Guidelines for the Development of an Individualized Learning Plan for Pharmacists Working in Primary Care Practice
These Guidelines outline important knowledge, skills, and values for pharmacists working in a family practice site. The guidelines are similar to the
standards of practice used by the Ontario College of Pharmacists and the Leslie Dan Faculty of Pharmacy at the University of Toronto but have been
modified to take into consideration the unique needs of family practice.
The Guidelines are based on feedback about common practice and therapeutic issues encountered by pharmacists in a previous pharmacist primary care
intervention study (Seniors Medication Assessment Research Trial – SMART). Designed with SMART physicians and pharmacists input, they reflect
areas that pharmacists could target for improvement as they strive to work collaboratively in family practice with the goal of improving drug-related
outcomes in elderly patients with complex medication regimens.
Goal of guidelines:
 To help pharmacists identify general learning needs and/or specific knowledge/ skills for improvement
How to use these Guidelines:
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
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For each category, assess your learning needs using the scale provided.
Identify a few priority areas to start with using the right-hand column.
Develop an action plan for these learning objectives (with mentor if available). May use OCP learning portfolio as a sample.
Periodically revisit checklist to monitor how well learning needs are being met. This may be done with a mentor’s help.
IMPACT project 2006
Guidelines for Development of an Individualized Learning Plan for Pharmacists Working in Family Practice
Knowledge – Clinical
In order to help pharmacists identify and solve a patient’s drug-related issues, it is helpful to ask the following questions to direct our thinking
(therapeutic thought process):
1.
2.
3.
4.
5.
6.
7.
What are the medical conditions/ signs and symptoms of the patient?
Are the medical conditions/ signs and symptoms under control?
How urgent is the situation?
Is the problem(s) being caused by drug therapy?
Is drug therapy needed for the problem?
What are the alternatives to treat the problem?
What is the best drug for this patient?
*****************
In order to know whether the medical conditions/ signs and symptoms are under control and the urgency of the situation (i.e. the first three questions),
the pharmacist should have an understanding of disease conditions (e.g. pathophysiology, signs and symptoms).
To know if the problem is being caused by drug therapy and/or if drug therapy is required (i.e. the remaining questions), the pharmacist should have
therapeutic and drug knowledge.
IMPACT project 2006
For the following medical conditions, please indicate the number that best represents your current skill level using the following scale:
1
needs complete
review
2
3
needs some
review
4
5
no review
needed
Prioritize your learning needs in the right hand column. This does not have to follow the same scale as above, you can decide on a few particular areas
that are high priorities for your learning needs so that you can get started with your learning plan. Come back to this document often to reassess your
learning plan.
Signs & Symptoms
(incl. interpretation of lab &
diagnostic tests, physical
findings)
Pathophysiology/
Etiology/
Risk factors/
Natural
progression
(complications,
sequelae)
Hypertension
Dyslipidemia
Diabetes
Pain
Constipation
Osteoporosis
CHF
Coronary artery
disease
Sleep disorders
Depression/
anxiety
Falls
GERD/ PUD
BPH/ urinary
incontinence
Osteoarthritis
IMPACT project 2006
Efficacy: Guideline
recommendations/Main
evidence supporting each
drug choice
Side
effects
Drug/
Disease
interactions
Cost/
formulary
coverage
Issues for use in
elderly (incl. precaution,
renal dose adjustment,
dosage forms)
Priority
areas
(pick top
choices to
start
learning
plan)
For each of the knowledge and skill areas below, please indicate the number that best represents your current skill level using the following scale:
1
needs complete
review
2
3
needs some
review
4
5
no review
needed
Prioritize your learning needs in the right hand column.
Skill
level
Priority
Areas
Skill
level
Knowledge – Technical/Procedural
Skills – determining personal learning needs
Locating relevant resources to answer DI question
and identify/ resolve DRPs (e.g. DIRC, Medline,
Micromedex)
Role of pharmacist in family practice site (experience
or shadowing)
Roles of family physicians and other practice staff
Resources/people to refer patient to for additional
non-pharmacological advice
Office procedures, charting system, and medication
management system (addressed during orientation)
Using therapeutic thought process to identify general
learning needs
Skills – Determining patient needs
Comprehensive interviewing (e.g. medication
assessment)
Brief, focused interviewing (e.g. addressing specific
patient issue, disease-specific?)
