Managed Care Pharmacy Practice Residency

Transcription

1 Managed Care Pharmacy Practice Residency Making a difference, one family at a time!

2 Managed Care Pharmacy Practice Residency Table of Contents Statement of Purpose Page 1 Instructional Design and Organization Page 1 Program Goals Page 2 Resident Performance Assessment Page 3 Primary Preceptors Page 4 Training Sites Page 5 Salary and Benefits Page 6 Application Process Page 6 Candidate Evaluation Criteria Page 7 Schedule of Instructional Activities Page 8 Program Goals and Performance Objectives Page 9 Sample Competency Checklist Page 18 Resident Performance Evaluation Form Page 20 Resident Performance Evaluation Form Page 22 Criteria-based Checklist (Snapshot Evaluation) Page 24 Candidate Recommendation Form Page 26 Updated September 2005

3 Managed Care Pharmacy Practice Residency I. STATEMENT OF PURPOSE In response to the changes in healthcare delivery systems, emerging reimbursement trends, and increasing recognition of the need to improve and document drug therapy outcomes, the Health Plan of San Joaquin Managed Care Pharmacy Practice Residency prepares pharmacists for leadership roles in the managed care setting. The program is designed to provide a solid foundation in population-based pharmaceutical care. Primary emphasis is placed on the development and implementation of medication use management initiatives and policies, clinical programs, formulary management, pharmacoeconomic and outcome assessment, drug information, effective communication, teaching and mentoring skills. Residents are guided to discover and develop their own unique talents, so as to engender optimal growth and satisfaction throughout their careers. It is our goal as preceptors to nurture in our residents the knowledge, skill, insight, and commitment that will enable them to raise the level of practice of Pharmacy in the managed care environment. As a result of having completed the HPSJ Managed Care Pharmacy Practice Residency, graduates will have the tools to excel and lead at a variety of managed care practice sites. II. INSTRUCTIONAL DESIGN AND ORGANIZATION The 12-month Residency in Managed Care Pharmacy Practices consists of activities developed by faculty from Health Plan of San Joaquin (HPSJ), University of the Pacific (UOP) and San Joaquin General Hospital (SJGH). Functionally, the Residency is divided into seven core training themes that represent the key subject areas around which all instructional activities are organized. A range of specific activities has been designed within each of the core training themes to ensure that residents are afforded maximum learning opportunities across the full scope of managed care pharmacist roles. Seven Core Training Themes (CTTs): 1. Inpatient Pharmacotherapy 2. Ambulatory Pharmacotherapy 3. Medication Use & Formulary Management 4. Drug Information, Communication & Customer Services 5. Business Administration 6. Teaching & Mentoring 7. Personal and Professional Leadership Structurally, the Residency is divided into six 2-month blocks. This approach ensures that instructional objectives are pursued in a logical, systematic progression. The ambitious goals of the HPSJ residency require careful scheduling in order to distribute the workload evenly throughout the year, so as not to overwhelm the resident at any one time. During each block, one or two of the core training themes are emphasized more heavily than the others. However, the resident is expected to prioritize and work on the ongoing, longitudinal activities within each of the seven core training themes. In addition to the activities associated with each 2-month block, the resident participates in the Pharmacist-managed ambulatory care clinics at SJGH throughout the entire residency year to ensure a continuous growth of clinical skills. HPSJ Managed Care Pharmacy Practice Residency Manual page 1

4 Six Training Blocks: 1. Pharmacy Operation 2. Institutional Clinical Practice 3. Medication Use Management 4. Clinical Program Development 5. Drug Policy and Outcome Management 6. Leadership and Management III. PROGRAM GOALS (See pages 9-17 for a complete list of program goals and objectives) Core Training Theme #1 Inpatient Pharmacotherapy 1-1: Effectively conduct direct patient-care activities using a consistent approach that reflects the philosophy of pharmaceutical care. 1-2: Build a knowledge base of information sufficient to design an effective medication therapy regimen. 1-3: Design, monitor, and evaluate patient-specific pharmacotherapy. 1-4: Recommend pharmacotherapeutic regimens and corresponding monitoring plans. 1-5: Implement the pharmacotherapeutic regimen and/or corresponding monitoring plan. 1-6: Redesign pharmacotherapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data. 1-7: Provide medication-use education to patients and caregivers. 1-8: Collect outcome data on patients. 1-9: Ensure continuity of care to and from the acute and ambulatory patient-care settings. 1-10: Document pharmaceutical care activities appropriately. Core Training Theme #2 Ambulatory Pharmacotherapy 2-1: Effectively conduct direct patient-care activities using a consistent approach that reflects the philosophy of pharmaceutical care. 2-2: Build a knowledge base of information sufficient to design an effective medication therapy regimen. 2-3: Design, monitor, and evaluate patient-specific pharmacotherapy. 2-4: Recommend pharmacotherapeutic regimens and corresponding monitoring plans. 2-5: Implement the pharmacotherapeutic regimen and/or corresponding monitoring plan. 2-6: Redesign pharmacotherapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data. 2-7: Provide medication-use education to patients and caregivers. 2-8: Collect outcome data on patients. 2-9: Ensure continuity of care to and from the acute and ambulatory patient-care settings. 2-10: Document pharmaceutical care activities appropriately. 2-11: As appropriate, establish a collaborative professional pharmacist-patient relationship. 2-12: When necessary in the primary care environment, identify appropriate personnel for managing patients health care needs. 2-13: Understand a process for formulating and delivering programs that center on disease prevention and wellness promotion. Core Training Theme #3 Medication Use and Formulary Management 3-1: Contribute to or lead the development and maintenance of a core formulary. 3-2: Collaborate in the customization and maintenance of a core formulary to meet a particular customer's needs. 3-3: Coordinate the development of or develop core clinical criteria for drug use. HPSJ Managed Care Pharmacy Practice Residency Manual page 2

