Implementation of an integrated pharmacist collaborative care model in specialty disease state clinics

Abstract

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To expand health-system specialty pharmacy (HSSP) clinical continuity by implementing a specialty integrated model for clinical services in target sites. Summary After evaluation of baseline clinical continuity and institutional goals, select clinics were identified as target sites to which to expand this integrated approach of a medication management clinic (MMC). In this MMC model, the key steps included engaging stakeholders, workflow training, optimization of the electronic health record, service evaluation, compliance with regulatory standards, and development of marketing strategies. The initial focus was development of innovative collaborative practice agreements (CPAs) to expand the scope of ambulatory care pharmacists’ practice. Analysis of existing specialty and ambulatory workflows and technology was completed before development of the integrated workflow. Existing credentialing policies were updated to support expanded practices, and marketing collaterals were developed to support growth of pharmacy referrals. Meetings with stakeholders took place to ensure smooth transitions into integrated areas. Primary endpoints included clinical continuity, as determined by prescription orders placed within the health system sent to the HSSP, and number of signed referrals to MMC. Secondary endpoints included disease state–specific clinical outcomes as well as overall outcomes such as medication adherence, laboratory test adherence, immunization rates, and patient and clinician satisfaction. An MMC model was successfully implemented in 5 target specialty practices. Specialty clinic CPAs were developed for rheumatology and digestive health (including viral hepatitis). Since implementation, clinical continuity increased 23% and referrals exceeded the target at 165%. Data on secondary endpoints are currently being collected to evaluate quality of pharmacy services. Pharmacy services have enhanced patient care and received positive feedback from clinicians. Conclusion Expansion of integrated decentralized pharmacists into target practices has increased clinical continuity and the number of pharmacist referrals. Clinicians have regarded pharmacists as vital members of the team. Creation of additional specialty CPAs will be needed to support further growth in other clinics.

Pharmacogenomics to support mental health medication therapy management: Clinical practice considerations and a conceptual framework to enhance patient care

“…In both of these workflows, a CPA advances team‐based care based on formal practice relationships between pharmacists and prescribers based on delineated functions and defined scope of practice delegated to a pharmacist. In the setting of PGx‐informed care, a CPA may support ordering of a test, return of results, prescribing, or deprescribing 44,45 …”

“…suggest that if genotypes are known and available for a specific gene when a relevant medication is being considered, that they can be used In the setting of PGx-informed care, a CPA may support ordering of a test, return of results, prescribing, or deprescribing. 44,45 A concierge-type, specialty clinic setting that typically focuses on unique PGx aspects of care across therapeutic areas has emerged, and the "PGx Service" model has evolved as an efficient process to facilitate test acquisition and return of results in a coordinated fashion across therapeutic areas in institutions implementing testing across multiple clinics and therapeutic areas. 46 In the context of mental health CMM at the clinic level, there are opportunities to directly coordinate with a centralized PGx Service, or incorporate a clinicspecific CPA to include PGx testing, interpretation, and medication management into the scope of practice which may encompass care for specialty and primary care referrals.…”

The medication management program in dermatology: a novel collaborative initiative

“…This model is based on collaborative practice agreements (CPAs), legal agreements whereby physicians allow a dedicated pharmacist to co-manage patients within specific guidelines. 5 At our institution, MMC services became integrated with dermatology in November 2021. ACPs may collaborate with one or more dermatologists depending on volume of patients prescribed specialty medications.…”