ASHP FOUNDATION

CARDIOVASCULAR RISK/DYSLIPIDEMIA TRAINEESHIP

Application Policies and Guidelines

Program development funded by an educational

grant from AstraZeneca Pharmaceuticals.

Universal Program Number (Self-Study): 204-000-06-034-H01 (10 hours/1.0 CEUs)

Universal Program Number (Experiential): 204-000-06-035-L01 (35 hours/3.5 CEUs)

The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

ASHP Cardiovascular Risk/Dyslipidemia Traineeship is an ACPE Certificate Program that provides CE credit for both the self-study and the experiential components: Participants must successfully complete the online self-study component test before they can participate in the experiential component to earn full credit for this Certificate Program.

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American Society of Health-System Pharmacists Research and Education Foundation

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ASHP FOUNDATION CARDIOVASCULAR RISK/DYSLIPIDEMIA TRAINEESHIP

CONTENTS

Traineeship Description and Curriculum ...... Page 3

Application Requirements and Procedures ...... Page 7

Selection Criteria ...... Page 8

Criteria for Experiential

  • Sites and Preceptors ...... Page 9

Administration of the Traineeship ...... Page10

Appendix A ...... Page 11

  • Sample Description of the Role of a Pharmacist

Providing a Dyslipidemia and Cardiovascular

Risk Reduction Service

1

Traineeship Description

Overview of the Traineeship

The Cardiovascular Risk/Dyslipidemia Traineeship is designed for pharmacists in acute and ambulatory settings who are providing or wish to provide these specialized services. The traineeship prepares participants (who have little experience in providing pharmaceutical care to patients with dyslipidemia or who otherwise would benefit from cardiovascular risk reduction) to design patient-specific pharmacotherapy; solve drug therapy problems; and develop protocols, policies, and procedures for the treatment of such patients.

The curriculum, consisting of a self-study program and a 5-day experiential program, provides intensive didactic and clinical training for selected pharmacists. The self-study program offers 10 continuing education hours (1.0 CEUs) via the modules provided by the ASHP Foundation. This is a prerequisite for attending the experiential program. The experiential program offers 35 continuing education hours (3.5 CEUs) and allows participants to observe and participate in the pharmaceutical care of patients at a health system with an established dyslipidemia and cardiovascular risk reduction service. A certificate will be given to participants who successfully complete all parts of the program.

Educational Goals

Self-Study Program

After being selected to participate in the self-study program of the traineeship (see Selection Criteria for an explanation of the selection process), participants will receive a copy of the ASHP FoundationDyslipidemia and Cardiovascular Risk Reduction Training Self-Study Program which will provide the problem-solving skills required for clinical practice in this area. It concentrates on acquiring knowledge about the disease states and conditions most likely to be encountered and the medications used in their management.

It is presumed that participants will already have a solid foundation in the following areas as they relate to the care of patients at risk for a cardiovascular event:

  • pathophysiology
  • clinical pharmacology and therapeutics
  • clinical laboratory data interpretation
  • clinical pharmacokinetics
  • medical terminology and abbreviations

The purpose of the self study element of this traineeship is that the trainee comes to the experiential stage with the sound background knowledge required in the specialized areas necessary to become an effective member of a team managing patientswho are at risk for a cardiovascular event. It therefore concentrates on acquiring knowledge about the disease states most likely to be encountered and the medications used in their management in order to be able to:

  • Design, recommend, monitor, and evaluate patient-specific therapeutic regimens that incorporate the principles of evidence-based medicine (the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients with dyslipidemia), and specifically to:
  • Build the information base needed to design a medication therapy regimen for a patient with dyslipidemia by collecting, organizing and generating patient-specific problem lists using all information needed by the pharmacist to prevent, detect, and resolve medication-related problems and to make appropriate medication therapy recommendations. Specifically this will require the ability to:
  • Explain signs and symptoms, epidemiology, risk factors, pathogenesis, natural history of disease, pathophysiology, clinical course, etiology, and treatment of dyslipidemia.
  • Explain the meaning of results of diagnostic and laboratory tests, physiologic monitoring and physical assessment commonly performed in this setting.
  • Explain the mechanism of action, pharmacokinetics, pharmacodynamics, pharmacoeconomics, usual regimen (dose, schedule, route, and method of administration), indications, contraindications, interactions, adverse reactions, and therapeutics of medications used in the environment of a dyslipidemia and cardiovascular risk reduction service.
  • Redesign therapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data. In order to do this the trainee should to be able to accurately assess the patient’s progress toward their therapeutic goals and be able to:
  • Accurately interpret the meaning of each test parameter measurement.
  • Explain factors that may contribute to the unreliability of monitoring results (e.g., patient-specific factors, timing of monitoring tests, equipment errors, outpatient versus inpatient monitoring.)
  • Explain the need to consider multiple organ system function when interpretinga group of individual test parameter measurements.
  • Explain the importance of the analysis of trends over time in monitoring test parameter measurements.
  • Build the information base needed to design a medication therapy regimen and therapeutic management plan for a patient with dyslipidemia.
  • Redesign therapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data giving consideration to secondary treatment options.