5 3-4: Coordinate the application of clinical criteria to support a customer's benefit design. 3-5: Formulate and implement a strategy for integrating the use of clinical criteria into patient care. 3-6: Coordinate the modification of an existing information system to support the integration and evaluation of clinical criteria for patient care. 3-7: Understand the process for developing and evaluating pharmacy distribution networks (community pharmacy, in-house pharmacy, mail service) for pharmaceutical products. 3-8: Perform prospective and retrospective financial and clinical outcomes analyses. 3-9: Construct reports and recommend plans for improving outcomes, based on conclusions drawn from analysis of financial and clinical outcomes data. Core Training Theme #4 Drug Information, Communication and Customer Service 4.1 Draw conclusions appropriate to the managed care setting from reviews of drug and medical literature. 4.2: Develop and provide clinical information and services. 4.3: Deliver effective provider education. 4-4: Communicate clearly and effectively when speaking or writing. 4-5: Publish a newsletter that provides pertinent medicationuse information for health care professionals. 4-6: Design, execute, and report the results of an investigation of a pharmacy-practice related issue. Core Training Theme #5 Business Administration 5-1: Develop or contribute to the development of a new product or service, or contribute to the enhancement of an existing product or service. 5-2: Contribute to a response to a request for proposal (RFP) for a product or service. 5-3: Market or support the marketing of the organization's products or services to prospective customers. 5.4: Contribute to the development and analysis of benefit design options for a customer. 5.5: Understand the process of negotiating and implementing contracts with pharmaceutical manufacturers. Core Training Theme #6 Teaching and Mentoring 6-1: Demonstrate effective education and training techniques. 6-2: Precept a Pharm.D. clerkship student on an acute care or ambulatory care rotation. 6-3: Provide staff development instruction to pharmacists, technicians, nurses, and physicians. 6-4: Prepare a lecture or set of discussion materials for leading a didactic class of pharmacy students. Core Training Theme #7 Personal and Professional Leadership 7-1: Consistently serve as an example of strong character and leadership. 7-2: Maintain active involvement in local, state, and national pharmacy organizations. 7-3: Manage time effectively on a day-to-day basis to fulfill professional responsibilities. 7-4: Prepare personal mission, vision, goals, and values statements. IV. SCHEDULE OF INSTRUCTIONAL ACTIVITIES (See page 8 for a sample residency calendar) V. RESIDENT PERFORMANCE ASSESSMENT Residents are evaluated according to a detailed set of performance goals and competency objectives specific to the core training themes. At the end of each training block, the primary preceptor for each HPSJ Managed Care Pharmacy Practice Residency Manual page 3

6 of the seven core training themes checks off all competencies that have been met (see pages for sample competency checklist.) The resident is expected to have attained competency for all of the objectives by the end of the sixth block. The resident also reviews the competency checklist and discusses goals for completing competencies in the future. If necessary, improvement strategies are discussed. In addition to the competency checklists, at the end of each 2-month block, the block preceptor completes a general performance assessment of the resident (see pages for the bimonthly performance assessment form) and compares results to the resident s self-evaluation (pages ) The resident also completes an evaluation of the preceptor and the general quality of the training experience during the rotation. Finally, the resident is evaluated throughout the year using criteria-based or snapshot evaluations. The criteria-based evaluation will involve selection of one residency learning objective and the associated learning activities for that objective. The resident is evaluated on how he or she performs the activities associated with that learning objective at that moment in his or her professional training; in other words, a snapshot of performance at one point in time (see pages for the sample criteria-based evaluation.) VI. ACCREDITATION The HPSJ Managed Care Pharmacy Practice Residency is expected to be accredited by ASHP/AMCP in VII. PRIMARY PRECEPTORS Allen Shek, Pharm.D., BCPS (Program Director) Associate Professor & Stockton Regional Clerkship Coordinator University of the Pacific (since 1999), Pharmacy Clinical Coordinator Health Plan of San Joaquin (since 2002) o Pharm.D. from University of Illinois at Chicago (UIC) 1998 o B.S. Pharm. from State University of New York at Buffalo 1991 o Completed ASHP-accredited Primary Care Specialty Residency, UIC 1999 o Clinical Associate, UIC 1 year o Board Certified Pharmacotherapy Specialist since 2004 o Staff Pharmacist, Sutter Merced Medical Center o Phi Kappa Phi National Honor Society, inducted April 1994 o Who s Who Among Students in American Universities & Colleges o Excellence In Pharmacy Award by Mylan Pharmaceuticals Inc o Rho Chi Pharmacy Honor Society, inducted November Sylvia Gates-Carlisle, MD, MBA Medical Director Health Plan of San Joaquin (since 2001) Medical Director Los Angeles Physicians Medical Group ( ) Regional Internal Medicine Department Chair Greater Los Angeles MedPartners and successor medical groups ( ) Staff Internist and Geriatrician Friendly Hills HealthCare Network ( ) Internal Medicine Department Head ( ), Physician Advisor, Utilization Management (85-89) CIGNA Central Service Area Staff Internist and Geriatrician CIGNA HealthCare of Southern California ( ) HPSJ Managed Care Pharmacy Practice Residency Manual page 4

