Rotation 6: Ambulatory Care – Ypsilanti and Livonia, MI

Posted by Jennifer at Tuesday, April 29, 2014

During this rotation, I traveled to two different clinics throughout the week, one located in Ypsilanti and the other located in Livonia.  At these clinics, my preceptor helps patients mainly in managing their diabetes, hypertension, and dyslipidemia.  In this setting, my preceptor has a collaborative practice agreement with a physician which gives him the right to prescribe medications within his defined disease areas (mainly diabetes, hypertension, and dyslipidemia).  This is a unique position for pharmacists, as typically pharmacists do not prescribe medications.

Before coming into clinic, I would work up my patients at home so that I could determine what the most crucial issues were that should be discussed with the each patient.  During the first hour of the day, my preceptor and I would talk about each patient.  We had valuable discussions about therapy regimens, and this helped me to review and improve my therapeutic knowledge.  During this time, we would also determine what we should talk about with the patient and what the next steps might be in the patient’s drug therapy.  Thinking of plans A, B, and C regarding changes in a patient’s medication regimen ahead of time was valuable.  Sometimes patients did not want to try certain drug therapies, so we would have a back-up plan in place. 

My preceptor and I would either see patients during a 30-minute in-person clinic visit, or we would talk with them over the phone during a 15-minute conversation.  During clinic visits, I would manually measure blood pressure and did a few foot exams for diabetic patients.  Talking with patients during this rotation was a great learning experience.  The goal of these encounters was to let the patient set the agenda of what issues they would like to talk about, and at the same time it was also important for me to gather specific information.  It was challenging at times to balance these two needs while staying on track time-wise, but I found that the more patients that I spoke with, the better I learned how to balance these goals. It was also interesting to be able to follow-up with patients a week or two after visits to see how the medication and/or lifestyle changes we discussed had affected their health. 

A pharmacist in the ambulatory care setting plays a unique and beneficial role in patient’s health, and it was great to participate in this first-hand!