This direct patient care rotation in Community Services is out of the Health Unit, which is adjacent to the parking lot of NRGH. We will see Community Health Services (CHS) clients as well as Geriatric Specialty Services (GSS) clients (geriatric medicine & geriatric-psychiatry) throughout the rotation, meeting them in their home which is truly a unique experience. These patients are generally medically complex and frail and often have had multiple admissions to the hospital. This is a collaborative service, working with our acute care colleagues if needed, as well as working with the various clinicians in CHS & GSS, including our clinic physicians, geriatrician and geriatric psychiatrist.

Clients are referred to the pharmacist for a comprehensive assessment and management of drug related issues. Each clinician is involved with clients in whom s/he has received a referral for. Interactions with clients are achieved through clinic visits, home visits and phone visits. Please note that access to a vehicle/transportation for home visits may be required during rotation.

This rotation provides the pharmacy resident with training and experience in the various aspects of geriatric pharmacotherapy and chronic disease management. This may include, but is not limited to: Interviewing client (and family) and conducting some basic physical assessment, Educating clients/family regarding their medication regimen, Optimization or simplification of medication regimen (management of polypharmacy), Developing and implementing care and monitoring plans – which may involve other clinicians (dietician, OT, PT, SW, RN/LPN, RT, etc), Documenting all client interactions and medication recommendations in consult & progress notes, Referring client on to other CHS clinicians if needed, Liaising with GP, NP, or specialists as needed.

Conditions we are often involved with include fall risk reduction, Parkinson’s disease, diabetes, COPD, CHF, pain, behavioural and psychological symptoms of dementia and other chronic diseases. A minority of our clients are younger and may have mental health substance misuse disorders. The remainder of the time is comprised of working on assigned projects and/or presentations and participating in scheduled therapeutic discussions. The resident is provided with informal feedback on a daily basis and is formally evaluated at the rotation midpoint and at the end of rotation.