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Personalized care in rural Wisconsin

When Margaret Pertzborn’s grandmother was diagnosed with cancer for the third time, she lived in a small town in rural Wisconsin that was populated by less than 2,000 people. The nearest hospital to her house was a half hour away. At the time, Pertzborn’s grandmother was 90 years old and suffering from macular degeneration. So Pertzborn and other relatives drove her grandmother the hour-long round trip to appointments at the 36-bed hospital nearest to them. Her grandmother returned to the same rural hospital years later for hospice care. Memories of kindness and care from the hospital staff stuck with Pertzborn.

“The nursing staff, cleaning staff, attendings, and even the cooks in the kitchen knew our family by name. They brought us snacks, magazines, gave us privacy, and treated my grandmother, as well as our grieving family, with the utmost respect,” says Pertzborn. “This experience not only cemented in my heart that I needed a career in healthcare, but that rural healthcare was a place for me.”

The experience inspired Pertzborn, who is now a third-year pharmacy student at the Medical College of Wisconsin (MCW) School of Pharmacy, to apply for a unique clinical experience at Ascension Our Lady of Victory Hospital, a critical access hospital located in Stanley, WI, as part of the school’s experiential education program. The rural health clinical rotation allows students to experience critical access healthcare from the perspective of a care provider.

“This experience led to the students’ understanding of the role of a pharmacist in a critical access hospital,” said Ciara Beckers, coordinator of Experiential Education. “They elected to do this opportunity because they have an interest in underserved populations.” The MCW School of Pharmacy has a focus on preparing students to work in underserved communities, such as in rural communities.

Critical access hospitals serve smaller communities and are usually located in rural settings where access to care is limited. Ascension Our Lady of Victory Hospital, located about 45 minutes from Eau Claire, WI has 12 beds and serves as a place for rural patients to seek care and treatment without having to travel to a larger city. “Our patient population is primarily coming in with chronic conditions,” says Brooke Luedtke, PharmD, the clinical lead pharmacist at Ascension Our Lady of Victory Hospital. “Most have congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or cellulitis.” Critical access hospitals treat a diverse set of patients since they are usually the only provider for multiple communities. “It’s a great way to service the community and allow them to seek care and treatment within their community at a much quicker rate than if they were to have to travel to a larger city,” says Dr. Luedtke.

Many patients are unable to drive to large metro area hospitals due to being home-bound or elderly. They need access to care in their communities. At critical access hospitals such as this one, pharmacists help bridge the gap in rural patient care.

Pharmacists at critical access hospitals are deeply integrated into the care team and provide an expanded scope of healthcare services. “Most of the day, the pharmacist will be out on the hospital floor, at the nurses’ station, in the emergency room with the provider asking questions, and they will be talking with patients,” says William Krombholz, another MCW pharmacy student who has completed the rural hospital rotation.

Krombholz and Pertzborn have participated in a variety of interprofessional education sessions through the MCW School of Pharmacy Doctor of Pharmacy (PharmD) program. The sessions allow them to collaborate with students of other healthcare specialties. These experiences simulate the kind of teamwork that happens between pharmacists and other care providers at a critical access hospital such as Ascension Our Lady of Victory. “Providers are regularly leaning on pharmacists to dose medications, make recommendations, and decide on medications for discharge. We do a lot of consulting during our daily rounds. We’re talking with providers, nursing staff, and social workers to see how we can best care for a patient,” says Dr. Luedke.

The care providers at Ascension Our Lady of Victory also collaborate with physicians outside of the hospital with the use of telemedicine technology to help treat their patients. Every three days, providers wheel a cart with a computer screen to their patients to consult with doctors who are remotely located. Through telemedicine, specialty care doctors who don’t practice nearby are able to collaborate with a patient’s interprofessional care team, including pharmacists.

Pertzborn and Krombholz developed a diverse set of skills and abilities through the PharmD curriculum that prepared them for rotation at a critical access hospital. “At the MCW School of Pharmacy, we’re being prepared to be the pharmacists of the future which means being able to do anything that the field of pharmacy presents to you,” says Pertzborn. Students learn about patient care each week in the longitudinal Patient Care Lab and are taught expanded patient care skills throughout the course including physical assessment, point-of-care testing such as strep throat or flu tests, as well as telemedicine. “Experiential Education rotations allow students to practice and apply these skills in clinical settings that they have acquired in simulated experiences on the Milwaukee campus,” says Sara Revolinski, PharmD, BCPS, Director of Experiential Education and Assistant Professor of Clinical Sciences.

The MCW School of Pharmacy offers the rural health rotation through its Experiential Education program with the support of the Friends of MCW, an organization of volunteers from MCW, affiliated institutions and the community that support the charitable, educational, scientific and community service activities of MCW and its affiliates. The Friends fund room and board for students who travel to Stanley every Friday for ten weeks.

“The students from MCW have been an absolute joy to have on site. They bring great energy, questions and fantastic knowledge with them,” says Dr. Luedtke. “Having students exposed to our healthcare setting gives them the opportunity to explore multiple areas of pharmacy. Critical access is a great option for students who are interested in experiencing a diverse pharmacy practice.”

During Pertzborn’s rotation at Ascension Our Lady of Victory Hospital she has focused on patient interaction and been able to care for patients like her grandmother as Stanley has an aging population with increasing healthcare needs. She has been able to work with these patients and their families one-on-one, providing personalized care. Seeing the difference that healthcare can make near the end of someone’s life is another reason why Pertzborn chose to pursue a career in pharmacy. “I think it means a lot to give people dignity in their last days,” she says.

“This rotation has taught me the most about caring for a person, not just treating a disease.”