Guidelines for the Development of an Individualized Learning Plan for Pharmacists Working in Primary Care Practice

Transcription

1 Guidelines for the Development of an Individualized Learning Plan for Pharmacists Working in Primary Care Practice These Guidelines outline important knowledge, skills, and values for pharmacists working in a family practice site. The guidelines are similar to the standards of practice used by the Ontario College of Pharmacists and the Leslie Dan Faculty of Pharmacy at the University of Toronto but have been modified to take into consideration the unique needs of family practice. The Guidelines are based on feedback about common practice and therapeutic issues encountered by pharmacists in a previous pharmacist primary care intervention study (Seniors Medication Assessment Research Trial SMART). Designed with SMART physicians and pharmacists input, they reflect areas that pharmacists could target for improvement as they strive to work collaboratively in family practice with the goal of improving drug-related outcomes in elderly patients with complex medication regimens. Goal of guidelines: To help pharmacists identify general learning needs and/or specific knowledge/ skills for improvement How to use these Guidelines: For each category, assess your learning needs using the scale provided. Identify a few priority areas to start with using the right-hand column. Develop an action plan for these learning objectives (with mentor if available). May use OCP learning portfolio as a sample. Periodically revisit checklist to monitor how well learning needs are being met. This may be done with a mentor s help.

2 Guidelines for Development of an Individualized Learning Plan for Pharmacists Working in Family Practice Knowledge Clinical In order to help pharmacists identify and solve a patient s drug-related issues, it is helpful to ask the following questions to direct our thinking (therapeutic thought process): 1. What are the medical conditions/ signs and symptoms of the patient? 2. Are the medical conditions/ signs and symptoms under control? 3. How urgent is the situation? 4. Is the problem(s) being caused by drug therapy? 5. Is drug therapy needed for the problem? 6. What are the alternatives to treat the problem? 7. What is the best drug for this patient? ***************** In order to know whether the medical conditions/ signs and symptoms are under control and the urgency of the situation (i.e. the first three questions), the pharmacist should have an understanding of disease conditions (e.g. pathophysiology, signs and symptoms). To know if the problem is being caused by drug therapy and/or if drug therapy is required (i.e. the remaining questions), the pharmacist should have therapeutic and drug knowledge.

3 For the following medical conditions, please indicate the number that best represents your current skill using the following scale: needs complete needs some no review review review needed Prioritize your learning needs in the right hand column. This does not have to follow the same scale as above, you can decide on a few particular areas that are high priorities for your learning needs so that you can get started with your learning plan. Come back to this document often to reassess your learning plan. Hypertension Dyslipidemia Diabetes Pain Constipation Osteoporosis CHF Coronary artery disease Sleep disorders Depression/ anxiety Falls GERD/ PUD Signs & Symptoms (incl. interpretation of lab & diagnostic tests, physical findings) Pathophysiology/ Etiology/ Risk factors/ Natural progression (complications, sequelae) Efficacy: Guideline recommendations/main evidence supporting each drug choice Side effects Drug/ Disease interactions Cost/ formulary coverage Issues for use in elderly (incl. precaution, renal dose adjustment, dosage forms) areas (pick top choices to start learning plan) BPH/ urinary incontinence Osteoarthritis

4 For each of the knowledge and skill areas below, please indicate the number that best represents your current skill using the following scale: needs complete needs some no review review review needed Prioritize your learning needs in the right hand column. Knowledge Technical/Procedural s determining personal learning needs Locating relevant resources to answer DI question Using therapeutic thought process to identify general and identify/ resolve DRPs (e.g. DIRC, Medline, learning needs Micromedex) Role of pharmacist in family practice site (experience Use of focused clinical questions to identify patientspecific or shadowing) learning needs Roles of family physicians and other practice staff Information retrieval chart Resources/people to refer patient to for additional Information searching and retrieval literature (e.g. non-pharmacological advice Office procedures, charting system, and medication management system (addressed during orientation) s Determining patient needs Comprehensive interviewing (e.g. medication assessment) Brief, focused interviewing (e.g. addressing specific patient issue, disease-specific?) Interviewing patients with special needs (cognitive, visual, hearing impairment, ESL) Basic physical assessment skills (e.g. BP measurement) General communication skills active listening, verbal/non-verbal, use of empathy Medline, Cochrane database, Clinical Evidence) Information retrieval team, community pharmacy, other Critical appraisal (of articles about therapy, of guidelines) to determine if results should be used in patient care (User s Guide; JAMA series) Evaluating: Study methodology Results interpretation (e.g. p value, confidence interval) How to apply results to patients s identifying and prioritizing drug-related problems Using systematic method (e.g. therapeutic thought process) to identify DRPs Prioritizing DRPs based on urgency

