Thursday, January 10, 2019

Rotation 4, 5, 6: Keeping up with Therapeutics

Posted by Michael Tsai at Thursday, January 10, 2019

Inpatient – Cardiology
On this rotation, I got to experience the day-to-day of a clinical pharmacist specialist in a health-system. My schedule would consist of working up patients early in the morning to make sure I had the most up-to-date lab results for the patients on my service and to check if anyone was admitted overnight.  I would start rounding with the medical team at around 9 am. The team consisted of an attending physician and 3 medical residents. During rounds, the medical residents would update the attending about the patients and make suggestions. They would also see the patient and update them on their progress. My role during rounds was to collect information and make any recommendations I previously discussed with my preceptor. I was actively thinking of labs to order and optimizing medication regimens. Outside of rounds, I also was responsible for medication reconciliations to ensure the medications the patient was taking at home was the same ones ordered in the hospital. I educated patients if they were put on a new anticoagulation medication and oversaw warfarin dosing and monitoring.

Throughout my rotation, I had the opportunity to work with three different medical teams, which showed me different leadership styles and receptiveness to recommendations. Additionally, I picked up on procedures and surgeries commonly seen in the cardiology floor. While they are not taught in our pharmacy curriculum, they may determine which medications the patient should receive.

Days were long on this rotation since there were up to 16 patients to follow at times, but it was a worthwhile experience as it sharpened my clinical knowledge. It also provided an experience in interprofessional teamwork. Working with physicians showed me how little I knew about medical procedures and surgeries, but also gave me confidence in my pharmacy knowledge, as I answered many of their questions about medications.

Drug Information – Managed Care
My next rotation was with the prescription drug plan of an employer group. This was my favorite rotation so far since I am interested in pursuing a managed care pharmacy career after graduation. Assignments on this rotation were project-based. The first task I had was to prepare documents for advisory committee meeting, where formulary decisions would be made. With a new medication recently approved by the FDA, I summarized the characteristics of the medication, clinical trial results, proposed place in therapy, and economic considerations. After presenting this to the advisory committee and hearing the committee’s final decision, I drafted the prior authorization criteria and medication request form for this medication. These were to be used by the plan’s pharmacy benefit manager to determine if coverage would be provided for patients requesting the medication.

Another highlight of the rotation was learning to use Microsoft Excel. Managed care deals with large populations, so datasets are commonly analyzed through Excel. I conducted a drug utilization review, where I identified an at-risk target population from medical and pharmacy claims data. Using this information, the plan sent out letters to prescribers identifying their patients who were at-risk.

During this rotation, I also got to sit in on several meetings, including ones with a mail-order pharmacy, specialty pharmacy, pharmacy benefit manager, and medical benefit. These meetings showed me how a health plan interacted with these other healthcare stakeholders. Additionally, my preceptor allowed me to attend the Academy of Managed Care Pharmacists (AMCP) Nexus conference. On top of learning from multiple sessions about trending topics in managed care pharmacy, I also had the opportunity to network with managed care pharmacists and speak with residency programs at the residency showcase.

I enjoyed seeing projects from beginning to end on this rotation. Since it was a smaller health plan, pharmacists were the jack-of-all-trades and worked on all aspects of managed care pharmacy. I learned much more about this career field and gained valuable experiences.

Open rotation
At the University of Michigan College of Pharmacy, there is an option to leave one rotation free. I chose to have this rotation off to work on residency applications, serve as a groomsman in a friend’s wedding, and visit friends and family in California. I was glad to have some time off to rest and recuperate (and catch nice photos like the one below).

Now that the sun has set on 2018, I’m looking forward to new experiences in 2019!

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