Clinical Pharmacy Education-Community Pharmacy Internship

1
Clinical Pharmacy Education-Community Pharmacy
Internship
Charles Lee, PhD Professor of Pharmaceutical
Sciences Lloyd L. Gregory School of Pharmacy Palm
Beach Atlantic University West Palm Beach, FL
2
Evolution of US Pharmacy Education

• 1821 PCP BS program
• 1950 USC 1st PharmD program
• 1960 UCSF 2nd PharmD program
• 1960-2000 BS/PharmD duel track or BSPharmD
  add-on for most pharmacy schools
• 2000 ACPE accredits PharmD program only
• 1975 Curriculum begins to increases focus on
  clinical
• Pharmacy practice transforms from product
  orientation to patient orientation
• Dichotomous practice models still exist

3
Pharmaceutical Care

• 1975 Mikeal et al
• Pharmaceutical Care is the care that a given
  patient requires and receives which assures
  rational drug usage

4
Pharmaceutical Care

• 1992 Strand et al
• Pharmaceutical Care is that component of
  pharmacy practice which entails the direct
  interaction of the pharmacist with the patient
  for the purpose of caring for that patients
  drug-related needs

5
Pharmaceutical Care

• 1993 ASHP
• Pharmaceutical Care is the direct, responsible
  provision of medication related care for the
  purpose of achieving definite outcomes that
  improve a patients quality of life

6
Pharmaceutical Care

• 1996 APhA
• Pharmaceutical Care is a patient-centered,
  outcomes-oriented pharmacy practice that requires
  the pharmacist to work in concert with patient
  and the patients other healthcare providers to
  promote health, to prevent disease, and to
  assess, monitor, initiate and modify medication
  use to assure that drug therapy regimens are safe
  and effective

7
Pharmacist- Formulation Scientist
John Stith Pemberton
8
Coca Cola Formula

• Invented in 1886
• 5 cents/glass
• 9 drinks/day
• 25 gallon/1st yr
• Sold in 1888 2,300
• Sold in 1923 25 mm
• 2009 market value125 bb

9
Pharmacist Provided MTM

• Comprehensive or targeted Medication Therapy
  Reviews
• Adherence Reviews-based on number or type of
  medications
• Targeted Medication Intervention Program
• High alert or high cost medications
• Targeted population (geriatrics or pediatrics)
• Disease State Management
• Interdisciplinary approach to achieve
  therapeutic goals
• Diabetes, cholesterol, asthma
• Health and wellness services
• Immunization
• Wellness screening
• Smoking cessation
• Weight management

10
Payer Perspective on Return on Investment

• APhA Survey for MTM program from 10 Respondents
  (2008)
• ROI ranged from 21 to 121 (median31)
• 700,000/yr saving for 200 patients for insurer
• 4.5 mm/yr for self-insured employer

11
ACPE

• 1932 ACPE was established for the accreditation
  of pharmacy education
• 1975 Expanded its scope of activity to include
  accreditation of continuing pharmacy education.
• 1999 developed standards for certificate programs
  in pharmacy.
• 2000 Recognized Doctor of Pharmacy as the only
  accredited pharmacy degree program
• 2003 Name changed to the Accreditation Council
  for Pharmacy Education in 2003.
• 2007 Revised standards, 30 standards, 3
  Appendices

12
ACPE Mission and Philosophy

• Establish standards and criteria for the
  accreditation of pharmacy education program,
  continuing education program and pharmacist
  certification program
• Promote continuous quality improvement and
  encouraging innovation in pharmacy education
• Consult and assist in the development of learning
  outcomes and assessment of professional
  competencies

13
Standards 2007 Areas of Emphasis

• STD 13 Curricular core-knowledge, skills,
  attitude, values
• STD 14 Pharmacy practice experiences
• STD 15 Assessment and evaluation of student
  learning and curricular effectiveness
• STD 19 Progression of students
• STD 24, 25 Faculty and staff-quantitative and
  qualitative factor
• STD 29 Library and educational resources

14
Pharmacy Curriculum

• Basic Biomedical Sciences
• Pharmaceutical Sciences
• Social, Behavioral and Administrative Sciences
• Clinical Sciences
• Electives
• Pharmacy Practice Experiences

