Collaborative Drug Therapy Management Research Articles

Role of pharmacist-provided point-of-care testing

APhA–APPM Patient care opportunities for pharmacists with point-of-care testing P o i n t o f c a r e (POC) testing, or “diagnostic testing performed at or near the site of patient care,” is a convenient, affordable, and reliable method for pharmacists to measure laboratory values.1,2 Currently, more than 120 POC tests waived under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are available for use in the evaluation and management of many acute and chronic diseases.3 Pharmacists can provide these tests to patients as alternative, accessible, and impactful health care options. With more than 8 million Americans having undiagnosed diabetes and more than 35 million having uncontrolled blood pressure, pharmacists have the opportunity to play a critical role in patient care through the provision of POC testing.4,5 Blood glucose and blood pressure screenings are just two of the simple POC tests that pharmacists can provide to screen for common chronic diseases, and such tests are often provided as complementary services in the community. The addition of lipid screenings and extensive counseling present both a clinical and business opportunity for pharmacists. In general, POC test screening results may serve as a preliminary means for screening for chronic disease states and potential diagnoses. POC testing may also serve as a valuable tool for pharmacist-provided disease state management of patients diagnosed with chronic disease(s). Convenient, inexpensive, and quick POC tests enable pharmacists to deliver necessary recommendations and interventions to help patients manage their disease states in a timely and convenient manner. Common POC tests used for disease state management include glycosylated hemoglobin (A1C) and blood glucose screenings for diabetes, blood pressure measurement for hypertension, lipid panel testing for cardiovascular disease, and prothrombin time (PT)/international normalized ratio (INR) testing for anticoagulation monitoring. While communication of recommendations to physicians can be a barrier, many states allow pharmacists to practice collaborative drug therapy management (CDTM).6 POC testing is most often associated with chronic disease screening and management, but a rapidly growing area is POC testing for inRole of pharmacist-provided point-of-care testing

The effect of a diabetes collaborative care management program on clinical and economic outcomes in patients with type 2 diabetes.

Clinical pharmacy services (CPS) in the primary care setting have been shown to help patients attain treatment goals and improve outcomes. However, the availability of CPS in community-based primary care is not widespread. One reason is that current fee-for-service models offer limited reimbursement opportunities for CPS in the community setting. Furthermore, data demonstrating the value of CPS in this setting are limited, making it difficult for providers to determine the feasibility and sustainability of incorporating CPS into primary care practice. To (a) evaluate the association between a pharmacist-led, diabetes collaborative drug therapy management program and patient outcomes, including glycemic control and health care costs, and (b) assess short-term economic outcomes in a primary care setting. A retrospective cohort analysis was conducted using medical record data. This study was conducted using patients with uncontrolled type 2 diabetes (T2DM), defined as HbA1c ≥ 7.0%. Outcomes were compared between patients referred to a diabetes collaborative care management (DCCM) intervention from 2009-2012 and patients who did not participate in the DCCM program. To illustrate the difference in HbA1c between the 2 cohorts over the follow-up period, mean time adjusted HbA1c values were estimated using a panel-type random effects regression model, with results plotted at 90-day intervals from index date through the end of the study period. To help control for confounding by other factors, multivariate regression models were run. A difference-in-difference model was employed to estimate the effect of the program on resource utilization and all-cause charges. A total of 303 DCCM and 394 comparison patients were included. Mean (95% CI) age was 57.4 years (55.963, 58.902) versus 59.9 years (58.613, 61.276; P < 0.001) with 48% and 44% female for DCCM and comparison patients, respectively (P = 0.49). Mean baseline HbA1c was higher for DCCM (10.3%; 10.10, 10.53) than comparison patients (8.4%; 8.26, 8.61; P < 0.001). The greatest reduction in HbA1c was seen for both groups at 9 and 12 months post-index date. At these time points, the mean time adjusted difference in HbA1c between groups was no longer significant. Multivariate modeling identified that the DCCM program was associated with a -0.44% (-0.64, -0.25; P < 0.001) lower HbA1c at follow-up relative to the comparison group controlling for potential confounders, including baseline HbA1c. Change in resource utilization from pre- to post-index date did not differ between groups. However, in the difference-in-difference multivariate analysis the difference in mean all-cause charges from the 12-month pre- to post-index periods DCCM patients experienced a smaller average increase in charges ($250) than comparison patients ($1,341; coefficient = -0.423; 95% CI = -0.779, -0.068). A pharmacist-led diabetes collaborative care management program in a patient-centered primary care setting was associated with significantly better follow-up glycemic control relative to comparison patients. Further, the data suggest that the DCCM program was associated with a less substantial increase in all-cause total costs in patients with uncontrolled T2DM relative to comparison patients, which could translate into reduced costs and improved outcomes to managed care payers.

