 months

• Significant improvement in LDL, HDLSignificant improvement in LDL, HDL

• 10% decline in total costs10% decline in total costs

- 33% decline in inpatient costs33% decline in inpatient costs

- 20 % increase in outpatient costs20 % increase in outpatient costs

• Glucometers, pharmacist fees, diabetes Glucometers, pharmacist fees, diabetes center costs, etc.center costs, etc.

• Improved outcomes at decrease costsImproved outcomes at decrease costs



• Follow-up projectsFollow-up projects

- Long-term diabetes careLong-term diabetes care

- Asthma careAsthma care

- Hypertension and lipid managementHypertension and lipid management

• All have shown improvements of patient All have shown improvements of patient care at lower costscare at lower costs

• All performed by appropriate collaboration All performed by appropriate collaboration and referal in community pharmaciesand referal in community pharmacies

• J Am Pharm Assoc 2003;43:173-84J Am Pharm Assoc 2003;43:173-84




• Pharmacy Times 1998, October supplPharmacy Times 1998, October suppl

Community Pharmacy Community Pharmacy Future DirectionsFuture Directions

Community Pharmacy Community Pharmacy Future DirectionsFuture Directions

• Disease screening programs to help Disease screening programs to help identify patients requiring in depth identify patients requiring in depth disease state management and MTMdisease state management and MTM

- Blood pressure, Glucose, Lipid profile, Blood pressure, Glucose, Lipid profile, HgA1c, OthersHgA1c, Others

• Working with local physician groups and Working with local physician groups and medical centers for improved referral medical centers for improved referral processprocess

Anticoagulation ClinicAnticoagulation ClinicAnticoagulation ClinicAnticoagulation Clinic• The Pharmacy Managed The Pharmacy Managed

Anticoagulation Clinic (AC) Anticoagulation Clinic (AC) is the largest single is the largest single provider of anticoagulation provider of anticoagulation monitoring services for the monitoring services for the Cleveland ClinicCleveland Clinic

• Pharmacy AC services are Pharmacy AC services are available in 6 distinct available in 6 distinct locations throughout the locations throughout the Cleveland areaCleveland area

- Patient appointments Patient appointments are typically 10 minutes are typically 10 minutes and include a point-of-and include a point-of-care blood test during care blood test during the appointmentthe appointment

Anticoagulation ClinicAnticoagulation ClinicAnticoagulation ClinicAnticoagulation Clinic

• More than 3,000 anticoagulation patients More than 3,000 anticoagulation patients referred by CC physicians received PCC referred by CC physicians received PCC medication management with ~40,000 INR medication management with ~40,000 INR tests in 2008 for all locationstests in 2008 for all locations

Anticoagulation ClinicAnticoagulation Clinic

• Economic analysis compared to non-Economic analysis compared to non-pharmacist run anticoagulation pharmacist run anticoagulation services (1998)services (1998)

• Cost avoidance of $300,000Cost avoidance of $300,000

- Decrease risk/admissions for Decrease risk/admissions for thrombosis and bleedthrombosis and bleed

• Benefit to cost ratio of 1.5:1Benefit to cost ratio of 1.5:1

• Revenue producing serviceRevenue producing service

- Working toward a budget neutral Working toward a budget neutral serviceservice

Anticoagulation Clinic Anticoagulation Clinic APPE ExperienceAPPE Experience


• Patient medication and medical historyPatient medication and medical history

- Asking specifically about concurrent Asking specifically about concurrent medications, changes in medications, medications, changes in medications, changes in health status, diet changeschanges in health status, diet changes

• Finger stick for Point of Care TestingFinger stick for Point of Care Testing

• Place blood sample on Place blood sample on the test stripthe test strip



• Place test strip in the devicePlace test strip in the device

• Read and interpret resultsRead and interpret results

• Adjust medicationAdjust medication

• If result is unexpected, inquire again If result is unexpected, inquire again about health, drug, diet status changesabout health, drug, diet status changes

• Document all information in the electronic Document all information in the electronic medical recordmedical record

Anticoagulation ClinicAnticoagulation ClinicAnticoagulation ClinicAnticoagulation Clinic

