ZSFG PGY1 pharmacy residency at ambulatory care clinics

PGY1 resident programs build upon Doctor of Pharmacy (PharmD) education and outcomes to develop pharmacy practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives. Residents who successfully complete PGY1 residency programs will be skilled in diverse patient care, practice management, leadership, and education, and be prepared to provide patient care, seek board certification in pharmacotherapy (i.e. BCPS), and pursue advanced education and training opportunities including postgraduate year two (PGY2) residencies.

Zuckerberg San Francisco General and Trauma Center (ZSFG) is offering a one-year PGY1 residency in Ambulatory Care. This is a collaborative program offered jointly by ZSFG and the San Francisco Health Network (SFHN) primary care department. 

ZSFG

• ZSFG is the safety net hospital and the only Level 1 Trauma Center for the vibrant City and County of San Francisco serving 100,000 patients each year.
• ZSFG serves a very diverse patient population and is known for its quality trauma, psychiatric, and HIV care.
• Our physicians are UCSF faculty and residents, and we are a training site for pharmacy residents and student pharmacists from UCSF School of Pharmacy. In this dynamic setting, the Department of Pharmacy Services provides quality patient-centered care with compassion and respect.

SFHN

• SFHN is a division of the San Francisco Department of Public Health that provides ambulatory care primary and specialty services for publicly insured and uninsured patients in San Francisco.
• Primary care serves 60,000 individuals in 12 family and internal medicine clinics throughout San Francisco.
• SFHN includes a variety of specialty clinics such as cardiology, endocrinology, nephrology, dermatology, rheumatology, and women's health. 
• Clinical pharmacists provide specialty services in HIV, pain, cardiology, and anticoagulation. 

Residents will have the opportunity to work with at least 10 ambulatory care clinical pharmacists in collaborative care teams that include providers, nurses, behavioral health clinicians, and nutritionists. 

• The resident will be oriented to the residency program structure.
• The resident will also spend time at the multiple of the San Francisco Department of Public settings to gain knowledge about the system of care.

Primary Preceptor: Anusha McNamara, PharmD, BCACP, Gideon Cayanan, PharmD, BCPS, Hong Vuong, PharmD, MPH, BCPS, and various other preceptors

Service: San Francisco Health Network (SFHN) has 12 primary care clinics with clinical pharmacy services (including our HIV/AIDS clinic, Ward 86) that are:

• Integrated into the team
• Referral based
• Scheduled appointments for adult patients with any chronic condition

Community primary care clinics with pharmacy services:

• Castro Mission Health Center
• Chinatown Public Health Center
• Curry Senior Center
• Maxine Hall Health Center
• Ocean Park Health Center
• Potrero Hill Health Center
• Silver Avenue Family Health Center
• Southeast Family Health Center
• Tom Waddell Urban Health Center

Hospital based primary care clinics with pharmacy services:

• Family Health Center
• Richard Fine People's Clinic

Pharmacist role:

• Interview patients
• Comprehensive medication review
• Identify and resolve all medication related problems
• Provide medication education to the team and patients
• Document patient encounters
• Follow up

Preceptors: Linda Truong, PharmD, BCPS

Service and pharmacist role: Administrative areas important to pharmacy management in ambulatory care

• Formulary management
• Responding to prior authorization requests
• Drug information
• Managed care
• 340B drug pricing within an FQHC

Resident duties:

• Complete a formulary monograph or drug class review AND drug utilization evaluation
• Present report to a committee
• Attend weekly drug shortage meetings
• Attend weekly meetings with 340B pharmacy benefits manager

Preceptors: Niloufar Moreau, PharmD, Christopher Burrell, PharmD

Service: ZSFG anticoagulation clinic clinical pharmacists manage SFHN and SF consortium clinic patients.

• Work closely with primary and specialty care teams
• Referral based
• Scheduled appointments for adult patients on anticoagulation treatments

Pharmacist role:

• Interview patients to assess factors related to INR (adherence, diet, illness, drug interactions)
• Triage patients suspected of thrombosis or bleed
• Identify and resolve anticoagulation related problems
• Manage perioperative LMWH bridging
• Provide medication education to patients
• Drug information
• Registry management of DOACs
• Document patient encounters
• Follow up

Preceptors: Janet Grochowski, PharmD, BCPS, AAHIVP

Service: Ward 86 (HIV/AIDS Clinic) provides integrated primary and specialty care for patients living with HIV and those at risk of HIV.

• Drop in services
• Mental health and substance use support
• Social work and case management
• Specialty services: geriatrics, pulmonology, dermatology, and anal dysplasia

Pharmacist role:

• Work collaboratively with the team for our most vulnerable clients
• Interview patients
• Comprehensive medication review
• Identify and resolve all medication related problems
• Optimize antiretroviral regimen
• Resolve medication access
• Provide medication education to the team and patients
• Document patient encounters
• Follow up

Preceptor: Niloufar Moreau, PharmD

Service: ZSFG cardiology clinic serves patients with cardiac conditions within SFHN and SF consortium clinics.

Pharmacist role:

• Interview patients
• Comprehensive medication review
• Identify and resolve all medication related problems
• Manage post hospitalization visits
• Provide medication education to the team and patients
• Document patient encounters
• Follow up

Preceptors: Michelle Geier, PharmD, BCPP, Reisel Berger, PharmD, BCPP, Hannah Van Ochten, PharmD, BCPP, APh, Yuna Song, PharmD, BCPP, APh, Suzannah Peterson, PharmD

Service: The outpatient mental health clinics include:

• South of Market Mental Health
• Mission Mental Health
• Chinatown/North Beach
• OMI Family Center
• Central City Older Adults
• Southeast Mission Geriatrics

Pharmacist role:

• Psychiatric clinical pharmacists work with the medical teams to provide comprehensive medication management under a collaborative practice agreement.
• The psychiatric clinical pharmacists generally meet with mental health clients for individual appointments. They document in the electronic health record in compliance with requirements from California Medi-Cal medication support services and receive reimbursement for these services as a provider.
• Some pharmacists may lead smoking cessation, clozapine and other groups. 