5 For each of the knowledge and skill areas below, please indicate the number that best represents your current skill using the following scale: needs complete needs some no review review review needed Prioritize your learning needs in the right hand column. s developing therapeutic plans s Documentation Eliciting desired endpoints/outcomes from patient Uses appropriate style of documentation for target and team perspective audience Weighing pros and cons of each therapeutic Uses systematic method to present information, alternative provides support for DRPs identified, and justifies recommendations Determining from MD what s/he expects pharmacist Documents in a clear and concise manner to do for patient Develops a plan that is clear, complete, and Documents relevant information that complements individualized for the patient team s documentation s implementing therapeutic plans s meeting practice-based needs Educating patients about appropriate medication use Delivering presentations on medication-related topics to family physicians and practice staff Facilitating patient adherence to medications Responding to drug information requests Use of evidence and patient specific information to Prioritizing workload to ensure that patient, practice, justify recommendations Discussion of therapeutic plan/ recommendations with physician Negotiates with team and patient who will be responsible for implementing which part of the plan s Follow-up/monitoring Use of a monitoring tool to define monitoring parameters and time-frame for follow-up Anticipates what changes are needed to plan in case things do not go as expected Integrates pharmacy monitoring plan in with team s overall monitoring plan and study requirements are met Organizing and coordinating changes to office systems to improve medication management

6 We recommend that you review these values and responsibilities when starting a position in family practice. We suggest that you review/ reflect on them again after a couple of months as many of the issues may make more sense after being in the practice for a while and experiencing situations firsthand. As you proceed in your practice, you will likely encounter examples of the values and responsibilities listed. In the columns below, you can write down a brief description of the scenario as you experience it in practice and any thoughts you may wish to discuss with your mentor. Values and Responsibilities Taking responsibility for a decision and being prepared to deal with a situation when the plan does not have the intended outcome Following patient through until all DRPs are resolved (or at least ensuring that someone else is able to take over responsibility) Dealing with uncertainty or ambiguity in diagnosis (eg. knowing when and how to discuss diagnosis with the family doctor rather than researching it yourself) Determining when additional research into a problem is not yielding useful results (knowing when to stop researching and develop a plan for discussion with the physician) Ensuring continuity of care/seamless care (b/w FP office, hospital, community pharmacy, home care, etc) Encouraging and reinforcing lifestyle choices that decrease risk and enhance health-related well-being on an individual patient (health promotion) Negotiating with patient re: use of herbal products for which weak evidence to support/may be harmful Respecting and taking into account both patient s and FP s concerns in patient care activities Negotiating with FP how much responsibility is acceptable for pharmacist to have in different family practice activities Maintaining confidentiality for study purposes, negotiating between patient and FP (issues around patient confidentiality) Providing patients with necessary information to enable them to make informed decisions and take responsibility for their health (patient empowerment/supporting shared decision-making) Advocating for patients best interests and intervening on their behalf with FPs Promoting evidence-based, rational and cost-effective medication use Description of example scenario as encountered in practice Reflections/new insights to be discussed with mentor Next steps: Develop an action/ learning plan to address your learning needs (may use OCP learning portfolio). Developed by: Elaine Lau, Barb Farrell, Zubin Austin, Lisa Dolovich, Lisa Kwok, Shelly House, Lisa McCarthy, Connie Sellors