Taught Autumn Quarters
Credit Hours: 4 (quarter)

Course Description
This is a class designed to allow students to experience how a pharmacist in a continuity setting would gather information and counsel patients in a variety of areas, as listed in the course syllabus. Information is provided using specific examples of specific products with emphasis is heavy in application to practice. Information on different OTC products, parapharmaceuticals, ancillary products, disease management issues, and breastfeeding issues are topics not covered in other courses. Recommendations of how products should be used or how disease management/healthcare management issues should be taught by pharmacists are also emphasized. Finally, specific recommendations of when medical care should be solicited are also discussed.

Method in Which Service-Learning Course Requirements Are Met:
1. Needed Service: Students will work in groups of 2 – 6 and select 2 to 3 of the following activities: direct focus groups for elderly where they will provide specific disease/medication information, participate in brown bag sessions where they will provide individualized medication information, flu vaccine clinics providing vaccine and post-care information, preparation/distribution of food boxes through the Food Bank and conduct a nutrition assessment, participate in American Diabetes Association sponsored activities.

2. Service-subject matter relation: Service activities allow students to apply what they have learned during their professional program – medication/disease counseling, how to optimize medication use, information about health care maintenance and prevention, issues related to nutrient-medication interactions, and learn about the organization and dissemination of information to diabetic patients through the American Diabetes Association.

3. Class contemplates learning through service: The students must document service activities on a weekly basis, write two summary reports, and a final reflections paper. The instructor will evaluate the weekly reports and blinded copies of the summary reports and reflections paper will be provided to the Salt Lake County Housing Authority and Aging Services. In addition, three to four reflection sessions (30 to 60 minutes) will be conducted by the sponsoring agencies, the teaching assistant who will have special training by the Bennion Center staff in facilitating these sessions, and the instructor.

4. Credit/Assessment of learning from service: Weekly documentation reports are worth 5%, summary reports are worth 10% (5% each), and the final reflections paper is worth 15%. In addition, the three exams, worth a total of 70% will incorporate concepts involved and experienced during service learning activities, which include how to provide medication and disease management information.

5. Service recipients evaluate service: Sponsoring agencies will be asked to evaluate the service activities and a variety of survey forms are being developed (and may include student involvement in the development of these forms) that will involve focus group and possibly brown bag activity recipients. The reflections sessions will also allow an opportunity for students to receive feedback from the sponsoring agencies since they work directly with the patients and may receive some important critique of the experience.

6. Service develops civic education: The weekly documentation reports include an opportunity for the student to reflect on how the service activity may affect how they practice pharmacy and to rate the experience, in terms of whether the experience provided information on how to interact more effectively with patients in the future. In addition, the summary reports will include a section on how a pharmacist might develop short and long term goals in the area of service activities. The final reflections paper will allow the student to provide final comments on whether the service learning will affect their future practice of pharmacy and to reflect on whether there is a need in the community for pharmacists to provide similar service activities.

7. Knowledge enhances service: The direct patient interactions will provide students with an opportunity to practice "pharmaceutical care,' which is defined in the literature as 'the responsible provision of drug therapy in order to achieve certain outcomes which will enhance a patient's quality of life.' This definition actually stresses the service component provided to patients and de-emphasizes direct distribution of medications.

8. Learning from other class members: Since students are required to volunteer in groups of 2 – 6, they may learn from each other through somewhat of a "Montessori" approach, where they may have different skills or attributes in providing information or in "people" skills or even in scientific knowledge base. In addition, the reflections sessions will permit the students to learn from each other in different activities in which they have participated.

Text: Handbook of Nonprescription Drugs

DATE – TOPIC

9/27 INTRODUCTION/ORIENTATION SERVICE LEARNING ORIENTATION
10/2 AMERICAN DIABETES ASSOCIATION ORIENTATION FOOD BANK ORIENTATION PEDICULICIDES/ ANTI-EMETICS
10/4 ANTI-DIARRHEALS/ LAXATIVES
10/9 REFLECTIONS SESSION ANTACIDS
10/11 INTERNAL/EXTERNAL ANALGESICS HEMORRHOIDAL PREPARATIONS
10/16 SKIN STRUCTURE/FUNCTION BACTERIAL/FUNGAL INFECTIONS ACNE
First Weekly Documentation Report Due

10/18 DERMATITIS/PSORIASIS OTICS
10/23 SUNSCREENS
REFLECTIONS SESSION
10/25 TEST
10/30 OPHTHALMICS/ CONTACT LENS PRODUCTS
First Summary Report Due

