early patient-oriented care program as an educational tool and service, The

American Journal of Pharmaceutical Education, Fall 1998 by Grabe, Darren W, Bailie, George R, Manley, Harold J, Yeaw, Barbara F

Darren W. Grabe, George R. Bailie1 and Harold J. Manley

Barbara F. Yeaw

The Early Patient-Oriented Care (EPOC) program was designed to provide early clinical education for baccalaureate pharmacy students while performing a clinical service for patients. Six students were assigned 12-15 hemodialysis patients to visit monthly under preceptor supervision. Educational activities changed over time as students gained experience. Approach to the patient, medication information retrieval, pharmaceutical care philosophy, and monthly medication reviews were taught in the first semester. Identification of drug related problems (DRPs), targeting on anemia and renal bone disease, were undertaken in the second semester. Resulting interventions identified were ranked for significance and impact on care. A patient satisfaction survey was performed. 105 DRPs were identified over four months. Interventions impacted on care, cost, or both: 41.9 percent, 23.8 percent, 34.3 percent of time, respectively. Eighty-six percent of recommendations were accepted in whole or in part. Over 75 percent of patients, overall, were satisfied with the EPOC program. The EPOC program provided practical and didactic education and a clinical service.

INTRODUCTION

Pharmaceutical care, a widely accepted philosophy of pharmacy practice, describes the performance by pharmacists of more patient-care oriented activities instead of a dispensing role(1-2) The education of students of pharmacy should be conducive to this role Contemporary pharmacy education should incorporate the pharmaceutical care philosophy as early as possible in the curriculum. Early involvement in a student's education may aid the student in learning disease states and therapeutics(3) Since one of the fastest growing healthcare arenas is ambulatory care, efforts in the education of pharmacy students should be focused in that direction.

The dialysis patient population represents a unique but small percentage of the total ambulatory population. Regardless, the growth in ambulatory care is reflected in the projected increases of dialysis patients by the year 2000. The United States Renal Data System (USRDS) reports an average annual increase of nine percent(4). With 257,266 reported beneficiaries at the end of 1995, the number would be expected to grow to more than 300,000 by the year 2000(4). This number would be expected to increase substantially if patients with chronic renal failure are initiated on dialysis earlier than what has been traditionally done(5). According to the USRDS 1997 Annual Data Report, there are approximately 3,200 dialysis units, of which only 650 are institutionally based(4) with the remainder as free standing. There are relatively few pharmacists practicing in outpatient hemodialysis units. There are approximately 80 pharmacists who are members of the nephrology practice research network of the American College of Clinical Pharmacy. If each pharmacist from this network practiced in one hemodialysis unit, that leaves the majority without a practicing clinical pharmacist.

Hemodialysis patients are typically prescribed 10 to 12 medications and commonly have multiple co-morbidities either as a result of, or as a cause of, end-stage renal disease(6). Because of the complex nature of the therapeutic regimens, and because of the unique circumstances surrounding hemodialysis patients, this population provides an excellent opportunity for students to learn pharmaceutical care while providing a valuable service to patients and other health care providers. This population is unique in that, although they are ambulatory outpatients, they return to the hemodialysis unit at regular, scheduled times and are in essence, a "captive audience."

At this institution, baccalaureate pharmacy students complete the Professional Experience Program (PEP) during the second semester in the fifth year. This program consists of three five-week rotations (clinical, community, hospital), each a total of 200 experiential hours. Therefore, students are not exposed to clinical pharmacy until the end of their educational program. This is also consistent with the current Doctor of Pharmacy degree where students will rotate at a specific site for a limited amount of time after their didactic sequence. Additionally, the anticipated entrylevel Doctor of Pharmacy program will also follow this example.

On the basis of this, we developed a novel educational traineeship, the Early PatientOriented Care (EPOC) program. This program was designed to provide an opportunity for student education at an early stage in their education, while performing a clinical service to patients. We report the results of the first year's experience of students in the EPOC program.

METHODS

All students were approached at the end of their third year and introduced to the concept of the EPOC program, during one of their class lectures. Meetings were then scheduled the following two days for those students who were interested to discuss more details regarding the program. Those students who wanted to participate were asked to fill out an application form. Six students were then chosen by agreement between two of the authors. The decision was based subjectively upon academic grades, enthusiasm, experience, professionalism, demeanor, and from feedback from previous faculty members from earlier courses. Students participating in the EPOC program would enter the program at the start of the first semester of the fourth year and gain weekly experience throughout the entire fourth and fifth years (four semesters total).