The inside scoop on pharmacist-led clinics

Policy Standing Committee

During APhA2014 in Orlando, FL, the APhA–ASP House of Delegates passed several resolutions in support of the expansion of pharmacist-led clinics. Seeking additional information, we recently asked experienced practitioners Bella Mehta, PharmD, Associate Professor of Clinical Pharmacy Practice and Administration at The Ohio State University (OSU) College of Pharmacy, and Margaret Williamson, PharmD, Assistant Clinical Professor in the Department of Pharmacy Practice at the Auburn University Harrison School of Pharmacy, to describe their practice sites and offer advice.

‘Wide variety of skills required’

According to Mehta, The OSU College of Pharmacy Clinical Partners Program is a pharmacist-run consulting clinic that provides disease management, wellness and prevention services, and medication therapy management (MTM) through collaborative practice agreements. Physicians refer patients to them and sometimes patients self-refer. They receive MTM consults from dieticians and nurses within the OSU Wexner Medical Center, have contracts with the self-insured health plan for the university, and use Outcomes MTM.

Through these agreements, they adjust dosing of anticoagulation therapy based on point-of-care International Normalized Ratio test results and offer low-molecular weight heparin bridging recommendations. They also offer a tobacco cessation program in conjunction with the OSU College of Dentistry, and provide tobacco cessation counseling and help coordinate prescriptions if
recommended. As part of these
collaborative agreements, they send reports to physician’s offices regarding their patients; if there is an acute matter they will contact them. Often they act as the liaison between the patient and other health care providers during care transitions.

There are a wide variety of skills required to run such a clinic, noted Mehta. Business skills are important, such as understanding of reimbursement, how to perform a community needs assessment, calculating return on investment, and marketing services. It also helps to have an understanding of managing teams and learning how to effectively communicate. A PGY1 residency can offer many of those skills, but also consider training programs that offer opportunities to learn leadership and practice management.

According to Mehta, often, first-year students come for shadowing experiences and APPE students are actively engaged in direct patient care and practice management. They also have a resident who is involved in all aspects of the clinic.

Commitment to educating students

According to Williamson, the Auburn University Pharmaceutical Care Clinic (AUPCC) serves the Auburn University employee population and the surrounding community, providing wellness, disease prevention, and MTM services. The wellness and disease prevention services include weight loss counseling, smoking cessation counseling, immunization screenings and delivery, and biometric wellness screenings.  MTM services include diabetes management, cardiovascular management, and medication reviews.

She noted that a typical day involves a half-day of disease prevention and MTM appointments and a half-day of biometric wellness screenings. Patients can be referred from their primary care provider or as a self-referral. Patients can also be referred from their wellness screening with the AUPCC for further follow-up and additional disease prevention services offered in the clinic. The AUPCC is a stand-alone pharmacist-run clinic, so there are no collaborating physicians onsite; however, the pharmacists work closely with primary care providers in the community to provide pharmacotherapy recommendations for patients. Williamson added that they have several providers who are champions for them in the community that refer patients to their service and rely on them for prescription drug
information.

The AUPCC is a training site for the school of pharmacy and pharmacy health services residencies. According to Williamson, it is part of the clinic’s mission to train both pharmacy residents and fourth-year student pharmacists. Residents and students both assist in assessment of the appropriateness of pharmacotherapy and in the development of recommendations.

If you are interested, Williamson recommends pursuing 1 to 2 years of pharmacy practice residency with an emphasis in ambulatory care, and in the mean time, scheduling several APPE rotations in the primary care setting.