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Ambulatory Clinic – Chronic Disease Management


  • Pharmacy preceptor/Ambulatory clinical pharmacist

  • Pharmacy student (APPE)

  • Diabetes mellitus patient


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Scene 1 – Pharmacy Preceptor and Student Preround/Discuss Patient
  Pharmacist Student
  “Ready for today?”  


“So, today’s patient you are seeing is relatively new.”

“His name is Mr. Smith, a 55-yr-old man.”

“I’ve seen him twice before, the first visit about 4 months ago settling him into the clinic for diabetes management, where he was pretty rough, bad diet, poor adherence, you get the picture.”

“His last visit I titrated up his metformin and recommended that he eliminate soda from his diet and this is his 3-month follow-up to see how much has improved.”

    “What did you do before?”

“Well, his A1c was 7.8%, and I would love to get it lower. So, if you look at the last note, you can see I increased his metformin from 500 mg BID to 1 G BID. I also encouraged him to lose some weight and be more active, but we’ll see if he followed through on that. He seems not as committed as I would like him to be to that.”

“The issue today is to see if his A1c dropped to goal, or if we need to add anything else.”

    “What do you want me to tackle today?”
  “Well, you already did some of the preliminary work, but I want you to see how he’s doing with DM, and if anything else is new. I have a feeling we may need to add another medication, so see how he feels about treatment options, including injectable or oral medications.”  


“I see he checked in, I’ll go see him now!”


“Sounds good, I’ll come with, but you’re in charge today.”

“I’ll help out if something comes up that may be too much.”


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Scene 2 – Student and Patient (Pharmacist shadowing in background)
  Student Patient

“Hello Mr. Smith”

“My name is ______, a pharmacy student who will be helping in your care.”

“My preceptor, Dr. _____ you have seen before, but they would like me to perform today’s visit under their supervision. Is that ok with you?”

    “Sure, that’s no problem.”

“Great! And thank you.”

“To start, do you mind if I ask a few questions?

    “Yeah that’s fine.”


“How are you feeling today?”

    “I’m all right. Only thing that is different that I mentioned to my primary about 2 months ago is that I have been having ...

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