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Residency

Central City CHC Ambulatory Care Rotation

Preceptor:

Laura Shane-McWhorter, PharmD, BCPS, FASCP, BC-ADM, CDE
Professor (Clinical) of Pharmacotherapy
University of Utah College of Pharmacy
lmcwhorter@pharm.utah.edu

 
Site Description:

Central City Community Health Center (CHC) is a federally qualified Family Practice Clinic that provides medical care to underserved patients. This primary care setting evaluates patients throughout the lifespan but the rotation will focus on certain disease states, such as diabetes, hypertension, hyperlipidemia, depression, thyroid disorders, women's health and other diseases. The pharmacist works with physicians and physician assistants to optimize medical care and medication use for underserved patients. The resident will develop an understanding of medications from a patient standpoint as well as from a therapeutic standpoint.

 
Rotation Description:

The rotation requires 4 weeks of daily attendance for approximately 8 hours a day at the Central City CHC. During this rotation, students will learn about several different disease states through direct patient contact. The different disease states will be the following:

  • Diabetes - Type 2 Emphasis
  • Hypertension
  • Hyperlipidemia
  • Diabetes During Pregnancy and Gestational Diabetes
  • Obesity in adults and children
  • Depression
  • Hypothyroidism

As the opportunity arises, the following may also be covered:

  • Renal disease
  • Thromboembolic disorders during pregnancy
  • Hepatitis C, gastroesophageal reflux disease, hepatic disease

During the rotation, residents will learn to provide diabetes self-management training and education to underserved patients so that patients may better understand their disease state. Residents will learn how to provide education so that patients may avoid both acute and chronic complications of their disease states. Patients at the clinic are underinsured or have no insurance. Residents will learn how to deal with cultural issues and language barriers of patients, since many patients speak only Spanish. There are many cost issues and residents will help prescribers select medications that are less costly to patients. Residents will learn about Pharmacy Assistance Programs that help provide medications at no cost to patients.

 
RLS Goals

E 7.1 — Use approaches in all communication that display sensitivity to the cultural and personal characteristics of the patients, caregivers, and health care colleagues
R 2.2 — Place practice priority on the delivery of patient-centered care to patients
R 2.3 — As appropriate, establish collaborative professional pharmacist-patient relationships
R 2.5 — When necessary, make and follow-up on patient referrals
R 2.8 — Recommend or communicate regimens and monitoring plans
R 2.12 — Document direct patient care activities appropriately
R 5.1 — Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public

 
Activities Evaluated:

Rotation Activity RLS Goal Teaching Methods
Conduct thorough patient interviews to determine current drug therapy and relevant medication history. (A minimum of 10 patients per week) R2.2
R2.3
E7.1		 Modeling
Coaching
Facilitating
Identify medication-related problems. Communicate recommendations for modifying drug therapy directly to the provider and document patient interactions in the medical record. (Approximately 20 per week, providing information to primary care providers, including Family Practice physicians and PAs) R2.2
R2.3
R2.5
R2.12
E7.1		 Direct Instruction
Modeling
Coaching
Facilitating
Provide patient-specific education on diabetes, hypertension, and hyperlipidemia integrating an individualized needs assessment, lifestyle, medication use, blood glucose monitoring, and as appropriate initiating insulin therapy R2.2
R2.3
R2.12
E7.1		 Direct Instruction
Modeling Coaching
Facilitating
Respond to drug information questions from providers and patients (On an as needed basis - approximately five/week) R2.2
R2.3
R2.12
E7.1		 Direct
Instruction
Modeling
Coaching
Facilitating
Lead 1-2 topic discussions based on recent journal articles R2.2 Coaching
Facilitating
Present two patient cases (formal case presentations to the preceptor and PharmD students on rotation) R2.2
E7.1		 Coaching
Facilitating
Attend weekly Family Practice Grand Rounds E7.1 Modeling

 
Core Topics Covered During Rotation:

Diabetes, hypertension, hyperlipidemia, diabetes during pregnancy or gestational diabetes, thyroid disorders, depression, and obesity.

At the end of the rotation, residents will be able to perform the following:

  • Provide information to patients on the metabolic problems found in diabetes
  • Provide education and information on target blood glucose, hemoglobin A1c, blood pressure, and lipid levels for persons with type 2 diabetes
  • Provide education and information on target blood glucose for gestational diabetes patients
  • Perform a 24-hour dietary recall and provide general information on healthy nutrition
  • Teach patients how to use a blood glucose monitor
  • Teach patients how to inject insulin
  • Teach patients how to do foot care
  • Teach patients about health care maintenance, including immunizations and eye exams
  • Provide 1 idea and/or instigate a service to make the clinic a better place for patients. For example: Gather patient information materials to facilitate education for patients

 
Teaching and Learning Methods:

The format of the course is experiential, teaching vignettes, oral/written patient case presentations and topic discussions, and self-directed information retrieval and evaluation. Specifically, direct instruction, modeling, coaching, and facilitating will be used.

Meeting time/location:
  Central City Community Health Center
  461 South 400 East
  Monday-Friday 8:00am – 5:00 pm

 
Required Readings

  • American Diabetes Association: Clinical Practice Recommendations 2009.  Diabetes Care 2010;33(Suppl 1):S11-S61.
  • Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (Diabetes Care 2009;32:193-203).
  • AACE and ADA Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care 2009;32:1119-1131.
  • American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes. Diabetes Care 2008;31(Suppl 1):S61-78.
  • American Diabetes Association: Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials. Diabetes Care 2009;187-192.
  • American College of Endocrinology/American Association of Clinical Endocrinologists Consensus Statement. Diagnosis and Management of Hyperglycemia – When do the Risks of Diabetes Begin? Endocrine Practice 2008;14:933-46.
  • Adult Treatment Panel III: Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-97.
  • Chobanian AV, Bakris GL, Black HR, et al: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289:2560-72.
  • Coronado GD, Thompson B, Tejeda S, Godina R: Attitudes and beliefs among Mexican Americans about type 2 diabetes. Journal of Health Care for the Poor and Underserved 2004;15:576-88.
  • Goyette D, Disco ME, Leal S, Schwed DH: The pharmacist as a primary care provider for the medically underserved. J Am Pharm Assoc 2003;43(5 Suppl 1):S52-3.
  • Shane-McWhorter L, Oderda GM: Providing Diabetes Education and Care to Underserved Patients in a Collaborative Practice at a Utah Community Health Center. Pharmacotherapy 2005;25:96-109.
  • Other References:
    • diPiro, Principles of Pharmacotherapy
    • Koda-Kimble, Applied Therapeutics
    • Natural Medicines Comprehensive Database
    • Handbook of Nonprescription Drugs
  • Useful Websites:

 
Evaluation:

The resident will receive feedback at least three times weekly from the preceptor. A short summative midpoint evaluation will be done in ResiTrak and a complete summative evaluation will be posted at the end of the rotation in ResiTrak.