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


Prev Chronic Dis. 2015;12(3) 

In This Article


Key Features of CDTM Policy Implementation

The elements of CDTM used at each site varied (Table 1).

Key Barriers to CDTM Policy Implementation

Key barriers to CDTM policy implementation raised by pharmacists and physicians across the 3 sites included a lack of reimbursement mechanisms for CDTM services, difficulty establishing trusting relationships with providers, and the time and resources needed to perform CDTM patient care services (Table 2). Respondents reported that a key reason for not entering into CPAs was that pharmacists were not recognized as providers under federal law and, therefore, unable to bill for services. Physicians reported that many of their physician colleagues were initially hesitant to relinquish control of their patients' drug therapy to pharmacists, particularly if they do not practice at the same location. However, it was reported that the distrust wanes over time. In addition, each state has different requirements, such as residency training or continuing education, for pharmacists to be eligible to engage in CDTM.[1,3] The pharmacists reported that the application costs for various certifications and the time needed to devote to continuing education requirements can be burdensome. Finally, Kerr Drug and Osterhaus Pharmacy pharmacists achieved a great deal of collaborative patient care by making therapeutic recommendations (ie, MTM) without entering into CPAs. Their reasons for preferring informal collaborations to CPAs included the time and logistics required to create CPAs and the limited scope of diseases or medications that may be included in a CDTM protocol. In summary, compensation for these services was identified as a barrier, so in some cases, the disadvantages of the required time and logistics for CPAs outweighed the perceived benefits.

Key Facilitators to CDTM Policy Implementation

The pharmacists and physicians interviewed at all 3 sites reported that physician buy-in, affiliation with an academic partner (eg, college of pharmacy), and having well-trained pharmacists on staff facilitated their ability to implement CDTM (Table 3). Pharmacist and provider collaboration — even on an informal or limited basis — helped solidify working relationships and increased provider buy-in over the long-term. Informants found that after providers began to experience the benefits of CDTM and other avenues of collaboration, they were more apt to collaborate.

Each site reported facilitators unique to their setting. At El Rio, the pharmacists widely disseminated reports describing positive patient outcomes, which helped to increase support for the collaborative care model. In addition, El Rio's chief clinical pharmacist worked methodically to build relationships with newly employed officers, administrators, and providers. These relationships increased the number of patients referred to El Rio's pharmacists and strengthened support among all stakeholders (eg, physicians). El Rio informants reported that a recent amendment to the state pharmacy act made engaging in CDTM less burdensome than in previous years. Finally, El Rio's CDTM protocols are written broadly to give pharmacists substantial freedom in choosing how they care for patients.

Kerr Drug informants reported that the introduction of entry-level doctors of pharmacy (PharmDs) into the pharmacy profession contributed to the willingness of physicians to work collaboratively with pharmacists because of the rigorous scientific and clinical training involved in attaining the PharmD degree and because graduating physicians gain exposure to PharmD students during medical training. Furthermore, Kerr Drug has offered a pharmacy residency program for more than 12 years, and it serves as a training site for students. These factors increased interactions among Kerr Drug pharmacists and providers and raised providers' support for and trust of the pharmacy profession. Similarly, the Osterhaus residency program was a critical part of collaborative relationships with providers. Osterhaus Pharmacy informants also mentioned having enough physical space to provide privacy for pharmacist–patient consultations. Finally, greater use of MTM via Medicare Part D and North Carolina's CheckMeds program, which provides free pharmacist MTM services to beneficiaries enrolled in Medicare prescription drug plans, made it easier for pharmacists to enter into CPAs because providers realized the advantages of working closely with pharmacists.