Embracing Interprofessional Education via Shared Diabetic Medical Appointments
Pharmacists and pharmacy trainees have integrated themselves into the interprofessional team in a multitude of practice settings, demonstrating their value in a variety of capacities. In the Beaumont Hospital, Dearborn Schaefer Internal Medicine Clinic, pharmacy and medical trainees provide care to uncontrolled diabetic patients via shared medical appointments with designated roles and responsibilities. This clinic serves as the outpatient training site for both pharmacy trainees and medical residents. Therefore, trainees benefit significantly by embracing the true essence of interprofessional education (IPE). The Center for the Advancement of Interprofessional Education (CAIPE) defines IPE as the involvement of educators and learners from two or more health professionals who create and foster a collaborative learning environment.1
In the Beaumont Schaefer Internal Medicine Clinic, pharmacy trainees (either the first year pharmacy resident or the fourth year Wayne State University pharmacy student) and the medical resident conduct the visit for uncontrolled diabetic patients together, addressing different components of the patient interview. Then, the trainees present the patient case, including their assessment and plan, with myself (the ambulatory care pharmacist specialist/preceptor) and the medical faculty in clinic. The plan is then discussed and agreed upon as a team. This discussion allows for teachable moments, and the trainees are given the opportunity to discuss the rationale for the plan they have created together. This is contrary to models where the pharmacy trainee and medical resident conduct their visits independently, which may not facilitate trainees' learning and providing care with one another. Indeed, this type of model has fostered a collaborative environment where the trainees are able to learn, while providing exceptional care delivered by the interprofessional team.
Student Pharmacist Involvement in Transitions of Care
The pharmacy profession has demonstrated its potential to improve economic and clinical outcomes in transitions of care (TOC) by improving the accuracy of medication reconciliation (MR), providing medication counseling, and reducing 30-day hospital readmissions.2 Although the benefits of pharmacy are well-described, one commonly cited issue with pharmacy-led TOC services is the difficulty in scaling the processes hospital-wide.3 One time and motion analysis found that 46 to 92 minutes were required per medication reconciliation.4 Thus, for a hospital with 23,500 annual admissions, 11 full-time pharmacy faculty would be required for MR alone.3 To expand services, some institutions have turned to pharmacy technicians and pharmacy students to lead medication reconciliation efforts.5
At Beaumont Hospital, Dearborn, the TOC pharmacist specialist has incorporated five Introductory Pharmacy Practice Education students from Wayne State University and the University of Michigan into the MR process. Every day one to two students are given high-risk patients to interview for a best practice MR. This semester, the students are on track to interview more than 80 patients and have identified, on average, more than four medication errors per patient interaction. The students are involved with allergy clarification and identification of social issues such as lack of insurance coverage, transportation problems, and low medication adherence. They also collect clinical data which will be used to identify clinical and social variables that are most highly associated with medication errors to create a more targeted MR program. Student and preceptor feedback have been positive regarding the process from both process and educational standpoints.
References
1.Buring SM, Bhushan A, Broeseker A, et al. Interprofessional education: definitions, student competencies, and guidelines for implementation. Am J Pharm Educ 2009; 73(4): 59.
2.Mekonnen AB, McLachlan AJ, Brien JE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 2016; 6: 1-14.
3.Pevnick JM, Shane R, Schnipper, JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9): 726-730.
4.Meguerditchian AN, Krotneva S, Reidel K, Huang A, Tamblyn R. Medication reconciliation at admission and discharge: a time and motion study. BMC health Services Research 2013; 13(485): 1-11.
5.Gortney JS, Moser LR, Patel P, Raub JN. Clinical outcomes of student pharmacist-driven medication histories at an academic medical center. J Pharm Pract 2018; XX(X): 1-8.