Maybe it’s just me, but when I talk with friends and colleagues around the country, there seems to be a lot of confusion about how we define what makes a pharmacist a clinical pharmacist and specifically, what clinical pharmacists do! As we look to the future where there will be dramatic changes in health care delivery in the USA, our time is short to demonstrate the value and potential impact of clinical pharmacists’ role in improving patient outcomes. As an organization that takes pride in being keenly “focused” on representing and meeting the needs of clinical pharmacists, one would think that we are well positioned to provide commentary on the subject. In fact, our members have a long history of contributing evidence to support the impact of clinical pharmacists on patient outcomes. However, we must continue to help our professional colleagues, patients, and society to recognize our contributions.

Let me update you on a few of our current initiatives that relate to the current ACCP Strategic Plan (see http://www.accp.com/docs/about/ACCP_Strategic_Plan.pdf). The plan lists as one of its priorities that “ACCP will position clinical pharmacists by: 1) Communicating with external constituencies to foster recognition of clinical pharmacists’ collaborative contributions to patient care, 2) Working with external constituencies to affirm clinical pharmacists’ credibility as clinicians and researchers who contribute unique value to patient care, and 3) Develop joint interprofessional communications that recognize clinical pharmacists’ essential collaborative roles in ensuring quality patient care.” Consistent with our plan, I have asked the 2012 ACCP Public and Professional Relations Committee to address the somewhat rhetorical question, “Should organized clinical pharmacy promote a consistent, standardized process of patient care provided by clinical pharmacists that could apply to any clinical practice setting?” The committee has been asked to prepare a variety of communication pieces to place this issue before ACCP members, calling upon previously published and otherwise accepted care processes used by clinical pharmacist that have been described in the literature. You will be hearing more about this in future issues of the ACCP Report. On a related front, the 2012 Publications Committee is charged with looking at how clinical pharmacy is defined (including inaccurate and/or incomplete descriptions) on the internet and through social networking sites.

At the combined meeting of the boards of the College, Pharmacotherapy, and the Research Institute during last October’s ACCP Annual meeting in Pittsburgh, Ed Webb challenged the group by stating there is a need to be able to define more precisely “what clinical pharmacists do.” (In a future issue of the ACCP Report we will also discuss ACCP’s beliefs regarding “who” can do this by focusing on the recommended credentialing pathway for clinical pharmacists.) The challenge facing us is that if we are going to assertively promote the value of the clinical pharmacist, we must be able to articulate to our colleagues and other health professionals exactly “what” the clinical pharmacist does to improve treatment outcomes and quality of care in a cost-efficient manner. The description must be consistent and easily understood; it must also be embraced by the clinical pharmacy discipline to the extent that virtually any clinical pharmacist can articulate what these activities are and exactly what consumers and professionals can expect from their clinical pharmacist.

In the November 2011 issue of the ACCP Report, Daniel Touchette, PRBN Network Director, explained that although there is plenty of evidence supporting the impact of clinical pharmacists on health care teams, most of the research does not address the specifics regarding efficiencies and what specific activities result in overall cost savings. There’s also a paucity of adequately powered randomized controlled studies to support the value of clinical pharmacists’ direct patient care activities. A new direction in the research agenda of the PBRN will seek to delineate the differences in various clinical pharmacists’ practices in an effort to identify sustainable practices that result in positive outcomes and more efficient utilization of resources.

Finally, you may also recall the commentary by Terry McInnis, MD, MPH in the October 2011 issue of the ACCP Report. She co-leads the Patient-Centered Primary Care Collaborative (PCPCC) Medication Management task force along with ACCP Associate Executive Director C. Edwin Webb and Dr. Linda Strand. Dr. McInnis noted in her commentary,

Comprehensive medication management involves optimizing the medications in an attempt to achieve the clinical goals of therapy for each disease state in a patient-centric approach. This practice must be orderly and fully understood by the profession and is essential to the successful discovery and resolution of drug therapy problems that are preventing patients from reaching these goals. The practice must be documented, communicated, evidence-based, and reiterative—in short, the practice requires a systematic approach.