Clinical pharmacy experience in ophthalmology setting of using collaborative drug therapy management (CDTM)

BackgroundAn increased influx of patients and limited access to specialised healthcare due to insufficient medical staff in ophthalmology has been reported for more than a decade. For this reason, our...

PHP126 - Pharmacy Directors’ perceptions of Administrators’ and Health Professionals’ attitudes towards Collaborative Drug Therapy Management (CDTM) in U.S. hospitals

PHP126 - Pharmacy Directors’ perceptions of Administrators’ and Health Professionals’ attitudes towards Collaborative Drug Therapy Management (CDTM) in U.S. hospitals

Collaborative drug therapy management and comprehensive medication management-2015.

The American College of Clinical Pharmacy (ACCP) previously published position statements on collaborative drug therapy management (CDTM) in 1997 and 2003. Since 2003, significant federal and state legislation addressing CDTM has evolved and expanded throughout the United States. CDTM is well suited to facilitate the delivery of comprehensive medication management (CMM) by clinical pharmacists. CMM, defined by ACCP as a core component of the standards of practice for clinical pharmacists, is designed to optimize medication-related outcomes in collaborative practice environments. New models of care delivery emphasize patient-centered, team-based care and increasingly link payment to the achievement of positive economic, clinical, and humanistic outcomes. Hence clinical pharmacists practicing under CDTM agreements or through other privileging processes are well positioned to provide CMM. The economic value of clinical pharmacists in team-based settings is well documented. However, patient access to CMM remains limited due to lack of payer recognition of the value of clinical pharmacists in collaborative care settings and current health care payment policy. Therefore, the clinical pharmacy discipline must continue to establish and expand its use of CDTM agreements and other collaborative privileging mechanisms to provide CMM. Continued growth in the provision of CMM by appropriately qualified clinical pharmacists in collaborative practice settings will enhance recognition of their positive impact on medication-related outcomes.

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

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.

がん化学療法によるB型肝炎ウイルス再活性化予防に関する医師・臨床検査技師・薬剤師による共同薬物治療管理と情報共有

がん化学療法によるB型肝炎ウイルス再活性化予防に関する医師・臨床検査技師・薬剤師による共同薬物治療管理と情報共有

Evaluation of the Feasibility and Utility of a Pharmacist-Centered Collaborative Drug Therapy Management Program for Oncology-Based Symptom Management

Collaborative drug therapy management (CDTM) is a practice agreement between a pharmacist and a physician, which allows the pharmacist to assume responsibility of drug therapy management. There has been limited documentation of CDTM practices in the oncology setting. Therefore, a CDTM program in the gynecology oncology clinic at Roswell Park Cancer Institute (RPCI) was initiated to establish the feasibility and utility of CDTM and its effects on patient care and physician satisfaction. Primarily, 3 symptoms were managed by the CDTM pharmacists, namely chemotherapy-induced nausea and vomiting (CINV), chemotherapy-induced peripheral neuropathy (CIPN), and women’s health. The CDTM program showed favorable results after a short 4-month period. The CDTM pharmacists were referred a total of 12 consultations for CDTM purposes; 8 patients enrolled in the CIPN CDTM protocol, 3 in the CINV protocol, and 1 in the women’s health protocol. The CDTM pharmacists were able to perform a total of 54 consultations, with a mean time of 16.9 minutes spent with each patient per consultation. Additionally, the CDTM pharmacists made 70 interventions and identified 6 medication-related adverse effects. The patient and physician satisfaction survey demonstrated the value of the CDTM pharmacists, and respondents were supportive of the program.

