Abstract
Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.
Highlights
Introduction and Statement of NeedU.S children’s hospitals and health systems have identified a lack of a standard definition for children with special health care needs (CSHCN)
According to the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA), Children with special health care needs (CSHCN) is defined as children and youth that “have or who are at risk for chronic physical, developmental, behavioral, or emotional conditions, Children 2019, 6, 58; doi:10.3390/children6040058
There are many gaps in the current system for medication management that directly affect pediatric patients and their families. These gaps can be divided into four major areas of attention: (1) lack of standardized formulations designed for children; (2) lack of information exchange and standard nomenclature to describe products used in children; (3) lack of collaboration for comprehensive medication management (CMM) between pediatricians and clinical pharmacists at the point of care; and (4) lack of effective feedback for understanding the impact of pharmacotherapy on patient outcomes
Summary
U.S children’s hospitals and health systems have identified a lack of a standard definition for children with special health care needs (CSHCN). While pediatric patients and their drug therapy needs, in general, are very different from adults, there are structures and processes of care that can be universally applied regardless of patient population Among these are comprehensive medication management (CMM) within the structure of collaborative practice agreements (CPAs) between clinical pharmacists and physicians, such as those which have been successfully developed and implemented in adult primary care practices, associations, and health systems [13]. This paper outlines the following: (1) organizing a collaborative practice for CMM between a clinical pharmacist and a pediatrician (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) describing and proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations. Children with Special Health Care Needs and Medical Complexity (CSHCN and CMC)
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