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TORONTO GENERAL HOSPITAL/ ST. MICHAEL'S HOSPITAL  DEPARTMENTS OF PHARMACY SERVICES

 HIV SPECIALTY RESIDENCY PROGRAM

HIV AMBULATORY CARE ROTATION

Site:

    HIV Clinic-4C (4th Floor)

    St. Michael's Hospital, Bond Street Site

    Patient load - approximately 200 active patients

    Medical staff - Dr. I.W. Fong (HIV/ID Specialist), medical residents on rotation; Dr. L. Bassarath (HIV Psychiatrist)

    Team members - nurses, pharmacist, dietitian, social worker, chaplain

    HIV Clinic hours - Monday (1300-1630h), Wednesday (0900-1200h), Friday (1300-1630h)

    Hemophilia Clinic hours - Tuesday (1000-1300h)

Rotation Duration:

     4 weeks

Preceptor:

    Tom Chin, PharmD

    Clinical Pharmacy Specialist

    Inner City Health Program

    Tel: 864-5702       Fax: 864-6058       Pager: 334-0117

    E-mail: chint@smh.toronto.on.ca

Goals:

    1. To develop the knowledge base in HIV pharmacotherapy, and to acquire the skills in identifying, resolving and preventing drug-related problems in HIV-infected patients who attend the Clinic.

    2. To develop an understanding of the special needs of HIV-infected patients who are on palliative care.

    3. To develop an understanding of the special needs of hemophiliac patients who are HIV-infected.

Objectives:

    1. Acquire knowledge of the pathophysiology of HIV-infection and relevant opportunistic infections.

    2. Acquire knowledge of the principles of management of HIV infection, and the clinical pharmacology of the antiretroviral agents used in treating the infection.

    3. Acquire knowledge of the principles of preventive or suppressive therapy for opportunistic infections, and the clinical pharmacology of the therapeutic agents used.

    4. Acquire knowledge of the management of non-infectious complications encountered in HIV-infected patients.

    5. Palliative care - to be developed

    6. Hemophiliac patients - to be developed

Terminal Competencies:

    1. Discuss the principles and current approaches in the pharmacotherapy of HIV infection with respect to:

      a) pathogenesis, epidemiology, risk factors, clinical and laboratory presentation,

      b) factors to consider when to initiate therapy, what regimen to initiate, when and what regimen to switch,

      c) clinical pharmacology of marketed and non-marketed antiretroviral agents,

      d) pharmacologic factors to consider in selecting a therapeutic regimen,

      e) patient factors to consider in selecting a therapeutic regimen,

      f) pertinent therapeutic endpoints and monitoring parameters for efficacy and toxicity.

    2. For a given patient, discuss and justify the selection of an antiretroviral regimen with respect to efficacy, toxicity, dosing, convenience, interaction, availability and cost.

    3. Explain the criteria for use of preventive or suppressive therapy for opportunistic infections in  HIV patients, and discuss the selection of the therapeutic agent based on efficacy, toxicity, dosing, convenience, interaction, availability and cost.

    4. For a given patient, recommend and justify the pharmacologic and/or non-pharmacologic agents that may be used to manage non-infectious complications.

    5. For a given patient, identify actual or potential drug-related problem(s), and develop and justify a care plan to resolve or prevent the drug-related problem(s) in a timely manner.

    6. Using the appropriate level of language, explain to the patient about  his/her medications with respect to purpose, side effects, dosage, administration and schedule, and provide the tools as necessary to aid patients in medication adherence.

    7. Provide follow-up care as needed to assist patients in preventing or resolving drug-related problems, either by telephone or arranged appointment.

    8. Provide appropriate, timely and concise response to drug information questions arising from patients in the appropriate language.

    9. Using effective drug information skills (identification of issue, systematic use of  appropriate search techniques, critical review of the literature, synthesis of relevant information, communication of information), provide appropriate, logical, concise and timely response to drug information questions arising from health care team members.

    10. Using effective presentation techniques, provide formal and/or informal presentations to the health care team and/or pharmacy staff on HIV-related topics.

    11. Attend all team meetings and participate in discussion of patient care issues.

    12. Function as a mature, responsible and professional member of the health care team with respect to punctuality, motivation, self-directed learning, dedication and compassionate in providing  patient care, and respect of patient confidentiality.

    13.  Palliative care - to be developed

    14.  Hemophiliac patients - to be developed resident\hivrotat