Monday, January 19, 2004
We have designed and begun implementing a study involving Proton Pump Inhibitor (PPI) therapy — Cost Reduction and Optimization of Proton Pump Inhibitor Therapy. Although there is currently no clinical evidence suggesting one PPI to have a superior efficacy or side effect profile, there is a significant difference between their cost. What we are attempting to determine with this study is the cost savings to both the individual patient, and the provincial drug plan, and the clinical response, when patients currently taking omeprazole, pantoprazole or lansoprazole are switched to the less expensive rabeprazole. Patient recruitment is well underway, and we have already begun receiving clinical feedback. The “preliminary” (and I stress preliminary) introduction and background to our study can be accessed here. I will keep you updated as the results become known.
Monday, January 05, 2004
With the New Year comes an entirely new concept to me – “blogging”. To those of us not immersed in the computer world, it is simply an online diary that can be updated to at any time. My intention is to update this site with the events, progress and challenges of our Primary Care position throughout the past week in hopes that you will pass along your comments, critiques and suggestions.
Being a new grad, you come out of University with this ideal of how the practice of pharmacy can and should be. Sadly, due to the pharmacist shortage, this ideal is often compromised due to a lack of funding, opportunity or staffing. Fortunately, I managed to find a pharmacy that shared this same ideal. Of course it meant that this city girl pack up and move out to a town I didn’t even know existed!
So far so good. I couldn’t have imagined a better response to our idea from the local medical community. The Health District, right down to the each individual health care worker has made the implementation of a pharmacist into the health care system relatively easy. Not only are they excited and willing to work together, but they have also provided clinic office space for me to work in.
Now to catch up on the past few months:
The first month out here I started with the basics – dispensing and counseling, and the day to day operations of the pharmacy (realizing quickly that four years of pharmacy school can not possibly teach you everything you’ll encounter in practice). My first primary care project involved the nursing home. I spent several days going through residents’ charts, doing medication reviews, tracking and requesting lab values. Any recommendations were made to the physician during the weekly rounds. Although I didn’t track the actual rate of physician acceptance, I would say it was fairly high – a nice boost to a new grad’s ego! To date, I still continue to attend the weekly nursing home rounds, with the majority of my responsibility being therapeutic recommendations.
I spent a week in July working at the Lung Association’s Discovery Asthma Camp as a staff pharmacist. I initially became involved with the camp as a pharmacy student, and enjoyed it so much I have attended the past three years. Camp was the first opportunity I had in experiencing first hand how interdisciplinary teams ultimately benefit the patient.
Gord took most of August off to travel on a much deserved holiday. The majority of my time was spent in the pharmacy, although I did find time to still attend the weekly nursing home rounds. I became a preceptor for a 2nd year pharmacy student. It definitely took some getting used to as not only was I just fresh out of school, but I wasn’t used to having to check someone else’s work. All in all, we both survived, and it proved to be a great learning and growing experience for both of us (although the student has since transferred into medical school!)
I spent most of the month at the medical clinic. While there, the two physicians would send me patients they felt would benefit from a medication review. Typically, I would go through the chart, request lab values if necessary (I can now calculate creatine clearance in my sleep), and perform a systematic medication review. In several cases I met directly with the patient to gain a better understanding of their medical history. Recommendations were sent to the physician via a formal write-up, with space included for physicians’ response. Outcomes tracked included actual and potential drug related problems discovered and solved, physician acceptance, and patient response. One case that stands out particularly was an elderly diabetic patient who I discovered had severe renal impairment. After appropriate medication changes were made, we have seen not only an improvement in her diabetic control but also in her renal function. Near the beginning of the month I achieved my Emergency Post-Coital Contraception (EPC) certification, and have since become a certified peer educator.
Although I continued to work at the clinic throughout the month, the one event that stands out the most in this month is the opportunity I had to attend Diabetes Education Classes with one of our elderly patients who was having trouble controlling her diabetes. The two-day classes, in Medicine Hat, AB proved invaluable not only for the patient but for myself as well. I received the most recent information regarding the new practice guideline, and picked up ideas for setting up a similar program in Leader. Once we returned from the classes, we made some adjustments in the patient’s medications, and she has since seen her blood glucose levels remain within target ranges.
Gord had the opportunity to be part of an interdisciplinary group that traveled to the United Kingdom to observe the primary health care system they have in place. He came back very excited and with several ideas for how we can enhance our practice out here.
Back in Leader, I had the opportunity to work directly with three different patients and their physicians in setting up a tapering regimen for long-term narcotic use. Although it entailed a lot of work, and you may not be their favourite person initially, it was truly rewarding to see a patient persevere and overcome their dependency.
Gord spent a lot of the month covering for a pharmacist who was hospitalized in a neighbouring town, so I was in the dispensary for most of the time. Gord and I did have time to sit down and discuss where we wanted to see the practice go in the next year, and develop some of the ideas we have. We are both very much looking forward to what the next year will bring.
Well, that sums up the past six months. It’s hard to believe that time has gone by that fast. Again, I welcome your comments and input at any time.