The self-study program includes study questions and a continuing education test. In order to advance to the experiential program and obtain continuing education credits, participants must pass the continuing education test with a 70% score.

Experiential Program

During the 5-day experiential program, participants observe experienced clinicians and design, monitor, and evaluate patient-specific pharmacotherapy for patients with dyslipidemia and/or requiring cardiovascular risk reduction management. The program focuses on critical thinking, decision-making, and communication skills. At the completion of the experiential program, participants should be able to:

Foundation skills

  • Use an organized system for staying current with the dyslipidemia and cardiovascular risk reduction literature
  • Communicate clearly when speaking or writing
  • Function effectively as a member of a cardiovascular risk service
  • Solve practice problems effectively
  • Display a caring attitude toward patients with dyslipidemia in all aspects of job responsibilities
  • Deliver effective education and training programs , that may include in-services, to health care providers or patients

Patient Care

  • Establish a collaborative working relationship with physicians and other health care providers working with patients with dyslipidemia and/or requiring cardiovascular risk reduction management.
  • Design, recommend, monitor, and evaluate patient-specific therapeutic regimens that incorporate the principles of evidence-based medicine (the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients). (When provided as part of the practice of direct patient care, this goal always involves a series of integrated, interrelated steps. To facilitate teaching and assessment, the eight steps relevant to patients requiring treatment for dyslipidemia are detailed below as separate, but related sub-goal areas.)
  • Build the information base needed to design a medication therapy regimen for a patient with dyslipidemia.
  • Design therapeutic regimens that incorporate the principles of evidence-based medicine, patient-specific data and ethics.
  • Design monitoring plans for therapeutic regimens.
  • Recommend or communicate therapeutic regimens and corresponding monitoring plans.
  • Implement the therapeutic regimen and/or corresponding monitoring plan for patients with dyslipidemia
  • Redesign therapeutic regimens and corresponding monitoring plans based on evaluation of monitoring data giving consideration to secondary treatment options.
  • Collect and evaluate outcome data on patients.
  • Use processes that help to ensure continuity of direct patient care across health care delivery settings.
  • Understand the components of disease management: identification of need for, and development, implementation and assessment of, treatment guidelines/protocols related to individual and population-based patient care with the potential of incorporating into the department/institution’s overall CQI plan.
  • Understand approaches to designing a process to prevent medication misadventures and to identify, assess, and manage those that occur.
  • Understand the role of the pharmacist in the management of medical emergencies.

Practice Management

  • Understand the development or modification of policies involving the use of medications in a health system.
  • Contribute to the development of a new pharmacy service or to the enhancement of an existing service.

Post-Experiential Requirements

On completion of the experiential section of the traineeship, trainees will be required to provide to ASHP Foundation the following documentation before a certificate will be issued:

  • A copy of the proposed policies and procedures that they have submitted to their health system as part of their proposal to institute a new or enhance an existing dyslipidemia/cardiovascular risk reduction service.
  • A report demonstrating that the trainee has become actively involved in dyslipidemia/cardiovascular risk reduction management their health-system site.
  • An outline of a presentation about the role of a pharmacist providing dyslipidemia and cardiovascular risk reduction service that they have made to associated healthcare providers

Qualifications of Applicant

To qualify for application to the traineeship, the applicant must be a licensed pharmacist in any state in the U.S. and be a graduate of an ACPE-accredited college or school of pharmacy. The applicant must have completed an ASHP-accredited residency or have two years experience in clinical practice.

Applicants must have a command of basic knowledge areas as they relate to patients with dyslipidemia including pathophysiology, clinical pharmacology and therapeutics, clinical laboratory data interpretation, clinical pharmacokinetics, and medical terminology and abbreviations. In addition, applicants should have experience with writing pharmaceutical care plans, conducting patient interviews, and delivering educational programs to other members of the health care team.

Upon completion of the program, the applicant will be responsible for personally providing pharmaceutical services to patients with dyslipidemia and requiring cardiovascular risk reduction management.

Qualifications of the Applicant's Health System

The applicant's employer must be a health-care system in the U.S. with resources for the provision of services for patientsat risk for a cardiovascular event. The chief executive officer of the system and physician who is responsible for the cardiovascular risk services must confirm, in writing, their commitment to the involvement of the pharmacist and/or establishment of a formal pharmaceutical service for patientsat risk for a cardiovascular event.

Application Procedures

To apply to the traineeship, the applicant must submit five copies of the completed application form plus the following items (the original plus four photocopies):

  • Applicant’s curriculum vitae, including a listing of publication citations.
  • A letter from the chief executive officer of the organization confirming a commitment to the involvement of the pharmacist and/or establishment of a formal pharmaceutical service for patients at risk for a cardiovascular event(in which the pharmacist routinely provides pharmaceutical care for patients with dyslipidemia), including the expected implementation date.
  • A letter from the physician responsible for the management of patients at risk for a cardiovascular event supporting a pharmaceutical service and/or involvement of the pharmacist on the patient care team.

