Ambulatory care practice irat

Pharmacists specializing in ambulatory care may practice in an

academic medical center, a community pharmacy, a private physician's office, or another type of practice with an outpatient focus (treatment of chronic and acute non-emergent illnesses)

Ambulatory care pharmacists may treat patients with a wide range of chronic conditions such as

diabetes, hypertension, asthma, and heart failure, or they may focus on a specialized patient population, such as patients with HIV or specific neurologic disorders. 

Collaborative Drug Therapy Management (CDTM)

which could include prescribing privileges for particular medications, the ability to order laboratory tests to monitor therapeutic outcomes, and the authority to adjust medications on the basis of physical examination data and laboratory tests.

Veterans' Affairs Healthcare System, or other hospital-affiliated setting, patient referrals usually come from

physicians or other healthcare professionals working within that system.

With the reluctance of many insurance companies to recognize pharmacists as patient-care providers,

ambulatory care pharmacists often have to request that individuals pay directly for services

Comprehensive medication reviews (CMRs)

are required annually by the Centers for Medicare & Medicaid Services (CMS) for every MTM-eligible patient (2 or more chronic disease states, 2 to 8 Part-D covered medications, annual cost threshold of $5,330), which involves reviewing all medications and identifying and resolving MRPs using the 5 core elements in the chart below

Target medication reviews (TMRs)

are required at least quarterly to monitor the patient’s drug therapy and identify and resolve actual or potential MRPs, which may include adverse drug interactions, drug interactions, duplication of therapy, and medication nonadherence.

The goal for all MTM services is to

improve patient outcomes.

How to Conduct a Medication Therapy Management Interview

1. Obtain information from the patient to establish a more comprehensive database than what exists in the pharmacy computer or health system medical record.

2. Establish a pharmacist-patient relationship by explaining the benefits of MTM.

3. Incorporate MTM Core Elements (MTR, PML, MAP, intervention, documentation, follow-up)

4. Observe the patient's behavior for trends that may affect outcomes.

In the United States, the Omnibus Budget and Reconciliation Act of 1990 (OBRA-90) mandates certain professional responsibilities of the pharmacist when dispensing prescriptions for Medicaid (government third-party payer) patients. These responsibilities include:

1. Patients who utilize the United States Medicaid program receive an offer from the pharmacist to be counseled on their medications.

2. Pharmacists maintain patient profiles for Medicaid patients that include information such as a list of disease states, medications, allergies, and adverse events.

3. Pharmacists must also perform a prospective drug utilization review of the entire patient profile prior to dispensing a prescription.

The goal of the OBRA-90 requirements is to help

reduce the incidence of drug-related problems such as medication-related adverse effects, duplication of therapy, and poor adherence, to prevent negative patient outcomes.

When it comes to counseling on prescriptions in NYS, the law mandates that a Pharmacist or intern counsel a patient if they are

1. a new patient to your pharmacy

2. an existing patient who is now being dispensed a new medication

3. an existing patient with an existing script by now the dose, strength, or directions have changed

4. being dispensed a controlled substance

All over-the-counter (OTC) medicines contain a 

 Drug Facts label on their outer package that tells you how, when, and how often to use a medicine.

Elements of a drug facts label

1.Active ingredients

2.Uses

3.Warnings

4.inactive ingredient

5.purpose

6.directions

7.other information

Dietary supplements are

substances you might use to add nutrients to your diet or to lower your risk of health problems, like osteoporosis or arthritis

The FDA was given regulatory power to do

POST-MARKETING surveillance and review voluntary adverse event reporting.

The Federal Trade Commission,

which monitors product advertising, also requires information about a supplement product to be truthful and not misleading.

The FDA regulations require that dietary supplement labeling include a descriptive name of the product stating that it is a "dietary supplement";

the name and place of business of the manufacturer, packer, or distributor; a list of ingredients; and the net contents of the product.

If you see a USP Verified mark (#9), this means that the

supplement has been independently tested to confirm the product meets USP quality standards.

OTC product consultations between pharmacists and patients take place in various settings throughout the pharmacy

the drive-through window, the register, the OTC aisle, the consultation room, or the telephone. Because these encounters sometimes can be disjointed and rushed, it is important to have a stepwise approach for assessing patients’ self-care needs and developing appropriate recommendations.

The primary goal of the OTC consult is to assist the patient in determining the best approach to a particular situation.  The consult may have one or more of the following outcomes:

1. Recommendation of  a product

2. Referral to the physician

3. Provision of health education without recommending a product at this time.

The QuEST process offers

pharmacist a quick guideline for assessing a patient’s condition systematically and completely.

QuEST

• Quickly and accurately assess the patient

• Establish that the patient is an appropriate self-care candidate

• Suggest appropriate self-care strategies to the patient

• Talk with the patient about these strategies.

SCHOLAR-MAC

• Symptoms

  

• Characteristics of symptoms

• History of symptoms

• Onset

• Location

• Aggravating factors

• Remitting factors

• Medications (prescription, OTC, herbal, dietary supplements) 

• Allergies

• Conditions (medical).

 

PQRSTA

• P: precipitating or palliating factors

• Q: quality of the symptoms

• R: radiating or remitting factors

• S: Site and severity

• T: Time (how long has this been occurring)

• A: associated symptoms