Collaborative pharmacy practice: an update

Abstract

Collaborative practice among health professionals is slowly coming of age, given the global focus on efficiency and effectiveness of care to achieve positive patient outcomes and to reduce the economic burden of fragmented care. Collaborative pharmacy practice (CPP) is accordingly evolving within different models including: disease management, medication therapy management, patient centered medical home, and accountable care organizations. Pharmacist roles in these models relate to drug therapy management and include therapy introduction, adjustment, or discontinuation, patient counseling and education, and identification, resolution, and prevention of problems leading to drug interactions and adverse reactions. Most forms of CPP occur with physicians in various settings. Collaborative practice agreements exist in many states in the US and are mentioned in the International Pharmaceutical Federation policy statement. Impetus for CPP comes from health system and economic concerns, as well as from a regulatory push. There are positive examples in community, ambulatory care, and inpatient settings that have well documented protocols, indicators of care, and measurement and reporting of clinical, economic, and patient reported outcomes; however, implementation of the practice is still not widespread. Conceptual and implementation challenges include health professional training, attitudes, confidence and comfort levels, power and communication issues, logistic barriers of time, workload, proximity, resistance to establish and adopt regulations, and importantly, payment models. Some of the attitudinal and perceptual challenges can be mitigated by incorporation of interprofessional concepts and practice in health profession education. Other challenges need to be addressed across health systems, given the inefficiencies and problems that arise from lack of communication and coordination of patient care including medication nonadherence, errors and patient safety, complexity of compounded health problems, and potential liability. The existing evidence needs to be examined to address some challenges and improve infrastructure for CPP.

Compounding medications in a rural setting: an interprofessional perspective

“…Literature has described the importance of interprofessional, collaborative, and patient-centered care and its particular importance in rural and remote areas. 13 , 17 , 18 , 27 – 29 Effective rural health care delivery is increasingly viewed as a team approach, rather than a series of individual health professionals’ efforts. 17 Conducting this workshop in a rural community allowed participants to reflect on actual rural health care practice.…”

“… 9 , 11 However, the presence of pharmacists within the collaborative health care team has been shown to improve patient outcomes and provide better health management through patient education and monitoring. 13 …”

Providing Comprehensive Medication Management in Telehealth

“…Hence, not all states allow for collaborative practice, which may pose a barrier to the provision of CMM through telehealth practice by clinical pharmacists in some locales . Moreover, despite the widespread enabling of collaborative practice agreements, specific regulatory challenges still exist that may significantly affect CMM delivery nationally and across state lines…”

Orienting patients to greater opioid safety: models of community pharmacy-based naloxone

“…As part of a growing trend in pharmacy practice, collaborative pharmacy practice agreements (CPAs) have been implemented for a range of health conditions with public health impact, including vaccinations, Lyme disease prophylaxis, and diabetes management [ 43 ]. CPAs permit a pharmacist to work in collaboration with a prescriber for the purpose of drug therapy management of patients, pursuant to an authorized and agreed upon protocol.…”