 to other chronic diseases, too.
In the review that follows, we’ll detail the impact that PPCM can have on patient care, health-care utilization, and cost effectiveness. (For a look at PPCM “in action,” see the sidebar below.) We’ll also review the challenges of implementing this model that, at present, is mostly found in academically-affiliated clinics and large health systems.
The physician-pharmacist collaborative care model in actionFor patients with chronic diseases such as hypertension and diabetes, pharmacists can be invaluable members of multidisciplinary health care teams by providing direct consultation to optimize pharmacotherapy. Although their particular role and responsibilities can vary widely from one primary care setting to the next, the following describes the general workflow of a physician-pharmacist collaborative care model in action.
The patient, 60-year-old Isabel B, arrives for an appointment for pharmacotherapy management of her hypertension. After checking in, a registered nurse (RN), medical assistant (MA), or the pharmacist obtains her vital signs, height, and weight prior to rooming. Additionally, any necessary point-of-care lab tests are obtained at this time.
Once the patient is roomed, the pharmacist collects a thorough medication history from Ms. B, verifying and updating her current medication list, confirming the dose and frequency of each medication, and gathering information regarding adverse effects and barriers to adherence. The pharmacist may also review current laboratory results and vital signs to assess the appropriateness and therapeutic efficacy of the current drug therapy regimen.
A. The pharmacist makes a change to Ms. B's medication regimen and orders any necessary laboratory tests for monitoring. A progress note is forwarded to Ms. B's primary care provider (PCP) to inform him/her of the changes made to the regimen and the follow-up interval.
B. The pharmacist presents pharmacotherapy recommendations to the attending physician or Ms. B's PCP. The therapeutic and monitoring plans are discussed and approved as a team at the time of Ms. B's visit.
C. The pharmacist sends a message to Ms. B's PCP regarding information discovered during the interview and provides recommendations for a treatment plan based on the visit. The PCP reviews the recommendations, and can either 1) send approval to the pharmacist through a message or 2) implement the appropriate drug therapy changes at Ms. B's next visit.
In Cases A and B, the pharmacist then reviews the final pharmacotherapy plan with Ms. B, discusses the medication and monitoring parameters, answers any questions related to the new treatment regimen, and schedules a follow-up visit. In Case C, the pharmacist may still provide medication counseling and answer questions related to drug therapy during the visit; however, review of the final pharmacotherapy plan may be done over the telephone after approval by the PCP. Alternatively, a follow-up appointment with Ms. B's PCP can be scheduled shortly after the visit with the pharmacist to discuss any recommended drug therapy changes.The Jewish Community Online
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Jew-hatred we don’t care about
The Baltic states are erasing the memory of the Holocaust - and even prosecuting survivors. Where is our outrage?
With Yom Kippur coming up, I know we are meant to be atoning for our own sins rather than making
accusations against others. But some crimes are too big to ignore.
The crime in question is the Holocaust - or, more precisely, the way we remember it. As the remnant of survivors shrinks, and as that event passes from living memory into history, there is a battle underway for how the Shoah will be recorded for posterity.
We think we know who our enemies are in this struggle. We would cite David Irving, recently allowed onto the airwaves of BBC Radio where he was described as a "controversial historian", even though the High Court has established that he is, in fact, a "pro-Nazi polemicist" (to quote the judge in his 2000 libel trial). We would mention Mahmoud Ahmadinejad, who regularly questions the historical veracity of the Holocaust.
But these are the easy targets. We are turning a blind eye to another, no less serious assault on the truth of the Shoah, an assault mounted by those widely regarded as our friends.
I am speaking of the Baltic states, those that now sit in the European Union as apparently democratic nations. Take Lithuania. It recently decided to take seriously its obligation to chase down those guilty of war crimes committed during the Second World War - by investigating four Holocaust survivors, Jews who had defied the Nazi slaughter to fight as partisans.
