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How to set up a pharmacist clinic

Determine the details of how the clinic would function. Here, we explain this process before using the TVGH pharmacist clinic as an example.
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Once we done with the support from local institution. Then, we go to the clinic structure setup. There are several things we need to do to set up a clinic, which are available staffing per weeks, and pharmacist credentials, focus of the service, and service time and frequency, service method and service standard operating procedure. And, we already talk about the clinic location and the referral process in the previous sections.
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Once you set up your clinics, you need to know how many pharmacists you have and how do you manage the available staffing. We have 7 pharmacists in total. And, this is our previous appointment schedule. We are now doing it electronically. And, we have 2 clinics per week, one is on Tuesday morning, the other is on Wednesday afternoon. In every clinic, we have 1 full-time pharmacist and 1 prn pharmacist. This is the way we do it. In each clinic time, we have 7 patients at most. If we have more than 7 patients. Then, we will call the prn pharmacist or the patient cannot finish their appointment on time.
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So, this is a way to do when you want to expanding your pharmacist clinics, and you want to try to arrange your staffing in the most flexible way, you can have a prn pharmacist as your backup.
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And, we go to the pharmacist credential. In our pharmacy department, our chief actually went to the United State to learn how to set up anticoagulation clinics. So, this is the healthcare you need to visit it and he bring back very useful knowledge and experience and it help us to set up the clinics.
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So, after our chief come back, then he will set up a prerequisite for anticoagulation service that pharmacists need to be a clinical pharmacist in cardiovascular, cardiovascular surgery and neuro-department for more than 1 year. After one year training as a clinical pharmacist, then we enroll a training program for weekly case-based interactive teaching with current anticoagulant clinic team. After that, all the potential pharmacists have to enroll in clinic internship for at least 16 hours, and you will see the pharmacists doing the service and you need to do it by yourself with a supervisor watching you. And after 16 hours, you can provide your service to the patient independently.
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After the training program, we also invite the experienced clinical pharmacist from the US, which is pharmacists in anticoagulation clinics. And, it will help us to increase our performance and we also arrange a lot of seminars and training programs to the pharmacists. And, some of the pharmacists will be interesting in enroll in the anticoagulation clinics, So, they have to go through the whole training program, which is one year training as a pharmacist, as a clinical pharmacist one month training, which is a very intense one for case-based discussion and for internship for 16 hours. Then you will become a pharmacist candidate for anticoagulation clinics.
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Then you have design the focus of the service. In our anticoagulation clinics, we focusing on patient use warfarin or Non-vitamin K antagonist Oral Anticoagulants. I will say it in NOACs in following. So, we provide initial use pharmacy education and follow-up, adverse drug reaction management and bridging suggestion, anticoagulation counselling, management of INR deviation and other type of service in our clinics.
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In those service, what we do is that we basically make sure the anticoagulant regiment is correct, and we make sure that all the medication list has in a good condition, doing good medical record and we will ask the lifestyle of our patient, what is their dietary habits, do they exercise regularly, is there are a smoker or alcoholic, and maybe do some lifestyle management to control their weight, and we also make record of their lab data. So, you need to design the focus of the service and what will you do in your service and make it on the list so all the pharmacists in the clinics can follow this specific rules.
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And, you have decided that what kinds of service method you want to use. In our case, the initial referral is always face-to-face communication and interview. After the first interview, the patient can choose he still want to do the face-to-face communication or they want to do it through telephone. In my personal experiences, I believe the face-to-face communication have the best quality because you not only talk through language, you talk through the expression on the patients’ faces, and their posture, and you will know that he maybe have some consideration of his current medication. However, if you only rely on face-to-face communication, it will be very time-consuming and you will be tied up on the schedules.
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So, telephone follow-up is a more flexible way to do the follow-up. You can make a call on your office by the time you are available. You don’t have to do it in your clinical hours, you can do when you have time. And, patient doesn’t have to take the day off and go to the hospital and wait for such a long time just for 30 minutes follow-up. I think it’s a win-win situation if you both agree to do the telephone follow-up. However, I personally prefer face-to-face communication.
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And, then you have to decide your service time and frequency. For our service, for warfarin and NOACs service, the initial referral we always take 60 min service time because we need to do a varied follow interview with the patients. We have to ask about the lifestyle and ask about what they think about if they take the anticoagulant or do they know their disease condition, and we need to provide the initial pharmacy education so, it will take a little bit longer.
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However, once you go through the initial referral, the follow-up appointment will only take 30 minutes, and in this 30 minutes, we go through the medication review and we will ask about if there is any change in their lifestyle or they take any new oral drugs or supplements or ask them that if they have their medication adherence better, then a better the first pharmacy education. And, the frequency for the follow-up is at least within 3 months because our doctor will have their lab tests every 3 months. So, we go with doctors’ lab data interval. We will do the follow-up every 3 months.

After securing support from interdisciplinary sectors, the next step to setting up a pharmacy is to determine the details of how the clinic would function. Here, we explain this process before using the TVGH pharmacist clinic as an example.

Key concepts

While setting up pharmacist clinics, consider:

  • Manpower rotations
  • Pharmacist credentials
  • Services
  • Service methods
  • Service duration and frequency

The TVGH anticoagulation clinic model

Manpower rotation. There are 7 pharmacists at the clinic, 2 clinics per week. In every clinic, there is 1 full-time pharmacist and 1 PRN (Pro re neta) pharmacist. In each clinic time, there are at most 7 patients. If there are more than 7 patients the PRN pharmacists will report to the clinic to assist the full-time pharmacist.

Credentials

Pharmacists need to work as a clinical pharmacist in cardiovascular, cardiovascular surgery and neuro-department for more than 1 year. After which, they must enroll in a weekly training program facilitated by the current anticoagulant clinic team. Finally, they must pass a 16-hour clinic internship to become independent pharmacists of the anticoagulation clinic.

Service and service methods

TVGH anticoagulation clinic focuses on patient prescribed with warfarin or non-vitamin K antagonist oral anticoagulants (NOAC). Services include providing initial use pharmacy education and follow-ups, adverse drug reaction management and bridging suggestion, anticoagulation counselling, management of INR deviation and many others.

Pharmacists need to make sure the anticoagulant regiment is appropriate, and all medication are in good condition. They must also keep good medical records and manage patient lifestyle to control their weight. Lab data management is also part of their responsibility.

At TVGH, the initial referral is always a face-to-face interview. Follow-ups can be done in the clinics or over the phone. Though face-to-face sessions are more productive, it is not as flexible as telephone follow-ups. You need to have a healthy balance of both formats.

Service times and frequency. Warfarin and NOACs related initial referrals are always 60 minutes. The follow-up appointment will only take 30 minutes. Each follow-up must be within 3 months of the previous session as physicians carry out lab tests every 3 months.

Share and learn:

  • Are there anticoagulation clinics in your country? Do they offer other services?
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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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