The Consultant Pharmacist and the Physician in the Nursing Home: Roles, Relationships, and a Recipe for Success

Abstract

Both physicians and consultant pharmacists have a longstanding role in nursing home care. The physician role was emphasized in 1974, when medical directors were required in all skilled nursing facilities. It was intensified in 1987, when the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) regulations required all nursing facilities to have a medical director and reinforced that each resident should have an attending physician who visits the resident at specified intervals. In 1974, the Medicare Conditions of Participation first mandated a quarterly drug regimen review (DRR) by a consultant pharmacist in nursing facilities, which was later increased to monthly. Subsequently, the State Operations Manual (SOM) has expanded its guidance to surveyors regarding the required elements of a DRR, to help them determine if an effective DRR was occurring.

A qualitative study of physicians' and nurses' experiences of multidisciplinary collaboration with pharmacists participating at case conferences

“…Therefore, we propose a more systematic approach to the medication review according to an agreed protocol, as a way to further enhance the professional input. [23] Third, the extra time spent on drug charts reduced available time for other tasks. If pharmacists should be included in the nursing home healthcare team there is a need to clarify whether time spent on medication reviews and at case conferences has a positive impact on patient outcome, or is perceived as cost-effective by the funding municipalities.…”

“…[22] Levenson and Saffel aimed to define some of this structure by clarifying the roles when pharmacists and physicians collaborated in nursing homes. [23] When initially presenting our study [14] to the nursing home leaders, we only presented how the pharmacist was to perform the medication reviews. We did not emphasize key elements (i.e.…”

Dissemination of Evidence‐Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial

“…32 CMS regulation F329 33 already requires consultant pharmacists to provide recommendations for reducing unnecessary medications, but their recommendations are ineffective when physicians do not accept them. 34 Targeting both external stakeholders may improve future prescribing improvement efforts.…”

The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT)

“…Indeed, this role is mandatory in all US nursing homes, which receive funding from major federal government health programmes. 101 A number of studies have been conducted in Australia involving pharmacists either as the main professional delivering the intervention or as part of a multidisciplinary team. Roberts and colleagues implemented a programme, which focussed on establishing professional relationships between pharmacists and nursing home staff, educating nurses on common issues in geriatric pharmacotherapy, and medication reviews prepared by the pharmacists.…”