American College of Clinical Pharmacy
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ACCP Report - March 2013

President’s Column

We Meant What We Said … But Let’s Be Clear About What We Said

Written by Curtis E. Haas, Pharm.D., FCCP, BCPS


Curtis E. Haas, Pharm.D., FCCP, BCPS

In 2006, ACCP published two important papers: a position statement that, by 2020, postgraduate residency training should be a prerequisite for the provision of direct patient care by clinical pharmacists1 and a white paper in support of the College’s belief that clinical pharmacists should be board certified.2 Since their publication, these two papers have frequently been misquoted and misunderstood by others in the profession—and occasionally, by some of our own members. The most common misstatement is that ACCP believes all pharmacists must complete residency training. A careful reading of the statement will reveal that the position is narrower than an “all pharmacists” proclamation.

In response to these often-misunderstood beliefs of the College, and in recognition of the importance of having these beliefs clearly articulated as ACCP pursues an initiative seeking expanded Medicare coverage for direct patient care services by qualified clinical pharmacists, the Board of Regents (BOR) has authorized the publication of a clarifying commentary titled, “Qualifications of Pharmacists Who Provide Direct Patient Care: Perspectives on the Need for Residency Training and Board Certification.” This publication may be found at http://www.accp.com/docs/positions/commentaries/ACCP_Brd_Commntry_Final_030513.pdf. The importance of this paper to ACCP’s priority initiative (expanded Medicare coverage) cannot be overstated, and I urge every member of the organization to take 10 minutes to read it. Many of our professional colleagues both inside and outside ACCP may not fully agree with or understand our positions on practitioner qualifications and clinical pharmacist provider status. Therefore, the clarity provided by this commentary will help equip ACCP members to engage in dialogue regarding these positions.

In my first presidential column, published in the November 2012 ACCP Report, I emphasized the importance of correctly and consistently using terminology to define clinical pharmacy practice. It is impossible to have a meaningful conversation if we are each speaking our own language. One of the most important terms in the new board commentary is direct patient care, which has important relevance to the appropriate training and credentialing of clinical pharmacists. Direct patient care as it pertains to clinical pharmacy practice was first defined by the College in the 2006 ACCP position statement on residency training.1 This definition was subsequently included in the glossary of the Council on Credentialing in Pharmacy (CCP) scope of pharmacy practice paper published in 2009.3 This glossary describes “the definitions, interpretations, and intent of the terms used throughout the [CCP Scope of Practice] paper.”3 CCP is a coalition of 12 pharmacy organizations; hence, it is reasonable to conclude that the publication of the scope paper by this coalition represented a consensus around the use of the terminology defined in the paper. The definition in the CCP glossary reads:

Direct patient care practice involves the pharmacist’s direct observation of the patient and his/her contributions to the selection, modification, and monitoring of patient-specific drug therapy. This is often accomplished within an interprofessional team or through collaborative practice with another healthcare provider.

During recent intraprofessional meetings and discussions there has been inconsistent use of the term “direct patient care” as part of the conversation related to seeking “pharmacist provider status”. The BOR commentary acknowledges that pharmacists provide many professional services to patients that have value but that these activities should not be considered to constitute direct patient care, as defined above, simply because a pharmacist has direct communication and interaction with a patient. In these same discussions, many of our colleagues argue that the profession must speak with one voice. A prerequisite to achieving that “one voice” is adherence to a common terminology (i.e., we need to agree on our language and then use it consistently). Since 2009, according to the CCP scope of practice paper, we seemingly have agreement on the meaning of direct patient care.

The overarching principle expressed in the BOR commentary is that clinical pharmacists who engage in direct patient care “should possess the education, training, and experience necessary to function effectively, efficiently and responsibly in this role.” It is hard to disagree with that logic, and our patients should expect nothing less than to have their care provided by qualified and competent health care team members. Unfortunately, the profession hasn’t reached agreement on the education, training, and experience needed to provide direct patient care. That is why credentialing is so important.

The position taken by the BOR commentary is that BPS board certification (or board eligibility, in some circumstances) is the cornerstone of the qualifications needed to provide direct patient care. Although the College also believes that residency training is the preferred and most efficient path to obtaining postgraduate training in preparation for board certification and a career as a clinical pharmacist, it also acknowledges that it is not the only path toward board eligibility.

Finally, ACCP believes that direct patient care should be provided by clinical pharmacists practicing as members of an interprofessional team, with established collaborative drug therapy management agreements or formal clinical privileges granted using local credentialing processes. The clinical pharmacist must have (1) formal and sustainable professional relationships with other members of the health care team and the patient, (2) a consistent process of care, and (3) shared responsibility and accountability for medication-related outcomes. The provision of comprehensive medication management is not possible in a professional vacuum or strictly as an outside consultant.

The position of the College is not applicable to all pharmacists or the full scope of pharmacy practice environments, but it is relevant to our clinical pharmacist members and emerging trainees who embrace or pursue a practice focused on the provision of direct patient care. The recently published BOR commentary provides a very clear and compelling restatement and clarification of what we meant.

  1. American College of Clinical Pharmacy’s vision of the future: postgraduate pharmacy residency training as a prerequisite for direct patient care practice. Pharmacotherapy 2006;26:722-33.
  2. Future clinical pharmacy practitioners should be board-certified specialists. Pharmacotherapy 2006;26:1816-25.
  3. The Council on Credentialing in Pharmacy. Scope of Contemporary Pharmacy Practice: Roles, Responsibilities, and Functions of Pharmacists and Pharmacy Technicians. Available at http://www.pharmacycredentialing.org/Contemporary_Pharmacy_Practice.pdf. Accessed March 6, 2013.