Collaborative Drug Therapy Management by Pharmacists - 2003

American College of Clinical Pharmacy, Raymond W. Hammond, PharmD, FCCP, Amy H. Schwartz, PharmD, Marla J. Campbell, PharmD, Tami L. Remington, PharmD, Susan Chuck, PharmD, Melissa M. Blair, PharmD, Ann M. Vassey, PharmD, Raylene M. Rospond, PharmD, FCCP, Sheryl J. Herner, PharmD, and C. Edwin Webb, PharmD, MPH

Disclosures

Pharmacotherapy. 2003;23(9) 

In This Article

Review of Progress Since the Last Position Statement

The body of evidence and literature supporting the role of pharmacists in improving patient and health care outcomes has increased steadily since 1997. In the hospital setting, four clinical pharmacy services are associated with lower mortality rates: clinical research, drug information, drug histories on admission, and participation in a cardiopulmonary resuscitation team.[24] Investigators also have shown that medication errors occur in about 5% of patients admitted to hospitals.[25] Institutions that deployed pharmacists in patient care areas reduced the risk of errors that adversely affected patient outcomes by 94% over those that did not. Other researchers have demonstrated that acceptance of pharmacists' recommendations concerning drug therapy reduced the rate of medication errors in an intensive care unit.[26] In outpatient and community environments, pharmacists' drug therapy management services have achieved improved patient outcomes related to dyslipidemia, heart failure, anticoagulation, asthma, diabetes mellitus, and other disease states, as well as improved rates of immunization.[27,28,29,30,31,32,33,34,35,36,37,38] These mounting data further support the benefit of including pharmacists as collaborative members of the health care team.

The previous ACCP position statement described the 1995 Pew Health Professions Commission report that sought to characterize the future of the health professions in the United States.[39] The commission predicted a shift toward a health care system that would emphasize enhanced integration and collaboration among health care professionals, provide a more diverse skill mix, and result in more efficient delivery of health care. To accomplish this paradigm, the commission suggested that health professionals redesign the organization of their workplace, redefine their scopes of practice, "rightsize" their workforce, and restructure their professional education programs.[39]

In 1998, the Pew Commission's fourth and final report in the series recommended further changes in the education and training of health professionals to accommodate future health care system needs.[40] The report suggested that, from its observations, the best integrated health delivery systems used interdisciplinary teams in the delivery of care. The commission therefore recommended that training programs for health professionals incorporate a strong interdisciplinary focus. Advantages of the interdisciplinary team approach noted in the report included more efficient use of resources, avoidance of mistakes and duplication of services, and encouragement of collaboration, consultation, and brainstorming by coordinating the expertise of several health professionals. Specifically for the profession of pharmacy, the Pew Commission advised the pharmacy education community to focus its curricular reform on the changing roles and responsibilities of pharmacists, the evolution of practice settings, development of teamwork skills, and collaboration with other health professionals. In addition, the opportunity for active practitioners to develop clinical skills was encouraged to extend roles beyond dispensing.

A significant driving force behind the ongoing demand for health care reform in the United States is the trillion-dollar price tag for health care as well as the rate of growth of this market. The cost of health care is expected to continue to increase moderately and steadily over the next several years. In a market-driven health care economy, three principal values exist: managing and, if possible, lowering costs; increasing patient satisfaction; and improving the quality of patient outcomes. These values are consistent with efforts to achieve more integration of services and collaboration among providers. By 2005, health maintenance organizations will provide health insurance coverage to most of the commercial market and one fourth of the Medicare market.[40] In capitated managed care systems, cost consciousness is a priority, occurring in tandem with the provision of high quality health care. Even in noncapitated health systems, cost containment is important to keep health care affordable and prevent premium increases. Health care providers increasingly are looking to pharmacists to monitor and manage drug therapy for both greater cost-effectiveness and improved patient outcomes.

By 2010, the life expectancy of women and men in the United States is predicted to be 86 years and 76 years, respectively. A large portion of the population includes the "baby boomers," who will begin to turn 65 during that year.[41] With the U.S. population living longer, increased numbers of people will develop chronic medical conditions, the most common treatment for which is pharmacotherapy. This increased need for services and care could be met more effectively by pharmacists providing CDTM to that population.

The Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified a shortage of interdisciplinary programs in the health care system that could address many of the needs of patients with chronic medical conditions.[4] As new drugs become available, the risk of prescribing errors increases. Again, pharmacists working within CDTM arrangements should be able to reduce the number of medication errors substantially, contributing to better patient outcomes and improved management of health care expenditures.

Information technology advances also have had a dramatic impact on health care systems. Patients with computer access are actively seeking out disease and drug information independent of the advice they seek from their health care providers. Direct-to-consumer advertising also has dramatically influenced patient interest and questions regarding disease state and drug management. One positive result of this movement is the emphasis on patients taking more responsibility for their own health care. Increased participation in health care decision making should positively influence relationships among patients and health care providers. Self-participation and shared responsibility for health care by patients may reduce the risk of medical errors, while stimulating health care providers to stay abreast of new therapies and the literature supporting or refuting emerging health care practices. Using counseling and education techniques, pharmacists are well suited to help patients manage and better use the wealth of health information afforded by technology and direct-to-consumer advertising.

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