Grade Form

The health care system has moved away from an acute care model to one with an emphasis on primary care and prevention.   Physicians must see a large number of patients and often do not have the time to completely meet all of patients’ individual needs.  Pharmacists are uniquely suited to identify, prevent, and solve drug-related problems.  New opportunities to become directly involved with patient care in the outpatient setting continue to develop.  In many states, pharmacists are allowed to prescribe medications under protocol in collaboration with a referring physician.  North Carolina has established the Clinical Pharmacist Practitioner (CPP) that will permit pharmacists to prescribe.  Consequently, today’s Doctor of Pharmacy student must be equipped with the appropriate skills to provide pharmaceutical care. 

The Ambulatory Care Advanced Practice Experience is a required 1-2 month rotation that exposes Doctor of Pharmacy students to the direct patient care model.  Students have the opportunity to provide pharmaceutical care in state-of-the-art primary care clinics.  Each full-time Campbell University School of Pharmacy ambulatory care faculty member is responsible for the care of patients at their clinical site and provides drug therapy management services in collaboration with physicians and other health care providers. 

The types of patients and disease states encountered by the learner will vary, based upon the individual site.  In general, students should be prepared to provide education and collaboratively manage patients with diabetes, asthma, hypertension, hyperlipidemia, COPD, obesity, and anticoagulation needs. 

Advanced Practice Experience Goals

The general goals and objectives for the Ambulatory Care Advanced Practice Experience are discussed below.  All goals and objectives may not be addressed at every Advanced Practice Experience site, depending on patient load, types of patient encountered, and length of rotation.  Learning strategies to meet the goals and objectives are simply suggestions and may be modified by the preceptor to meet the individual student’s needs.

• Appreciate common medications used in primary care.
• Understand the common diseases encountered in primary care.
• Understand the use of drug information resources.
• Understand the need for a complete patient database.
• Appreciate appropriate physical assessment techniques.
• Understand history-taking process.
• Appreciate the importance of patient education.
• Become an effective communicator on the health care team.
• Appreciate the importance of drug-related problems.
• Solve drug-related problems.
• Appreciate the importance of outcomes monitoring.
• Understand the role of the pharmacist in collaborative drug therapy management (CDTM).
• Embrace professionalism.

Objectives

By the end of the rotation, students  will be able to do the following for medications commonly used in primary care:

1. Identify the drug class.  

2. List indications for use.

3. Describe the mechanism of action.

4. Describe potential adverse drug events.

5. Identify the potential time course for adverse drug events.

6. List monitoring parameters for therapeutic efficacy.

7. List monitoring parameters for potential adverse drug events.

8. Identify potential drug-drug interactions.

9. Identify drug-disease interactions.

10. Evaluate cost-effectiveness compared to other therapeutic options.

11. List contraindications for use.  

12. Identify pregnancy category.

Learning strategies:  case presentations, review Top 300 drug cards, small group discussion

2.  Understand the common diseases encountered in primary care. 

            By the end of the rotation, students will be able to do the following for diseases commonly used in primary care:

1. Describe the epidemiology of the disease.

2. Discuss the pathophysiology of the disease.

3. List the negative outcomes of the disease.

4. Discuss the impact of the disease on the patient and the healthcare system.

5. Describe strategies to prevent the disease.

6. Discuss non-pharmacological strategies to treat the disease.

7. Outline a treatment algorithm for managing the disease.

8. Apply clinical practice guidelines to the care of patients.  

Learning strategies: case presentations, reading, small group discussions                  

3.  Understand the use of drug information resources. 

By the end of the rotation, a student will be able to:

1. Identify a patient-specific question.

2. List appropriate resources for answering a question.

3. Develop a search strategy for answering a question.

4. Apply the evidence-based medicine (EBM) approach to a specific patient.

5. Critically evaluate literature to determine strengths and weaknesses of a study.

6. Provide answers in a timely fashion.

Learning strategies: journal club, answering questions for the clinical site.

4.   Understand the need for a complete patient database.

 By the end of the rotation, the student will be able to:

a.     Organize the appropriate information for a pharmacist workup of drug therapy (PWDT) from the patient and/or the medical record:

• Patient identifier

• Chief complaint

• History of present illness

• Past medical history

• Family history

• Social history

• Current medications

• Past medications

• Vital signs

• Review of systems

• Pertinent positives of the physical examination  

• Pertinent negatives of the physical examination

• Laboratory results

• Study findings  

b. Perform blood pressure measure accurately.

c. Perform heart rate measurement accurately.

d. Perform respiration rate measurement accurately. 

e. Other, e.g., peak flow and glucose monitoring.

f. Introduce oneself as a Pharm.D. student.

g. Obtain a medical history (PMH, FH, SH) for a  specific patient.

h. Perform medication history (allergies, prescription medications,    over-the-counter medications, herbal  medications, vitamins, prescription coverage) for a specific patient.