7 Staff Physician United Health Plan, Huntington Park, California ( ) o MD from Brown University Program in Medicine (1982) o Internal Medicine Internship and Residency-LAC-USC Medical Center ( ) o MBA from University of California, Irvine (1998) o Diplomate, American Board of Quality Assurance and Utilization Review Physicians (1992) o Diplomate, American Board of Internal Medicine (1987) o Diplomate, National Board of Medical Examiners (1983) o Member, State Interagency Coordinating Council (2002-present) o Co-recipient, Volunteer Physician of the Year, Venice Family Clinic (1996) o Clinician of the Year, CIGNA HealthCare of Southern California Central Region (1991) o National Health Service Corps Regional Administrator's Award (1987) Andrea Hinton, Pharm.D., BCPS Clinical Pharmacist San Joaquin General Hospital (since 2000) o Pharm.D. from the University of California at San Francisco o Completed ASHP-accredited Pharmacy Practice Residency, The University of Arizona o Adjunct Professor, University of the Pacific since 2000 o Board Certified Pharmacotherapy Specialist since 2004 o National Pharmacy Leadership Society, Phi Lambda Sigma - Chapter President, 1998/99 o CVSHP Secretary 2003/04 o CVSHP Chapter Delegate ; o SJGH Pharmacist of the Year 2002 Koob Vang, Pharm.D. Pharmacist, Ambulatory Care San Joaquin General Hospital (since 2005) o Pharm.D. from the University of the Pacific o Completed ASHP-accredited Pharmacy Practice Residency, San Joaquin General Hospital 2005 VIII. TRAINING SITES Health Plan of San Joaquin (HPSJ) HPSJ is a publicly sponsored, not-for-profit, managed care health plan designed by and for the people of San Joaquin County. Licensed as a Health Maintenance Organization under the State of California Knox-Keene Act, HPSJ contracts with the State Department of Health Services for care of persons on Medi-Cal in San Joaquin County, as well as the Healthy Families Program regulated by the California Managed Risk Medical Insurance Board. In addition to regular Medi-Cal benefits, HPSJ offers members extra services such as: Primary care doctors and clinics Member service representatives Bilingual services Health education programs Advice nurse for after-hours medical assistance Quarterly member newsletter Case management when necessary Patient advocacy Grievance and complaint resolutions HPSJ's primary focus is on improving the health and well-being of those it serves. HPSJ's provider network includes over 140 Primary Care Physicians, 500 specialist and ancillary providers, all acute care hospitals in San Joaquin County, and several referral centers in San Francisco and Sacramento for specialized care. Pharmacy benefit, utilization management, disease management and clinical HPSJ Managed Care Pharmacy Practice Residency Manual page 5

8 initiatives are all performed internally. HPSJ also serves as a third-party administrator for the selffunded medical plans sponsored by San Joaquin County for its employees and retirees. San Joaquin General Hospital (SJGH) SJGH is a 212-bed public facility operated by San Joaquin County Health Care Services. The main, state-of-the-art facility opened in The inpatient census generally ranges from 100 to 140. In addition to intensive care and medical/surgical units, the hospital houses a 32-bed Level III intensive care nursery, a labor and delivery unit, a pediatrics unit and an 11-station dialysis unit. The campus also includes several ambulatory clinic areas. The San Joaquin General Hospital Pharmacy Department employs over 48 full-time employees of professional and support personnel. A full range of inpatient services is provided, including pharmacotherapy monitoring. The ambulatory pharmacy processes over 220,000 prescriptions per year. Ambulatory pharmacists participate in asthma, anticoagulation, heart failure, and diabetes clinics. The hospital is a training site for Family Practice, Surgery, Internal Medicine, and Transitional medical residents, as well as a major regional training site for pharmacy clerkship students from University of the Pacific School of Pharmacy. IX. SALARY AND BENEFITS The Pharmacy resident is hired on a one-year contract basis, with a salary of $45,000 per annum plus benefits. A generous supply of holidays and vacation days is also provided. Expenses are covered for registration and travel to the annual CSHP Seminar, the AMCP Educational Conference and the ASHP Midyear Clinical Meeting, as well as to the Western States Regional Residency Conference in Pacific Grove, California. X. APPLICATION PROCESS To be considered as a candidate for the HPSJ Managed Care Pharmacy Practice Residency, applicants are required to submit the following items to the program director no later than January 15: 1. A letter of interest describing why the applicant has chosen to complete a managed care pharmacy practice residency and why he/she is specifically interested in the residency at HPSJ (please include an address) 2. A recommendation from three faculty or work supervisors. At least two must be familiar with the applicant s clerkship performance. Recommendations must be submitted on the HPSJ Candidate Recommendation Form (see pages ) Letters of recommendation may be attached to the form, but are not required. 3. An official transcript of all course work completed in the professional pharmacy curriculum 4. A current curriculum vitae 5. One professional writing sample (newsletter, published manuscript, drug monograph/review, etc). All materials should be forwarded to: Allen Shek, Pharm.D., BCPS Pharmacy Residency Program Director Health Plan of San Joaquin Phone: (209) W. Fremont Street, Suite 200 FAX: (209) Stockton, California ashek@hpsj.com Qualified applicants will be contacted by the program director to arrange an on-site interview. The onsite interview is a required portion of the application process and will not be waived. HPSJ Managed Care Pharmacy Practice Residency Manual page 6

