Evolution, Current Structure, and Role of a Primary Care Clinical Pharmacy Service in an Integrated Managed Care Organization

Seven key parameters that facilitate clinical pharmacy practice: a comparison between Israel and the United States

Clinical pharmacists have advanced training that enables them to manage medication therapy, including prescribing, titrating, and discontinuing medications, in order to achieve therapeutic goals. In some countries, such as the United States, advances in training, responsibility, legal frameworks, and public acceptance of new roles have proceeded in parallel to expand the scope and contribution of clinical pharmacists over several decades. In this manuscript, we detail seven discrete key parameters of professional advancement for clinical pharmacists, corresponding to the seven areas in which they must advance in order to contribute fully to delivering high-quality medical care. For each key parameter, we briefly summarize the progress made in the United States to date, as well as goals for future progress. We then compare this to the development of the analogous key parameter in Israel. We found that on some key parameters, the development of clinical pharmacy in Israel lags behind the United States. This manuscript can provide a roadmap for the future advancement of clinical pharmacy in Israel, toward its full realization as a profession that can contribute to delivering high-quality medical care.

From Pilot to Scale, the 5 Year Growth of a Primary Care Pharmacist Model

This case report details the five year journey of implementing, growing and optimizing a primary care pharmacist model in the ambulatory clinic setting within a health system. There is published evidence supporting the numerous benefits of including pharmacists in the primary care medical team model. This case report provides information regarding evolution of practice, the pharmacists’ roles, justification and financial models for the pharmacist services, as well as lessons learned and determined conclusions.

Assessment of Pharmacy Department Patient Safety Culture with the Use of Validated Work Environment Survey Indices

CONTEXT

Patient safety culture (PSC) improvement is a strategy that can foster patient well-being. Measuring PSC without using a validated instrument has been proposed.

OBJECTIVE

To assess the strengths of correlations between the Agency for Healthcare Research and Quality's validated Community Pharmacy Survey on Patient Safety Culture (CPSPSC) composites and nonvalidated People Pulse (PP) work environment indices.

DESIGN

This was a cross-sectional, anonymous, voluntary survey.

METHODS

This survey was conducted online in an ambulatory pharmacy department that had approximately 900 staff members within an integrated health care delivery system. All pharmacy department staff were asked to participate. CPSPSC composites and PP indices were calculated as percent-positive scores (PPS). Thirty-six correlations between PP index and CPSPSC composite PPS were assessed with the Pearson product-moment correlation coefficient. Correlation strengths were interpreted as very weak (± 0.00 to 0.19), weak (± 0.20 to 0.39), moderate (± 0.40 to 0.59), strong (± 0.60 to 0.79), and very strong (± 0.80 to 1.0).

RESULTS

A total of 429 (47.4%) pharmacy staff participated. Overall, correlations between CPSPSC composites and PP indices' PPS varied widely. Although all correlations were positive and the majority of correlations were statistically significant, no correlations were identified as very strong. Ten correlations were strong, 16 were moderate, 4 were weak, and 3 were very weak.

CONCLUSION

Although health care system personnel may prefer to measure PSC with a survey instrument that assesses a variety of workplace environment measures, these findings suggest that use of nonvalidated work environment indices will not provide accurate assessment of PSC in a pharmacy department.

Collaborative drug therapy management and comprehensive medication management-2015

The American College of Clinical Pharmacy (ACCP) previously published position statements on collaborative drug therapy management (CDTM) in 1997 and 2003. Since 2003, significant federal and state legislation addressing CDTM has evolved and expanded throughout the United States. CDTM is well suited to facilitate the delivery of comprehensive medication management (CMM) by clinical pharmacists. CMM, defined by ACCP as a core component of the standards of practice for clinical pharmacists, is designed to optimize medication-related outcomes in collaborative practice environments. New models of care delivery emphasize patient-centered, team-based care and increasingly link payment to the achievement of positive economic, clinical, and humanistic outcomes. Hence clinical pharmacists practicing under CDTM agreements or through other privileging processes are well positioned to provide CMM. The economic value of clinical pharmacists in team-based settings is well documented. However, patient access to CMM remains limited due to lack of payer recognition of the value of clinical pharmacists in collaborative care settings and current health care payment policy. Therefore, the clinical pharmacy discipline must continue to establish and expand its use of CDTM agreements and other collaborative privileging mechanisms to provide CMM. Continued growth in the provision of CMM by appropriately qualified clinical pharmacists in collaborative practice settings will enhance recognition of their positive impact on medication-related outcomes.

Defining and advancing ambulatory care pharmacy practice: it is time to lengthen our stride

PURPOSE

This paper reviews the basic tenets of ambulatory care pharmacy practice, including (1) the historical development of patient-centered care provided by pharmacists, (2) the need for and value of comprehensive medication management, (3) the education, training, and qualifications of pharmacists, and (4) demonstrated improvement in health and healthcare outcomes from pharmacists' services.

SUMMARY

When ambulatory care pharmacists engage in patient care to their full capacity, physician time is saved, access to care is improved, and clinical and economic outcomes are enhanced. There is a need for ambulatory care pharmacists to work toward optimizing safe medication use and optimizing medication therapy for patients with diabetes, asthma, cardiovascular disease, and renal disease. Other opportunities for the development of ambulatory care pharmacy services exist in preventive care, precision therapeutics, medication therapy management, mitigation of healthcare disparities, and implementation of national healthcare reform. Interprofessional patient care teams should include ambulatory care pharmacists in patient-centered medical homes and accountable care organizations. Ambulatory care pharmacy practice would benefit by enhancing specialty residency training and by creating a residency/fellowship for advanced subspecialty clinical practice and research. Provider status is essential to recognize pharmacists as an integral part of the patient care team.

CONCLUSION

By assertively advancing ambulatory care practice, pharmacy will help achieve the national priorities of improving patient care, patient health, and affordability of care.

Collaborative Practice Model Between Cardiologists and Clinical Pharmacists for Management of Patients With Cardiovascular Disease in an Outpatient Clinic

The increasing prevalence of cardiovascular disease (CVD) has prompted leading cardiovascular organizations to advocate utilization of a team approach to patient care that includes nonphysician providers. In spite of that, the American College of Cardiology reported that nonphysician providers are underutilized in the management of patients with CVD. A survey of cardiologists revealed that the underutilization is a result of lack of understanding of how best to involve nonphysician providers in the health care team. Clinical pharmacists are one category of nonphysician providers that have recognized effectiveness in managing patients with CVD. No example of a comprehensive model of collaboration between cardiologists and clinical pharmacists is described in the literature that could serve to close this gap in understanding. The objective of this report is to describe a model of cardiologist–clinical pharmacist collaboration in the longitudinal management of patients with CVD that has been successfully implemented in 2 diverse settings. The implementation, evolution, scope of practice, required pharmacist training, logistical elements needed for success, and implementation barriers are reviewed. A summary of the patients referred to the clinic are examined as well.