Course Outline and Syllabus for Students Course Number: PHM350 Course Title: Pharmacotherapy in Ambulatory Care Course Coordinator and contact information: Jon Hunchuck, BScPhm, ACPR, PharmD Assistant Professor, Leslie Dan Faculty of Pharmacy Pharmacist, Women s College Hospital jonathan.hunchuck@utoronto.ca (416) 323-6400 ext: 4858 Natalie Crown, BScPharm, ACPR, PharmD Assistant Professor, Leslie Dan Faculty of Pharmacy Clinician Educator, Women s College Hospital natalie.crown@utoronto.ca (416) 323-6210 Course Description: Ambulatory care pharmacists are accountable for addressing drug therapy needs and developing sustained partnerships with patients in an outpatient environment. They practice in primary care, family health teams, community pharmacies and specialty clinics. This practice can be independent or in collaboration with other health care providers. Ambulatory care pharmacists require the knowledge and skills to triage, prescribe, administer and monitor medication therapies. They provide pharmaceutical care to patients with a variety of medical conditions and levels of acuity. This course will provide students with the knowledge, skills, and values to be a contemporary ambulatory care practitioner with an emphasis on ambulatory care sensitive conditions, minor ailments and preventive care. Elective: X Classes: Tuesdays 1-3pm, PB B250 Office Hours: Tuesdays 12-1 PM (PB 210) and 3-4 PM (PB210, except March 18 in PB 310) Course Learning Objectives: Upon completion of this course, students will have achieved the following level of learning objectives: Knowledge 1. Define ambulatory care pharmacy practice. 2. Discuss the management of ambulatory care sensitive conditions (ACSC) and describe their significance to the Canadian health care system. 3. Summarize the etiology, pathophysiology, epidemiology, clinical presentation, risk factors, risk stratification, prevention and natural history of the following ACSCs (hypertension, angina, chronic obstructive pulmonary disease, asthma, congestive heart failure, diabetes). (Advanced) 4. Compare and contrast the relevant (available, investigational, complementary and alternative, emerging) classes of agents used for the identified ACSCs based on the following criteria; indications, efficacy, mechanism of action, pharmacokinetics, pharmacodynamics, pharmacogenomics, adverse effects, contraindications, drug interactions (drug-drug, drug-food, drug-laboratory), convenience, cost, formulations, stability. (Advanced) 5. Distinguish among commonly used health screening devices and discuss their role and limitations. 6. Outline the management of the selected minor ailments with attention to the following: (Advanced) a. Epidemiology and pathophysiology b. Signs and symptoms, and approach to patient assessment c. Differential diagnosis including when to refer (alternative diagnoses, red flag symptoms that could indicate more serious conditions) d. Prescribing (non-pharmacologic & pharmacologic) e. Follow-up parameters (laboratory tests, physical assessment) f. Patient education
7. Evaluate the indication, effectiveness and safety of commonly used natural health products (e.g. vitamins, supplements). (Advanced) 8. Describe the clinical characteristics and long term complications of vaccine preventable diseases. (Introductory) 9. Determine whether a specific vaccine is recommended for a given patient case. 10. Review the literature for associations between vaccines and adverse effects. 11. Provide patient level education on the indication, effectiveness, and safety of common vaccines. 12. Address common questions arising regarding routine vaccination practices (e.g. vaccination schedules, administration, storage, stability). Skills 1. Justify the selection of a therapeutic regimen for a patient presenting with a given minor ailment. (Advanced) 2. Gather and interpret relevant patient data (demographics, review of systems/physical assessment, laboratory tests, diagnostic testing and current/past drug therapy) in order to identify drug therapy problems. (Advanced) 3. For complex patients with multiple medications and/or medical conditions: (Advanced) a. Prioritize drug therapy problems b. Justify the selection of a preferred therapeutic regimen scenario based on the assessment of relevant alternatives c. Develop, justify and evaluate a care plan d. Develop follow-up plans for patients with multiple indications for drug therapy. 4. Locate, critique and apply reliable sources of information to address knowledge required to support an ambulatory care practice. (Advanced) 5. Develop a process for assessing the importance of drug-drug interactions between prescription, overthe-counter and natural health products. (Advanced) Attitudes/Values 1. The student will undertake assessment and care plan development activities in a manner respecting patient autonomy and the individual therapeutic goals. 2. The student will use interprofessional patient centered care principles to reach decisions for therapeutic alternatives. 3. The student will demonstrate respect and collaboration in a team environment. 4. The student will recognize the role of the pharmacist in preventive medicine and wellness promotion.
