Competency. The APPE curriculum, in the aggregate, includes but is not limited to: (1) direct patient care, (2) interprofessional interaction and practice, (3) medication dispensing, distribution, administration, and systems management, and (4) professional development.
A pharmacist practicing in community and ambulatory care practice settings needs to possess competencies in the areas including pharmacist-delivered patient care (i.e. medication therapy management), public health, communication, dispensing systems management, business management, pharmacy law, and leadership. Listed below are example performance competencies and the affiliated course activities. Please note not all of competencies listed below will be evaluated in this course.
Pharmacist-Delivered Patient Care.
- Demonstrate and routinely apply strong clinical skills and provide direct patient care services
- Medication Therapy Management (MTM)
- Define and appropriately document comprehensive MTM services
- Conduct a patient interview and provide education
- Conduct comprehensive medication review
- Identify and resolve medication therapy problems, manage drug interactions, and resolve gaps in care
- Recommend therapeutic alternatives and generic substitutions
- Document services and follow up with other health professionals
- Use multiple MTM platforms as required by third-party payers
- Support and assist patient behavior change
- Proactively identify and resolve patient-specific barriers to medication adherence
- Complete physical assessments and make appropriate recommendations or referrals
- Describe and apply clinical practice guidelines to patient care
- Facilitate patient self-administration of medications and disease monitoring
- Demonstrate knowledge of appropriate administration of technique for dosage forms commonly dispensed in community pharmacy
- Proactively assess and resolve issues related to medication safety
- Describe common doses of drugs requiring monitoring and collaborative drug therapy management
- Proactively perform counseling and medication education which complies with OBRA-90
Activities – medication therapy management, OTC counseling, patient counseling
Public Health.
Clinical Application of Public Health Policy:
- Discuss the pharmacist’s role in education and intervention in public health initiatives applicable to pharmacy practice
- Collect, interpret, and make recommendations based on the results of health and wellness screenings and diagnostic tests
- Proactively assist with patient self-care, including helping patients make appropriate selections of over-the-counter medications and dietary supplements
- Proactively promote healthy lifestyle and nutrition and describe how it impacts drug therapy and overall health
- Describe the role of a pharmacist in emergency management
- Identify and explain the major roles of the pharmacist in population-based provision of care (as distinguished from direct patient care)
Immunization:
- Be certified to administer immunizations (preferably early in curriculum to allow for practice and utilization during the professional program)
- Describe the Vaccine Information Statement (VIS), the Vaccine Adverse Events Reporting System (VAERS), and state vaccine registries
Activities – seminars, immunization activity, OTC review, medication therapy management
Communication Skills.
Health Literacy:
- Determine patient level of health literacy by observation or interview, appropriately adjust counseling delivery, and to communicate at all levels of health literacy
- Solve adherence challenges created by low health literacy
Patient communications:
- Support patient behavior change and self-efficacy through skills such as motivational interviewing
- Demonstrate a respect for patient confidentiality and privacy rights
- Demonstrate patient compassion and empathy
Medication management team communications:
- Identify and manage conflict at all levels
- Supervise and motivate employees
- Delegate appropriate tasks
- Effectively articulate team objectives and measure and report team performance
Activities – patient counseling, insurance activity, Star Rating activity
Dispensing Systems Management.
Extemporaneous Compounding:
- Perform basic, non-sterile compounding
Supply Chain:
- Describe the pharmaceutical supply chain and anticipate, identify, and troubleshoot problems with the supply chain
- Oversee and effectively manage the drug procurement process
Operations:
- Outline typical pharmacy dispensing workflow
- Comprehend and adopt a given set of pharmacy operating procedures
- Comprehend and adopt an existing collaborative drug therapy management agreement
- Evaluate prescription for legitimate medical use, and appropriate dose
- Describe the roles and responsibilities of each pharmacy staff member
- Describe dispensing processes when pharmacy automation is utilized
Quality:
- Describe the concepts of quality measurement and improvement
- Apply national standards, guidelines, and best practices
- Develop a plan for quality and performance improvement
Pharmacy Technology:
- Describe the role of computerized pharmacy management systems in dispensing
- Dispense prescriptions utilizing technology-assisted workflow
- Describe the role of pharmacy robotics, point-of-sale systems and electronic signature capture
- Describe the electronic health record (EHR) and the role and responsibilities of a pharmacist who has access to a certified EHR
Activities – dispensing skill, purchasing activity, Star Rating activity, ISMP survey
Business Management.
Lead the operations of a community pharmacy practice site and to:
- Manage inventory costs and inventory levels or order points
- Identify cash flow problems and apply solutions to address
- Describe basic finance terms and analyze a financial statement
- Apply healthcare economics and pharmacoeconomics
- Describe strategies for asset protection and safety
Effectively use pharmacy technology including:
- Automated filling systems
- Prescription processing systems with contemporary features
Understand and communicate managed care/drug-coverage policies and to:
- Explain the purpose/function of a Pharmacy Benefit Management (PBM) program and the general concept of managed care
- Discuss general concepts associated with the benefit structure of a health plan, including co-pay vs. co-insurance, premium vs. deductible and maximum out of pocket costs
- Outline general provisions of Medicare Parts A, B, C and D, and Medicaid, including enrollment and other payment programs
- Provide guidance to patients seeking assistance to apply for drug payment programs
- Troubleshoot denied claims
- Discuss the concept of drug utilization review, formulary management and provide functional definitions of key managed care strategies (e.g., prior authorizations, step therapy, quantity limits)
- Identify major factors that contribute to prescription drug related fraud and abuse
- Identify the major factors influencing drug costs for a managed care organization (e.g., pharmacy costs, drug-pricing methodologies, contracts/rebates, discounts)
Activities – dispensing skill, insurance activity, Medicare Part B and D activity, purchasing activity
Leadership Abilities.
- Display confidence in the patient care skills learned in pharmacy school
- Demonstrate professional behavior (attitude, dress, appearance, etc.) in practice settings
- Embrace and advocate changes that improve patient care
Legal Considerations.
- Understand laws and regulations that affect pharmacy practice
- Understand other state and federal rules and regulations affecting legal operation of a pharmacy.
- Identify issues, pending legislation, and regulations across all levels of government and how to make a positive impact
- Understand professional ethics as they apply to the practice of pharmacy
- Apply knowledge and understanding of all legal and ethical aspects of pharmacy practice required to evaluate a patient care decision
Activities: PEB self-inspection, dispensing skill