9 XI. CANDIDATE EVALUATION CRITERIA Each candidate s qualifications will be judged according to the following criteria: 1. All application materials received by the program director no later than January Anticipated graduation from an accredited school of pharmacy prior to the start of the residency. 3. Demonstration of a strong commitment to pursuing a leadership role in managed care pharmacy. 4. Strong academic background in therapeutics and pharmacology, and strong performance on clerkship rotations. (Note: A high GPA is helpful, but not required.) 5. Demonstrated ability to effectively apply pharmacotherapy knowledge on clerkship. 6. Examples of extra effort and initiative via extra-curricular activities, special projects, or unique work experiences. 7. Demonstration of strong verbal and written communication skills. Residents will be expected to maintain professional membership in AMCP, CSHP and ASHP. HPSJ Managed Care Pharmacy Practice Residency Manual page 7

10 HPSJ Managed Care Pharmacy Practice Residency Sample Schedule of Instructional Activities Ongoing Longitudinal Projects Block 1 Jul-Aug Block 2 Sep-Oct Block 3 Nov-Dec Block 4 Jan-Feb Block 5 Mar-Apr Block 6 May-Jun Block Rotations Core Training Themes (CTT) Pharmacy Operation Institutional Clinical Practice Medication Use Management Clinical Program Development Drug Policy and Outcome Management Leadership/ Management CTT # 1 Inpatient Pharmacotherapy (Hinton) CTT # 2 Ambulatory Pharmacotherapy (Vang/Shek) CTT # 3 Medication Use & Formulary Management (Shek/Carlisle) CTT # 4 Drug Info, Communication & Customer Service (Shek/Carlisle) Review PA Attend P&T, Drug/ drug Class Reviews, PA criteria reviews, Drug Utilization Review Answer DI Questions Publish Newsletters & provider alerts WSC Presentation Research Coumadin (July) CHF (Aug) Learn HPSJ formulary, PA process and pharmacy operation Newsletter article (Aug) Internal Medicine (Sept) Infectious Disease or Cardiology (Oct) HIV Clinic (Oct) ID Clinic (Oct) or Cardiology Clinic (Oct) Select WSC Project Provider Alert (Oct) Diabetes (Nov) Asthma (Dec) Polypharmacy intervention Fraud/abuse program Fraud/abuse QI DUR Newsletter article (Nov) Assess customer need Academic detailing Attend UM/OI meeting Coumadin (Jan) CHF (Feb) Polypharmacy intervention Optimization program Disease management program Provider Alert (Feb) WSC Abstract due Diabetes (Mar) Asthma (Apr) Polypharmacy intervention Drug Coverage Guide Fraud/abuse program Fraud/abuse QI DUR Newsletter article (Mar) Diabetes (May) Asthma (June) Provider Alert (May) WSC Presentation CTT # 5 Business Administration (Shek/Carlisle/Hackworth) CTT # 6 Teaching & Mentoring (Shek/Carlisle) CTT # 8 Personal & Professional Leadership (Shek/Carlisle) Assist in monitoring of pharmacy expenditure SPOC discussion Lecture/Discussions at UOP Lunch and learn Academic detailing Perform Self-eval Set Personal Goals Attend Medical Director meetings Pharmacy Expenditure Analysis Lunch and Learn Time Mgt Training Set personal mission vision, goals, & values Review RLS Attend CSHP Seminar Attend AMCP Ed Conf Review personal goals Pharmacy Expenditure Analysis MD Noon Conference Lecture (SJGH) Attend ASHP Midyear Review personal goals UOP Lecture Attend Medical Director meetings (Feb) Review personal goals Pharmacy Expenditure Analysis Grade UOP posters Lunch and Learn Asparagus Festival Review personal goals Attend Senior Management meetings Assess Residency Attend CEO meetings Plan lifelonglearning Review personal goals HPSJ Managed Care Pharmacy Practice Residency Manual page 8

