What constitutes an advanced clinical pharmacist? As the scope of practice for pharmacists expands worldwide, defining the professional roles and responsibilities and the required credentials of advanced clinical pharmacists becomes more critical.
According to the American Heritage Dictionary, “advanced” is an adjective meaning “highly developed or complex,” “being at a higher level than others,” “ahead of the times; progressive,” and “far along in course or time.”
In 2009, the Council on Credentialing in Pharmacy (CCP), now a coalition of 12 national pharmacy organizations, published a key resource paper describing a framework for credentialing in pharmacy practice.1 Under the patient care domain, the framework defines the scope of practice for pharmacists on the basis of (1) breadth of patient or practice focus, from broad to narrow; and (2) level (depth) of knowledge, skills, and experience or complexity of care provided, from entry level to advanced. Accordingly, four quadrants are identified. Representing the entire spectrum of patients cared for, a practicing pharmacist may be a generalist practitioner, focused practitioner, advanced generalist practitioner, or advanced focused practitioner, according to the CCP framework (Figure).
The figure describes the scope of practice delivered by practitioners in each quadrant outlined in the CCP framework. Advanced practitioners have a highly developed level of knowledge, skills, and experience and provide care to patients with complex diseases requiring complex therapies/or technologies. Advanced generalists provide such care to a wide variety of patients and/or diseases. Advanced focused practitioners provide care to focused patient populations (i.e., specialized in any particular specialty area).
The figure also depicts where pharmacists fit across the continuum of practice and professional development, starting when they attain a professional degree and licensure to practice and continuing to when they complete postgraduate residency training, years 1 and 2; when they have earned select multidisciplinary certifications; and when they have earned select pharmacist-only certifications granted by the Board of Pharmacy Specialties (BPS).
The CCP framework does not specify the competencies needed to deliver patient care. In this regard, the ACCP clinical pharmacist competencies define the knowledge, skills, attitudes, and behaviors necessary to deliver comprehensive medication management in team-based, direct patient care environments.2 In addition, for a pharmacist to earn a particular credential, he or she must demonstrate specific competencies. As an example, for a pharmacist to earn the Board Certified Pharmacotherapy Specialist (BCPS) credential granted by BPS, he or she must meet the following eligibility requirements: must have graduated from an accredited pharmacy program, must hold an active license to practice, must have completed either 3 years of post-licensure practice experience with at least 50% of time spent in pharmacotherapy activities or have completed postgraduate year one residency training, and must have achieved a passing score on the BPS pharmacotherapy certification examination. The examination is comprehensive of the domains delineated in the BPS pharmacotherapy content outline: patient-specific pharmacotherapy, drug information and evidence-based medicine, and system-based standards and population-based pharmacotherapy.
The CCP framework is comprehensive of the scope of practice continuum, encompassing both advanced and specialized patient care. Moreover, this practice-specific, credential-focused, and practical framework is easily applied by individual pharmacists planning their own professional development and by professional leaders responsible for ensuring the competence of the clinical pharmacist workforce.
The editorial team welcomes readers’ comments on this topic. Personal views and/or definitions/frameworks endorsed by national professional organizations are welcome. Submit comments by e-mail, using subject line: “Commentary on Advanced Clinical Pharmacists,” to [email protected].
Figure. Scope of practice and example credentials for clinical pharmacists.
AE-C = Asthma Educator-Certified; BCACP = Board Certified Ambulatory Care Pharmacist; BC-ADM = Board Certified-Advanced Diabetes Management; BCCCP = Board Certified Critical Care Pharmacist; BCOP = Board Certified Oncology Pharmacist; BCPPS = Board Certified Pediatric Pharmacy Specialist; BCPS = Board Certified Pharmacotherapy Specialist; CDE = Certified Diabetes Educator; PGY1 = postgraduate year one; PGY2 = postgraduate year two.
Adapted with permission from: Council on Credentialing in Pharmacy.
1. Council on Credentialing in Pharmacy (CCP). Scope of Contemporary Pharmacy Practice: Roles, Responsibilities, and Functions of Pharmacists and Pharmacy Technicians. Washington, DC: CCP, February 2009. Available at www.pharmacycredentialing.org/Contemporary_Pharmacy_Practice.pdf. Accessed April 16, 2018.
2. American College of Clinical Pharmacy, Saseen JJ, Ripley TL, et al. ACCP clinical pharmacist competencies. Pharmacotherapy 2017;37:630-6. Available at https://onlinelibrary.wiley.com/doi/epdf/10.1002/phar.1923. Accessed April 16, 2018.