Trends in Collaborative Drug Therapy Management

Karen E. Koch, PharmD

Disclosures
In This Article

Abstract and Introduction

Collaborative drug therapy management (CDTM) is practiced throughout the United States and is officially recognized in 25 states and by the federal government (armed forces and Veterans Affairs). CDTM requires the pharmacist to partner with the physician to provide optimal drug therapy management. In the typical CDTM arrangement, the physician delegates management authority to the pharmacist within the terms of a formal agreement. Collaborative management authority can include ordering laboratory tests, assessing patients, initiating and modifying drug therapy, monitoring patients, and administering drugs. This article describes the regulatory and practice status of CDTM, as well as the issues of training, reimbursement, and liability.

Collaborative drug therapy management (CDTM) is practiced whenever pharmacists work with physicians and other health professionals to solve patient- and medication-related problems or make decisions regarding drug prescribing, monitoring, and drug regimen adjustments. These pharmacists provide more than basic dispensing functions and drug information and, as a result, share responsibility with the physician for the patients' outcomes. CDTM is relatively new in some regions and practice settings; however, it has been practiced for decades in other health care areas.[1,2,3,4] It is a hot topic in pharmacy journals[5,6,7,8,9,10,11,12,13,14] because many states are currently reviewing legislation that would enable pharmacists to provide CDTM.

Although CDTM is a term recently coined by pharmacists[15] to describe their collaboration with physicians, other health care professionals, such as nurses and physicians assistants, also collaborate with physicians to provide drug therapy management. A recent Internet search for the term "collaborative prescribing" found more than 1,800 citations, the majority of which were not associated with pharmacists.

What is CDTM, and why is it important to pharmacists? CDTM requires professional partnering between physicians and pharmacists for the express purpose of managing drug therapy and disease states. Activities may include initiating, modifying, and monitoring drug therapy; ordering and performing laboratory tests; assessing patients' responses to therapy; educating and counseling patients; and administering medications.

CDTM is practiced in acute, ambulatory, and home care settings, and its acceptance is growing rapidly. A 1996 national survey[16] of more than 700 hospital pharmacy directors found that 56% of hospital pharmacists participated; only 35% did so in 1994. Because this method allows the pharmacist to have a direct impact on patient care and clinical outcomes, it is the most efficient and effective way to provide pharmaceutical care. The imperative for CDTM is that it provide cost-effective drug therapy management; note that this does not imply work by a less expensive health care provider, but it refers to total cost-effectiveness, which includes good outcomes. The expectation is that CDTM will grow as managed care companies see good outcomes and cost savings.

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