Pharmacist–led anticoagulation management is utilized by over seven LG Health Physicians family medicine practices, a multi-disciplinary cardiology practice, and a mechanical circulatory support (MCS) device clinic. Warfarin management is provided through an anticoagulation collaborative drug therapy management (CDTM) agreement. The pharmacists are also dedicated to anticoagulation stewardship and patient education. The resident is a resource for other healthcare providers.
The PGY2 resident will care for patients and be a resource for providers at a large cardiology practice. 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.
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 due to a combination of behavioral health and medical challenges. 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.
During this experience, the resident will work with patients of Diabetes and Endocrinology Specialists (DES). The pharmacist primarily works with patients with diabetes. The pharmacist works with the provider(s) to titrate and/or adjust medication regimens to more rapidly achieve therapeutic goals. These patients require closer follow up than the usual interval of 3-12 months. Some patients referred have been declined for surgery until they reach specific diabetes control parameters. The pharmacist works with these patients to reach goals required to be approved for surgery.
The PGY2 resident works closely with geriatricians, nurse practitioners, and social work in a clinic-based setting to help build awareness in caring for the ambulatory older adult population. The resident pharmacist will conduct visits with older adults for various consults, such as chronic disease state management, polypharmacy and deprescribing, and additional counseling and patient education opportunities. A focus on seeing the importance of transitions of care for older adults, exposure to common “bread and butter” geriatric disease states, review and participation in advanced care planning, and end-of-life discussions will be seen during the learning experience. Additionally, the resident will be able to provide journal clubs, in-services, and/or case presentations to advocate for our growing population of elderly patients.
During this experience, the resident will work at two sites: Comprehensive Care and the Tuberculosis Clinic. Comprehensive Care is dedicated to caring for those who are HIV positive, taking pre-exposure prophylaxis therapy, transgender, and family members of someone living with HIV. The multidisciplinary team consists of but is not limited to physicians (family medicine specialists and certified HIV specialists), nurses, social workers, nutritionists, and pharmacists. The Tuberculosis Clinic is held at the local branch of the Pennsylvania Department of Health. Patient populations commonly seen include latent tuberculosis treatment and active tuberculosis.
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.
Pharmacists are embedded in over ten LG Health Physicians family medicine practices throughout Lancaster County. Due to the geographical distribution of these practices, a wide array of patient populations are served. These include patients with difficulty affording medications, geriatric populations, multiple comorbid disease states, Spanish-speaking, and varying degrees of health literacy. Chronic disease state management is provided to patients via CDTM agreements established with providers. Examples of our CDTMs include, but are not limited to, diabetes, hypertension, COPD and asthma.
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. The pharmacist’s role is to evaluate the referred patient’s medication profile, recommend a personalized treatment plan, provide patient education, monitor for adverse effects, and addresses other medication-related concerns, as appropriate.
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.