In December 2011, the Office of the Chief Pharmacist of the U.S. Public Health Service released a report to the U.S. Surgeon General on Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. The report is constructed around four focal points¹:

• Pharmacists Integrated as Health Care Providers: Definition of primary care; pharmacist roles; interprofessional collaboration and support
• Recognition as Health Care Providers: Advanced pharmacy practice models; pharmacy education and training
• Compensation Mechanisms: Essential for sustainability; legislation history; medication therapy management (MTM) under Medicare Part D
• Evidence-Based Alignment with Health Reform: Quality of care and patient outcomes; disease prevention and management; cost-effectiveness and cost-containment; primary care workforce; access to care

The report summarizes pharmacists’ contributions to patient care in various practice settings either as part of a health care team or as an individual provider working in collaboration with physicians in a pharmacist-delivered service. It highlights the role of the pharmacist in managing diseases through collaborative practice agreements with physicians in which pharmacists

• perform patient assessment (subjective and objective data including physical assessment);
• have prescriptive authority (initiate, adjust, or discontinue treatment) to manage disease through medication use and deliver collaborative drug therapy or medication management;
• order, interpret, and monitor laboratory tests;
• formulate clinical assessments and develop therapeutic plans;
• provide care coordination and other health services for wellness and prevention of disease; and
• develop partnerships with patients for ongoing (follow-up) care.

In addition to reciting the evidence supporting the impact of various pharmacist services on improving patient and health care outcomes, the report summarizes the economic benefit, explaining that, between 1998 and 2005, the overall average benefit gained was $10.07 per $1 of funds allocated to clinical pharmacy services.^2-4 The report maintains that compensation mechanisms are needed to sustain such services that will be in alignment with health care reform and future primary care workforce demands and that pharmacists should be recognized as health care providers, as defined in the Social Security Act and other health legislation and policy.

In a public letter in support of the report, Regina Benjamin, M.D., MBA, U.S. Surgeon General, recognized that the comprehensive patient care services that pharmacists provide through collaborative practice agreements increase access to care, optimize patient outcomes, and contain health care costs. Moreover, she recommended that health leaders and policy-makers explore ways to expand such services.⁵ Dr. Benjamin noted that recognizing pharmacists as health care providers is appropriate and that compensation models are needed to sustain these patient-centered pharmacy services.

1. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service, December 2011. Available at www.usphs.gov/corpslinks/pharmacy/comms/pdf/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf. Accessed February 1, 2012.
2. Schumock GT, Meek PD, Ploetz PA, Vermeulen LC; and the Publications Committee of the American College of Clinical Pharmacy. Economic evaluations of clinical pharmacy services—1988-1995. Pharmacotherapy 1996;16:1188–208.
3. Schumock GB, Butler MG, Meek PD, et al. Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Pharmacotherapy 2003;23:113–32.
4. Perez AD, Doloresco F, Hoffman JM, et al. Economic evaluations of clinical pharmacy services: 2001–2005. Pharmacotherapy 2009;29:128.
5. 2011 Support Letter from the U.S. Surgeon General. Available at www.usphs.gov/corpslinks/pharmacy/comms/pdf/2011SupportLetterFromUSSG.pdf. Accessed February 1, 2012.