HCD - Ambulatory Care Lecture - OCT 9

Introduction

  • Introductions by Faculty

    • Professor with experience in ambulatory care practice

    • Assistant Professor Doctor Rita Alhush (Doctor E)

    • Alumni of the college

    • Background in ambulatory care from the VA

    • Assistant Professor Doctor Getsik

    • Faculty member with 21 years at the college

    • Background in inpatient and ambulatory care

Faculty Backgrounds

  • Doctor Rita Alhush (Doctor E)

    • Specialized in primary care

    • Recent experience at the VA, involved in rotating clinical education

    • Challenges faced due to administrative issues with site rotations

    • History of working in inpatient and retail settings before joining academia

    • Experience in the pharmaceutical industry (Sanofi) before returning to patient care

  • Doctor Getsik

    • Background from Pennsylvania; attended University of Pittsburgh

    • Experience in retail and hospital pharmacy

    • Transitioned into residency training with a focus on cardiology and teaching

    • Worked in inpatient medicine before moving to ambulatory care

Lecture Objectives

  • Define ambulatory care

  • Discuss common medical conditions and medications in ambulatory care

  • Identify settings of ambulatory care pharmacy services

  • Explore the pharmacist's role in ambulatory care settings

Understanding Ambulatory Care

  • Definition of Ambulatory Care

    • Health services provided on an outpatient basis, avoiding the need for hospitalization.

  • Key Characteristics

    • Focus on prevention, early diagnosis, and management of chronic conditions

    • Examples of settings: primary care, urgent care, outpatient surgery, rehabilitation, and mental health services.

Types of Ambulatory Care Settings

  • Primary Care

    • Includes family practitioners, nurse practitioners, and general practitioners providing routine medical care.

    • Responsible for diagnosing conditions, delivering vaccinations, etc.

  • Specialty Care

    • Providers with expertise in specific areas (e.g., cardiology, dermatology)

  • Urgent Care

    • For nonlife-threatening medical issues, serving as an alternative to ER visits.

  • Outpatient Surgery

    • Surgical procedures done without overnight stays in the hospital.

  • Diagnostic Services

    • Centers that perform imaging (MRIs, X-rays) and other diagnostic tests.

  • Rehabilitation Services

    • Physical and occupational therapy for recovery post-surgery or injury.

  • Preventative Care

    • Focused on preventing diseases through screenings and immunizations.

  • Mental Health Services

    • Facilities for intensive outpatient care, particularly for mental health conditions.

Advantages of Ambulatory Care

  • Reduced burden on hospitals

  • Increased accessibility for patients

  • Cost-effective healthcare delivery

  • Convenience for patients seeking routine care.

Common Medical Conditions Treated in Ambulatory Care

  • Chronic Conditions

    • Hypertension, diabetes, asthma management, obesity, and prevention of disease complications.

  • Mental Health

    • Conditions like depression and anxiety managed through pharmacological approaches.

  • General Treatments

    • Pain management, antibiotics for infections, cholesterol management, anticoagulants, GERD management, dermatological conditions, and contraceptive services.

Role of Pharmacists in Ambulatory Care

  • Patient Management

    • Monitor chronic diseases, prescribe medications under collaborative practice agreements (CPA), and conduct patient education.

  • Consultations and Collaborations

    • Work closely with doctors and other health providers to optimize patient outcomes.

  • Medication Therapy Management (MTM)

    • Annual reviews mandated for Medicare patients to assess all medications for appropriateness, interactions, and adherence.

  • Collaborative Drug Therapy Management (CDTM)

    • Pharmacist's ability to prescribe and manage care under specific agreements with physicians.

    • Each state has different regulations regarding CDTM and pharmacist prescribing authority.

Types of Ambulance Care Settings

  1. Independent Private Medical Practices

  2. Hospital-Based Outpatient Services

  3. Emergency and Urgent Care

  4. Community-Based Clinics

    • Federally Qualified Health Centers (FQHCs)

    • Non-profit services and mobile clinics

  5. Government Operated Facilities

  6. Telehealth and Home Health Services

Challenges in Ambulatory Care

  • Coordination of Care

    • Complications with patients receiving care across multiple health systems (e.g., Mass General Brigham, Beth Israel)

  • Documentation Requirements

    • Importance of maintaining detailed records in electronic health systems for continuity and quality of care.

Closing Remarks and Interactive Discussion

  • Opportunity for students to ask questions and discuss insights about ambulatory care roles, diverse settings, and future practices.