Heather P. Whitley, PharmD, BCPS, CDE

Clinical Assistant Professor of Pharmacy Practice
Auburn University Harrison School of Pharmacy

After receiving my Doctor of Pharmacy degree, I completed two ASHP-accredited residencies: pharmacy practice and a specialty in primary care. Both residencies were completed at the Medical University of South Carolina (MUSC), a major academic medical institution that relies heavily on clinical pharmacists. Most patient care services provided were via a multidisciplinary format and usually included a clinical pharmacist. Therefore, upon completion of the second residency I was comfortable functioning as a member of an interdisciplinary team in which pharmacy support was not only encouraged but expected. When I accepted my current position as a clinical assistant professor with Auburn University Harrison School of Pharmacy (HSOP) and entered my new practice site I was confronted with an extremely different set of expectations from those outlined in my previous educational arena. 

Role

Student education

• Train 4th year pharmacy students during their advanced experiential rotation and pharmacy practice residents while on my rotation
• Mentor 4th year pharmacy students through development of their formal seminar and manuscript
• Facilitate Integrated Pharmacology sessions for third year pharmacy students
• Supervise 3rd year medical students during their rural community rotation
• Provide periodic didactic lectures to medical, dental, or optometry students at the University of Alabama at Birmingham (UAB) and medical students and residents at the University of Alabama

Outreach at the rural family medicine clinic

• Provide pharmaceutical care to patients followed at a rural family medicine clinic in Moundville, Alabama. Patients most commonly seen by me for diabetes, hypertension, dyslipidemia, and tobacco cessation.
• Act as a patient advocate for those in need of financial medication assistance
• Aid patients select economical Medicare Part D plans
• Support the physician, nurse practitioner, and nurses with drug information and selection of most appropriate medications for patients
• Provide monthly medication or disease state inservices
• Provide bi-monthly flyers (mini-posters) for the healthcare professionals
  

How They Got There

Although my residencies prepared me well for life as an academician and for providing evidence-based pharmaceutical care, I learned very little about caring for patient populations who reside in rural regions. The family medicine clinic where I practice with one physician and nurse practitioner is located in the rural Black Belt of Alabama. It is adjacent to pasture land where crops and cattle are harvested. The town has one flashing light and an amazing home-style cooking cafe which all residents patron. The average family income varies widely, but many households of 2 live on incomes of less than $20,000 per year. Providing healthcare to patients in this region has opened my eyes to the needs of a rural community.

A previous HSOP faculty member initiated pharmaceutical industry-sponsored medication assistance program services in the clinic approximately one year prior to my attendance. Although clinical services were not provided during this time, the clinicians and patients appreciated the pharmacist’s aid and requested I continue providing medication assistance for patients as the previous pharmacist had done. 

In addition to learning the ropes of pharmaceutical medication assistance programs and Medicare Part D selection, I wanted to prove my competency in providing patient care. When meeting with a patient for medication assistance I would review his or her entire chart for control of various chronic disease states and appropriate medication therapy. When I identified duplicate therapies, contraindications, non-compliance issues, or undertreated disease states I would notify one of the practitioners, provide a recommendation to adjust therapy, and follow-up with the patient to monitor progress. All recommendations for dose titration, therapy initiation or alterations were approved by the physician or nurse practitioner. Both the physician and nurse practitioner began to trust my competency and now routinely refer patients to me specifically for medical management of various chronic disease states. 

I derive tremendous satisfaction from practicing in this rural family medicine clinic. I enjoy serving my patients and fellow clinicians and believe they appreciate my contributions.

Other Professional Activities

Other Outreach:

• Provide periodic disease-state presentations or medication presentations to various community groups including senior citizens and grade schools
• Triage patients at a volunteer-run indigent clinic in Tuscaloosa, AL

Committee:

• Participate on the Alabama Obesity Task Force
• Participate in the pharmacy Residency Advisory Group at DCH Hospital in Tuscaloosa, AL
• Collaborate with the Rural Health Institute for Clinical and Translational Research at The University of Alabama

Coordinator of Inner Change United Methodist Church small groups:

• Developed structure for the initiation and implementation for life and growth groups
• Support approximately 20 small groups that meet weekly.
• Conduct monthly leadership meetings for the leaders of the small groups

Advanced Training

• ASHP-accredited Primary Care Specialty Residency with emphasis in Ambulatory Care. June 2006.
• ASHP-accredited Pharmacy Practice Residency with emphasis in Primary Care. June 2005.

Additional certifications and accreditations:

• Board Certified Pharmacotherapy Specialist. January 2007.
• Certified Diabetes Educator. June 2007.
• Motivational Interviewing Training Institute, Train the Trainer; Auburn University HSOP. July 2007.
• Basic Cardiac Life Support. June 2007.
• Junior Investigators Program; Institute for Rural Health Research, The University of Alabama. May 2007.
• Pharmacy-based Immunization Delivery Certificate Training Program and Faculty Train the Training Certification. March 2007.
• Academician Preparation Program; South Carolina College of Pharmacy. June 2006.
• APhA Pharmaceutical Care for Patients with Diabetes. April 2006.
• Advanced Cardiac Life Support. July 2004.

Advice

1. Take time to follow-up. Call the physician for whom you just prepared a TPA drip to verify that it reached the patient and is having a positive outcome. Swing by the patient’s room to introduce yourself as the pharmacist and ask if you can provide any additionally pharmacy service, such as explaining the need for each medication ordered. Call the patient at home that you discussed diet and exercise with last week after he was newly diagnosed with diabetes. Making the extra effort to follow-up shows the patient and providers that you genuinely care and reminds them of the important roll the pharmacist plays in healthcare.
2. When establishing clinical pharmacy services in areas void of untraditional pharmacy interaction be flexible, respectful, and patient. Your ideas of methods to integrate into the current setting, founded on previous experiences, may not be accepted or may not function well in the new location. Realize that you must adapt to the surroundings rather than expect the surroundings to adapt to you. Respectfully request and recommend ideas to provide pharmaceutical care, while realizing that they may not be accepted immediately. Anticipate the development of pharmacy services to be a slow and gradual process. Continued perseverance to provide excellent pharmaceutical care will eventually be recognized and then supported.