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 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.

Geriatrics

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.

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.

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 is an elective learning experience for the ambulatory care PGY2 resident. The pharmacist in this clinic serves as a resource for patients initiated on a new oral chemotherapy agent. The role of the clinical pharmacist is to provide education to review proper administration, monitoring, adverse reactions, storage, precautions and safe handling at home, and dietary restrictions. The clinical pharmacist also completes a comprehensive medication therapy management review and provides recommendations to the appropriate managing provider. The pharmacist serves as a resource to both patients and healthcare team members. In addition to the medication access clinic, the resident will have the opportunity to shadow other areas at ABBCI such as Medical Oncology, Symptom Management, Palliative Care, and Infusion Pharmacy, as well as spend time with nurse navigators and dieticians, to serve as a pharmacist resource to the providers and other office staff.

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 conditions such as autoimmune disorders, lupus, myositis, osteoarthritis, osteoporosis, rheumatoid arthritis, Sjogren's syndrome, and vasculitis. Several providers from LGHP ARS also practice and provide care to women at the Women's Specialty Center (WSC) that provides personalized primary and specialty care. 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. Currently, there is no clinical pharmacy presence at LGHP ARS aside from specialty pharmacy counseling on PTH analogs, adalimumab, secukinumab, and other rheumatologic medications as needed/appropriate. The PGY2 pharmacy resident will complete co-visits with the physicians/providers at ARS and WSC.

Specialty Pharmacy Services

The role of the clinical pharmacist is to provide medication education to patients on specialty medications. Some of the specialty clinics include, but are not limited to, Hematology/Oncology, Arthritis and Rheumatology, Hepatitis C, and Cardiology. In addition to the specialty medications, the clinical pharmacist provides education on direct oral anticoagulants, anti-diabetics, and respiratory agents. The clinical pharmacist completes a comprehensive medication therapy management review and provides recommendations to the appropriate managing provider. In addition to patient education, the PGY2 pharmacy 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. The PGY2 pharmacy resident will also have exposure to monitoring of departmental metrics involving specialty pharmacy services.

Other electives per resident interest may be explored.