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Description

This Advanced Practice Experience is designed to provide the professional and motivated student with experience and knowledge of the practice of pharmacy in geriatric medicine.  The student will learn the philosophies of geriatric medicine, how to monitor drug therapy in the elderly patient, the clinical manifestations, treatment and monitoring parameters of common disease states seen in the elderly, and how to effectively communicate with elderly patients and health professionals regarding geriatrics issues.

Justification

Legal and professional factors exist supporting clinical pharmacy training in geriatrics and extended care facilities:

• Population studies project an increasing and significant proportion of elderly persons with in the U.S.  In addition, it is also known that the geriatric population now comprises 13% of the population and yet consume 30% of all prescriptions and nearly 50% of all nonprescription drugs.
• Obscure disease presentation and age-related changes especially when combined with complex medication regimens must be considered when developing a therapeutic plan for geriatric patients.
• Older adults often have chronic illnesses upon which acute illnesses are superimposed, making optimal medication management challenging.
• Federal regulations for nursing homes require pharmacists to review the drug regimen of each patient on a monthly basis.
• Data indicates that clinical pharmacists can improve the quality of patient care in long term care facilities, ambulatory care clinics, and hospitals.  Clinical pharmacy services result in a reduction of unnecessary or inappropriate medications, and early detection and prevention of actual and potential drug-related problems.

Advanced Practice Experience Goals

1. To provide knowledge and experience in the prevention, identification, treatment, and monitoring of diseases and other medical problems in the elderly.
2. Introduce the student to resources of information in geriatrics, and how to apply this information to individual patients.
3. Foster compassion, professionalism, morality, and ethical conduct in geriatric pharmacy practice.

Objectives

At conclusion of this experience, the student will be able to:

• Describe the pathophysiology, prognosis, clinical presentation, and treatment options for common problems and health issues faced by geriatric patients.
• Identify and collect necessary information for elderly patients, and initiate a problem-oriented list..
• Apply knowledge of drug mechanism of action, dosing, side effects, drug-drug interactions, drug-disease interactions, and age-related changes to selecting medications for elderly patients.
• Identify alternatives to potentially inappropriate medications; including, where applicable, the application of federal indicators for drug regimen reviews.
• Demonstrate clinical problem solving skills by formulating an optimal therapeutic plan, providing recommendations, monitoring drug therapy for efficacy and adverse effects, and providing follow-up recommendations.
• Describe health care issues that face the elderly population (e.g. transitions of care, medication costs, finding medical information, community resources, physical impairments, and adherence issues that complicate care) and apply that information when formulating a therapeutic plan.
• Communicate effectively both verbally and/or in writing with elderly residents, their caregivers, and other health professionals regarding pharmacotherapy and long-term care issues.
• Use appropriate drug information resources, critically evaluate the information, and appropriately apply it to both individuals and groups of geriatric patients.

Student Evaluation of Preceptor/Site

Required Readings:

1)Fick et al. Archives of Internal Med 2003;163:2716-2724. http://archinte.ama-assn.org/cgi/reprint/163/22/2716 

2)Bressler R, Bahl JJ. Principles of Drug Therapy for the Elderly Patient. Mayo Clin Proc. 2003;78:1564-1577. http://www.mayoclinicproceedings.com/toc.asp?FID=33&issue=December%202003&folder_description=December%202003,%20Vol%2078,%20No.%2012

3.)  ASCP Statement on Beers' Criteria Drugs.  http://www.ascp.com/public/ga/2005/docs/ASCPAMDABeers.pdf

Recommended Website Information

I.  Medical References

• American Journal of Pharmacotherapy                  http://www.ajgeripharmacother.com
• Geriatrics                                                                   http://www.geri.com
• The Merck Manual of Geriatrics                              http://www.merck.com/mrkshared/mmg/home.jsp

II.  Professional Organizations

• American College of Chest Physicians                       http://www.chestnet.org/
• American Geriatric Society                                           http://www.americangeriatrics.org/
• American Pharmaceutical Association                       http://www.aphanet.org
• American Society of Consultant Pharmacists             http://www.ascp.org
• American Society of Health-System Pharmacists      http://ashp.org
• Institute for Safe Medication Practices                        http://www.ismp.org
• NC Association of  Pharmacists                                  http://ncpharmacists.org

III.  Federal and State Agencies

• FirstGov                                                              http://www.firstgov.gov/Topics/Seniors.shtml
• Fix my Healthcare                                              http://www.fixmyhealthcare.com/
• Healthy People 2010                                         http://www.healthypeople.gov/
• NC Division of Aging                                         http://www.dhhs.state.nc.us/aging/
• NC Senior Care                                                 http://www.ncseniorcare.com/index.htm
• Pharmsafety                                                       http://www.pharmsafety.net/
• World Health Organization                               http://www.who.int/whr/2004/en/
• Medicare Tutorial                                              http://www.cms.hhs.gov/partnerships/tools/materials/medicaretraining/english/htms/modenu1.htm                 

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