15
Standards for Pharmacy Practice Experiences

• Standard No. 14 Curricular Core-Pharmacy
  Practice Experiences
• The school must provide a continuum of required
  and elective pharmacy practice experiences
  throughout the curriculum to support the
  achievement of professional competencies
• The pharmacy practice experiences must integrate,
  apply, reinforce, and advance the knowledge
  skills, attitudes and values developed through
  the other components of the curriculum
• The pharmacy practice experience must include
  direct interaction with diverse patient
  populations in a variety of practice settings and
  involve collaboration with other health care
  professionals
• Required IPPE (gt300 hours), APPE (gt1400
  hours)
• Electives

16
IPPE Standards Guideline 14.4

• Minimum 300 hours over 3 years (P1-P3)
• Involve actual practice experiences in community
  and institutional settings
• Assume direct patient care responsibilities under
  appropriate supervision
• Early sequencing in the curriculum
• Interface with didactic course work
• Provide introduction to the profession, leading
  to entry into APPE

17
IPPE Program- Content Example 1

• Community pharmacy
• Institutional pharmacy
• Community service and medical missions
• Clinical pharmacy
• Community patient-centered care
• Geriatrics

18
IPPE Program- Content Example 2

• First year service learning experience
• Second year practice skills experience
• Third year Patient care experience

19
IPPE Program- Content Example 3

• Early pharmacy education with community teachers
• Mentoring program
• Community practice
• Institutional practice
• Pharmaceutical care clinic

20
IPPE Program- Content Example 4Rite Aid
Internship

• Year 1
• Defining the Rite Aid Internship
• Rite Aid pharmacy computer system (NEXGEN),
  HIPAA, CIA and Rite Aid policies and procedures.
• Pharmacy professionalism
• Year 2
• Inventory management
• Dispensing practices
• Automation
• Third party training

21
IPPE Program- Content Example 4 Rite Aid
Internship

• Year 3
• Pharmacy workflow
• Clinical Services
• Third Year Intern Project
• Mentor 1st or 2nd year Rite Aid Intern
• Business of Pharmacy
• Year 4
• Learning the profit loss system
• Mentoring a 3rd year Rite Aid Intern
• Fourth Year Special project
• Learning Pharmacy Manager responsibilities

22
IPPE Program- Content Example 5Walgreens
Pharmacy

• Prescription Medications
• OTC products
• Herbal products
• Patient counseling guidelines
• Disease state information
• Pharmacy Law and Ethics
• Management of Pharmacy

23
Commonality and Differences

• Pharmacy program- 6yr vs 24
• College setting-medical center affiliated vs
  independent
• Site setting-community vs institutional
• Site availability-region dependent
• Site specialty
• State law dictates time to start internship
• Structured vs episodic learning?
• Partially fulfilled by simulation program?

24
Course Designation and Contents

• Sch 1 PHAR 530, 532, 538
• Sch 2 IPPE 101, 103, 201, 301, 303
• Sch 3 PHR1242, 2112, 3232
• Community
• Institution
• Patient care

25
Course Syllabus

• Course description
• Course pre-requisites
• Textbook and other learning materials
• Learning objectives/outcomes
• Measure of outcomes
• Course outline and agenda
• Evaluation
• Course policies and procedures
• Standards of dress and personal appearance

26
PHAR 530, 532, 558

• Objectives/Outcomes
• Affirm the role of the pharmacist in the health
  care team
• Provide ethical patient care
• Promote the safe use of medications
• Perform calculations required to compound,
  dispense and administer medications
• Identify the most frequently prescribed drugs by
  category
• Demonstrate effective communications skills
• Evaluate information from resources of the health
  care system and integrate it into pharmacy
  practice
• Promote health improvement, wellness and disease
  prevention
• Demonstrate critical thinking skills to
  facilitate decision making
• Examine legal/ethical aspects of patient care
• Describe the process of third-party claims
  adjudication
• Incorporate technology/informatics into pharmacy
  practice
• Participate in service learning opportunities
  PHAR 532, 558 with additional objectives

27
PHAR 530 Objectives/Outcomes

• 8. Promote health improvement, wellness and
  disease prevention
• Read information found in a patient medication
  profile
• Assess selected therapeutic outcomes, including
  pulse rate and blood pressure
• 9. Demonstrate critical thinking skills to
  facilitate decision making
• Discuss OTC pharmacotherapy decisions on product
  selection with preceptor

