Collaborative drug therapy management: case studies of three community-based models of care.

Margie E Snyder,Dyann Matson-Koffman,Michael Greenberg,Tara R Earl,Siobhan Gilchrist,Holly Heisler,Michelle Revels

doi:10.5888/pcd12.140504

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.

Highlights

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]
Respondents reported that a key reason for not entering into collaborative practice agreements (CPAs) was that pharmacists were not recognized as providers under federal law and, unable to bill for services
Greater use of medication therapy management (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. This is the first study of its kind to examine real-life examples of CDTM implementation in various community settings

Summary

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]. 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. Pharmacist patient care services provided through CPAs have been shown to improve patient outcomes for diabetes, hypertension, anticoagulation, and other chronic diseases [4,5,6]. 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]. Pharmacists ( in community settings) are not routinely providing CDTM [8], they may be collaborating informally with physicians to make drug therapy recommendations.

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Conclusion