Defining and advancing ambulatory care pharmacy practice: It is time to lengthen our stride

Abstract

By assertively advancing ambulatory care practice, pharmacy will help achieve the national priorities of improving patient care, patient health, and affordability of care.

Impact of an Integrated Pharmacy Transitions of Care Pilot Program in an Urban Hospital

“…[4][5][6][7][8][9][10][11] With the increase of pharmacy involvement in ambulatory care clinics and transitions of care, hospitals may offer several outpatient pharmacy services upon discharge to ensure continuity of care. 13,14 The Pharmacy Transitions of Care (PTC) pilot program was developed to decrease hospital readmission rates through integrated pharmacy services during transitions of care in a 300-bed urban tertiary teaching hospital. PTC is a voluntary program which offers a pharmacy review of discharge medications, bedside delivery of discharge prescriptions from the hospital's outpatient pharmacy, comprehensive medication education, scheduling of hospital ambulatory care clinic appointments, and follow-up telephone calls to monitor patient's medication therapy after discharge from the hospital.…”

The Position of Clinical Pharmacists in Delivering Advanced Pharmacy Practice Education and Services: Short Communication

“…Oral chemotherapy services, wellness services, cognitive memory screening, psychotherapy, pharmacogenetic testing, health education, concordance, counselling, medication therapy management (MTM), follow-up and referral services Determine educational and training opportunities for community pharmacists, thereby improve patient-centred experiences that supplement their confidence, knowledge, and skill in providing advanced pharmacy services [35][36][37][38][39][40][41][42][43][44][45][46] Surgical department Cardiopulmonary resuscitation (CPR) Determine pharmacist participation on CPR teams in health care delivery organizations [47,48] Regulatory scrutiny Drug Pricing Evaluate and monitor drug pricing through the use key metrics on cost savings achieved, maintenance costs, and other aspects of program involvement [49] In-patient Pharmaceutical care Provision of pharmaceutical care, identification of drug therapy problems, prevention of adverse drug reactions and monitoring of drug therapy management [48,50,51] Out-patient department Ambulatory care, patient education Assertively advancing ambulatory care practice, to achieve the national priorities of improving patient care, adherence, patient health, and affordability of care [48,52,53] Pediatric department Pediatric care Provision of advanced pediatric care [48,54] Intensive care units and oncology department Palliative care services Introducing the concept of 'advanced practice roles' in pharmacy within the new integrated regionalized palliative care service [48,55,56] …”

Implementing Evidence-Based Guidelines: The Role of Ambulatory Care Pharmacists

“…Given that medication management plays a key role in chronic disease management, clinical pharmacists can reduce medication-related problems such as nonadherence, inappropriate use, and suboptimal therapy [1]. The 1996 Asheville Project, which contracted with pharmacists to provide diabetes care, has been widely publicized because it showed significant improvements in clinical and economic outcomes [6].…”

“…For example, starting colchicine for gout flare prophylaxis when initiating allopurinol, monitoring uric acid levels, and providing patient education about the potential for flares when initiating and dose-adjusting allopurinol, as well as the goal of attaining a target uric acid level, can promote patient understanding, thus enhancing adherence and optimal use of urate-lowering therapy to ultimately improve long-term gout control. Ambulatory care pharmacists are optimally positioned to utilize guidelines by providing direct comprehensive medication management, which has demonstrated improved clinical and economic outcomes [1].…”