Editor’s note: This is the second installment of a four-part commentary prepared expressly for the ACCP Report. See part I in last month’s issue of the ACCP Report at http://www.accp.com/report/index.aspx?iss=0512&art=1.

As noted in part I of this series, we believe there should be a consistent process of patient care provided by clinical pharmacists that can be consistently applied to any clinical practice, extending from the ambulatory care setting to the intensive care unit. For such an approach to patient care practice by clinical pharmacists to be effective, it should be simple, straightforward, and easily described, but it must also be comprehensive, readily accessible, easy to document, and applicable to the care of all patients. In addition, other health care stakeholders, including physician organizations, payers, other health care providers, and patients, should readily understand it. As mentioned previously, it also should be articulable, measurable, codeable, and researchable.

As we explore WHAT it is that clinical pharmacists do, we must examine the currently existing models of clinical pharmacy practice. These models represent several different approaches to managing a patient’s medications, and all have similarities and differences. Not all clinical pharmacists across the United States follow one specific model; their practices are likely to be a function of their background, training, and practice environment. The clinical pharmacy practice models described in the literature include (1) pharmaceutical care practice, (2) medication therapy management (MTM), (3) comprehensive medication management (CMM) as integrated into the patient-centered medical home (PCMH), and (4) the Society of Hospital Pharmacists of Australia (SHPA) Standards of Practice for clinical pharmacy. A fifth approach, the individualized medication assessment and planning (iMAP) process, is the focus of ongoing work that has not yet been published. Other examples exist in practice, including collaborative working relationships between physicians and pharmacists, disease state management, and specialty clinics/programs. In part II of this series of commentaries, we summarize five different models of clinical pharmacy practice. Next month, the strengths, weaknesses, and applicability of these models to all practice settings will be explored as we continue to ask WHAT it is that clinical pharmacists do.

^aCommittee members: Ila Harris (Chair), Beth Phillips (Vice Chair), Eric Boyce, Sara Griesbach, Charlene Hope, Denise Sokos, and Kurt Wargo.

References

1. Cipolle R, Strand L, Morley P. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management Services, 3rd ed. New York: McGraw-Hill, 2012.
2. American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Available at http://www.pharmacist.com/mtm/CoreElements2. Accessed January 2, 2012.
3. Patient-Centered Primary Care Collaborative Resource Guide: The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. Available at http://www.pcpcc.net/files/medmanagement.pdf. Accessed January 2, 2012.
4. The Society of Hospital Pharmacists of Australia (SHPA). SHPA Standards of Practice for clinical pharmacy. J Pharm Pract Res 2005;35:122–46.
5. Crisp GD, Burkhart JI, Esserman DA, Weinberger M, Roth MT. Development and testing of a tool for assessing and resolving medication-related problems in older adults in an ambulatory care setting: the individualized medication assessment and planning (iMAP) tool. Am J Geriatr Pharmacother 2011;9:451–60.