Collaborative Drug Therapy Management: Case Studies of Three Community-based Models of Care

Margie E. Snyder, PharmD, MPH; Tara R. Earl, PhD, MSW; Siobhan Gilchrist, JD, MPH; Michael Greenberg, JD, MPH; Holly Heisler, MPH, MBA; Michelle Revels, MA; Dyann Matson-Koffman, DrPH, MPH, CHES

Disclosures

Prev Chronic Dis. 2015;12(3) 

In This Article

Abstract and Introduction

Abstract

Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management.

Introduction

In collaborative drug therapy management (CDTM), qualified pharmacists working in the context of a defined protocol are permitted to assume professional responsibility for performing a full scope of services: assessing patients; ordering drug therapy–related laboratory tests; administering drugs; and selecting, initiating, monitoring, continuing, and adjusting drug regimens.[1] Authority for CDTM is generally incorporated into a state's pharmacy practice act in the sections describing pharmacists' scope of practice.

Pharmacist–provider collaborative practice agreements (CPAs), such as CDTM, are a strategy for expanding the pharmacist's role in team-based care with other providers and improving health outcomes. CPAs can link patient care provided in traditional clinical settings with pharmacist care in community-based settings. CPAs emerged in the 1960s[2] and are now legally enabled in most states; however, the range of services authorized under each state's practice act varies.[3]

Pharmacist patient care services provided through CPAs have been shown to improve patient outcomes for diabetes, hypertension, anticoagulation, and other chronic diseases.[4–6] The 2014 Community Preventive Services Task Force (Task Force) recently issued recommendations showing strong evidence for team-based care involving pharmacists and nurses to improve hypertension control and other chronic disease risk factors.[7] Despite the noted benefits, pharmacists (particularly in community settings) are not routinely providing CDTM,[8] although they may be collaborating informally with physicians to make drug therapy recommendations. One increasingly common opportunity for this informal collaboration is the use of medication therapy management (MTM), a required benefit for select Medicare Part D beneficiaries.[9–11] In MTM as most commonly defined, a pharmacist reviews a patient's medication regimen and must suggest changes to the prescribing physician for approval, rather than make any changes independently. This activity is permitted in any pharmacist's scope of practice. CDTM takes this relationship a step further by enabling the pharmacist to make independent drug therapy changes under a protocol that may enhance the efficiency of the pharmacist and health care delivery.

There are more than 60,000 community-based pharmacies in retail settings (supermarkets, chain drug stores, and independent pharmacies), and approximately 39% of federally qualified health centers (FQHCs) have onsite pharmacies across the United States.[12,13] The Centers for Disease Control and Prevention (CDC) funded this study to understand how CPAs, such as CDTM for hypertension management, are implemented in community pharmacies and to explore ways for more pharmacists to provide CDTM. The objectives of this study were to understand how CDTM practices were implemented in 3 community settings and to identify common and unique facilitators and barriers to implementing CDTM.

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