American College of Clinical Pharmacy
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ACCP Report - March 2017

President’s Column

Focus on Clinical Guidelines and Consensus Statements

Written by Marcia L. Buck, Pharm.D., FCCP, FPPAG, BCPPS


Marcia L. Buck, Pharm.D., FCCP, FPPAG, BCPPS

One of the critical issues addressed by the Board of Regents this winter in its continued work on the next ACCP strategic plan was the need to promote clinical pharmacists as essential contributors to national and international guidelines and consensus statements. Clinical guidelines have become an integral part of patient care. These documents may be developed at the institutional level or may represent the recommendations of a larger group, such as an interprofessional collaboration among clinicians within a particular field.1 Guidelines are meant to help providers determine the best course of action and to streamline or standardize aspects of patient care; they are not meant to be mandatory or enforced as policy. Guidelines reflect an in-depth assessment of the available literature using rigorous, well-defined methods to grade the available evidence. In contrast with guidelines, consensus statements provide an overview of state-of-the-art practice. Consensus statements often represent the commonly held opinions of a group of experts but, unlike policy or position papers, may not reflect total agreement among members. Consensus statements may be developed in person or using the Delphi method, an iterative process in which each member separately modifies and refines a series of statements until a consensus has been reached. More recently, a blend of the two methods has become common. The usefulness of guidelines and consensus statements in health care is enriched by an interprofessional approach. Clinical pharmacists, by virtue of their training and experience, bring a unique perspective to these projects and add to the members' combined expertise.

I would like to highlight the work of just a sample of ACCP members on several important new publications. Dr. Jacquelyn Bainbridge recently served as one of 13 expert clinicians on the interprofessional Consortium of Multiple Sclerosis Centers Framework Taskforce to evaluate current standards of care in multiple sclerosis.2,3 This work was recently published as a two-part series in the International Journal of MS Care. The articles emphasize a comprehensive care model using an interprofessional patient-centered team approach. These comprehensive diagnostic and treatment overviews are a useful resource for clinicians, as well as an excellent reference for pharmacy students and residents. Several other ACCP members continue to serve as members of the interprofessional Clinical Pharmacogenetics Implementation Consortium (CPIC). Drs. Kelly Caudle, Henry Dunnenberger, James Hoffman, and Mary Relling recently participated in a workgroup to develop standard nomenclature for pharmacogenetic test results.4 This is an essential step in facilitating both clinical practice and clinical research. Our members have in fact been at the forefront of many CPIC initiatives. In addition to the individuals listed earlier, Drs. Gillian Bell, Roseann Gammal, Cyrine Haidar, and James Kevin Hicks recently wrote CPIC guidelines for medication optimization based on polymorphisms in metabolic enzymes.5,6

Dr. Joanna Stollings recently completed her work as a panel member for a National Institutes of Health–funded research infrastructure project to create a core set of outcomes measures to assist researchers in conducting longitudinal studies of former critical care patients. Additional resources include a database of strategies to increase patient retention and a tool for assessing mortality risk. Resources for acute respiratory failure are now available at www.improveLTO.com. The scope of our members' contributions to interprofessional guidelines and consensus statements is quite impressive. As an organization, we applaud these efforts, but there is still work to do. Guidelines and consensus statements continue to be published that would have benefited from one or more clinical pharmacists at the table. ACCP continues to expand its efforts to support the inclusion of clinical pharmacists as necessary members of panels and workgroups for new projects. We also want to hear more about your involvement in these endeavors. Please e-mail us about your contributions. I'd like to hear how our members are advancing health care by taking part in this work.

1.De Boeck K, Castellani C, Elborn JS. Medical consensus, guidelines, and position papers: a policy for the ECFS. J Cyst Fibros 2014;13:495-8.
2.Newsome SD, Aliotta PJ, Bainbridge J, et al. A framework of care in multiple sclerosis, part I: updated disease classification and disease-modifying therapy use in specific circumstances. Int J MS Care 2016;18:314-23.
3.Newsome SD, Aliotta PJ, Bainbridge J, et al. A framework of care in multiple sclerosis, part II: symptomatic care and beyond. Int J MS Care 2017;19:42-56.
4.Caudle KE, Dunnenberger HM, Freimuth RR, et al. Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC). Genet Med 2016;19:215-23.
5.Bell GC, Caudle KE, Whirl-Carrillo M, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 genotype and use of ondansetron and tropisetron. Clin Pharmacol Ther 2016 Dec 21. [Epub ahead of print]
6.Gammal RS, Court MH, Haidar CE, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for UGT1A1 and atazanavir prescribing. Clin Pharmacol Ther 2016;99:363-9.