28
PHAR 530 Course Schedule

• DATE ACTIVITY
• Aug 26 IPPE Orientation, A workbook is provided
  to the student with a
  list of questions and activities to help guide
  the site visit
• Sep 02 Criminal background check and HIPAA and
  OSHA training
• Site Visit 1
• Sep 09 Foundations lab
• Sep 16 Site Visit 2
• Sep 23 Service learning opportunity or
  alternate site visit date
• Sep 30 Site Visit 3
• Oct 07 Reflection 1 due in LiveText
• What is
  professionalism, and why is it important?
• Site Visit 4
• Midpoint IPPE evaluations should be completed
  in EMS
• Oct 14 Fall Break Day/School holiday
• Oct 21 Site Visit 5
• Oct 28 IPPE Conference
• Dec 9 extended over the semester

29
PHAR 530 Assessment Criteria

• Professionalism and Behavior evaluated by
  preceptor
• Minimum score 3.0 to pass, but does not count
  toward grade
• Competency assessment by community practice
  preceptor (70) and faculty (30)
• Minimum score 3.0 to pass
• Orientation/Conference 1 15
• Conference 2 15
• Medical Terminology 15
• LiveText Reflection 1 10
• LiveText Reflection 2 10
• Workbook Questions/Activities 35
• Total 100
• Preceptor training critical

30
PHAR 530 Grading Criteria

• A workbook is provided to the preceptor with a
  list of questions and activities to help guide
  the site visit
• Assessment of professionalism and performance
  will be completed in the EMS web-based system by
  the Preceptor at the site using a grading rubric
  that describes performance requirements
• Grading Scale
• Honors 4.75 - 5.00
• High Pass 4.50 - 4.749
• Pass 3.0 - 4.49
• Failure lt3.0

31
PHAR 532 Course Schedule

• WK -1 Course Orientation, Campus Conferences
• WK 1 Mon-Fri , 36 hr (4.5 days)
• 1. Orientation to department and site
• 2. Role of pharmacist in health care team
• 3. Interdisciplinary communication
• 4. Provide ethical patient care
• 5. Distribution order processing
• 6. Define and discuss systems management
• 7. Purchasing, Inventory Control
• 8. Discuss Performance Improvement Initiatives
• WK 1 Fri 1-4 pm Conference, Webex conference if
  necessary
• WK 2 Mon-Fri, 36hr
• 9. Legal Controlled Substances
• 10. Medication Reconciliation
• 11-15
• WK 2 Fri 1-4 pm Conference, Webex conference if
  necessary
• Intense schedule in 2 weeks (80 hr)

32
PHAR 532 Assessment Criteria

• Professionalism and Behavior evaluated by
  preceptor
• Minimum score 3.0 to pass, but does not count
  toward grade
• Competency Assessment by institutional practice
  preceptor (80) and faculty (20)
• Minimum score 3.0 to pass
• Conferences Attendance 20
• Calculations Worksheet 25
• Service Learning Reflection 10
• IPPE Hospital Workbook Content Exam 25
• LiveText Reflections 20
• Total 100
• Preceptor training critical

33
PHAR 538 Course Outline

• WK 1-18
• 7 site visits
• 3 on-campus conferences
• Workbook/Assignment activities
• Community service activity at site
• Health care project at site
• Journal site visit, Reflection in LiveText

34
PHAR 538 Course Schedule

• Week 1 on campus conference
• Orientation
• LiveText, EMS review, Terminology
• Week 2 Foundations lab
• Week 3 Site Visit 1
• Prior to site visit
• Complete OTC CASE
• Top Rx Drugs
• Drug Information Question
• SITE activities
• 1. Ear Care OTC Products Case
• 2. Begin planning a health promotion activity,
  Participate in educational offerings
  designed to benefit the health of the general
  public
• Self Care Diabetes
• Blood Pressure Hypertension
• Cholesterol Hyperlipidemia
• 3. Discuss with Preceptor the patient interview
  using edited Script and Form created in
  Communications Class.
• 4. Ask for a patient to interview or use a
  relative or family friend.

35
PHAR 538 Assessment Criteria

• Professionalism Behavior Minimum score 3.0 to
  pass
• Competency Assessment Minimum score 3.0 to pass
• Participation/Attendance Conference 1
• Develop Conflict Management Script, hand in
  scenario 20
• Participation/Attendance Conference 2
• Management, hand in organization chart 10
• REFLECTIONS 20
• Patient Interview 10
• Service Learning Reflection 10
• Management Overview Reflection 10
• Workbook Activities Completion 10
• Terminology Quizzes 10
• Total 100
• Use LiveText or Blackboard for documentation

36
IPPE 101/IPPE 103 Course Outcomes

• Same eight (8) performance outcomes
• Different settings 101 (community), 103
  (institution)
• Outcome 2 Given a patient, caregiver, or health
  care
• professional, conduct an interview to collect
  subjective
• information required for professional functions
  at the
• practice site.
• Activities to achieve outcome
• Elicit patient-specific information necessary for
  processing prescriptions/medication orders.
• Ask appropriate questions to clarify subjective
  information.
• Accurately document subjective information.

