Learning Experiences

Established in 2015, our primary care pharmacy team has significantly expanded to provide comprehensive medication management through collaborative practice agreements. Our pharmacists autonomously manage a variety of chronic conditions, including:

• Heart Failure
• Type 2 Diabetes
• Hypertension
• Hyperlipidemia
• Asthma
• COPD
• Tobacco Cessation

In addition to chronic disease management, our services include polypharmacy and deprescribing, comprehensive medication reviews, and bariatric perioperative management of type 2 diabetes and hypertension. Our team maintains a schedule fill rate exceeding 90% and can conduct up to 12 patient visits daily through in-person, video, and telephone consultations.

One of the most rewarding aspects of the service is the accessibility it offers. Visits are not billed to insurance, allowing pharmacists to provide care to a diverse population, encompassing a wide range of ages, backgrounds, comorbidities, and socioeconomic statuses.

Our pharmacists play a key role in an interdisciplinary team consisting of physicians, advanced practitioners, nurses, diabetic educators, and registered dieticians. Pharmacists are embedded at larger clinic sites such as Madison East, Madison West, Madison South, Sun Prairie, Baraboo, and Janesville. Additionally, they provide remote support to smaller, more rural clinics, ensuring comprehensive care across the region.

For nearly three decades, the Anticoagulation Clinic has been at the forefront of managing the anticoagulation needs of Dean Medical Group patients. During this time, this department has adapted to significant changes in the anticoagulation landscape, earning recognition as an Anticoagulation Center of Excellence. Our dedicated team of clinical pharmacists and nurses operates under three distinct collaborative practice agreements to manage warfarin, direct oral anticoagulants (DOACs), and develop perioperative plans.

To ensure continuity of care, each clinician manages a specific patient group (POD), allowing them to build strong, ongoing relationships with their patients. Our clinic currently oversees approximately 2,600 warfarin patients and 3,500 DOAC patients, in addition to creating 200 perioperative plans each month. We collaborate closely with primary care providers, cardiologists, and surgeons to deliver high-quality care.

Given the expansive reach of Dean Medical Group, which includes over 60 clinics across south-central Wisconsin, our anticoagulation clinic operates entirely remotely. We utilize telephone and MyChart encounters to maintain effective and efficient operations, with each clinician managing 20-30 anticoagulation visits daily. This approach ensures that we can provide comprehensive care while leveraging technology to meet the needs of our diverse patient population.

The infectious disease rotation is a traditional block learning experience. The pharmacist is embedded within the infectious disease clinic at SSM South. The team also remotely serves outlying clinics in Columbus, Beaver Dam, Baraboo, Janesville, and Waupun. Pharmacists have their own patient schedule and conduct visits in-person, via video or phone call. Pharmacists are key members of an interdisciplinary healthcare team alongside physicians, advanced practitioners, and nurses. Their primary responsibilities include; serving as a medication resource for the healthcare team, collaborating with other healthcare providers to manage chronic conditions, and engaging in patient care through in-person, video, and telephone encounters.

The most common disease states managed include:

• HIV
• Hepatitis C
• Hepatitis B
• HIV Pre-Exposure Prophylaxis
• Sexually Transmitted Infections
• Outpatient Parenteral Antimicrobial Therapy

SSM Health Dean Outpatient Infusion/Oncology consists of the main infusion clinic at the Madison South clinic, and 6 satellite clinics throughout south central Wisconsin. The Madison South Infusion/Oncology pharmacy is staffed by three full-time pharmacists who collaborate with two offsite pharmacists to verify and check sterile products across all seven sterile product pharmacies.

The main clinic in Madison features 12 infusion and 20 oncology patient treatment bays, as well as 7 shared private treatment rooms. More than 20 oncology providers rotate through the South Clinic, and specialty infusion medication orders are received from numerous providers across over 10 departments within the Dean clinic system.

Infusion/oncology pharmacists are responsible for ensuring the safe and effective use of medications for all patients receiving treatment at SSM Health Dean infusion clinics. Their routine responsibilities include:

• Verifying Epic orders
• Visually checking compounded sterile products
• Reviewing new infusion and oncology medication regimens
• Processing oral chemotherapy prescriptions
• Managing post-bone marrow transplant vaccine patients
• Answering drug information questions
• Additionally, they may assist with biosimilar conversion, managing medication shortages, educating staff on new drugs, and addressing other topics as they arise. This comprehensive role supports the safe and effective delivery of care to a diverse patient population.

The Heart Failure rotation is a specialty rotational experience. The Heart Failure Clinic is embedded within the Cardiology department at Dean St. Mary’s Outpatient Center (DSMOC). The clinic providers are advanced practice nurse practitioners (APNPs), who focus on heart failure management and palliative care. The clinic is supported by a group of nurses and medical assistants, who perform triage, provide inpatient heart failure education prior to discharge, and outreach patients for follow-up. The pharmacist serves as a medication resource for the healthcare team, collaborates with other healthcare providers in caring for patients, and engages in direct patient care through in-person, video, and telephone visits. The pharmacist’s primary focus is to help initiate and optimize doses of guideline-directed medical therapy (GDMT) for heart failure patients.

The Population Health rotation is an 8-week remote learning experience. The Population Health Pharmacy Team is comprised of four clinical pharmacists split between Oklahoma, Missouri, Illinois, and Wisconsin, as well as four system pharmacy technician coordinators. The Wisconsin-region Population Health Pharmacy Team provides care to patients of SSM primary care providers across Wisconsin. The Population Health Pharmacy Team’s main focus is on Centers for Medicare and Medicaid Services (CMS) Medication-related Quality Measures.

During this rotation, the PGY-2 Ambulatory Care Pharmacy Resident collaborates with the System Director of Ambulatory Clinical Pharmacy Services, gaining exposure to the strategic, clinical, operational, and financial aspects of ambulatory pharmacy management. The rotation emphasizes leadership development, quality improvement, and practice advancement within a large health system. The resident will develop an understanding of the importance of forming relationships and trust with key stakeholders, integrating new technologies to improve services, and prioritizing services to meet organizational and patient care needs.

Resident experiences include:

• Assisting with the development or revision of protocols and policies
• Active involvement in a state, regional, or national professional organization
• Participation in systemwide pharmacy committees
• Leading initiatives to advance ambulatory pharmacy practice and services
• Delivering a professional development session for PGY1 residents and/or preceptors
• Opportunities to precept APPE students and teach at a local school of pharmacy
• Engaging in population health activities and quality improvement projects

The research project will be completed over the duration of the residency year and will include a project proposal, IRB review, data collection, analysis, and completion of a manuscript suitable for publication.

The resident will present their research project at a national conference (ACCP or Midyear), Wisconsin Pharmacy Residency Conference (WPRC), and SSM Pharmacy Residency Conference.