Learning strategies: role-playing, PDTW assessment at the beginning of rotation, case presentations.

5.   Appreciate the importance of effective communication with patients and the health care team.

By the end of the rotation, the student will be able to:

a. Provide patient education at the appropriate level for the individual patient.

b. Identify and address patients specific needs and questions.

c. Provide correct information to patients.

d. Ask patients to verbalize understanding.

e. Demonstrate appropriate nonverbal mannerisms with patients.

f. Discuss the role of the pharmacist in patient education.

g. Demonstrate the appropriate use of devices (peak flow meters, glucometers, etc.)

h. Describe the appropriate use of medications.

i. Discuss the rationale for treating a disease.

j. Provide written instructions to reinforce important points.

k. Present recommendations to providers in a manner that are:

• Non-threatening
• Confident
• Clear
• Organized
• Evidence-based
• Patient-specific

l.  Discuss patient-specific options with team members.

m. Describe evidence for recommendations and decisions.

n. Document interventions appropriately in the chart using SOAP or FARM format that is:

• Succinct
• Organized
• Prioritized
• Inclusive of all interventions
• Written in medical terminology

Learning strategies: role-playing, small-group discussions, reading, patient care.

6.    Appreciate the importance of drug-related problems.

By the end of the rotation, the student will be able to:

a. Discuss the impact of drug-related problems on the patient and the healthcare system.

          b. Identify drug-related problems including:

1. Non-adherence
2. Incorrect dose
3. Incorrect schedule
4. Adverse drug event
5. Drug-drug interaction
6. Drug-disease interaction
7. Therapeutic failure
8. Therapeutic duplication
9. Ineffective medication
10. Not cost-effective

c. List additional information necessary to further assess drug-related problems.

d. Prioritize drug-related problems

e. Describe the etiology of a specific drug-related problem.

f. Develop a plan for solving drug-related problems for a specific patient.

g. List alternative therapies for treatment.

h. List patient factors that aid in therapy selection.

i. Describe the evidence that supports the therapeutic plan.

Learning strategies: readings, small group discussions, case presentations, patient care.

7.  Appreciate the importance of outcomes monitoring.

By the end of the rotation, the student will be able to:

1. Identify monitoring parameters for therapeutic efficacy in a specific patient.
2. Identify monitoring parameters for adverse drug events in a specific patient.
3. Develop a therapeutic plan for monitoring drug therapy.
4. Describe the frequency for outcomes monitoring.
5. Manage drug therapy.

Learning strategies: reading and small group discussions, case presentations.

8. Understand the role of the  pharmacist in collaborative management (CDTM).

By the end of the rotation, the student will be able to:

1. Define CDTM.
2. Discuss the role of the Clinical Pharmacist Practitioner.
3. Describe the benefits of pharmaceutical care.
4. List types of patients that benefit from CDTM.

Learning strategies: Reading and small group discussion, CDTM project.

9. Embrace the importance of professionalism.

By the end of the rotation, the student will be able to:

1. Demonstrate integrity in all activities.
2. Appropriately Resolve conflict with colleagues.
3. Demonstrate responsibility for patient care.
4. Maintain patient confidentiality.
5. Request assistance from preceptor when uncertainties arise.
6. Perform activities in a self-directed manner.
7. Acknowledge limits of one's own knowledge and skills, and seek assistance for improvement.
8. Act promptly and diligently to improve knowledge, skills, and/or attitudes in response to feedback.
9. Deliver constructive feedback in ways that are helpful and respectful of other's needs and feelings.
10. Treat patients, colleagues and others with kindness, dignity and respect, both in their presence and in discussion with others.

Learning strategies: Preceptor modeling and feedback, readings and small group discussion.              

Suggested Readings:

1.  ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult.  http://www.americanheart.org/presenter.jhtml?identifier=3032845

2.  JNC 7 Express.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  NIH Publication No. 03-5233.  December 2003.  http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

3.  Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.  JAMA. 2001; 285(19). http://jama.ama-assn.org/cgi/reprint/285/19/2486

Student Evaluation of Preceptor/Site

Experiential Program Homepage