University of Louisville - Geriatrics

Practice setting

Our practice is in a university Geriatrics outpatient specialty and primary care clinic. We care for older adults as a consult on geriatric syndromes or as PCPs depending on patient preference. As they say in Geriatrics, it’s “meds, meds, meds” when constructing a differential assessment, and as such, the Geriatric Pharmacy service is robust in assisting the Geriatricians and NPs caring for our patient panel. We see about 35 patients between two clinics on busy days and perhaps 15 on not busy days, but since Geriatricians are rare, they don’t have clinic every day as they serve on Geri hospital consult and nursing home service also.  

Why was the pharmacy service developed?

Not based on data or an identified quality improvement. The service was developed because of a gift to the University from a concerned private citizen, and this gift program became an endowed program.

What training, certification, credentialing, and practice agreement is utilized by the practice site?

The lead Pharmacy Faculty is Geri Resident trained and BCGP, FASCP credentialed.
We have 4th year Pharmacy students, Am Care, IM residents rotating.
 
What outcomes are being measured to evaluate the model's success?

More research outcomes, posters, conference sessions and manuscripts.

How have you made this service sustainable?

The endowed program supporting it.  

How did you gain support of administrators, providers, and other key stakeholders?

We are still struggling with implementation but that seed endowed support allowed for pilot and demonstration efforts which opened the door to further Pharm collaboration with Family Medicine and Geriatrics. However, adoption is very difficult.  

What are some lessons learned while implementing your practice model that you would like to share?

Up front negotiation and planning with follow through is key. Actually, throughout the entire time the faculty leading the endowed program has worked within the Medical School and clinical medicine departments, it is a constant fight to prevent being the person who does all the work that the physician faculty members do not want to do, since they are not paying for the FTE. For example, teaching educational sessions for medical residents, precepting research and scholarly activity. As Pharm.D.s we are perfectly capable of providing these things for a medical school and training program. But that keeps us from integrated patient care (because in the physician centered world, they view patient care as their reimbursement and protect that closely not realizing that our service in Ambulatory Care is value added for their outcomes rather than lightening their load in other ways.