37
IPPE 101- Community Practice

• Site based activity Points
• Community Experience (1 wk, 40 hr) 70
• (Preceptor Evaluation)
• School based activity 30
• Orientation
• Web based tutorial
• Assignment/Project
• Total points 100

38
IPPE 103- Institutional Practice

• Site based activity Points
• Institutional Experience (1 wk, 40 hr) 70
• (Preceptor Evaluation)
• School based activity 30
• Orientation
• Web based tutorial
• Assignment/Project
• Total points 100

39
Assessment Criteria

• Categorical/Numerical (MC/10, NI/8, SD/0)
• Meets Competency (MC-10 points)
• Sometimes needs assistance to complete criterion
  elements.
• Needs Improvement (NI-8 points)
• Usually needs assistance to complete criterion
  elements.
• Significant Deficiency (SD-0 points)
• Always or nearly always needs assistance to
  complete criterion elements
• Grade
• 90 100 A
• 80 89 B
• 70 79 C
• lt 70 F

40
Professionalism and Behavior Criteria

• Items
• Patient and provider communication
• Appearance, attire
• Timeliness, commitment
• Initiative
• Pass/Fail, does not count toward grade
• Meets Competency
• Significant Deficiency
• SD may contribute to failing course

41
IPPE 201-Patient Care I

• Min 50 hr during the 2nd year
• 2-3 students/group
• 6 assignments
• Course Outcomes
• Develop pharmacist-patient relationship
• Collect pharmaceutical care database
• Develop problem list
• Make appropriate health care recommendations
  (under guidance of preceptor)

42
IPPE 201 Assessment

• Preceptor evaluation 80 of course grade
• Assignment Assessment Activity Points
• 1 Database Collection 10
• 2 Medication History and Personal Medication
  Record 15
• 3 Vital Signs/ ROS/Problem List 15
• 4 SOAP note 15
• 5 15-minute Patient Case Presentation 15
• 6 Supervised Interview 10
• Course master evaluation 20 of the course grade
• Workshop Participation
• Medication history, documentation (e.g., SOAP
  note) 14
• Course Closure Activities
• Reflection Paper 6
• Total Points for the Course 100

43
IPPE 301-Patient Care II

• Min 50 hr during the 3rd year
• 5 assignments
• Course Outcomes
• Engage in the process of providing Medication
  Therapy Management (MTM) services
• Learn to identify and assess medical and
  medication-related problems.
• Develop, implement, and follow-up on
  recommendations for identified problems in
  collaboration with their preceptor and other
  healthcare providers.
• Develop communication skills with other members
  of the healthcare team.

44
IPPE 301 Assessment Criteria

• Preceptor evaluation 60 of course grade
• Assignment Assessment Activity Points
• 1 Supervised Interview 12
• 2 Medication Therapy Review with problem list
  16
• 3 SOAP Note with Cover Letter
• Medication Action Plan
• Personal medical record (PMR) 16
• 4 F/U SOAP Note Updated PMR 16
• Course Master evaluation 40 of the course grade
• 5 Health Fair Poster Session 10
• Workshop Activities Participation 20
• Complete Student Portfolio (midpoint
  final) 10
• Total Points for the Course 100

45
IPPE 303 Community Pharmacy Practice

• Min 160 hr in 4 wk during the 3rd yr
• Six (6) terminal performance objectives
• 5. Identify five potential elements of
  medication error prevention at the practice site,
  using ISMP recommendations.
• Access at least weekly the ISMP FDA Safety
  Alerts.
• Describe issues related to dangerous
  abbreviations, high alert medications, and look
  alike/sound alike medications.
• Discuss with the preceptor each of the five
  safety issues identified and possible solutions.
• Post in Blackboard two safety intervention
  assignments.
• The interventions can be for an individual or the
  practice. List the issue and the corrective
  action taken.

