This is the final installation of our series of commentaries exploring a uniform patient care process for clinical pharmacy that can be implemented in any practice setting. Part I set the stage for the series by providing background discussion of this issue. Part II included a table summarizing five currently recognized models of clinical pharmacy practice. Part IIIa discussed the strengths, weaknesses, similarities, and differences of the current models and their applicability to different practice settings. The most recent installment, part IIIb, presented two patient cases in different practice settings to demonstrate the practical application of each of the five models.
We have recommended that a uniform model of clinical pharmacy practice be defined and that the process include steps that occur every time a clinical pharmacist encounters a patient, no matter the setting, condition(s), or medications. We also believe the model should be easy to explain and understand, practical to implement, measurable, codeable (for documentation and payment purposes), and researchable. Health professionals, payers, patients and their families/caregivers, and the public should be able to understand this process and thereby come to know what the clinical pharmacist does to contribute to the optimization of patient outcomes. Clinical pharmacists should be able to implement the model easily and document their contributions to patient care in a reasonable time.
Recommendations
As a committee, we sought to identify a model that we believed would meet these criteria. We critically reviewed five existing clinical pharmacy models: pharmaceutical care practice, medication therapy management (MTM), comprehensive medication management in the patient-centered medical home from the Patient-Centered Primary Care Collaborative (CMM), Society of Hospital Pharmacists of Australia Standards of Practice for Clinical Pharmacy (SHPA), and individualized Medication Assessment and Planning (iMAP). All the models reviewed have excellent characteristics in their own right, and many met most of the criteria. However, we were charged by the ACCP President to eventually recommend to the Board of Regents a single model for consideration and discussion. This model could be an existing model, a new model, or a hybrid of the patient care processes discussed above. The committee will arrive at a final recommendation for the Board of Regents based on its own analyses, together with input from ACCP member clinical pharmacists. This recommendation will be published in a forthcoming white paper.
Therefore, although several of the models reviewed hold promise, the committee has recommended that ACCP await additional data and input from clinical pharmacists regarding each of the practice models reviewed before considering endorsement of a specific process of care to guide clinical pharmacist practice.
We Need to Hear from You!
From this series of commentaries, the committee seeks to initiate an open discussion among clinical pharmacists regarding which model (if any) should be promoted by organized clinical pharmacy as a consistent process of patient care in every clinical practice setting. Several of the models discussed in these commentaries are very similar, and each has individual strengths, weaknesses, and differences in applicability across practice settings. To begin soliciting input on the viewpoint of rank-and-file clinical pharmacists, the committee has developed an ACCP member survey to gather opinions on this important issue. A link to this survey will be distributed by e-mail in mid-September to all non-trainee and non-student ACCP members to gain as much insight as possible from established, experienced clinicians. We ask those who receive the survey to please cast their vote on the model that they feel meets the requisite criteria and that can be readily implemented in any practice setting; or to express other opinions on this issue.
If you are planning to be at next month’s 2012 ACCP Annual Meeting in Hollywood, Florida, be sure to attend the meeting’s Keynote Address and Town Hall session. The Keynote Address, titled “Advancing a Comprehensive and Consistent Practice for Clinical Pharmacists—The Future Is Now,” will take place on Sunday, October 21, from 8:15 a.m. to 10:00 a.m., in Great Hall 3 of the Westin Diplomat Hotel. A panel of experts from a broad variety of professional settings will discuss this important topic. The Business and Town Hall Meeting will be held Sunday afternoon from 2:30 p.m. to 4:45 p.m. During the Town Hall Meeting, results from the member survey discussed above will be presented, together with a presentation by Terry McInnis, M.D., MPH, FACOEM, who will provide a physician’s perspective on clinical pharmacist practice. In addition, attendees will be invited during the Town Hall Meeting to voice their opinions on the issue of adopting a consistent clinical pharmacist process of care. We anticipate that a large number of clinical pharmacists will attend this session and participate in what should be a lively discussion.
ACCP member comments and feedback are vital to the success of ACCP and to the viability of the clinical pharmacy discipline. Indeed, as ACCP President Larry Cohen has pointed out in his recent columns in the ACCP Report, we have clearly defined WHO we are, in terms of education, training, and clinical experience. However, we must now better define, demonstrate, and communicate the specifics of WHAT we do. By embracing a comprehensive and consistent model for clinical pharmacy practice, our discipline will have the opportunity to position the clinical pharmacist as an essential part of our future health care system.
aCommittee members: Ila Harris (chair), Beth Phillips (vice chair), Eric Boyce, Sara Griesbach, Charlene Hope, Denise Sokos, and Kurt Wargo.
References
- American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy 2008;28:816–7.
- Patient-Centered Primary Care Collaborative Resource Guide: The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. Available at www.pcpcc.net/files/medmanagement.pdf. Accessed September 4, 2012.