11 HPSJ Managed Care Pharmacy Practice Residency Program Goals and Related Competency Objectives Core Training Theme #1 Inpatient Pharmacotherapy 1-1: Effectively conduct direct patient-care activities using a consistent approach that reflects the philosophy of pharmaceutical care. 1-1a: Develop a written statement of philosophy of practice that matches the tenets of pharmaceutical care. 1-1b: Display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems. 1-1c: Choose daily activities so that they reflect a priority on the delivery of direct patient care. 1-1d: Devise efficient strategies for one s own direct patient-care activities that maximize the delivery of appropriate pharmaceutical care to each patient within a limited time frame. 1-2: Build a knowledge base of information sufficient to design an effective medication therapy regimen. 1-2a: Explain signs and symptoms, etiology, epidemiology, risk factors, pathogenesis, pathophysiology, clinical course, and treatment of diseases commonly encountered in the acute care setting. 1-2b: Explain the mechanism of action, pharmacokinetics, pharmacodynamics, pharmacoeconomics, usual regimen (dose, schedule, form, route, and method of administration), indications, contraindications, interactions, adverse reactions, and therapeutics of drugs being monitored. 1-2c: Use patient medical charts, records, and/or electronic data to collect pertinent information for preventing, detecting, and resolving drug-related problems. 1-2d: Integrate effective communication techniques in interviews with patients, caregivers, health care professionals, and others in order to collect information. 1-3: Design, monitor, and evaluate patient-specific pharmacotherapy. 1-3a: Determine the presence of any of the following medication therapy problems in a patient s current medication therapy: medication used with no medical indication medical conditions for which there is no medication prescribed medications prescribed inappropriately for a particular medical condition anything inappropriate in the current drug therapy regimen (dose, form, schedule, route, method of administration, duration) presence of therapeutic duplication prescribing of drugs to which the patient is allergic presence or potential for adverse drug events presence or potential for clinically-significant drug-drug, drug-disease, drug-nutrient, or druglab test interactions interference with medical therapy by social or recreational drug use patient not receiving full benefit of prescribed medication therapy problems arising from financial impact of medication therapy on the patient patient s lack of understanding of his/her therapy patient non-adherence to medication therapy 1-3b: Specify evidence-based pharmacotherapeutic goals for the patient that integrate patientspecific data, disease-specific and drug-specific information, and ethical quality of life considerations. 1-3c: Design a pharmacotherapeutic regimen that meets the prioritized goals established for a patient, and integrates patient-specific disease and drug information, ethical issues, quality-oflife issues, pharmacoeconomics principles, and compliance issues. 1-3d: Design evidence-based monitoring plans for pharmacotherapeutic regimens that effectively evaluate achievement of patient-specific pharmacotherapeutic goals. HPSJ Managed Care Pharmacy Practice Residency Manual page 9

12 1-4: Recommend pharmacotherapeutic regimens and corresponding monitoring plans. 1-4a: Communicate recommendations for a pharmacotherapeutic regimen and corresponding monitoring plan to prescribers and patients in a way that is systematic, logical, and secures consensus from the prescriber and patient. 1-5: Implement the pharmacotherapeutic regimen and/or corresponding monitoring plan. 1-5a: When appropriate, initiate the pharmacotherapeutic regimen according to the health system s policies and procedures. 1-5b: When appropriate, order tests required by the monitoring plan according to the health system s policies and procedures. 1-6: Redesign pharmacotherapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data. 1-6a: Accurately interpret the meaning of each parameter measurement. 1-6b: Modify a pharmacotherapeutic plan as necessary based on evaluation of monitoring data. 1-7: Provide medication-use education to patients and caregivers. 1-7a: Design medication use education for patients and caregivers that effectively meets their needs, including information about herbal and other alternative medicine therapies. 1-7b: Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration. 1-8: Collect outcome data on patients. 1-8a: Collect outcome data based on the patient s response to therapy. 1-9: Ensure continuity of care to and from the acute and ambulatory patient-care settings. 1-9a: Use a systematic procedure to communicate pertinent pharmacotherapeutic information to and from the acute and ambulatory care settings. 1-10: Document pharmaceutical care activities appropriately. 1-10a: Appropriately select pharmaceutical care activities for documentation. 1-10b: Use effective communication practices when documenting a pharmaceutical care activity, according to health system policy. 1-10c: Write a concise, effective note in the progress section of a patient s chart, using a SOAP format or some other approach that ensures a systematic presentation of information and a consistent format. Core Training Theme #2 Ambulatory Pharmacotherapy 2-1: Effectively conduct direct patient-care activities using a consistent approach that reflects the philosophy of pharmaceutical care. 2-1a: Develop a written statement of philosophy of practice that matches the tenets of pharmaceutical care. 2-1b: Display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems. 2-1c: Choose daily activities so that they reflect a priority on the delivery of direct patient care. 2-1d: Devise efficient strategies for one s own direct patient-care activities that maximize the delivery of appropriate pharmaceutical care to each patient within a limited time frame. 2-2: Build a knowledge base of information sufficient to design an effective medication therapy regimen. 2-2a: Explain signs and symptoms, etiology, epidemiology, risk factors, pathogenesis, pathophysiology, clinical course, and treatment of diseases commonly encountered in the ambulatory care setting. 2-2b: Explain the mechanism of action, pharmacokinetics, pharmacodynamics, pharmacoeconomics, usual regimen (dose, schedule, form, route, and method of HPSJ Managed Care Pharmacy Practice Residency Manual page 10

