Pharmacists in Family Medicine a New Model in

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

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

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 Pharm. D see patients independently? Question #8 • Can a Pharm. D bill independently for patient care? Question #9 • Does your residency program have a formal curriculum for pharmacy teaching?

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

Background

Background § Clinical pharmacist involvement in FP training programs first described in 1980’s ØIncreasing involvement as teachers since that time § Clinical pharmacists in FP residency programs: ØImprove medication prescribing ØImprove patient satisfaction ØImprove 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.

Background § Clinical pharmacists in non-FP ambulatory settings have improved outcomes in: ØAnticoagulation ØAsthma ØDiabetes ØHeart Failure ØHypertension § 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.

Dickerson LM, et al. Fam Med

Roles of Clinical Pharmacists in FP Residency Programs in the US § Survey of FPRPs to evaluate involvement of clinical pharmacists Ø 579 programs identified Ø 155 (27%) had a clinical pharmacist on faculty • 56% in community-based programs • 44% in university-based programs Dickerson LM, et al. Fam Med

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

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

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 3% Pregnancy/Lactation 2% Med Assistance Programs 2% Monitoring Therapy 2% Patient Education 1% Physician Education 1% Other 1%

Description of Precepting Activities by Clinical Pharmacist Questions by Post-Graduate Year n = 1, 888 Ables, AZ. Fam Med 2002; 34(9): 658 -62.

Other Clinical Pharmacist Responsibilities § Scholarly Activities ØClinical Research ØQuality Improvement Projects ØPublications § Administrative Activities ØResident recruitment ØResidency committees ØLibrary maintenance ØPharmaceutical representative interactions ØDidactic / 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 • Pharm. Ds work with residents in hospital Family Medicine (& other) service • No formal curriculum • Pharm. D salary paid by COP and hospital

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

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

Our Residency Programs UT / Saint Francis Family Medicine Residency Program Jeremy Thomas, Pharm. D &, Andrea Franks Pharm. D • Community-based, University run residency program • University of Tennessee COP located in Memphis • Pharm. Ds work with residents in FPC and hospital • There is a formal rotation • Pharm. Ds 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!