Crooked Oak Pharmacy Services Clinic (COPSC) and Norlanco Pharmacy Services Clinic (NPSC) are two pharmacist-led anticoagulation clinics. The learning experience will focus on the care of patients on anticoagulation for the treatment or prevention of thrombosis, utilizing a collaborative drug therapy management agreement. The resident will provide direct patient education, perform point of care INR testing, evaluate appropriate laboratory studies, adjust warfarin dosing and monitor for adverse events. The resident will also work with providers to transition patients to and from the direct oral anticoagulants, and create care plans for periprocedural disruptions in anticoagulation therapy. The resident will communicate with other ambulatory care providers, nursing, retail pharmacies, and family to disseminate the information necessary to ensure the safe and effective use of these high-risk anticoagulants.
The Heart Group learning experience is focused in anticoagulation management and will expose the resident to a variety of cardiac conditions requiring anticoagulation. The Heart Group is a large, multidisciplinary cardiology practice consisting of 29 cardiologists with differing areas of expertise. The service manages more than 1,850 patients on warfarin therapy. The resident will manage warfarin utilizing a collaborative drug therapy management agreement and serve as a pharmacy resource within the practice.
The PGY2 resident will care for patients and be a resource for providers at The Heart Group, cardiology specialist practice at Lancaster General Health. The Heart Group is a large cardiology practice comprised of 28 cardiologists and more than 20 nurse practitioners. The main office cares for patients with general cardiology needs as well as subspecialty needs including heart failure (HF), electrophysiology, valvular heart disease, and cardiovascular risk reduction. The resident will provide direct patient care in the Heart Failure (HF) and outpatient diuretic clinics. The pharmacists in these clinics utilize a collaborative drug therapy management (CDTM) agreement to perform medication titration of HF guideline directed medical therapy (GDMT), and protocols for the initiation of intravenous diuretic therapy. The PGY2 resident will gain experience in caring for HF patients in both the office setting and via telephone/electronic means. In addition to direct patient care, the PGY2 resident will be exposed to other specialty clinic types in the practice and serve as a pharmacist resource for the providers and office staff.
Care Connections is a community care team providing an innovative, intensive, and temporary primary care medical home for high-risk patients striving to meet the needs of individuals who have been admitted to the hospital multiple times related to various social determinants of health and medical complexity. The resident will perform various roles involving comprehensive medication management and transition of care services as part of a multi-disciplinary team that includes, but is not limited to physicians, fellows, nurse practitioners, nurse case managers, patient care navigators, chaplains, and social workers.
The geriatrics learning experience for the PGY2 Ambulatory Care Pharmacy Resident focuses on outpatient care in older adults with an emphasis on bread and butter geriatric syndromes, chronic disease states, care coordination and advance care planning, amongst other things at Lancaster General Health Physicians Geriatrics. This learning experience allows for interdisciplinary care opportunities with a team consisting of geriatricians, nurse practitioners, pharmacist, and social worker using an interdisciplinary approach to help facilitate care of older adults. The resident will be able to partake in monthly continuing education sessions, journal clubs, and practice meetings. Additionally, the resident will also have opportunities to rotate in the memory clinic, long term care facilities, outpatient hospice and palliative care, and osteoporosis clinic if interested.
Medication Therapy Management (MTM): Penn Medicine Lancaster General Health partners with third party payers to identify and address potential gaps in care. Gaps in care are addressed via targeted medication reviews (TMR) or comprehensive medication review (CMR). Examples include, but are not limited to, lack of recommended therapy based on patient disease state(s), medication adherence concerns, medication cost concerns, and therapies with increased risk to the patient via drug-drug, drug-disease, or other interactions. The resident conducts the TMR or CMR with the patient either in-person or via telephone. Medications are reviewed with the patient and identified gaps in care are communicated to the appropriate health care provider.
Ambulatory Collaborative Care Team (ACCT): The ACCT is a group that consists of a nurse care manager, social worker, community health worker and ambulatory clinical pharmacist. The team works with the high-risk patient population within the organization. These patients are deemed high risk due to criteria such as at least three chronic illnesses, frequent hospitalizations and/or psychosocial barriers.
The pharmacist’s role is to evaluate the referred patient’s medication profile, recommend a personalized treatment plan, provide patient education and monitor for adverse effects. The pharmacist also assesses medication adherence, recommends cost effective medications, and addresses other medication-related concerns, as appropriate.
This longitudinal experience consists of one-two sessions/week at varying points during the residency year. The PGY2 resident will assist the ambulatory clinical manager in a variety of projects, monitoring department metrics, and leadership activities. The resident will also attend pertinent management meetings and huddles. This experience will allow for ongoing self-reflection of professional development and experience in clinical service management.
Family Medicine Crooked Oak, Lincoln, Norlanco, Twin Rose, Internal Medicine, and Walter Aument Family Health Center are outpatient family medicine practices located throughout Lancaster County. Due to the geographical distribution of these practices, a wide array of patient populations are served. This includes patients with difficulty affording medications, geriatric populations, multiple comorbid disease states, Spanish-speaking, and varying degrees of health literacy. The resident will provide chronic disease state management to patients via collaborative drug therapy management (CDTM) agreements established with providers. Based on the patient encounter, various risk assessments and history, the resident will create a personalized treatment plan for each patient. Other activities may include, but are not limited to, patient education, responding to drug information requests, medication adherence screening, and provider/staff education.
The resident will be expected to complete both a primary research project and a medication use evaluation. At least one of these projects should be suitable for publication.
The service learning experience will afford the resident the opportunity to contribute to the greater good of local communities within Lancaster County. Commitment to service is intended to enrich the learning experience by teaching civic duty, exposing the resident to real world situations, and developing community engagement while addressing local program specific needs.