13 2-2c: 2-2d: administration), indications, contraindications, interactions, adverse reactions, and therapeutics of drugs being monitored. Use patient medical charts, records, and/or electronic data to collect pertinent information for preventing, detecting, and resolving drug-related problems. Integrate effective communication techniques in interviews with patients, caregivers, health care professionals, or others in order to collect information. 2-3: Design, monitor, and evaluate patient-specific pharmacotherapy. 2-3a: Determine the presence of any of the following medication therapy problems in a patient s current medication therapy: medication used with no medical indication medical conditions for which there is no medication prescribed medications prescribed inappropriately for a particular medical condition anything inappropriate in the current drug therapy regimen (dose, form, schedule, route, method of administration, duration) presence of therapeutic duplication prescribing of drugs to which the patient is allergic presence or potential for adverse drug events presence or potential for clinically-significant drug-drug, drug-disease, drug-nutrient, or druglab test interactions interference with medical therapy by social or recreational drug use patient not receiving full benefit of prescribed medication therapy problems arising from financial impact of medication therapy on the patient patient lack of understanding of his/her therapy patient non-adherence to medication therapy 2-3b: Specify evidence-based pharmacotherapeutic goals for the patient that integrate patientspecific data, disease-specific and drug-specific information, and ethical quality of life considerations. 2-3c: Design a pharmacotherapeutic regimen that meets the prioritized goals established for a patient, and integrates patient-specific disease and drug information, ethical issues, quality-oflife issues, pharmacoeconomics principles, and compliance issues. 2-3d: Design evidence-based monitoring plans for pharmacotherapeutic regimens that effectively evaluate achievement of patient-specific pharmacotherapeutic goals. 2-4: Recommend pharmacotherapeutic regimens and corresponding monitoring plans. 2-4a: Communicate recommendations for a pharmacotherapeutic regimen and corresponding monitoring plan to prescribers and patients in a way that is systematic, logical, and secures consensus from the prescriber and patient. 2-5: Implement the pharmacotherapeutic regimen and/or corresponding monitoring plan. 2-5a: When appropriate, initiate the pharmacotherapeutic regimen according to the health system s policies and procedures. 2-5b: When appropriate, order tests required by the monitoring plan according to the health system s policies and procedures. 2-6: Redesign pharmacotherapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data. 2-6a: Accurately interpret the meaning of each parameter measurement. 2-6b: Modify a pharmacotherapeutic plan as necessary based on evaluation of monitoring data. 2-7: Provide medication-use education to patients and caregivers. 2-7a: Design medication use education for patients and caregivers that effectively meets their needs, including information about herbal and other alternative medicine therapies. 2-7b: Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration. HPSJ Managed Care Pharmacy Practice Residency Manual page 11

14 2-8: Collect outcome data on patients. 2-8a: Collect outcome data based on the patient s response to therapy. 2-9: Ensure continuity of care to and from the acute and ambulatory patient-care settings. 2-9a: Use a systematic procedure to communicate pertinent pharmacotherapeutic information to and from the acute and ambulatory care settings. 2-10: Document pharmaceutical care activities appropriately. 2-10a: Appropriately select pharmaceutical care activities for documentation. 2-10b: Use effective communication practices when documenting a pharmaceutical care activity, according to health system policy. 2-10c: Write a concise, effective note in the progress section of a patient s chart, using a SOAP format or some other approach that ensures a systematic presentation of information and a consistent format. 2-11: As appropriate, establish a collaborative professional pharmacist-patient relationship. 2-11a: Formulate a strategy that effectively establishes a collaborative professional pharmacistpatient relationship. 2-12: When necessary in the primary care environment, identify appropriate personnel for managing patients health care needs. 2-12a: When indicated, refer patients to an appropriate clinic, physician, nurse, or ancillary support program for care. 2-12b: Devise a plan for follow up of a referred ambulatory care patient. 2-13: Understand a process for formulating and delivering programs that center on disease prevention and wellness promotion. 2-13a: Explain a process for formulating and delivering programs that center on disease prevention and wellness promotion. Core Training Theme #3 Medication Use and Formulary Management 3-1: Contribute to or lead the development and maintenance of a core formulary. 3-1a: Explain the types and purpose of core formularies (i.e., open, closed, variable copay) and their financial and clinical impact on both customer and member. 3-1b: Explain how manufacturer contracts may affect the composition of a core formulary. 3-1c: Explain the process of developing a core formulary. 3-1d: Explain factors in the managed care environment, including cost and quality objectives that affect the development of a core formulary. 3-2: Collaborate in the customization and maintenance of a core formulary to meet a particular customer's needs. 3-2a: Explain how the needs of the customer affect decision-making about formulary modifications. 3-2b: Identify the impact on a particular customer of a given modification to the core formulary. 3-3: Coordinate the development of or develop core clinical criteria for drug use. 3-3a: Define and explain the purpose of core clinical criteria for drug use. 3-3b: Explain how limitations in the reliability and comprehensiveness of electronic data affect the development of clinical criteria. 3-3c: Explain the opportunities and limitations implicit in developing clinical criteria for drug use. 3-4: Coordinate the application of clinical criteria to support a customer's benefit design. 3-4a: Explain how the needs of the customer affect decision making about clinical criteria for drug use. 3-4b: Explain the opportunities and limitations implicit in developing clinical criteria for drug use. HPSJ Managed Care Pharmacy Practice Residency Manual page 12