11/1 COUGH/COLD PRODUCTS
11/6 ASTHMA EDUCATION SOPORIFICS ANALEPTICS

REFLECTIONS SESSION
11/8 DIABETES EDUCATION BY PHARMACISTS
11/13 BREASTFEEDING ISSUES
11/15 DIABETES EDUCATION BY PHARMACISTS
11/20 OSTOMY CARE PRODUCTS
11/22 WOUND CARE PRODUCTS
Second Summary Report Due

11/27 TEST
REFLECTIONS SESSION

11/29 VITAMINS/DIET AIDS FOOD-DRUG INTERACTIONS
12/4 OTC DRUG ABUSE SMOKING CESSATION EDUCATION BY
PHARMACISTS
12/6 DENTAL PRODUCTS DURABLE MEDICAL EQUIPMENT
Reflections Paper Due

This class has been taught primarily as a didactic class for the last several years, but is now being taught with a new dimension – service learning. Since this class is designed to include issues relevant to pharmacists practicing in a community setting (and this may include community hospitals, consultant pharmacists, as well as community retail pharmacies), service learning will help enhance the understanding of the delivery of pharmaceutical care in a community setting. Although students have been introduced to the concept of pharmaceutical care, this class will help clarify issues related to the delivery of this service. Perhaps, one way to think about this concept has been in the following format:

Medicine provides medical care
Nursing provides nursing care
Dentistry provides dental care
What does pharmacy provide? Drugs?
Pharmaceutical care involves the following:
Responsibly providing information about drug therapy
Helping to achieve certain outcomes (treatment or prevention of diseases)
Enhancing a patient's quality of life

For many patients in the community, including elderly, there are many services that a pharmacist can provide, such as brown bag sessions, disease management focus groups that provide information about specific diseases, such as diabetes, stroke prevention, congestive heart failure, hyperlipidemia, etc., or specialty clinics such as flu clinics.

In past years, PH PR 527 has had rudimentary aspects of service learning, such as the requirement of doing a group presentation on varied topics such as diagnostic kits, the role of the pharmacist in presenting healthcare or therapeutic topics such as treatment of osteoporosis, treatment of hyperlipidemias, or other similar topics. This evolved over the course of time and then also included the requirement of a term paper that discussed an in-depth patient counseling scenario. Preparation time has varied, but has involved a time commitment that included at least 30 hours during a quarter. This year, PH PR 527 will substitute the group presentation and counseling term paper for service learning activities.

Course Objectives:

1. To describe the professional functions of the pharmacist in community settings and develop critical thinking skills for providing pharmaceutical care in community practice.
2. To develop an understanding of OTC medications, parapharmaceuticals, ancillary products, and other healthcare issues involving pharmacists in different settings.
3. To enhance training in patient counseling and compliance by service learning involvement in brown bag sessions, flu clinics, and disease management focus groups.
4. To be able to describe signs and symptoms of conditions that necessitate physician referral.
5. To provide monitoring parameters for efficacy, toxicity, and drug interactions in the community setting.

The course will cover a variety of topics relating to challenges facing pharmacy practice and the expanded role of the pharmacist as a provider of pharmaceutical care.

There will also be guest lecturers in this course in areas designed to expose the student to a variety of timely subjects relating to community practice. These individuals are presenting information for your benefit. At all times, we should treat them with courtesy and respect. The exams will include the information from these lectures.

At the beginning of each week starting October 16 you will be asked to turn in a documentation report of the service learning activities in which you participated during the previous week. A sample form is provided on the next page. These will be included as part of your grade. (These documentation reports will not be returned, so please make a copy). You will also be required to prepare two summary reports of the activities in which you have participated during the course of the quarter. These will be due on October 30 and November 22. A final reflections paper will be due on the last day of class, December 6. In addition, there will be three exams two mid-terms, and a final.

GRADING:
1. Exam I (October 25) 25%
Exam II (November 27) 25%
Final (Week of December 1 1) 20%

2. Service Learning Activities
Weekly Documentation Reports 5%
Summary Reports 10 % (5 % each)
Reflections Paper 15%

WEEKLY DOCUMENTATION REPORT
1. Service learning site:
2. Service learning activity (Brown bag, focus group, clinic, other):
3. Date/time spent in service learning activity:
4. Summary of activity:
5. What did you learn from this experience? (Positive and/or negative issues)
6. Rate the experience: (This experience provided information on how to interact more effectively with patients in the future):
Strongly agree, Agree, Neither agree nor disagree, Disagree, Strongly disagree
7. How will this experience affect how you practice pharmacy?
8. How could the activity have been changed to provide a more optimal experience?

