AMBULATORY CARE WITH THE INDIAN HEALTH SERVICE

Author: Emily Stefanelli

INTERESTED IN A UNIQUE, , challenging, and rewarding pharmacy practice experience? Let me tell you about my job. I work for the Indian Health Service, an agency within the Department of Health and Human Services and part of the US Public Health Service (USPHS). The USPHS is one of the Uniformed Services, along with the Army, Navy, Marines, Air Force, and Coast Guard. The Indian Health Service was created in 1955 with a mission to raise the physical, mental, social, and spiritual health status of American Indians and Alaska Natives to the highest level. Assistant Surgeon General Charles W. Grim, DDS, MHSA, is the current director of the Indian Health Service. The agency provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. I work as a pharmacist at a health clinic in Kayenta, Ariz?a town of 6000 residents on the Navajo reservation. The Navajo Nation is the largest Indian reservation in the United States, spanning over 25,000 square miles in Arizona, New Mexico, and Utah. About 17,000 Native Americans receive their care at Kayenta Health Clinic.

Kayenta Health Clinic is an ambulatory care setting with an emergency room. A diabetes management clinic has been established, with plans to implement a hypertension clinic in the near future. The outpatient clinic operates week days from 8 AM to 6 PM, and the emergency room is open 24 hours a day, 7 days a week. The facility?s 5 pharmacists rotate calls to help with after-hours emergency codes. Emergency medications are stocked in an Omnicell cabinet and in crash carts. The pharmacy is fully automated with a ScriptPro system and fills 500 to 800 prescriptions per day.

In the Indian Health Service, pharmacists utilize the entire health record when filling prescriptions. We scan the past medical history and lab results, as well as physician and nursing notes. Access to this information improves continuity of care and enhances our ability to assess medication use. Patient counseling is also very important in the Indian Health Service. Our clinic has 2 private counseling rooms that allow us to sit down with patients individually to discuss medication use and possible side effects. For new prescriptions, we ask the 3 prime questions: (1) What did your doctor tell you about this medication?; (2) How did your doctor tell you to take the medication?; and (3) What did your doctor tell you to expect? We allow the patient to tell us what they know in this manner, and then we fill in the gaps. We are trained to use only open-ended questions in order to facilitate discussion. For refill prescriptions, we ask patients: (1) What are you using this medication to treat?; (2) How do you take this medication?; and (3) What problems are you experiencing with this medication?

As members of the Commissioned Corps, officers are required to meet basic readiness standards to prepare for deployment in the event of a national disaster. Standards include physical fitness, immunizations, basic life support certification, and educational modules on the topic of disaster relief. Thousands of officers were called upon to help after Hurricanes Katrina and Rita pummeled the Gulf Coast. Since joining the Indian Health Service, I have attended Basic Officer Training and Indian Health Service Pharmacy Practice Training. In Basic Officer Training, I learned about the history and significance of the Commissioned Corps, proper uniform wear, and codes of conduct. Indian Health Service Pharmacy Practice Training was a review of pharmacy school condensed into 1 week! We practiced physical assessment techniques and lab interpretation, used role-play scenarios to improve counseling and conflict resolution skills, and learned about tools such as the Basic 7 to gather information in an orderly manner from patients presenting with new complaints.

Aside from the numerous professional opportunities, the Navajo reservation offers countless recreational and cultural attractions. Monument Valley, Lake Powell, Canyon de Chelley, Zion and Bryce National Parks, Colorado ski resorts, the Four Corners Monument, and the Grand Canyon are all within a few hours? drive. In Kayenta, residents and visitors enjoy fabulous hiking on the red rocks surrounding the town. Living here is also a great way to learn about the beliefs and traditions of the Navajo people.

I earned my Doctor of Pharmacy degree from Rutgers, The State University of New Jersey, in May of 2005. The Indian Health Service interested me because I desired a unique practice experience in which I could help an underserved population. I applied during my fifth year and was accepted into a competitive program called the Senior Commissioned Officer Student Training and Extern Program. This was an outstanding opportunity because I received a salary during my last year of school in exchange for 2 years of work with the Indian Health Service after graduation. I visited several sites in order to observe the practice setting firsthand. Kayenta?s clinic appeared small but friendly, nestled against the beautiful red rocks. I was very pleased to have my plans in place prior to the sixth year. More often, pharmacists join the Indian Health Service after graduation. Many take advantage of loan repayment and sign-on bonuses. The Indian Health Service also offers American Society of Health-System Pharmacists-accredited pharmacy practice residencies throughout the country. The Indian Health Service presents a distinctive and rewarding opportunity to pharmacy graduates.

Ms. Stefanelli is a staff pharmacist with the Indian Health Service, USPHS.