15 3-4c: 3-4d: Predict the impact on a customer of the adoption of particular clinical criteria for drug use. Predict the impact on the organization of the adoption of particular clinical criteria for drug use. 3-5: Formulate and implement a strategy for integrating the use of clinical criteria into patient care. 3-5a: Explain the components of a strategy that would successfully integrate the use of clinical criteria into patient care. 3-5b: Explain how the individuality of the customer will affect a strategy for integrating the use of clinical criteria into patient care. 3-5c: Identify the impact on a customer of the adoption of particular clinical criteria for drug use. 3-5d: Identify the impact on the organization of the adoption of particular clinical criteria for drug use. 3-5e: Design a strategy for continuously assessing and improving clinical criteria for patient care. 3-6: Coordinate the modification of an existing information system to support the integration and evaluation of clinical criteria for patient care. 3-6a: Identify internal and external decision support information needs for a given customer. 3-6b: Explain the types of information required to integrate and evaluate clinical criteria for patient care. 3-6c: Explain the types of information that are supplied by the organization's existing information system. 3-6d: Identify situations in which internal or external customer information needs require modification of the existing information system. 3-6e: Identify the appropriate information to be supplied for required modifications in the existing information system. 3-6f: Explain terminology and concepts used by information systems personnel in the development and modification of information systems. 3-7: Understand the process for developing and evaluating pharmacy distribution networks (community pharmacy, in-house pharmacy, mail service) for pharmaceutical products. 3-7a: Explain the process for developing and maintaining a pharmacy distribution network for a pharmaceutical product, including customization to meet a customer's needs. 3-7b: Explain business requirements surrounding a distribution network for pharmaceutical products. 3-7c: Explain the need to balance the cost and access requirements of a particular customer. 3-7d: Explain components of a distribution network and how they interact with each other to effectively balance cost and access. 3-7e: Assess the success of a distribution network for pharmaceutical products. 3-7f: Explain the types of data appropriate to assess financial and clinical performance. 3-8: Perform prospective and retrospective financial and clinical outcomes analyses. 3-8a: Explain the principles and methods of basic pharmacoeconomic analysis. 3-8b: Explain the purpose of a prospective and retrospective financial or clinical outcomes analysis. 3-8c: Explain study designs appropriate for a prospective and retrospective financial or clinical outcomes analysis. 3-8d: Explain the types of data that must be collected in a prospective and retrospective financial or clinical outcomes analysis. 3-8e: Explain possible reliable sources of data for a financial or clinical outcomes analysis. 3-8f: Explain methods for analyzing data in a prospective and retrospective financial or clinical outcomes analysis. 3-8g: Explain how results of a prospective and retrospective financial or clinical outcomes analysis can be used to modify internal business decisions to a customer's formulary or benefit design. 3-9: Construct reports and recommend plans for improving outcomes, based on conclusions drawn from analysis of financial and clinical outcomes data. 3-9a: Explain the components of a report of financial or clinical outcomes data. 3-9b: Explain techniques for customizing general reporting formats to fit specific customer needs. 3-9c: Explain the components of a recommendation that addresses outcomes improvement. HPSJ Managed Care Pharmacy Practice Residency Manual page 13

16 Core Training Theme #4 Drug Information, Communication and Customer Service 4.1 Draw conclusions appropriate to the managed care setting from reviews of drug and medical literature. 4.1a: Explain how the environment of managed care affects the way in which one applies conclusions drawn from the drug and medical literature. 4.2: Develop and provide clinical information and services. 4.2a: Write or coordinate the writing and production of information or educational materials suitable for a particular customer's needs to be used in the dissemination of a specified clinical practice. 4.2b: Identify the appropriate network for distributing specific information or educational materials. 4.2c: Formulate a strategy that will convince users that implementation of a specified clinical practice will be beneficial. 4.2d: Assess the effects of providing information or educational materials on desired outcomes. 4.3: Deliver effective provider education. 4.3a: Formulate effective academic detailing strategies that give providers accurate information upon which to base decisions. 4.3b: Formulate effective strategies for communicating formulary restrictions and options to providers. 4-4: Communicate clearly and effectively when speaking or writing. 4-4a: Use an understanding of the principles of efficiency, the purposes of documentation, customary practice, and the recipient s preference to determine the most appropriate method of communication. 4-4b: Organize all written and oral communication in a logical manner. 4-4c: Address all communication at a level appropriate for the audience. 4-4d: Use correct grammar, punctuation, spelling, style, and formatting conventions in preparing all written communication. 4-4e: Speak clearly, distinctly, and at an appropriate speed in English. 4-4f: Maintain eye-contact and avoid distracting habits when speaking. 4-4g: Use public speaking skills to speak effectively in large and small group situations. 4-4h: Use listening skills effectively in performing job functions. 4-4i: Use knowledge of visual aids to enhance the effectiveness of communication. 4-4j: Exercise skill in the use of audio-visual equipment. 4-4k: Demonstrate proficiency in the use of Microsoft Word, PowerPoint, Excel, and Publisher. 4-4l: Use persuasive communication techniques effectively. 4-4m: Prepare all communications so that they present a positive image of a pharmacy professional. 4-4n: Use effective strategies for communicating with patients who are non-english speakers or who are impaired (e.g., blind, deaf, cognitively impaired, illiterate). 4-5: Publish a newsletter that provides pertinent medicationuse information for health care professionals. 4-5a: Select article topics that are timely and of interest to the audience. 4-5b: Write articles in an interesting and persuasive manner. 4-5c: Select headings and graphics that augment the written material and plan a layout that is both effective and visually appealing. 4-5d: Carefully edit the final proof to ensure accuracy of information and the absence of typographical errors. 4-6: Design, execute, and report the results of an investigation of a pharmacy-practice related issue. 4-6a: Identify a potential practice-related issue that needs to be studied. 4-6b: Use a systematic approach procedure for performing a comprehensive literature search. 4-6c: Draw appropriate conclusions based on a summary of a comprehensive literature search. 4-6d: Generate questions to be answered by an investigation. 4-6e: Design a study that will answer the question identified. HPSJ Managed Care Pharmacy Practice Residency Manual page 14

