The residency curriculum is delivered in a longitudinal fashion to allow residents to establish continuity and effective, long-term relationships with the patients they care for and healthcare teams with whom they collaborate. Blocks for the year include:
- Orientation: (July/August) - introduction to pharmacotherapy clinic and home-based primary care, long-term care "boot camp" (including Medicare regulations, interpersonal skills, etc.), community resources, PACE 101, Medicare nuts and bolts
- Longitudinal curriculum: beginning in August
- Electives (longitudinal or focus block): beginning in April
MAHEC Geriatrics Clinics
Geriatric Pharmacotherapy Clinic
Residents will obtain their Clinical Pharmacist Practitioner (CPP) license and provide care independently in a busy, fully established pharmacotherapy clinic for ambulatory seniors. Primary services provided will include comprehensive medication management in conjunction with Medicare Annual Wellness Visits, anticoagulation management, and diabetes education and management.
Interdisciplinary Geriatric Consultation Clinic
The consultation clinic performs comprehensive geriatric assessments for patients identified as being at high risk for geriatric syndromes such as dementia, falls, chronic pain, urinary incontinence, and polypharmacy. Residents will work alongside an NP and MA to deliver comprehensive care during clinic and home visits.
An established interdisciplinary clinic since 2007, the Osteoporosis Clinic provides specialty consultations for patients with osteoporosis or low bone mass for either primary or secondary prevention of fragility fractures. Pharmacists in this clinic offer pharmacotherapy recommendations for treatment of osteoporosis, optimization of calcium and vitamin D supplementation, and minimization of medications that heighten fall risk.
Academia (UNC Eshelman School of Pharmacy)
UNC Eshelman School of Pharmacy was recently recognized by U.S. News & World Report as the #1 pharmacy school in the United States. In 2010, the Asheville satellite campus was founded to address the pharmacist shortage that exists in much of rural western NC. Asheville-based students learn about comprehensive medication management in settings that have been recognized as models for the nation.
Residents will grow as leaders in pharmaceutical education and research, benefitting from direct involvement in the School’s innovative curriculum and the mentorship of esteemed faculty.
- Participation in resident-oriented curricula in leadership, scholarship and service
- Teaching around three classes per semester
- Co-coordination of Geriatric Pharmacotherapy elective, including area-wide interprofessional exercise
- Serving as primary preceptor for up to four students on their APPE rotations
- Serving in a leadership role with a student organization such as Beyond Clinic Walls
Program of All-Inclusive Care for the Elderly (PACE)
CarePartners PACE is a capitated program for older patients that need support to remain safely at home. The service provides interdisciplinary care and services to sustain and promote independence of seniors who meet nursing home eligible criteria but wish to remain in their home. On site disciplines include a recreational therapist, physical and occupational therapists, dietician, physicians, nurses, social workers, chaplain, pharmacist, and speech therapist.
- Review patients’ medical records and medication lists to identify appropriate recommendations to optimize care for the geriatric patient.
- Develop and implement a comprehensive medication management plan, including dose adjustments, considerations for barriers to adherence, monitoring, and follow-up.
- Communicate effectively with other members of the healthcare team, including the patient and caregiver.
- Develop an appreciation for the patient’s needs as a whole, including aspects such as environmental, social, personal and spiritual needs.
Geriatric Psychiatry (Black Mountain Neuro-Medical Treatment Center)
This specialized skilled nursing facility cares for adults with significant behavioral conditions that coexist with neurocognitive disorders (including dementia and neurodevelopmental disorders). All residents must have been denied placement in a community nursing facility and therefore present unique challenges, owing to their need for 24-hour supervision and assistance with activities of daily living.
- Attend care plan meetings with other team members (attending physician, psychiatrist, nurses, clinical psychologist, speech pathologist, social worker, PT/OT, restorative aide).
- Interact with patients on their respective floors while completing regular drug regimen reviews.
Long-Term Care Consulting
Residents will provide longitudinal consulting support for skilled nursing facilities (i.e., nursing homes) directed by MAHEC geriatric medicine faculty.
- Understand the roles and responsibilities of consultant pharmacists in the long-term care setting.
- Understand Medicare regulations and the survey process as they relate to extended care facilities.
- Participate in interprofessional decision making regarding appropriate, patient-centered care for individuals in the long-term care setting.
- Develop clinical expertise in designing, implementing, and monitoring pharmacotherapy regimens for the institutionalized geriatric population.
Hospice & Palliative Care (Mission Health and Asheville VAMC)
- Actively participate in interdisciplinary team meetings.
- Perform comprehensive medication reviews and provide recommendations to minimize harms, drug interactions, and medication overuse.
- Communicate with patients and caregivers/family members regarding goals of care and realistic treatment expectations.
- Develop educational tools for patients, caregivers, and health care team members.
- Evaluate appropriateness of preventive medications in the context of patient care goals, treatment targets, time to benefit, and life expectancy.
- Evaluate appropriateness of “potentially inappropriate” medications (such as benzodiazepines) in end-of-life situations.
- Apply effective pain management strategies, balancing risks of misuse, dependence, and adverse effects vs. benefits for comfort, function, and quality of life.
Dementia Clinic (MemoryCare, Inc.)
MemoryCare is a nationally revered, non-profit organization using a physician directed team based model with nurse and social worker care managers to provide specialized medical care to older adults with memory loss. The program provides education and counseling for caregivers and assists families by directing them to available community resources. Approximately 85% of the individuals and their caregivers served by MemoryCare live at home. MemoryCare strives to be a model program for quality dementia care and provides community and professional education related to aging and memory issues.
- Gain exposure to a physician dementia specialist practice in the community setting, and an appreciation of how clinicians incorporate the elements of history, physical and behavioral observations into decisions related to prescribing or discontinuing drug therapy at various stages of a neurodegenerative cognitive disorder.
- Collaborate with the physician team on comprehensive medication reviews to minimize unwanted drug-associated impairments to cognitive or motor functioning. Contribute to the team’s efforts in educating patients and caregivers on best strategies for home medication safety and adherence.
- Provide recommendations related to pharmacologic therapy, including drug choice and appropriate dosing, for cognitive and behavioral management.
Rural Block (Cherokee Indian Hospital)
Residents will each spend 1-2 weeks at Cherokee Indian Hospital rounding in an outpatient geriatric specialty clinic and long-term care facility. Housing will be provided.
Half-day sessions will focus on a variety of topic areas including:
- Literature evaluation and application of evidence-based medicine
- Review of “bread and butter” geriatric syndromes and disease states
- Recognizing and avoiding age-related bias
- Ethical dilemmas in care of the older adult
- Medicare, Medicaid, and medication assistance tools
- Caring for special populations (e.g., rural/Appalachian, Cherokee Indian)
- Health care teams (role of multiple disciplines and medical specialties)
- Self-care, preventing burnout
Residents will attend national meetings for American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacy (ASHP) Midyear Clinical Meeting, and the American Geriatrics Society (AGS) or Academy of Senior Care Pharmacists (ASCP).
Possible electives include (but are not limited to):
- Family Medicine consulting
- Geriatric Psychiatry (Park Ridge Health)
- Asheville VA (ambulatory or Community Living Center sites)
- Additional long-term care, including innovative practice models
Sample Longitudinal Schedule