Pharmacist Collaborative Practice Privileges in Diabetes Management
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Presentation on theme: "Pharmacist Collaborative Practice Privileges in Diabetes Management"— Presentation transcript:
1 Pharmacist Collaborative Practice Privileges in Diabetes Management Nisha Patel, PharmDPGY1 Pharmacy ResidentEl Rio Community Health Center, Tucson, AZ5/20/11
2 El Rio Community Health Center A private, non-profit community health center since 1969The largest provider of medical and dental services to the uninsured and Medicaid populations of Pima County, Arizona.75% live below Federal Poverty Level78% are Hispanic and American IndianMember of the Patient Safety and Clinical Pharmacy Services Collaborative sponsored by the Health Resources and Services Administration (HRSA)
3 El Rio Community Health Center The first sight in state of Arizona to receive collaborative practice agreementCollaborative practice started in 2001diabetes, hypertension, and cholesterol managementA total of four clinical pharmacists working in collaboration with approximately 50 providersIncludes the management of diabetes, hypertension and cholesterol
4 El Rio Community Health Center A total of 2200 are managed by the clinical pharmacistsPatient-Centered Medical HomePt centered medical home: this concept promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health
5 Collaborative Drug Therapy Management (CDTM) Collaborative Drug Therapy Management (CDTM) is a type of collaborative practice where a provider and one or more pharmacists have jointly agreed, on a voluntary basis, to work together under protocol where the pharmacist may perform certain patient care functions authorized by provider subject to specific conditions and/or limitations.
6 Collaborative Drug Therapy Management (CDTM) The duties of the pharmacists involved in CDTM may includePatient assessmentOrdering drug therapy-related lab testsAdministering drugsSelecting, initiating, monitoring, and adjusting drug regimens
7 Collaborative Drug Therapy Management (CDTM) 45 out of 50 states now have provisions for CDTMHowever, authorized abilities allowed under CDTM vary from state to stateInvolves written protocols between prescribers and pharmacistsThese protocols may be required to be specific for disease, for patient, or for both. In Arizona the protocols are specific for disease.Except for Alabama, Delaware, District of Columbia, Illinois, and New York.For Arizona, it is specific for disease state
8 Collaborative Drug Therapy Management (CDTM) State laws or boards of pharmacy usually spell out what needs to be included in the protocolDepending on practice setting, there can be different requirements for pharmacists engaging in CDTMFor example, community phamacists in some states might be required to get approval of protocols by their board of pharmacy. On the other hand, protocols in the hospital setting might only need approval by the Pharmacy and Therapeutics committee or they might be exempted from certain requirements
9 Collaborative Drug Therapy Management (CDTM) States might also require pharmacists to have special training or approval/certification by the state board of pharmacyTypically focuses on managing complex medication regimens or chronic disease medication therapies for diabetes, hypertension, dyslipidemia, anticoagulation, or asthmaPharmacists need to have requisite clinical training and practice experience
10 Protocol Agreements Regardless of Practice Site CDTM agreements between a pharmacist and a provider, or group of providers, are voluntary agreementsCDTM agreements provide delegated authority by the provider and increase the opportunity for pharmacists to contribute their specialized expertise to a patient’s drug therapyCDTM agreements should be between the provider and the pharmacist NOT the provider and the practice sites.
11 CDTM in State of Arizona CDTM is guided by board-approved drug therapy management agreementNo location restrictionsAllows CDTM agreements with physicians and nurse practitionersThe CDTM agreement in AZ was limited to only four practice sitesAn acute care hospital; A nursing care institute; A staff model HMO; A community health centerHowever, the lagistlation has recently changed and it removed the location restrictions for pharmacists to enter into drug therapy agreement with physicians and also allowed such agreements to be entered into with nurse practitioners that are primary care practitiioners.—This law will go into effect on July 20 of this year
12 CDTM in State of Arizona Authorized abilities per practice agreement for pharmacistsImplement, monitor, and modify drug therapyThe protocol has to be renewed annuallyPharmacists have to complete 6 hours of CE per disease state annuallyAdapted from Arizona Administrative Code. Available at:Pharmacists can modify or implement drug, dosage, or dosage formOrder and interpret laboratory tests-Some states may allow pharmacists additional authorities: such as to administer drugs by injection (California), allow therapeutic interchange (changing from diovan to lisinopril, mariland, missori etc. but it has to be specified in the protocol agreement.
13 El Rio Community Health center The CDTM includes diabetes, blood pressure and cholesterol managementPatients have to have diagnosisPatients are referred to clinical pharmacist by primary care providersPharmacist processes the referralpatients have to give consent before clinical pharmacists can see them. Also the consent form is scanned in to patient’s medical record.
14 El Rio Community Health Center Yearly monofilament testYearly eye screeningDepression screeningOn board NutritionistReferralsDepression screening- as we all know depression has major impact on patient’s ability to manage their disease states
15 El Rio Community Health Center Several project involvement to improve outcomes and expand programCardinal Foundation GrantEDGE GrantProject IMPACT DiabetesCardinal foundation grant –EDGE grant – group classes for diabetes using conversation maps.
16 Considerations before Entering a CDTM Agreement Agreements are voluntary and entered into on an individual basisProvider and pharmacist should identify specific communication responsibilities for sharing information and improving patient’s continuity of careProvider and pharmacist should discuss how often and in what form (electronic, phone etc.) they should communicate regarding patient monitoring and CDTM activities1, these agreements are voluntary3. Furthermore,--Effective communication is essential to avoid confusion and fragmented care
17 ConclusionCDTM arrangements can be a powerful and positive way to improve patient care and build inter-professional relationshipsAllow providers and pharmacists to make the most of their respective education and training for patients’ best interests
18 ConclusionA comprehensive approach to healthcare, encouraging the collaboration of health care providers, improves the quality, efficiency and cost-effectiveness of medical careThe growing body of literature supporting the role of pharmacists in diabetes careProvide “continuity of care”There is a growing body of …Pharmacists can provide “continuity of care” by following patient care progress between provider visits, utilizing their clinical expertise to monitor and manage diabetes medication plans, and educating patients on disease, lifestyle, and adherence issues.