Selection Criteria

All applications will be reviewed by a panel appointed by the ASHP Foundation Board of Directors. The panel will review the applicant's materials and score them according to the following application criteria:

PointsCriteria

15Academic preparation (degree, residency, certificate programs)

20Clinical practice and ambulatory care experience (general clinical experience as described qualification of applicant section)

20Training expectations (expectations of the applicant and proposed duties of pharmacist after training)

20Institutional viability for service (involvement of pharmacist in care team)

25Support of administration and physician(s) (support for pharmacist to attend training and commitment of institution to start or enhance service)

100Total

Applicants receiving the highest scores will be selected as participants in the self-study program. Those selected to participate in the self-study program must pass the continuing education test in order to advance to the experiential program.

Criteria for Training Sites and Preceptors

Qualifications of the Training Site

The health system selected as a site for the experiential portions of the traineeship must have a pharmacy service providing care for patientsat risk for a cardiovascular event. The site should have a pharmacist or pharmacists who routinely provide pharmaceutical care for patients with dyslipidemia in either an ambulatory clinic or service connected to a health-system. The administration(s) of the participating institution(s) will provide adequate time to pharmacists and other practitioners to conduct the Dyslipidemia and Cardiovascular Risk Reduction Traineeship Program. Additionally, the availability of space for lectures, seminars, conferences, and hands-on clinical experiences should be adequately provided.

The proposed training site must be accredited by the JCAHO or other appropriate organization, when applicable. The institution's department of pharmacy should meet the ASHP Minimum Standards for Pharmacies in Hospitals or other appropriate standards.

In addition, a site must be able to provide 5 days of continuous experiential training, with at least 4 hours per day of direct patient contact (in any combination of time blocks) with patients with dyslipidemia or requiring cardiovascular risk reduction management. In cases where the primary training site can not provide at least 4 hours per day of direct patient contact, other affiliated clinics or services within the training site city can be used to augment the training experience. In cases where the training site city has relationships affiliated clinics and other services that service patients at risk for a cardiovascular event or dyslipidemia, the primary training site is encouraged to partner with these sites to provide the trainee with diverse experiences.

The site must submit a letter from the administrator and physician (on whose service the experiential portion of the traineeship will take place) stating that the health system supports the traineeship program.

Qualifications of the Preceptor

The primary preceptor for the traineeship must be a pharmacist who routinely provides pharmaceutical care for patients with dyslipidemia. He or she must submit a letter from a physician specializing in critical care indicating that the preceptor participates in the design, recommendation, monitoring, and evaluation of patient-specific pharmacotherapy for patients with dyslipidemia and provides medication-use education to patients and their caregivers where appropriate.

All preceptors for the traineeship must be currently involved in practice-based teaching of pharmacy students or other health care professionals. It is desirable for preceptors to have demonstrated the impact of their practice on outcomes or to have participated in scholarly achievement.

Administration of the Traineeship

The Cardiovascular Risk/Dyslipidemia Traineeship Program is administered by the ASHP Research and Education Foundation, 7272 Wisconsin Avenue, Bethesda, Maryland20814, and funded through an educational grant from AstraZeneca Pharmaceuticals. Other administrative policies applying to this ASHP Foundation traineeship include the following:

  • The traineeship is awarded to an individual participant.
  • No stipend or honorarium is awarded to the participant.
  • The participant is responsible for providing his or her transportation to the experiential site. The receptor will be responsible for providing a list of recommend living accommodations for the participant.
  • The ASHP Foundation will reimburse the participant for food (up to a daily total of $40).
  • If the participant must cancel his or her participation, he or she must notify the ASHP Foundation and preceptor at least four weeks in advance of the starting date of the experiential portion of the program.
  • The participant may be required to sign a liability statement and/or submit proof of liability insurance as appropriate to the assigned experiential training site.
  • The participant will be required to attend all sessions of the program and complete the post-training requirements and program evaluation form.

Appendix A

The Role of a Pharmacist in Dyslipidemia and CardiovascularRisk Reduction Services1

The impact of cardiovascular disease has on this country’s health is well known. In order to have a greater impact on reducing the number of cardiovascular events, it is desirable to reduce cardiac risk factors prior to the initial clinical event. Considering the American Heart Association (AHA) and National Cholesterol Education Program ((NCEP) guidelines promoted in recent years, several institutions have established intervention clinics and programs aimed at preventing these cardiovascular events.2 Many of these services are provided by pharmacists.

The pharmacist is in a unique position to offer testing and counseling to the patient, as well as to provide therapeutic feedback to the physician.2 A pharmacist providing assistance in managing dyslipidemia should be viewed as a physician “extender” rather than as a substitute care provider. The pharmacist’s expertise is in individualizing drug therapy and managing outcomes of drug therapy. Management includes the effective, safe use of drugs, monitoring for potential adverse drug reactions and patient education.

Depending on the practice environment, this pharmacist role can be accomplished in many ways. Many pharmacists choose to be consultants, evaluating patients as requested by the primary provider. Other pharmacists have created an environment where they will schedule and see patients “in-between” physician visits, thus decreasing the number of times the primary provider must see the patient. Once the diagnosis of dyslipidemia is made, the physician will refer the management to the pharmacist who then provides education, follow-up and manipulation of drug therapy. The physician maintains his or her regular schedule of patient visits.