17 4-6f: 4-6g: 4-6h: Use a systematic procedure to collect data. Draw valid conclusions through evaluation of data. Use effective communication skills to report orally, using appropriate audiovisual aids, and in writing the results and recommendations of the investigation. Core Training Theme #5 Business Administration 5-1: Develop or contribute to the development of a new product or service, or contribute to the enhancement of an existing product or service. 5-1a: Accurately identify unmet needs of customers (i.e., patients or plan members, physicians and other health care providers, pharmacies, and payers). 5-1b: Use modeling to predict the financial effect(s) of implementing a proposed new or enhanced product or service or meeting unmet customer needs. 5-1c: Accurately predict system and human resource needs for developing and implementing a new or enhanced product or service. 5-1d: Accurately predict the outcome(s) for patients of implementing a new or enhanced product or service. 5-1e: Accurately predict the financial benefit to the managed care organization of implementing a new or enhanced product or service. 5-2: Contribute to a response to a request for proposal (RFP) for a product or service. 5-2a: Explain the variation in types of responses appropriate for RFPs from different sources. 5-2b: Accurately interpret the information requested by a particular RFP. 5-2c: Identify appropriate sources of information required to respond to an RFP. 5-2d: Explain the components of a formal proposal presentation. 5-3: Market or support the marketing of the organization's products or services to prospective customers. 5.3a: Contribute to the pharmacy component of a marketing plan for one of the organization's products or services. 5.3b: Explain the concept "marketing." 5.3c: Explain the organization's business and how it can meet a customer's needs. 5.3d: Explain the role of market analysis in devising a marketing strategy. 5.3e: Explain the components of a marketing strategy. 5.3f: Explain the process by which various organizational entities team to produce a marketing strategy. 5.4: Contribute to the development and analysis of benefit design options for a customer. 5.4a: Explain the components of benefit design. 5.4b: Explain the legal requirements and business implications of benefit design options. 5.4c: Explain how to analyze the effect on a particular customer of a given benefit design option. 5.5: Understand the process of negotiating and implementing contracts with pharmaceutical manufacturers. 5.5a: Explain the process of negotiating contracts with pharmaceutical manufacturers. 5.5b: Identify the implications for the company and customer of a particular contract. 5.5c: Explain reporting requirements to evaluate contract performance. 5.5d: Explain strategies to ensure contract performance. Core Training Theme #6 Teaching and Mentoring 6-1: Demonstrate effective education and training techniques. 6-1a: Base presentations on clearly stated goals and objectives and design an assessment strategy to determine whether goals were met. 6-1b: Organize material to flow logically and tailor content to the specific audience. 6-1c: Prepare useful handouts and audiovisual materials. 6-1d: Choose an instructional method that delivers material effectively and maintain audience HPSJ Managed Care Pharmacy Practice Residency Manual page 15

18 interest. 6-2: Precept a Pharm.D. clerkship student on an acute care or ambulatory care rotation. 6-2a: Clarify performance expectations with the students. 6-2b: Meet with students to review patients. 6-2c: Help students find the answers to their own questions. 6-2d: Provide instruction and clinical guidance to students as needed. 6-2e: Be accessible and approachable to students. 6-2f: Treat students fairly and respectfully. 6-2g: Write and administer an oral final clerkship exam based on a unique patient case. 6-3: Provide staff development instruction to pharmacists, technicians, nurses, and physicians. 6-3a: Identify appropriate, relevant topics for inservicing other health professionals. 6-3b: Design and deliver effective inservice material for physicians, nurses, pharmacists, and other practitioners on drug therapy issues. 6-4: Prepare a lecture or set of discussion materials for leading a didactic class of pharmacy students. 6-4a: Identify an appropriate topic of interest with which the resident has a reasonable comfort level. 6-4b: Research the subject to ensure that the most current and accurate information is taught to the students. 6-4c: Organize the material and prepare a handout that results in the systematic, logical presentation of the information. 6-4d: Rehearse so that material is delivered smoothly and with confidence; for a discussion, effectively facilitate participation by the student audience. Core Training Theme #7 Personal and Professional Leadership 7-1: Consistently serve as an example of strong character and leadership. 7-1a: Maintain a mature professional image. 7-1b: Work harmoniously and collaboratively with others in the health system. 7-1c: Display compassion for patients and a spirit of advocacy in serving them. 7-1d: Maintain a positive attitude and appreciate the importance of attitude in interpersonal relationships and personal/professional satisfaction. 7-1e: Present oneself as a self-assured, assertive member of the profession. 7-1f: Maintain a stable affect and display a consistent demeanor in all interpersonal interactions. 7-1g: Manage stress constructively. 7-2: Maintain active involvement in local, state, and national pharmacy organizations. 7-2a: Maintain membership in ASHP, CSHP and AMCP. 7-2b: Attend the CSHP Seminar. 7-2c: Attend the ASHP Midyear Clinical Meeting. 7-2d: Attend the AMCP Educational Conference. 7-3: Manage time effectively on a day-to-day basis to fulfill professional responsibilities. 7-3a: Maintain a written or electronic day planner to prioritize and track daily activities according to one s goals and values. 7-3b: Plan multi-task projects in a logical, systematic manner to ensure that all steps can be completed according to schedule. 7-3c: Conduct sufficient short and long-range planning and execute plans so as to ensure that all projects and assignments can be completed effectively and on time. 7-3d: Effectively use time management skills to fulfill practice responsibilities. 7-3e: Demonstrate consistent use of a systematic approach to problem solving. 7-4: Prepare personal mission, vision, goals, and values statements. 7-4a: Write a personal mission and vision statement. 7-4b: Develop a set of personal core values. HPSJ Managed Care Pharmacy Practice Residency Manual page 16