Psychiatric pharmacy practice sites: Continuously evolving to meet patients' needs

The field of psychiatric pharmacy has continuously advanced for the past few decades with origins dating back to the 1960s and 1970s.1 Historically, psychiatric pharmacists practiced in traditional settings such as private or academic hospitals, Veteran's Affairs hospitals, mental health clinics, pharmaceutical industry, and academia. However, psychiatric pharmacists' training and expertise in neuropsychiatric medications make them ideally suited to work in a wide variety of clinical settings. Their pharmacotherapy knowledge regarding both medical and psychiatric medications allows them to proficiently serve in capacities unique among healthcare professionals.At present, there are over 1500 members of the College of Psychiatric and Neurologic Pharmacists (CPNP) and over 800 pharmacists board certified in psychiatric pharmacy (BCPP).2 Outside of the typical practice sites for psychiatric pharmacists, new opportunities are frequently being developed. Various descriptions of practice sites have been published, including primary care clinics, assertive community treatment teams, clozapine clinics, and indigent care clinics.3–7 Additionally, innovative opportunities for professional advancement and reimbursement such as medication therapy management, collaborative drug therapy management, and comprehensive medication management have become more commonplace.8–9As healthcare reform continues to impact healthcare organizations and professionals, psychiatric pharmacists should continue to look for untapped opportunities to improve clinical and economic outcomes. Finding niches, gaps in care, or other unique ways to impact patient care will continue to be crucial as the profession of psychiatric pharmacy moves into the future and works toward obtaining provider status.The November 2014 issue of the Mental Health Clinician is devoted to highlighting a number of unique and innovative psychiatric pharmacy practice sites. Descriptions of clinics and integral roles of psychiatric pharmacists within a Hepatitis C Clinic and an integrated behavioral health clinic will be presented. Other direct patient care practices will be highlighted including psychiatric pharmacists serving in a medical emergency department, a healthcare home, and a federally qualified health center targeting transitions in care. Pharmacists' roles in other nontraditional settings including information services/publishing and a statewide managed care organization will also be included. Last, a toolbox outlining tips for establishing psychiatric pharmacy practice sites will be presented.

New roles for pharmacists in community mental health care: a narrative review.

Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists’ role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists’ attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.

Student perspectives on prescriptive authority

PurposeTo gauge student perceptions regarding collaborative drug therapy management (CDTM), including prescriptive authority activities, and to determine student perceptions of level of preparedness and desire to provide these services. MethodsA 15-item survey was administered to all currently enrolled students in the University of Missouri—Kansas City (UMKC) School of Pharmacy. The study population included students in years one through three of didactic coursework as well as students in their experiential year. ResultsOverall, 44.3% (n = 90) of students felt adequately prepared for CDTM and the prescriptive authority activities that fall under that scope. Of the respondents, 74% (n = 29) of students in their last experiential year reported feeling prepared. The majority of students also believe pharmacists can accurately choose, initiate, and modify drug therapy. Moreover, 77% (n = 61) of fourth-year students expressed interest in participating in some form of CDTM upon graduation. ConclusionsThe majority of pharmacy students feel adequately prepared for the prescribing responsibilities that fall within a collaborative drug therapy management agreement, and most intend to be an active participant.

A Review of Advances in Collaborative Pharmacy Practice to Improve Adherence to Standards of Care in Diabetes Management

The prevalence of diabetes in the United States is increasing and so is the need to provide diabetes care. Given the time commitment and complexity of diabetes management, an interdisciplinary approach is recommended. Pharmacists are integral members of the diabetes care team because of their accessibility and expertise in medication management. Pharmacists are receiving specialized training and becoming more involved in direct patient care through collaborative practice opportunities such as medication therapy management and collaborative drug therapy management. These collaborative practice models increase patient access to care and allow pharmacists to optimize drug therapy and provide important education to promote diabetes self-management. Studies show pharmacists practicing in a variety of outpatient environments can reduce HbA1c, LDL and BP as well as improve adherence to recommended American Diabetes Association guidelines (yearly monofilament exams, dilated eye exams, microalbumin screening, etc). Pharmacists working as part of the health care team can ensure optimal diabetes management.

Development of a collaborative drug therapy management protocol for extended-release intramuscular naltrexone

The Center for Drug and Alcohol Programs (CDAP) at the Medical University of South Carolina (MUSC) focuses on research and clinical services for substance use disorders. CDAP is comprised of both inpatient and outpatient services. Outpatient services include an intensive program with daily group meetings and an individualized treatment program where patients are able to take part in one-on-one counseling. Approximately 1200 outpatients are seen in the CDAP clinics annually, 300 of which are in the intensive outpatient program. The patients seen in CDAP have a range of substance use disorders which include alcohol and opioid dependence, among others. Given the patient population, there is a significant demand for extended-release intramuscular naltrexone (ERIN), but the CDAP clinics are neither staffed nor structured for medication administration or storage. A previously established pharmacist-run clinic exists at MUSC for the purpose of administering long-acting injectable antipsychotics and monitoring the patients who receive them. An explanation of the financial impact of the antipsychotic injection clinic to our institution is described by Phan and Vandenberg. With the increasing patient and physician demand, a protocol was developed to allow pharmacists to administer ERIN in the pharmacist-run clinic.

