Wednesday, February 20, 2013

Rotation 6: Cherry Street Health Services

Posted by Alison Van Kampen at Wednesday, February 20, 2013

If you are looking for autonomy, this is the rotation for you. This was a pretty cool rotation and I got a pretty good idea of what it is like to be an independent practitioner in an Ambulatory Care Setting.

About Cherry Street/ General Info:
Cherry Street Health Services is an outpatient clinic that serves the underserved. The patient population consist of people that meet specific criteria (low or no income, lack of access to health care, etc) and the clinic provides almost any service they could want. There is an adult medicine unit (where I spent most of my time), a pharmacy, vision, dental, pediatrics, and mental health services.

At this rotation I mostly worked with a specific group of patients who were part of the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) or Spread (I know the letters don't exactly match up but just go with it). These patients entered the program with uncontrolled blood pressure and the goal of the group is to help the patients gain control of their BP through additional contact with them. I also did counseling and medication reviews for patients that were not part of this group when requested by one of the physicians, nurses, dieticians, etc.

I worked very independently at this rotation. I typically saw my preceptor, Fred Schmidt, for about 15 minutes of the 8 - 9 hours that I was at the clinic each day. He worked primarily in the outpatient pharmacy while I spent most of the day in my office in the Adult Medicine Unit working up patients or working on projects.

Typical Day:
On a typical day I would first work up any PSPC or Spread patients that were coming into the clinic for an appointment that day. Each time one of these patients came to the clinic I would do a medication review with them to check for compliance, understanding, efficacy, and side effects. After each of these meetings I would touch base with the primary health care provider for that patient, bring up any issues I noticed, and make any recommendations that I felt may be appropriate.

I would also work up any patients that were scheduled to meet with me for medication education, medication review, or follow up after starting a new medication. I would meet with patients at various times throughout the day and record all of my interactions and any recommendations I made to the primary health care provider. Documentation takes up a good portion of the day and I'm fairly certain I developed a mild case of carpel tunnel syndrome.

In the afternoons I typically made phone calls to check in with PSPC or Spread patients. I would call if the patient had not been at the clinic in at least 3 months or if they had uncontrolled blood pressure at their last visit and the visit was over 1 month ago. Patients were often difficult to contact because they do not always have permanent residences or old phone numbers were on file.

In addition, I answered any drug information questions that came up throughout the day, and I maintained the warfarin log book.

There were several small and large projects that I completed through out the rotation. Here is a list of the projects I had (most of them at least)
  • Short paper on MTM services
  • P&T projects: one on therapeutic substitution and reviews of the new medications Tudorza (aclidinium bromide), Quilllivant XR (methylphenidate ER Susp), and Xeljanz (tofactinib)
  • Group Meeting Presentation: The PSPC and Spread patients meet once monthly to work together to meet goals and there is a presentation on a relevent topic fer them which I gave.  My topic was low-fat cooking for the holidays.
  • Legislative Review Paper: Call MPA and ask about current bills that could impact pharmacy, research the bill(s), and write a paper on the topic
  • Student Handbook:  I updated the student handbook with relevant or helpful information along the way for the next student.  The student handbook is really all the orientation that students get on this rotation.  I was lucky to have the previous student come in one day to explain my responsibilities and how to do things.  I otherwise would have been lost for the majority of the rotation
  • Data collection for new Spread patients:  My preceptor was planning to expand the Spread group to include more patients and I complied information on all of the patients that could have potentially been added to the Spread group.
  • Once again all of these things were documented and put in my student profile for Fred to evaluate at the end of the rotation.
Additional Things I Did:
Each week I attended and took notes for a PSPS/Spread team meeting (consisting of me, my preceptor (Fred Schmidt), and the primary care providers for the patients in the PSPS/Spread groups. The next student came in one day to be oriented to the sight and my preceptor's mentee came in one day to shadow me.  There was also a day where my preceptor was going to the University of Michigan to speak with the P1 students and I joined him and gave them some information on what I was doing as a P4 student. I also attended the P&T committee meetings monthly.
Overall Impressions:
This was a good rotation for Ambulatory Care.  You get A LOT of independence and stay really busy throughout the day.  There really is not much guidance from the preceptor throughout the rotation and you are kind of thrown in to the rotation in a sink or swim fashion.  It can be stressful on days when you have a lot of patients to see or a lot of work to get done but there are also days when there are no patients scheduled for you to see and so things tend to balance out.  Overall, a good rotation if you self motivated and can handle working on your own a lot.

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