Pharmacy Services

Pharmacy Services Residency

HIV Clinic

(PGY1 Rotation - Ambulatory Care)

 
Preceptor:

Christine Jamjian, PharmD, AAHIVP

 
Site Description:

The HIV Clinic is located at the University of Utah Health as part of the Infectious Diseases Clinic. The HIV Clinic provides HIV care to approximately 2,000 patients.

The pharmacist involved in the care of HIV-infected patients in Clinic 1A at the University of Utah Health participates with other members of the health care team (e.g. physicians, physician assistants, nurses, social workers, and case managers) in the management of patients for whom medications are a focus of therapy. The pharmacist in Clinic 1A also serves as a source of information for the providers and the community. Pharmacy services in Clinic 1A are designed to support the different components of the medication-use process (ordering, dispensing, administering, monitoring, and educating) in order to achieve positive patient outcomes.

 
Rotation Description and Typical Weekly Activities:

The pharmacy resident is expected to review patients’ charts in preparation to meet with the patients. After meeting with the patients, he/she will review their findings with the practitioner and address any medication-related issues. The Pharmacy resident will also provide patient education for HIV management and new HIV regimens, evaluate drug therapy regimens, and provide recommendations for optimizing drug therapy, monitoring, and patient adherence. The pharmacy resident will document all patient care activities in the electronic medical record. While in the clinic, the pharmacy resident will respond to any drug information requests from the providers. The pharmacy resident will discuss with the preceptor a variety of HIV/AIDS topics. The pharmacy resident will attend Monday Mornings Infectious Diseases Conference (8am to 9am), Dilemmas in Antiretroviral Therapy (DART) (2nd Wednesday of every month), Case Management Meeting (Every Thursday 9:30 to 11:30), and Stump the Stars (Every Thursday from 5pm to 6pm). The resident is expected to be available to the clinic Monday through Friday from 8am to 5pm – or until patient care tasks are complete.

 
RLS Goals:

  • Goal R1.1: In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process.
    • OBJ 1.1.1 (Applying) Interact effectively with health care teams to manage patients’ medication therapy.
    • OBJ 1.1.2 (Applying) Interact effectively with patients, family members, and caregivers.
    • OBJ 1.1.3 (Analyzing) Collect information on which to base safe and effective medication therapy.
    • OBJ 1.1.4 (Analyzing) Analyze and assess information on which to base safe and effective medication therapy.
    • OBJ 1.1.5 (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).
    • OBJ 1.1.6 (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.
    • OBJ 1.1.7 (Applying) Document direct patient care activities appropriately in the medication record where appropriate.
  • Goal R3.1: Demonstrate leadership skills.
    • OBJ 3.1.2 (Applying) Apply a process of on-going self-evaluation and personal performance improvement.

Activities Evaluated:

Rotation Activity

RLS
Goal

Teaching
Methods

Evaluate antiretroviral therapy for HIV infected patients including monitoring for safety and efficacy
Identify medication related problems including adherence issues, adverse events to antiretrovirals and how to manage those, drug interactions between antiretrovirals and other medications and supplements, barriers to acquiring medications

Communicate recommendations for modifying drug therapy directly to the provider

OBJ 1.1.1:

Interact effectively with
health care teams to manage patients’
medication therapy
OBJ 1.1.4:
Analyze and assess information on which to base safe and effective medication therapy

Instruction
Modeling
Coaching
Facilitating

Conduct daily 5-8 patients’ interviews to determine current drug therapy and update medication reconciliation
Educate patients & care providers on new antiretroviral regimens
Recommend an antiretroviral regimen based on patients’ genotype and life style

Objective R1.1.2:

Interact effectively with
patients, family members, and caregivers

Instruction
Modeling
Coaching
Facilitating

Review 5-8 patients’ charts prior to visit daily
Chart review will include:
Medication Reconciliation, adherence, vaccinations, appropriate laboratory monitoring for safety and efficacy of antiretroviral therapy, recommendation to start antiretroviral therapy based on patients’ CD4 count, viral load and/or other co-morbid conditions,

Objective R1.1.3:
Collect information on which to base safe and effective medication
Therapy

Instruction
Modeling
Coaching
Facilitating

Management of HIV patients including medication management, dose adjustments, ordering of labs, and providing education for patients.
Labs for clinic HIV patients may be ordered as appropriate for patients and monitored regularly according to current practice and organizational policies

OBJ 1.1.5:
Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).

Instruction
Modeling
Coaching
Facilitating

Plans for HIV patients will include monitoring for safety and efficacy as well as a timeline for follow up

OBJ 1.1.6
Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.

Coaching and Facilitation

Documentation of all patient care activities and interactions will be provided in the electronic medical record for all pharmacist-patient interactions
Documentation will include pertinent information and will be forwarded to the appropriate health care professionals verbally or electronically in a timely manner
Types of documentation will be discussed

OBJ1.1.7
Document direct patient
care activities appropriately in the medical
record or where appropriate

Instruction, Modeling, Coaching and
Facilitation

Use and incorporate feedback from preceptors to continuously improve patient care interactions and dosing/monitoring decision-making

OBJ 3.1.2
Apply a process of ongoing self-evaluation and personal performance improvement.

Coaching
Facilitating

 
Readings and Preparatory Work:

  1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
  2. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Available at http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.
  3. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.  Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf.

Evaluations:

The preceptor will have regular discussions and observe the resident with patients and clinicians, especially at the beginning of the rotation. The resident will receive formative feedback orally and then do a snapshot of their experience at the midpoint. At the end of the rotation, a summative evaluation of the resident’s work will be provided and then recorded in PharmAcademic.

Updated March 2016