Collaborative Practice Agreements


A Step in the Right Direction for Advancing Healthcare in Alabama

As the healthcare field continues to grow and adapt, implementing additional methods of patient care are vital to sustaining a high level of healthcare in the United States. As the U.S. population ages, the prevalence of chronic diseases is increasing as well. These circumstances are creating a crossroads in healthcare, raising the question of how to care for the growing number of patients and what profession can effectively take on this task.

Pharmacy is in a prime position to help shoulder this responsibility. Moving beyond a dispensing role, pharmacists can work alongside physicians to ensure patients receive exceptional care through Collaborative Drug Therapy Management (CDTM).

CDTM establishes Collaborative Practice Agreements (CPA) with physicians, enabling pharmacists to provide a variety of clinical services. With CPAs, pharmacists work under defined protocols to perform a wide range of services customized to the preferences of the collaborating physician and pharmacist. For pharmacists and physicians to take advantage of these opportunities, they must practice in a state with an established CPA. Authority to participate in CDTM is delegated by a state's pharmacy practice act. Unfortunately, Alabama is the only state without a CPA in the pharmacy practice act.

To better illustrate the advantages of CDTM, it's important to look at the incredibly diverse settings in which pharmacists can practice. CPAs can be implemented in a variety of disciplines such as the management of asthma, hypertension, dyslipidemia, diabetes mellitus, and anticoagulation among many others.

Pharmacist responsibilities in these collaborative settings have been diverse. They include medication reviews, and working alongside physicians developing treatment plans unique to each patient's needs. Additionally, pharmacists communicate the plan to the patient and provide disease state counseling, freeing the physician to treat the next patient.

While CPAs open doors for pharmacists providing new opportunities, patients also see benefits from the collaborative teams. Two studies in particular, assessed patients with hypertension and diabetes mellitus. All of the patients in pharmacist integrated teams achieved statistically significant improvements in clinical parameters regarding their degree of control. For example, patients with a baseline blood pressure of 149/84 mm Hg achieved an average blood pressure reduction of 17/9 mm Hg (132/75) after nine months. A study evaluating chronically uncontrolled diabetic patients with an average baseline A1C of 9.3 percent, obtained an A1C of 8.18 percent after one year and an A1C of 8.06 percent at the study's conclusion. By comparison, patients in the control group without pharmacist care, achieved an A1C of 8.69 percent after year one, but only reached an A1C of 8.67 percent at the end of the study.

One of the main patient benefits of pharmacist integrated care was the increased access to healthcare. All of these patients continued to see their physician and also saw a pharmacist once every one to three months, as they gained better control of their health conditions. The researchers concluded this increased follow-up with a healthcare provider made a difference in patients gaining better control of their disease states.

Finally, physicians were able to save time with their workload while working alongside pharmacists through CPAs. Effectively managing patient populations with hypertension, diabetes mellitus and other chronic conditions requires a significant amount of time, which physicians usually lack due to their substantial daily work load. Once an agreement on the care plan is reached, the physician is able to diagnose more patients. During that time, the pharmacist stays with the previous patient to answer any remaining questions, provide disease state education, and give medication counseling.

Support for CPAs is growing nationwide. Nicholas Gentile, the American Society of Healthcare Pharmacists (ASHP) director of state and leader of ASHP's grassroots political action campaigns, has advocated for expanded pharmacist responsibilities through CPAs such as point of care tests, acute illness screenings and managing medication regimens in chronic diseases. To address concerns of pharmacists competing with physicians for patients, Gentile stated "We're not trying to pull patients out of physician practices. In fact, we're trying to work alongside these physicians, nurse practitioners, and other providers to help patients have the best care possible."

Improved clinical outcomes, increased access to care and assisting physicians with their daily workload, only scratch the surface of what CPAs can do for the pharmacy profession, and the healthcare system as a whole. Therefore, implementation of CPAs is a step in the right direction to better serve our patients in the ever changing environment of healthcare.

Austin Crocker is Pharm.D. Candidate for 2017 in the Samford University McWhorter School of Pharmacy. Katie Lomax, Pharm.D. BCPS is an assistant professor in the Samford University McWhorter School of Pharmacy.


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