46
IPPE 303 Assessment Criteria

• O Outstanding (10 points) The student is able
  to perform all of the skills elements with
  minimal
• assistance from the preceptor.
• A Acceptable (8 points) The student is able to
  perform the skill but requires assistance from
  the preceptor for some of the skills elements.
• N Not acceptable (0 points) The student is
  unable to perform the skill without assistance
  from the preceptor for all or most of the skills
  elements.
• Grade (solely assessed by preceptor)
• 90 100 of 60 points A
• 80 89 of 60 points B
• 70 79 of 60 points C
• lt 70 of 60 points F

47
Professionalism and Behavior Criteria

• ITEM 4 Initiative
• Acceptable/Unacceptable, does not count toward
  grade
• Acceptable
• The student consistently (greater than 90)
• (1) Accepts responsibility and demonstrates
  accountability without
• repeated reminders
• (2) Demonstrates a sense of duty
• (3) Demonstrates an earnest desire to learn
• (4) Demonstrates the willingness and flexibility
  to contribute to the
• well-being of others
• (5) Applies knowledge, experience, and skills
  to the best of his/her ability.
• Unacceptable
• Does not meet criteria for acceptable as stated
  above.

48
PHR 1242 Community Professional Development I

• Visit 1 Introduction to learning
• Visit 2 Concept of Pharmaceutical care
• HW 2 Component of Rx
• Practice skills
• OTC moment
• Visit 3 Pharmacy workflow
• HW3 Rx label
• Practice skills
• OTC moment
• Visit 4-13
• Visit 7 Midterm Preceptor Evaluation of student
  performance
• Visit 14 Final Evaluation and Review

49
PHR 1242 Community Professional Development I

• HW 3
• Self-study assignment
• Rx label
• Formulations and substitutions
• Pharmacy skills focus
• Information on Rx label
• List 7 drugs in negative formulary
• OTC moment
• Active ingredients in Robitussin, Delsym
• Journal reflection
• How efficient is the workflow at your site?

50
PHR 1242 Assessment Criteria

• Assessment of workplace performance (preceptor)
  15
• Assessment of professional competency
  (preceptor) 15
• Site based assignment 15
• ETR journal and IDK cards 15
• Quizzes 10
• Attendance/dress code(count toward grade) 10
• Case scenarios, class group assignments 20
• Total 100
• Grading scale
• Agt90
• B80-89
• C75-79
• Flt75

51
Professionalism and Workplace Performance
15 items, categorical
52
PHR 1242Community Practice Competencies
15 items, categorical
53
PHR 2112 Institutional Professional Development
II

• Visit 1 Syllabus and Course Overview
• Visit 2 Medication order processing
• Self learning activities
• Professional insight
• Reflection and journal entries
• Visit 3 Hospital Pharmacy automation
• Self learning activities
• Professional insight
• Reflection and journal entries
• Visit 4-10
• No midpoint point evaluation
• Final Evaluation and Review (Grading rubrics the
  same)

54
PHR 2112 Site Based Learning ActivitiesVisit 3

• Self-learning activities
• Describe the basic process of unit dose drug
  distribution in the hospital and how automation
  is used
• Are nurses able to access drugs from the
  automated dispensing machine that do not yet
  appear on the patients profile? If so, what
  safeguard are in place?
• Professional insight
• What do pharmacists consider to be the major
  sources of stress in hospital pharmacy?
• How do they deal with stress?
• Reflection and journal entries
• Some pharmacists are concerned that automation
  may jeopardize job security. What kind of skills
  should you develop so that your job will always
  be secure, regardless of automation?

55
PHR 2112Institutional Practice Competencies
16 items, categorical
56
PHR 3232 Professional Development III

• Clinical Pharmacy
• 6 visits, 80 hr
• Geriatrics
• 1 visit 8 hr
• Class meetings wk1-wk16
• 32 hr
• Case presentations
• others

57
PHR 3232 Assessment Criteria

• Service learning Projects 45
• Clinical Pharmacy 25
• Geriatric 10
• Case Presentation 10
• Professionalism 25
• Peer Case Evaluation 12
• Electronic Thought Reflection 8
• CV and cover letter 5
• APPE Portfolio 5

58
Experiential Training Log
59
Student Assessment of Preceptor
60
Student Assessment of Preceptors(ACPE Appendix C)

• Ability to facilitate learning
• Communication skills
• Quality as a role model
• Effectiveness related to pharmacy education

61
Stake Holders in the Partnership

• ACPE
• School
• Student
• Preceptor/site

62
Preceptors Perspective

• Assist with daily activities
• Access to college resources
• Professional growth
• Academic appointments /recognition
• Material/financial rewards (e.g. CE, training,
  travel)
• Personal satisfaction and gratification of being
  a part of pharmacy education
• Shape the future of pharmacy practice
• Develop life long mentoring relationships
• Give back to the profession
• Recruitment tool
• Staff development