CPNP Announcements

CPNP Announcements

New York pharmacists push for CDTM

Collaborative drug therapy management (CDTM) officially arrived in New York in 2011 as a three-year experiment, and pharmacists in the state have been working since then to ensure that their legal authority for practice remains in place. “Our sunset is next year,” said New York State Council of

California provider status bill heads to governor

California provider status bill heads to governor

APhA fights potential death from anaphylaxis

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. This condition, often caused by certain foods, insect bites or stings, and some medications, affects an estimated 2% of people worldwide, according to the World Allergy Organization (WAO), although cases are often under-reported and under-recognized, and prevalence appears to be increasing. To manage the condition, people at risk should be properly educated about anaphylaxis and carry an epinephrine autoinjector, which can be used in an emergency to reverse the potentially fatal symptoms.

Board of Regents CommentaryQualifications of Pharmacists Who Provide Direct Patient Care: Perspectives on the Need for Residency Training and Board Certification

In 2006, the American College of Clinical Pharmacy (ACCP) released a position statement and a white paper to provide the College's viewpoints on the importance of postgraduate pharmacy residency training as a prerequisite for direct patient care practice and the vision that future clinical pharmacists engaged in direct patient care would be certified by the Board of Pharmacy Specialties (BPS). Since the release of these papers, some members of the pharmacy profession have interpreted ACCP's position as maintaining that all pharmacists-regardless of the focus of their professional practice activities-should complete formal postgraduate residency training and be board-certified specialists. That interpretation is not accurate. In this commentary, ACCP further defines "direct patient care" and states that it believes that clinical pharmacists engaged in direct patient care should be board certified (i.e., and residency-trained or otherwise board eligible) and have established a valid collaborative drug therapy management (CDTM) agreement or have been formally granted clinical privileges. The rationale for this viewpoint is presented in detail. The pharmacy profession has appropriately invested substantial resources to ensure the quality of its accredited residency training programs and board certification processes. ACCP believes that these training and certification programs are essential steps in preparing clinical pharmacists to provide direct patient care.

The Novel Image of Pharmacist of a Super-aged Society in Japan

The percentage of the population over age 65 in Japan was greater than 23% in 2010. Therefore, Japan is the world's first "super-aged society", and our country needs a new regional health care system. Our medical systems face many challenges, such as this increase in elderly population with chronic diseases, maintenance of universal health insurance and free access to hospitals, and expensive health care costs. It is not easy to change the current health care system without a sufficient number of doctors. On the other hand, Japan's curriculum in pharmaceutical education has been expanded to six years to establish a new profession of pharmacist. Rapid progress in the market of pharmacies in accepting prescriptions since 1974 has caused pharmacists to primarily act as "technicians". But this is not the best way to solve the serious problems of Japanese medical systems. I want to present the image of a next-generation pharmacist (Pharmacist 3.0), to be involved in the idea of collaborative drug therapy management (CDTM) in this article. The total optimization of our medical supply system with all medical and pharmaceutical specialists is necessary in Japan.

Introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan

目的 : 共同薬物治療管理 (CDTM) を地域医療に導入するための方略の一つとして, 事前に処方医と事後報告を行うポジティブリストを作成し, 疑義照会を事後報告へ切り替えることによる効果を検証した.方法 : 事後報告に替えることのできる疑義照会をリソルブ疑義と定義した上で, ポジティブリストに基づく事後報告への切り替えを行い, その効果をリソルブ疑義の件数, 保険点数およびジェネリック医薬品使用率の変化を調査することにより評価した.結果 : 医師の治療計画を変更することなく, ポジティブリストにより178件 (疑義照会全体の22.7%) の疑義照会を事後報告に替えることができ, 疑義照会にかかる時間を大幅に短縮することができた. これにより保険点数は17,455点削減でき, ジェネリック医薬品使用率は46.6%まで上昇した.結論 : ポジティブリストに基づく薬剤師自身の判断で疑義照会を事後報告に切り替えることにより, 疑義照会実施件数および医療費削減とジェネリック医薬品使用率上昇を可能とした.