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Hospital Pharmacy:Lecture five
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Hospital Pharmacy:Lecture five


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sAmbulatory Pharmacy Services in Hospital Setting

sAmbulatory Pharmacy Services in Hospital Setting

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  • 1. Ambulatory Care Services In Hospital Pharmacy Anas Bahnassi PhD RPh
  • 2. Lecture Objectives: Upon completion of this lecture the student should be able to:1. Describe ambulatory care practice2. Describe the impact of ambulatory care practices3. Provide examples of activities provided through ambulatory care services4. Identify future opportunities and challenges
  • 3. No Need Define Ambulatory Care forOvernight “all health-related services for Stay patients who walk to seek their care” Seaton, Ambulatory Care, PSAP Ambulatory Clinics Free Standing Pharmacies general (primary care); Hospital Assisted Living Outpatient Centers Departments specialty (day surgery, chemotherapy)
  • 4. Rationale of Ambulatory Care• Shift from Hospital Ambulatory care: – Managed Care requiring decreasing long hospital stays. – Increased outpatient procedures especially for elderly with multiple chronic conditions – More focus on preventive medicine and patient education – The Goal is to decrease health care costs• Continuity of care: – bridging the gaps – secondary prevention clinics
  • 5. Value of Ambulatory Pharmacy Serviceso Increase physician availabilityo Increase # patient visitso Decrease hospitalization rates: Asthma clinic, Pauley et al, 1995o Drug cost savings: Jones et al, 1991o Improve quality of care: o More thorough work-up o Address adherence issues: Ulcers: Lee et al, 1999 o Better treatment outcomes: o Anticoagulant control, Chiquette et al, 1998 o Hypertension, Erickson et al, 1997 o Diabetes, Coast-Senior et al, 1998 o Fewer adverse drug reactions: Miller et al, 1996
  • 6. First Contact Continuity of Care Comprehensive Care Primary Care Individualization DiseaseAmbulatory Prevention Care Patient Education Particular Organ Secondary Disease Care Prevention Specialized Training
  • 7. Pharmacist: Roles & Responsibilities in Ambulatory Care Services• Screening and early detection – dyslipidemia – hypertension – diabetes – osteoporosis• Health promotion and disease prevention – immunization – smoking cessation – general wellness
  • 8. Pharmacist: Roles & Responsibilities in Ambulatory Care Services• Medication history and assessment – disease specific – efficacy, toxicity, adherence – medication management – herbal products• Pharmacotherapeutic interventions – identification/prevention of drug-related problems – establishing goals and outcomes – initiate Pharmacy – modify Care plan – discontinue – monitor drug therapy
  • 9. Implementation of Pharmaceutical Care Plan Documentation Communication – With Who: • physician • Health care team • community pharmacy • community agencies (e.g. VON) – How to: • chart • team rounds • telephone
  • 10. Documented Study on the Impact of Ambulatory Care ServicesTelephone follow-ups reduce seniors drug-related problemsPatients aided by pharmacist callsBy Lynn HaleyVANCOUVER – Telephone followup can greatly reduce drug-related problems (DRPs) in geriatric patients, researchers atthe Toronto Rehabilitation Institute reported at the recent17th World Congress of the International Association ofGerontology. The Medical Post, VOLUME 37, NO. 28, August 21, 2001 Kwan, Alibhai, Papastavros, Armesto, Toronto Rehab Institute
  • 11. Additional Drug-related problems identified during Telephone follow-up: 4% Non-adherence 10% 27% Adverse reaction 17% Pt unclear about med. regimen Inappropriate dosing/administration Additional drug reqd *20% 22% Unclear indication* new category that emerged during follow-up
  • 12. •101 interventions were carried out • 66% of interventions were provided by the pharmacist over the telephone Intervention type % Total1. Medication education  41.6%2. Dosing regimen modification  20.0% (e.g. timing, use of compliance aids)3. Therapeutic recommendation 12.9% (resulting in new prescription)4. Consult Geriatrician 11.8%5. Refer to community resources  8.0% (e.g. community pharmacy, VON)6. Earlier clinic follow-up visit 4.9%
  • 13. Initiating Ambulatory Care PracticesMultidisciplinary falls clinic:• Medications contribute to falls• Role of the pharmacist: – interventions will be patient specific – weighing risk vs. benefit – preventive measures (e.g. osteoporosis) – education of the patient informed choices
  • 14. Challenges1. Team dynamics: – overlapping scopes of practice (health teaching) – clarify roles and responsibilities – key messages2. Marketing your services: – education of patients and health care providers, re: scope of practice – when to refer
  • 15. Challenges3. Delivering patient education – effectiveness and impact – adult vs. student education – group education - interactive vs. didactic – multi-cultural aspects – varying levels of education – handouts4. Changing the public’s perception – creating a demand for cognitive services
  • 16. ASHP StandardsMinimum standards for pharmaceutical care services in ambulatory care:1. Leadership and Practice management2. Medication therapy and pharmaceutical care3. Drug distribution and control4. Facilities, equipment and other resources
  • 17. Future Opportunities• Reimbursement• Credentialing (value added) – residency – Pharm.D. – fellowship – specialty certification
  • 18. Future Opportunities• Measuring quality of care – identifying representative markers of care (e.g. BP, lipid levels)• Measuring patient satisfaction – timeliness, efficiency, communication• Impact on long term outcomes – e.g. diabetes education- > control BS -> impact on complications?
  • 19. SummaryTremendous opportunity for growthMultidisciplinary team resources availableDedicated time for direct patient care and follow-upTaking the lead in care - primary liaisonOpportunity to try new ideas!
  • 20. Hospital PharmacyAnas Bahnassi PhD RPh attribution – non-commercial – share alike