Pre-requisites: Pharmacotherapy 1-5 (PHM101,PHM201, PHM202, PHM203, PHM204), PHM230: Physical Assessment and Injection techniques, MTM 1-4 (PHM105,PHM205,PHM206, PHM305). Required Resources/Textbooks/Readings: Pharmacotherapy: A Pathophysiologic Approach, eighth edition, J DiPiro, et al. Therapeutic Choices for Minor Ailments. 1 st ed Canadian Pharmacists Association, 2013 (formerly Patient Self Care) Recommended Resources/Textbooks/Readings: as assigned Topic Outline/Schedule This course will focus on three areas: 1) Integrated Cases: Integrated case discussions will focus on the following ambulatory care sensitive conditions: diabetes, congestive heart failure, angina, COPD, and asthma. Using patient cases, students will develop and discuss care plans for the management of ambulatory care sensitive conditions that involve prioritizing multiple issues. Cases will build upon content from prior pharmacotherapy modules and will focus on management of these conditions from an ambulatory care perspective and increasing in complexity. In each case, students will identify and develop a care plan to address 2 or more DTPs relating to primary issue as well as secondary considerations e.g. Integrated case discussion (diabetes) - primary issue: glycemic control (addition of third oral agent, or insulin management) - secondary issues: identifying cardiovascular risk factors (e.g. consideration of ASA, statins for primary prevention), managing neuropathic pain Students will individually submit documentation at the conclusion of each case (e.g. chart note, letter to family physician, document a pharmaceutical opinion) 2) Self-Care and Minor Ailments and Natural Health Products Students will work in groups of 5-6 to prepare a 10 minute presentation for either a 1) minor ailment or 2) natural health product (e.g. vitamin, supplement) for a specific indication. Each group will also be responsible for submitting a 2 page written product summary relating to their topic. Presentations will be delivered during weeks 10 and 12. Minor Ailments: Pinworms Hemorrhoids Insomnia Low Back Pain Nausea Fever Oral Care Infant Colic Cold Sores Vaginal Candidiasis Natural Health Products: B Vitamins (in Cardiovascular Disease) Omega 3 (in Cardiovascular Disease) Garlic (in Cardiovascular Disease) Echinacea (in Cough and Cold) Zinc (in Cough and Cold) Vitamin C (in Cough and Cold) Ginseng (in Cough and Cold) Oscillococcinum (in Influenza) Vitamins for Eye Health Vitamin E (in Cancer) Green Tea (in Weight Loss) Omega 3s (in Rheumatoid Arthritis) Black Cohosh (in Menopause) St. John s Wort (in Depression) Ginkgo (in Cognition) Saw Palmetto (in Prostatism) Glucosamine and Chondroitin (in Osteoarthritis) Cranberry (in Urinary Tract Infection) Calcium and Vitamin D (in Bone Health)
3) Pharmacists Role in Preventative Medicine and Health Promotion (Weeks 2,4,6) approximately 6 hours Students will develop the knowledge required to: Devise a plan for a health screening service Evaluate screening results to make therapeutic recommendations and determine appropriate follow-up and referral. Recommend specific vaccines given an individual patient case Discuss the benefits of vaccination and address safety concerns. Topics covered will include vaccination therapeutics including vaccination schedules, women s and family health, disease screening & associated point of care testing, as well as medical devices and mobility aids (home health care products). Assessment Midterm Exam (February 14 th, 2014) 35% (Covers Weeks 1-5) Final Exam (final examination period) 50% (Covers Weeks 6-14) Minor Ailments Assignment - 10% (5% for presentation & 5% for written product summary) Documentation: 5% Documentation: Guidance for documentation submission will be posted on blackboard. Documentation for the patient case is submitted at the beginning of each integrated case discussion. Students will receive individual marks for their submitted documentation on 2 cases per term. Documentation is graded using a global assessment rubric. Minor Ailments Assignment: Guidance for minor ailments presentation & written product summary will be posted on blackboard. Deadline for submission of handouts/written product summary is March 7, 2014. Assessment will be provided using a global assessment rubric, and will be the same for all group members. Expectation for pass grades for all Pharmacy courses is 60%. Policy and procedure regarding make-up assignments/examinations Missed Exam Policy Students who miss an examination or a test and who have a valid petition filed with the Registrar s office will be eligible t o complete a makeup examination or test. The format of this examination or test will be at the discretion of the course co-ordinator and may include, for example, an oral examination. Missed Assignment Policy: Students who fail to submit an assignment by the specified due date, and who have a valid petition filed with the Registrar s office will be eligible to submit the completed assignment, or an alternative assignment based on course requirements, with no academic penalty Late Assignment Policy: Students who fail to submit an assignment by the specified due date will receive a deduction of 10% for each day beyond the due date, to a maximum of 50%. Assignments will not be accepted for grading after 5 late days. Make Up Assignment (Minor Ailments Presentation): Students who miss the Minor Ailment s Presentation and who have a valid petition on file with Registrar s office will be eligible to complete a makeup presentation. The presentation topic and format will be determined at this discretion of the course coordinator. This presentation will be delivered to the course co-ordinator.
Topic Outline and Tentative Schedule: Instructors will do their utmost to ensure that the schedule remains as printed; however, due to unforeseen circumstances, lectures may need to be rescheduled. Students will be notified of any changes. Week Date Topic 1 January 7, 2014 Orientation Introduction to Ambulatory Care Pharmacy Practice Ambulatory Care Sensitive Conditions 2 January 14 Vaccination therapeutics Childhood vaccination: Dispelling myths about vaccination, common vaccination questions (pain management) 3 January 21 Integrated Case Discussion: Diabetes 4 January 28 Preventative Health Care & Disease Screening Point of care testing (HbA1c, cholesterol, osteoporosis, hypertension) 5 February 4 Integrated Case Discussion: Asthma 6 February 11 Integrated Case Discussion: Congestive Heart Failure February 14 3:30pm-5:30pm MIDTERM BA1160 = Last Names: A K EX 310 =Last Names: L Z 7 February 17-21 READING WEEK 8 February 25 Integrated Cases: COPD 9 March 4 Integrated Cases: Stable Angina 10 March 10 *Room change: SF 1101* Minor Ailments Presentations March 11 Minor Ailments Presentations 11 March 18 PAIN WEEK class cancelled 12 March 25 Minor Ailments Presentations 13 April 1 Minor Ailments Presentations (1 hour) Preventive Care for: Maternal & Fetal Health (1 hour) 14 April 8 Medical Devices & Aids to Daily Living