Dr. McInnis, a physician, believes that two elements are equally critical to the pharmacy profession’s success: (1) a professional, standardized practice, and 2) the evolution of the pharmacist as a practitioner “taking care of patients” as part of the patient-centered medical home or accountable care organization (ACO) team. She went on to say that,

This systematic approach embodied in a common professional practice of pharmacy will unleash the full power of the appropriate use of the phenomenal medications that we have to improve health for patients and simultaneously lower our total healthcare costs in collaboration with physicians and other team members! Then we as a society will realize the true value that pharmacists can play by applying the full-force of their pharmacology knowledge in this clinical role.

Dr. McInnis ended her commentary with a challenge to us all:

Will you take your knowledge of pharmacology to the level of applying it to practice by making the more difficult recommendations such as suggesting based on the evidence, an additional drug be added, a change of dosage, or a different drug prescribed which resolves a drug therapy problem that you have systematically found and documented, based on the evidence and your professional knowledge, to actually improve patient outcomes and safety? Are you prepared to consistently practice at the absolute top level of your license and scope of practice?”

While I completely agree with and endorse the statements from Dr McInnis related to “standardized practice,” perhaps (for those of us concerned about the broad implications of establishing such activities as practice “standards”) a more successful tact would be to establish a set of “guidelines” that articulate a “consistent set of practice activities” that a patient or health professional could expect to experience when interacting with a clinical pharmacist. For more information regarding PCPCC and comments from Dr McInnis see http://www.pcpcc.net/files/medmanagement.pdf.

In keeping with Dr. Bill Kehoe’s 2011 Presidential Theme “A Look Back to the Future,” I will close by referring you to two historical documents from ACCP. In the August 2000 issue of Pharmacotherapy, ACCP published a White Paper titled, “A Vision of Pharmacy’s Future Roles, Responsibilities, and Manpower Needs in the United States” (see http://www.accp.com/docs/positions/whitePapers/pos26.pdf). Written by the 1997–1999 ACCP Clinical Practice Affairs Subcommittee A and approved by the Board of Regents in May 2000, I highly recommend re-reading this paper. Although the paper was written more than a decade ago, a few key points made by the authors deserve to be revisited today:

• The process of evolving to future roles will probably eventually result in the emergence of a single practice model, although one that may be actualized differently within a variety of settings. Additionally, as practice models evolve, different segments of the profession will progress at different rates and perhaps along different paths.
• Each sector of the profession should participate collaboratively to plan both strategically and realistically to promote the evolution of practice models that consistently support a philosophy of practice that clearly identifies the patient as the primary beneficiary of the profession.
• Pharmacy’s leadership may be confronted by the challenge of valuing the initial differences among approaches necessary to implement patient-centered care in diverse practice settings, while simultaneously seeking to achieve solidarity through a shared philosophy of practice.
• Professionals must work together patiently, honestly, and meaningfully to revise pharmacy’s practice systems to support a level of patient care that genuinely affects patients’ drug therapy outcomes.

Last, I refer you to “The Definition of Clinical Pharmacy,” written and approved by the ACCP Board of Regents in April 2005 (see http://www.accp.com/docs/positions/commentaries/Clinpharmdefnfinal.pdf). This paper offers an abridged definition of clinical pharmacy (“That area of pharmacy concerned with the science and practice of rational medication use”). But more important, for those who take the time to more closely review the paper, is the unabridged definition, including its references to clinical pharmacy as a discipline, its description of the clinical pharmacist, and its account of the roles of the clinical pharmacist in the health care system. These final two documents, included here for both historical interest and contemporary relevance, demonstrate that ACCP and its members have been actively promoting the role of the clinical pharmacist for many years. But I think we continue to have much work ahead of us. If we are successful in articulating a consistent approach to practice and gaining acceptance of this approach across the clinical pharmacy discipline, our next steps should include:

• educating and training students and residents in accord with this practice;
• promoting the practice to other health professionals as “the what” that clinical pharmacists can and will contribute to patient care; and
• employing these practice activities as the basis for research on how the clinical pharmacist affects patient outcomes and the cost of care

It was remarkable to me to see that ACCP’s perspective and vision have remained constant over time. I believe that it’s quite likely that we were just a decade or two ahead of our time – in a sense, we were seeking to embrace the future before its time. Well, I think that future has now arrived!