Subject(s)
Community Pharmacy Services/organization & administration , Diffusion of Innovation , Pharmacists/psychology , Precision Medicine/methods , Decision Support Techniques , Delivery of Health Care, Integrated/organization & administration , Humans , Interprofessional Relations , Models, Organizational , Pharmacogenetics/organization & administration , United StatesABSTRACT
It is the position of the American College of Clinical Pharmacy (ACCP) that formal postgraduate residency training, or equivalent experience, is required to enter direct patient care practice. Therefore, it is important to align professional degree educational outcomes with the knowledge, skills, and attitudes needed to enter residency training. This position statement addresses the outcomes necessary in the professional degree program curriculum to ensure the ability of pharmacy graduates to transition effectively into postgraduate year one residency training. Five key outcome areas are identified: communication, direct patient care, professionalism, research, and practice management. The position statement examines how performance in each of the five outcome areas should be addressed by professional degree programs. The ACCP believes that for the student to achieve the clinical proficiency necessary to enter residency training, the professional degree program should emphasize, assess, and provide adequate opportunities for students to practice: communication with patients, caregivers, and members of the health care team in direct patient care environments; provision of direct patient care in a wide variety of practice settings, especially those involving patient-centered, team-based care; professionalism under the supervision and guidance of faculty and preceptors who model and teach the traits of a health care professional; application of principles of research that engender an appreciation for the role of research and scholarship in one's professional development; and application of practice management, including documentation of direct patient care activities that affect drug-related outcomes.
Subject(s)
Education, Pharmacy , Pharmacy Residencies , Communication , Humans , Patient-Centered Care , ResearchABSTRACT
OBJECTIVE To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. SETTING A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. PRACTICE DESCRIPTION Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. PRACTICE INNOVATION The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. PARTICIPANTS 18 patients taking clopidogrel, a drug metabolized by CYP2C19. MAIN OUTCOME MEASURES Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. RESULTS Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between person's first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. CONCLUSION A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge.
Subject(s)
Community Pharmacy Services/organization & administration , Cytochrome P-450 CYP2C19/genetics , Pharmacists/organization & administration , Pharmacogenetics/methods , Aged , Aged, 80 and over , Clopidogrel , Community Pharmacy Services/economics , Feasibility Studies , Female , Genetic Testing/economics , Genetic Testing/methods , Humans , Male , Medication Therapy Management , Middle Aged , Pharmacists/economics , Pharmacogenetics/economics , Physicians/statistics & numerical data , Platelet Aggregation Inhibitors/metabolism , Platelet Aggregation Inhibitors/therapeutic use , Professional Role , Reimbursement Mechanisms , Ticlopidine/analogs & derivatives , Ticlopidine/metabolism , Ticlopidine/therapeutic useABSTRACT
OBJECTIVES: To identify and characterize postgraduate year 2 (PGY2) pharmacy residency programs with a secondary emphasis on academia. METHODS: Residency programs were identified using the American College of Clinical Pharmacy (ACCP) online directory of residencies, fellowships, and graduate programs and cross-referenced with the American Society of Health-System Pharmacists (ASHP) residency directory. An electronic questionnaire was developed and sent to residency program directors to collect attributes of each program. Data were analyzed using descriptive statistics. RESULTS: Most programs were initiated during the past decade. More than two-thirds were ASHP-accredited and half had a primary specialty in ambulatory care. The average program structure consisted of clinical practice service (50.4%), experiential teaching (18.5%), classroom-based teaching (16.4%), research (10.7%), and service (3.7%). Most residents (90.0%) accepted an academic appointment upon completion of these programs. CONCLUSIONS: Postgraduate year 2 residency programs with an emphasis on academia provide experiences in clinical practice, experiential and classroom teaching, research, and service. These residency programs result in participants obtaining academic positions after graduation.
Subject(s)
Education, Pharmacy, Graduate , Pharmacy Residencies , Teaching , Humans , Pharmacists , Surveys and QuestionnairesABSTRACT
AIM: To describe the exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. An institutional review board-approved protocol for a clopidogrel pharmacogenetic program in a community pharmacy was developed to address feasibility and evaluate the pilot program. STUDY CONCEPT: Subjects taking clopidogrel are asked to participate at the point of medication dispensing. A pharmacist schedules an appointment with subjects to discuss the study and collects a buccal swab sample for CYP2C19 testing. When the results are available, the pharmacist consults with the subject's prescriber regarding test result interpretation and associated recommendations, and schedules a second appointment with the participant to discuss results and review any physician-approved therapeutic changes. The intervention-associated consultation is then billed to the subject's insurance. RESULTS: Subject enrollment has begun. CONCLUSION: Community pharmacists may be valuable partners in pharmacogenetics.