You read that right. Four heroes of the Jewish resistance are wanted for questioning by the Lithuanian state prosecutor. Among those investigated is Yitzhak Arad, former head of Yad Vashem. Now 81, he faced prosecution - only dropped in recent days - for his conduct as a 16-year-old. His mistake, it seems, was to have recalled in his memoirs the raid he and his comrades made on the village of Girdenai. That place was a target, according to Dr Arad, because its people, armed by the Nazis, had shot partisans while the latter tried to take food.
Hunting down the victims like this is shocking - but it shouldn't come as too much of a surprise. After all, since independence in 1991, Lithuania has prosecuted only three former collaborators with the Nazis. And that's not because such people are in short supply. On the contrary, the Lithuanians joined the Nazi Jew-killing effort with such glee that they wiped out 95 per cent of the country's Jewish population - 200,000 people - which put them close to the top of the collaboration league table. Of course, German officers led and directed the operation. But it was local Lithuanian volunteers who made the speed and scale of it possible. And they didn't just disappear in 1945.
The pursuit of Dr Arad and his fellow partisans is appalling, but it fits with a Lithuanian effort to play down the horrors of the Nazi era - and to cast themselves as the real victims. Vilnius's Museum of Genocide Victims lingers on the 74,500 Lithuanians who suffered under Moscow's post-war rule, but makes only a brief mention of - and features no exhibit on - the 200,000 murdered Jews. Similarly, while only those three Nazi collaborators have been prosecuted, there have been 24 prosecutions of Soviet-era crimes.
In this, Lithuania is utterly in step with its neighbours. Latvia gained unwanted publicity when it declared a public holiday, "Legionnaires' Day", to celebrate the veterans of the Latvian Legion Waffen SS. In attendance at the 2005 rally in Riga of these old Jew-killers was the head of Latvia's armed forces and the deputy speaker of its parliament. Local Russian-speaking Latvians mounted a counter-demonstration, but they were condemned by the Latvian president for failing to respect the SS men's "right of free speech".
Meanwhile, a bill reached the Estonian parliament last year honouring those who had volunteered for the 20th Waffen Grenadier Division of the SS as "fighters for Estonia's independence" - and ensuring they got a decent pension.
Now, I understand what these Baltic nations are up to. The oppressor they are keen to remember is Stalin and the Soviet Union: that makes them want to airbrush away the Nazi period, recasting Lithuanian SS men as early freedom fighters against Moscow.
But here is what I don't understand. Where is the Jewish outrage on this? Where are the institutions that, rightly, look out for antisemitism in every corner of the Arab press and every nook and cranny of the blogosphere? Why are they - we - not screaming blue murder at the conduct of these nations, now given the full respectability of EU membership?
Could it be that our communal leaders would rather not make waves because these nations of the "New Europe" are pro-America and therefore, usually, pro-Israel? Or is it because we have decided our fight with radical Islamism takes precedence over all other threats, including this kind of naked assault on our past?
I don't know what the answer is. I only know that what is going on is appalling - and our silence shameful.Your Stay With Us
Upon arrival at Recovery Mountain, you will be greeted by your individual peer recovery specialist. They will get you settled into your suite and review our program and schedule with you. Your peer recovery specialist will also provide you a tour of the campus and you can grab a bite to eat in the main dining area. Shortly thereafter, you will meet with your assigned clinician for about an hour or so. Your clinician will conduct a thorough evaluation and design a treatment plan to meet your specific needs. This treatment plan will be updated throughout your stay at Recovery Mountain. Our clinicians are all masters level with over 25 years of experience working with individuals struggling with addiction and dependency.
Our goal at Recovery Mountain is to provide each guest with a program and a lifestyle they can take with them when they go. Our guests participate in education and experiential therapies (activities that involve actions, movements, and activities rather than the more traditional “talk therapy”). These activities can form the foundation for a life free of dependency. Recovery Mountain guests are involved in many experiential activities that take them away from the main campus. Some of the seasonal activities you will participate in while with us are:
- Paddle Boarding & Paddle Board Yoga
- Equine Therapy
- Concerts & Comedy Performances
- Snow Tubing
- Snow skiing and boarding
- Visits to Regional Historic Sites
As you prepare to move on from Recovery Mountain