Preparing the Summary Report
As a pharmacist, you may be asked to document your activities to justify your position or for quarterly reports, quality assurance information, and other similar scenarios. Your participation in preparation of summary reports will provide you with an initial experience that should be useful in your professional career.

Summary reports should include a two page, double-spaced, typed report for the instructor and service learning site coordinator. In addition to the text, please include a cover page with your name, the course number/name and the date. Reports are due on October 30 and November 22. One report should include experiences with a focus group experience, and one should include experiences with a brown bag and/or clinic session. Your report should include the following:

1. A brief description of the setting in which you participated (e.g., Salt Lake County Authority High Rise, Valley Fair Housing Complex, assorted clinic sites or other brown bag session sites). Whom does this site serve? How do they accomplish their goals?
2. A brief description of the activity in which you participated. Include the type of activity, number of people who participated and patient demographics if possible.
3. A brief description of the time spent in the service learning activity involved. Include the time involved in preparation, and a description of the type of preparation that may have been done for the activity (reading about diabetes, reading about congestive heart failure, etc.)
4. A brief description of outcomes (patient counseling and education, enhanced compliance, issues regarding target therapeutic outcomes with prescription or OTC medications or alternative medications, appropriate use of medication boxes, recommendation of referral to the patient's physician, or anything else that you may consider an outcome).
5. Summary reports usually contain a final paragraph of new professional goals (from a pharmacist's standpoint) or opportunities to strive for; your last paragraph should contain a similar statement of new goals which would be then be instigated and then evaluated in the next summary report (this might include how you would optimize the service activity which you described in the summary report or a proposal for new service opportunities that might be launched by the present activity; think of this section as a statement of short-term and long-term goals).

Preparing the Reflections Paper
Each student should prepare a report of findings and recommendations in the form of a 4-6 page, double-spaced, typed narrative for the instructor and service program coordinator. In addition to the text, please include a cover page with your name, the course number/name, and the date. The reflections paper will be due on the last day of classes before finals week. Your report should include the following:

1. A brief description of the organizations for which you participated in service learning activities – Whom do they serve? How do they accomplish their goals? How did you fit in? How could (or should) the activities of pharmacy students/pharmacists best be utilized in this setting?
2. A brief critique of the organization – How well do they accomplish their goals? Is the organization adequately able to serve their intended target? What resources are available to attain their goals? Where might the organization turn for additional resources money, volunteers, etc.?
3. What have you learned during this service experience? Has this experience reinforced or changed any of your ideas about volunteerism? What are your current thoughts and reflections regarding volunteering again? Would you volunteer in the same capacity? What are other volunteer activities in which you would consider participating?
4. How do you think that learning outcomes during this experience would have differed from doing a research paper about the types of patients or activities in which you actually participated?
5. From a student's perspective, what was the best part of the experience? What was the most challenging (worst) part? Would you recommend continuation of service learning as a part of this course? What are your thoughts on relating course content and process to community pharmacy practice (hospital as well as retail or other settings)? For future students, how might this experience be optimized or improved? As your instructor, is there a way that I can better facilitate a positive experience? How do you believe this experience has affected your academic experience to date at the College of Pharmacy? Provide some final comments on how service learning activities in which you participated will affect how you practice pharmacy and whether you believe it would be beneficial for community pharmacists to provide similar service activities (e.g., is this the true meaning of pharmaceutical care?)

You must each spend a total of 30 hours during the quarter in a service learning activity; 20 of the hours should be a direct patient contact endeavor. Ten hours could include preparation of newsletters, contacting pharmaceutical representatives from OTC manufacturers to ask for "benign" samples such as lotions, toothpaste, and other health and beauty aids, writing about your experiences, evaluating patient education materials for focus groups, soliciting/obtaining patient medication boxes (7 day/qid dosing) from a pharmacy chain or some place such as InterWest Medical or Robinson's Medical Supply, or other activities related to your service learning endeavor. You will be asked to spend a minimum direct patient contact time of 4 hours in a focus group, 4 hours minimum at a brown bag session, and 2-4 hours at a flu vaccine clinic. The remainder of the patient contact time can come from follow-up education or home visits after focus groups, brown bag sessions, or flu vaccine clinic. There are evolving opportunities and I will inform you of these activities as they arise. The following list includes some of the different service learning opportunities:

Service learning opportunities:
1. Focus groups at a high rise or senior centers (4 hours minimum). These will start on a scheduled basis every Tuesday and Thursday from 2:00 – 4:00 pm starting October 10 until November 30 at the high rise at 1990 S 200 E and at Valley Fair Apartments at 3060 W 3650 S. Contact L Shane-McWhorter after class to sign up. Sign up in groups of 4 – 6.
2. Brown bag sessions – there will be opportunities through Salt Lake County Aging Services and other organizations (4 hours minimum). There are a few set up for October 26, November 7 and November 9. Please contact L Shane-McWhorter after class for a list of other sites where you may want to set up brown bag sessions, especially during National Pharmacy Week, October 22 – 28. Sign up in groups of 4 – 6.
3. Flu vaccine clinics (2 – 4 hours). Please contact L Shane-McWhorter after class. Sign up in groups of 2 – 4.
4. Preparation/distribution of food boxes. Contact Kim Sutherland from Life Care Services. Sign up in groups of 2.
5. Participation in American Diabetes Association activities during November since this is National Diabetes Month. Contact Joyce Nelson. Sign up in groups of 2-4.
6. Participation in ticket activities at the American Diabetes Association Haunted House (This is an optional activity, but may be counted as 4 hours of patient contact time). Please contact L Shane-McWhorter after class. Sign up in groups of 2.
7. Preparation of a newsletter for the Clark Cushing Heritage Center (deadline for this is October 13; however this will involve only a 3-4 paragraph length newsletter on aging issues and medications, stressing how certain health food store products are used in a cavalier way by the elderly and yet may interact with other medications). Contact Carol Dixon from SL County Aging Services.
8. Preparation of a newsletter(s) for the Salt Lake County Housing Authority on general issues related to disease states or medications. Contact Mary Thompson.
9. Preparation of a survey form to evaluate the experience of the patients during the focus groups or brown bag sessions. Contact L Shane-McWhorter.

Description of available service learning activities:
Focus Groups will involve a team of 4-6 students at one of two places, the High Rise Complex at 2100 South and 200 East or at the Valley Fair Complex. During this activity, you will show a film (we have several available; the first film will be one recently produced by the University of Utah called Today's Pharmacist – Caring for People) to a group of elderly patients and then open up the floor for discussion or questions that the participants may have. After this occurs, there will then be an opportunity for you to sit down with the patients (the students may do this on an individual basis) and then fill out wallet cards (we also have these available) for the patients, listing the patient's medications. The wallet cards would be of value if the patient was incapacitated and paramedics wanted to determine what meds the patient is taking. Other activities would be to answer specific questions the patient may have about their medications, and determine the need for a follow-up visit to that patient to deliver and explain specific education materials such as information on asthma, diabetes, COPD, etc. A unique opportunity would be to check with Sherrie Rico and determine whether there are any patients that may benefit from being connected with a drug company indigent program (I have 1-800 phone numbers to assist you in this endeavor). If you choose, you can spend more time with a patient whom you determine may benefit from medication focused home visits, such as helping to optimize times of day for a patient to take certain medications so that it fits in with their lifestyle, making sure that prescription labels match how they are taking their medications and checking with their pharmacist to advise them of a discrepancy that perhaps should be addressed by their physician. You may want to check with me or with Mary Thompson or Sherrie Rico if you have any questions about medication-related activities.

Brown bag sessions will involve talking to patients about medications that they bring and providing patient education information. Usually, these are set up and patients line up for 10 – 15 minute appointments. This also provides another opportunity for a follow-up home visit to provide further information. The sign ups are in groups of 4 – 6. Follow-up home visits should be done in groups of two students.

Flu vaccine clinics will involve talking to patients about information about what they may experience with the flu vaccine, information about the type of strains they are being inoculated against, possible side effects, but most importantly, providing affirmation about the value of flu shots. Sign ups are in groups of 2 – 4.

Food box preparation is another activity that may be arranged through Kim Sutherland at Life Care Services. This involves preparing and/or delivering food boxes to patients and performing a brief nutritional assessment, using a form provided by the agency. This activity enhances awareness of nutrient-drug interactions. Sign ups are in groups of 2.

American Diabetes Association November activities (November is National Diabetes Month) may be arranged through Joyce Nelson. Sign ups are in groups of 2 – 4. The ADA Haunted House will start September 29 and will be open every night except Sundays and Mondays. The location is 3485 S Main Street and will be held from 7:30 to 10:00 pm on week nights and 7:00 to 12:00 pm on weekends. You may sign up for this immediately after class today. Sign ups are in groups of 2.