63
Elements of Precepting

• Partnership for education
• Role modeling
• Education
• Coaching
• Evaluation of performance
• Professionalism
• Teamwork
• Investment of time energy
• Individualization of learning activities
• Guidance

64
Core Value for Preceptors

• Professionalism
• Desire to educate and share knowledge with
  students
• Willingness to mentor
• Time commitment for precepting
• Respect for students
• Willingness to work with a diverse student
  population

65
Preceptor Responsibilities

• Student orientation
• Throughout the internship/rotation
• Guide
• Coordinate
• Instruct
• Role model
• Assess/Evaluate

66
School Perspectives

• Engage in the real world of pharmacy practice
  (avoid ivory tower syndrome)
• Experience cannot be taught in classroom, it
  must be practiced and modeled, need preceptor as
  the education partner
• Marketing students for future employment
• Impart new academic concept onto pharmacy practice

67
Recruit Practice Facilities(ACPE Standard No 28)

• Implement criteria for selection
• Select sites and preceptors with established
  quality criteria
• Execute affiliation agreement between the site
  and the school
• Preceptor training
• Oversight of preceptor/site for quality assurance
  
• Explore new preceptor/site for turnover and
  replacement

68
Preceptors and Sites

• Adequate number of sites
• Diversity of practice facilities
• Preceptors to hold position in school for
  commitment
• Adjunct faculty practice sites
• University based experiential sites ( medical
  center)
• College based faculty sites in affiliated
  institutions

69
Preceptors Training(ACPE Appendix C)

• Orientation to schools mission, goal and value
• Review of schools curriculum and teaching
  methodologies
• Review of schools IPPE objectives
• Review of schools performance assessment and
  grading system
• Web based tools and resources

70
Preceptors Package

• Syllabus for the course
• Workbook
• Professionalism Assessment Form
• Competency Assessment Form
• Resource access (library, online) information
• System access information (e-mail, LiveText,
  Blackboard etc)

71
Oversight of Pharmacy Practice Experience (ACPE
Appendix C)

• The experience director is responsible for
  oversight and quality assurance of the experience
  program
• Expertise, credibility and commitment of
  preceptor/site
• Number of students per site
• Schools should have systems, such as computerized
  system to manage the pharmacy practice
  experiences
• Preceptor/site evaluation by students

72
Students Perspective

• Need experience before taking on the real
  practice world
• Expressed willingness/enthusiasm for learning
• Personal accountability and responsibility for
  actions
• Dependability and reliability
• Effective use of time and resources
• Courteous, respectful and non-judgmental
  communication with preceptors, patients, staff
  and fellow students
• Agent for change in pharmacy practice for the
  future

73
Continued Evolution of Pharmacy Practice

• Economic pressure
• Declining dispensing fee
• Centralized dispensing operation (e.g., mail
  order)
• Fee for service to patients to improve
  profitability (MTM)
• Desire to be integrated as a member of the
  healthcare team
• Put education in good use
• Medication related morbidity and mortality

74
Continued Evolution of Pharmacy Practice

• Medication related morbidity and mortality
• 3 -10 of hospital admissions are
  medication-related
• 1.5 mm preventable medication related adverse
  events
• Cost-177 bb (yr 2000)
• Pharmacists can play a valuable role in reducing
  patient risk.

75
Challenges to Patient-Centered Care

• Time consuming third party billing
• Lack of reimbursement model
• Insufficient staffing
• Inability to access patient information
• Lack of private area
• Lack of education program
• www.pubmedcentral.nih.gov/articlerender.fcgi?artid
  2690893

76
References

• Accreditation Standards and Guidelines for the
  Professional Program in Pharmacy Leading to the
  Doctor of Pharmacy Degree. http//www.acpe-accredi
  t.org/pdf/ACPE
• American Society of Health-System Pharmacists
  Education and Training.
• http//www.ashp.org/Import/PRACTICEANDPOLICY/Poli
  cyPositionsGuidelinesBestPractices/BrowsebyTopic/E
  ducation/PolicyPositions.aspx0315
• VCU School of Pharmacy. http//www.pharmacy.vcu.ed
  u/sub/exper/preceptors.aspx
• University of Maryland School of Pharmacy
• http//www2.pharmacy.umaryland.edu/administration
  /elp/courses.html
• Palm Beach Atlantic University Gregory School of
  Pharmacy
• http//pharmacy.pba.edu
• An enhanced community Advanced Pharmacy Practice
  Experience to improve patient care. Am J Pharm
  Educ. Kassam and Kwong, 2009 73(2) 25.