Anticoagulation

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.

Cardiovascular Diseases

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

Care Connections is a temporary primary care practice for medically complex patients with psychosocial needs. These patients have been admitted to the hospital multiple times due to a combination of medical challenges and behavioral health needs. The team is made up of physicians, nurse practitioners, a pharmacist, case managers, social work, and patient navigators. The PGY2 resident will be an integrated team member and provide comprehensive medication therapy reviews including medication intakes for new patients, transitions of care services, and disease state management. Additionally, the PGY2 resident will have the opportunity to provide education to the Care Connections team.

Geriatrics

The PGY2 resident will work 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 and their family/caregivers for various consults, such as chronic disease state management, polypharmacy and deprescribing, and will have 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.

Population Health

Population Health encompasses a broad scope of ambulatory pharmacist activities.

Payer Based Gaps in Care Initiatives: The ambulatory pharmacist clinicians work directly with stakeholders in the Accountable Care Organization as well as collaborating payers, through which the pharmacists provide clinical interventions addressing care gaps and cost savings initiatives for their patient populations.

Practice Management

During this longitudinal experience, 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.

Primary Care

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. 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.

Research

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.

Service

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.

Preceting and Presentations

The PGY2 resident will provide formal medication management education to healthcare providers as well as further develop self-assessment of their teaching skills and personal performance improvement. The three main formal presentations required are Pharmacotherapy Grand Rounds, Morning Report, and a regional/national presentation. The resident will also create the weekly ambulatory care pharmacy Pearl of the Week and disseminate them to clinicians and staff. Layered learning opportunities for the PGY2 resident will include PGY1 pharmacy residents and pharmacy students.

Endocrinology

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.

Family Medicine Education

This learning experience consists of two parts. During Part 1, the PGY2 pharmacy resident will precept a PGY1 pharmacy resident for their ambulatory care learning experience in chronic disease state management. During Part 2, the PGY2 pharmacy resident will have the opportunity to interact with medical residents in the ambulatory clinics. The family medicine residents rotate through LGHP Downtown Family Medicine and Walter Aument Family Health Center for their primary care clinic experience. This portion of the experience focuses on interdisciplinary learning. The PGY2 pharmacy resident will shadow the family medicine resident in clinic and be available as a pharmacist resource. They will also participate in family medicine education sessions including morning reports, noon conference, and grand rounds as professional development when clinic schedule allows.

Hematology/Oncology

The hematology/oncology medication access clinic serves as a resource for patients initiated on new oral anticancer therapy. The PGY2 resident will provide education to patients on these agents, complete a comprehensive medication therapy review, and provide recommendations to the appropriate managing provider. In addition to the medication access clinic, the PGY2 resident will have the opportunity to gain exposure to other areas such as the outpatient Hematology and Medical Oncology clinic, Symptom Management Clinic, Palliative Care, and Infusion Pharmacy to serve as a pharmacist resource for the providers and other healthcare team members.

Infectious Diseases/ HIV-AIDS

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.

Pain Management

The inpatient pain management service optimizes medication therapy for patients with chronic and acute on chronic pain. The pain management service consists of a pharmacist only at this time. Some topics covered include, but are not limited to, nociceptive and neuropathic pain, equi-analgesic conversions, opioid-induced side effects, and adjunct pain medications. Responsibilities of the clinical pharmacy specialist include rounding with the inpatient pain management service or completing pharmacy pain consults, drug information, completion of pain-related initiatives, contribution to policy development as well as involvement several multidisciplinary meetings related to pain and addiction. The pharmacist also provides education to healthcare professionals as well as patients and caregivers. The PGY2 pharmacy resident will focus on patient cases that would be managed similarly in the ambulatory care setting as well as focusing on TOC and providing recommendations for pain regimens at discharge.

Rheumatology

Penn Medicine Lancaster General Health Physicians Arthritis & Rheumatology (ARS) serves as a specialty LGHP practice offering diagnosis, treatment, and management of various rheumatologic conditions such as lupus, osteoarthritis, osteoporosis, rheumatoid arthritis, Sjogren's syndrome, among others. The practice overall serves and treats comprehensive care for rheumatic conditions, along with education on self-injectable medications, geriatric fracture management, and various joint procedures/injections. The PGY2 resident will have the opportunity to complete co-visits with physicians and providers at ARS with a large focus on osteoporosis. Residents will also be able to complete specialty pharmacy counseling on rheumatologic agents such as parathyroid hormone analogs, adalimumab, secukinumab, and others as the service continues to grow. /p>

Specialty Pharmacy Services

During this experience, the PGY2 resident will provide education to patients initiated on new specialty medications through the medication access clinics. Specialty areas include but are not limited to, Hematology/Oncology, Arthritis and Rheumatology, Hepatitis C, and Cardiology. In addition to the specialty medications, the clinics provide education on direct oral anticoagulants, anti-diabetics, and respiratory agents. The PGY2 resident will provide education to patients initiated one these agents, as well as complete a comprehensive medication therapy review and provide recommendations to the appropriate managing provider. In addition to patient education, the PGY2 resident will also be exposed to the operations related to handling and processing specialty prescriptions, gain familiarity with specialty pharmacy accreditation, conduct outreach for patients prescribed specialty medications, and partner with clinical pharmacists caring for patients initiating specialty medications.

Other electives per resident interest may be explored.