Preceptor: Damian Peterson, PharmD, BCPS, BCPP

Service: On the Permanent Housing Advanced Clinical Services (PHACS) team, the clinical pharmacist will be rotating through a variety of supportive housing buildings throughout the week for patient outreach in their homes.

Pharmacist role:

• The primary role of the clinical pharmacist is to prescribe buprenorphine under a collaborative practice agreement and provide reduction (e.g., fentanyl testing strips, naloxone, safe injection supplies).
• The clinical pharmacist may assist with management of chronic disease states, acute medical conditions, and address any medication/insurance related questions or issues.
• On Delivery days the clinical pharmacist is responsible for counseling patients on new medication starts, dose adjustments, and triaging any other issues that arise.
• The resident will gain experience through assessing urine drug screens, counseling new buprenorphine starts, furnishing naloxone, furnishing nicotine replacement therapy and assessing client’s appropriateness for ongoing buprenorphine treatment.

Preceptor: Sharon Ashong, PharmD

Service: ZSFG pain management clinic serves patients with chronic pain within SFHN and SF consortium clinics. The team includes anesthesiologists, spine specialists, and consultants in rehabilitation and orthopedics.

Pharmacist role:

• Interview patients
• Comprehensive medication review
• Identify all medication related problems
• Manage complex pain cases
• Provide recommendations to PCPs

Preceptors: Raymond Ho, PharmD, DABAT, Ben Tsutaoka, PharmD, DABAT

Service: California Poison Control System is a 24 hour-a-day informational hotline serving California residents. CPCS San Francisco Division consists of medical toxicology attending physicians, medical toxicology fellows, and pharmacists specialized in clinical toxicology. 

Pharmacist role: The pharmacists provide immediate, free, and expert telephone advice to both the lay public and health professionals regarding treatment and monitoring of exposures to poisonous or toxic substances.

Preceptor: Liseli Mulala, RPh, MPH, PhD, CDCES, BCMTMS

Service: The transitions of care program at ZSFG consists of a pharmacist and learners. Patients are seen in hospital rooms who are to be discharged from the hospital for the following conditions:

• Asthma
• COPD
• Heart failure
• Myocardial infarction
• High alert medications (such as anticoagulants)
• Patients on teams that do not have a clinical pharmacist (neurology, orthopedics)

Pharmacist role:

• Comprehensive medication review
• Provide medication management recommendations to the care team
• Precept IPPE and APPE students including leading topic discussions
• Provide medication education

Preceptor: Hong Vuong, PharmD, MPH, BCPS

Service: SFHN complex care management program works within the primary care medical home. The team consists of a nurse case manager, health coach, social worker, PCP, and consultant clinical pharmacist. It serves patients who are "high-risk, high-cost" through in-home comprehensive assessment, a patient-centered care plan, and coaching toward goals.

Pharmacist role:

• Take part in patient home assessments
• Identify all medication related problem
• Provide recommendations to PCPs

Preceptor: Alexandra Brown, MD

Service: The Tuesday PM (follow up) and Thursday PM (new patient) Neurology clinic represents general neurology care. The clinic sees patients with diverse neurological etiologies (Parkinson's disease, epilepsy, etc.). Patients are scheduled both in-person and telehealth during these afternoons with active neurological issues.  A multiple sclerosis specialty clinic also takes place one half-day per month on a Thursday PM.

Pharmacist role:

Neurology clinic does not currently have a clinical pharmacy practice. This rotation will be an opportunity for residents to insert themselves into the practice by seeing patients already scheduled to see neurologists. 

• Interview patients and comprehensively review medications prior to neurologist appointment
• Co-visits with neurologist
• Identify all medication related problem
• Provide recommendations to neurologist

• This is a 6 week longitudinal learning experience for 1.5 hours of case conference weekly with an additional 2 full day boot camps and 1 day of facilitating an OSCE.
• The learning experience provides the PGY1 residents with various opportunities to establish, demonstrate and improve their teaching skills.
• The learning experience will incorporate the requirements to complete the UCSF Teaching Certificate program.
• The resident will gain experience in facilitating small group conferences, preparing conference cases, writing and grading exams, providing didactic lecturing, and precepting students’ clinical rotations. 
• The teaching experience at UCSF School of Pharmacy (SOP) will specifically focus on small group facilitation skills and larger large-group presentations in the Neuroscience and Psychiatry block or Cardiovascular block 
• The resident will prepare a CE presentation to be given to pharmacists, pharmacy technicians, and pharmacy students.  The resident may additionally give the presentation virtually to CSHP members. 

• This is a 52 week longitudinal learning experience with 2 hours per week through the year.
• The resident will participate in our ZSFG Study Design series and will develop skills in adhering to a research timeline, designing and implementing appropriate study methodologies, conducting data collection and analysis, and summarizing research findings.
• There are a wide variety of study designs that may be featured in the resident’s research project (e.g., prospective or retrospective cohort studies, longitudinal analyses, survey research, qualitative reviews, etc.)

• Residents will be assigned to cover pharmacy operations in the Zuckerberg San Francisco General Outpatient Pharmacy.