Interviewing patients with special needs (cognitive,
visual, hearing impairment, ESL)
Basic physical assessment skills (e.g. BP
measurement)
General communication skills – active listening,
verbal/non-verbal, use of empathy
IMPACT project 2006
Use of focused clinical questions to identify patientspecific learning needs
Information retrieval – chart
Information searching and retrieval – literature (e.g.
Medline, Cochrane database, Clinical Evidence)
Information retrieval – team, community pharmacy,
other
Critical appraisal (of articles about therapy, of
guidelines) to determine if results should be used in
patient care (User’s Guide; JAMA series)
Evaluating:
 Study methodology
 Results interpretation (e.g. p value, confidence
interval)
 How to apply results to patients
Skills – identifying and prioritizing drug-related
problems
Using systematic method (e.g. therapeutic thought
process) to identify DRPs
Prioritizing DRPs based on urgency
Priority
Areas
For each of the knowledge and skill areas below, please indicate the number that best represents your current skill level using the following scale:
1
needs complete
review
2
3
needs some
review
4
5
no review
needed
Prioritize your learning needs in the right hand column.
Skill
level
Priority
Areas
Skill
level
Skills – developing therapeutic plans
Skills – Documentation
Eliciting desired endpoints/outcomes from patient
and team perspective
Weighing pros and cons of each therapeutic
alternative
Uses appropriate style of documentation for target
audience
Uses systematic method to present information,
provides support for DRPs identified, and justifies
recommendations
Documents in a clear and concise manner
Determining from MD what s/he expects pharmacist
to do for patient
Develops a plan that is clear, complete, and
individualized for the patient
Documents relevant information that complements
team’s documentation
Skills – implementing therapeutic plans
Skills – meeting practice-based needs
Educating patients about appropriate medication use
Delivering presentations on medication-related topics to
family physicians and practice staff
Responding to drug information requests
Prioritizing workload to ensure that patient, practice,
and study requirements are met
Organizing and coordinating changes to office systems
to improve medication management
Facilitating patient adherence to medications
Use of evidence and patient specific information to
justify recommendations
Discussion of therapeutic plan/ recommendations
with physician
Negotiates with team and patient who will be
responsible for implementing which part of the plan
Skills – Follow-up/monitoring
Use of a monitoring tool to define monitoring
parameters and time-frame for follow-up
Anticipates what changes are needed to plan in case
things do not go as expected
Integrates pharmacy monitoring plan in with team’s
overall monitoring plan
IMPACT project 2006
Priority
Areas
We recommend that you review these values and responsibilities when starting a position in family practice. We suggest that you review/ reflect on
them again after a couple of months as many of the issues may make more sense after being in the practice for a while and experiencing situations firsthand.
As you proceed in your practice, you will likely encounter examples of the values and responsibilities listed. In the columns below, you can write down
a brief description of the scenario as you experience it in practice and any thoughts you may wish to discuss with your mentor.
Values and Responsibilities
Description of example scenario as
encountered in practice
Taking responsibility for a decision and being prepared to deal with a
situation when the plan does not have the intended outcome
Following patient through until all DRPs are resolved (or at least ensuring that
someone else is able to take over responsibility)
Dealing with uncertainty or ambiguity in diagnosis (eg. knowing when and
how to discuss diagnosis with the family doctor
rather than researching it yourself)
Determining when additional research into a problem is not yielding useful
results (knowing when to stop researching and develop a plan for discussion
with the physician)
Ensuring continuity of care/seamless care (b/w FP office, hospital, community
pharmacy, home care, etc)
Encouraging and reinforcing lifestyle choices that decrease risk and enhance
health-related well-being on an individual patient level (health promotion)
Negotiating with patient re: use of herbal products for which weak evidence
to support/may be harmful
Respecting and taking into account both patient’s and FP’s concerns in patient
care activities
Negotiating with FP how much responsibility is acceptable for pharmacist to
have in different family practice activities
Maintaining confidentiality for study purposes, negotiating between patient
and FP (issues around patient confidentiality)
Providing patients with necessary information to enable them to make
informed decisions and take responsibility for their health (patient
empowerment/supporting shared decision-making)
Advocating for patients’ best interests and intervening on their behalf with
FPs
Promoting evidence-based, rational and cost-effective medication use
Next steps: Develop an action/ learning plan to address your learning needs (may use OCP learning portfolio).
IMPACT project 2006
Developed by: Elaine Lau, Barb Farrell, Zubin Austin, Lisa Dolovich,
Lisa Kwok, Shelly House, Lisa McCarthy, Connie Sellors
Reflections/new insights to be
discussed with mentor