• Students learn to care for these patientsStudents learn to care for these patients

- How to recognize drug-drug interactionsHow to recognize drug-drug interactions

- How to recognize food-drug interactionsHow to recognize food-drug interactions

- Dealing with minor bruising and bleedingDealing with minor bruising and bleeding

- Dealing with urgent patient situationsDealing with urgent patient situations

- Providing additional disease management Providing additional disease management to patients with multiple medical problems to patients with multiple medical problems and multiple drug related problemsand multiple drug related problems

Patients with difficult-to-treat diabetes: Patients with difficult-to-treat diabetes: Cleveland Clinic PharmacyCleveland Clinic Pharmacy

Patients with difficult-to-treat diabetes: Patients with difficult-to-treat diabetes: Cleveland Clinic PharmacyCleveland Clinic Pharmacy

• Referred to pharmacists in an internal Referred to pharmacists in an internal medicine clinicmedicine clinic

• Patients seen in clinic, and requested to Patients seen in clinic, and requested to return for follow-up with the pharmacist return for follow-up with the pharmacist initially in 2-4 week intervalsinitially in 2-4 week intervals

• Pharmacist counsels patients on use of Pharmacist counsels patients on use of glucometer, medication adherence, diet, glucometer, medication adherence, diet, and symptoms of their diseaseand symptoms of their disease

• Multiple parameters measured including Multiple parameters measured including HbA1CHbA1C

Patients with difficult-to-treat Patients with difficult-to-treat diabetes: Cleveland Clinic Pharmacydiabetes: Cleveland Clinic Pharmacy

Patients with difficult-to-treat Patients with difficult-to-treat diabetes: Cleveland Clinic Pharmacydiabetes: Cleveland Clinic Pharmacy• Patient data reviewed for those who were Patient data reviewed for those who were

followed by a pharmacist for at least 6 followed by a pharmacist for at least 6 months with at least 3 visitsmonths with at least 3 visits

• Patients who were seen by the pharmacist Patients who were seen by the pharmacist had a significant decline in HbA1C of had a significant decline in HbA1C of more than 2% decreasing their risk for more than 2% decreasing their risk for cardiovascular disease, nephropathy and cardiovascular disease, nephropathy and retinopathyretinopathy

Patients with difficult-to-treat Patients with difficult-to-treat diabetes: APPE experiencediabetes: APPE experience

Patients with difficult-to-treat Patients with difficult-to-treat diabetes: APPE experiencediabetes: APPE experience

• Review patient medical record for Review patient medical record for appropriate therapy, dosing, drug appropriate therapy, dosing, drug interactions, drug related problemsinteractions, drug related problems

• History including compliance and dietHistory including compliance and diet

• Medication, diet, lifestyle councelingMedication, diet, lifestyle counceling

• Medication adjustmentMedication adjustment

• Case presentations, “journal club”, Case presentations, “journal club”, lectures to health professionalslectures to health professionals

ACPE: Future Vision of Pharmacy ACPE: Future Vision of Pharmacy Practice Vision StatementPractice Vision Statement


• As experts regarding medication use, As experts regarding medication use, pharmacists will be responsible for: pharmacists will be responsible for: - rational use of medications, including the rational use of medications, including the

measurement and assurance of medication measurement and assurance of medication therapy outcomes therapy outcomes

- promotion of wellness, health improvement, promotion of wellness, health improvement, and disease prevention and disease prevention

- design and oversight of safe, accurate, and design and oversight of safe, accurate, and timely medication distribution systems timely medication distribution systems



• Pharmacists will have the authority Pharmacists will have the authority and autonomy to manage medication and autonomy to manage medication therapy and will be accountable for therapy and will be accountable for patients’ therapeutic outcomespatients’ therapeutic outcomes



• Pharmacists will be the health care Pharmacists will be the health care professionals responsible for professionals responsible for providing patient care that ensures providing patient care that ensures optimal medication therapy outcomesoptimal medication therapy outcomes

Clinical Aspects of Pharmacy Education: Focus on Advanced Pharmacy Practice Experience Mort Goldman,...

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