Pharmacy has progressed far beyond the "counting and pouring" of its orgins. Today, pharmacists' vast knowledge of drugs is being utilized in many ways to help patients and the health care system achieve more efficient drug therapy outcomes. According to the American College of Clinical Pharmacy (ACCP), over 75% of states have enacted legislation that creates a more active role for the pharmacist by engaging in collaborative practice with physicians to improve a patient’s drug therapy.

Collaborative drug therapy management (CDTM) by pharmacists is defined by the ACCP as a collaborative practice agreement between one or more physicians and pharmacists, wherein qualified pharmacists working within the context of a defined protocol are permitted to assume professional responsibility for performing patient assessments; ordering drug therapy-related laboratory tests; administering drugs; and selecting, initiating, monitoring, continuing, and adjusting drug regimens. A drug therapy management protocol is a written plan that delegates legal prescriptive authority to pharmacists under designated circumstances. It serves to guide their conduct, direct the course of action, and delineate the functions, procedures, and decision criteria to be followed.  

Collaborative practice requires all health care professionals to share the responsibility of the patient. Pharmacists work together with physicians by using their knowledge and skills to increase patient outcomes.

What is required for CDTM? The ACCP has compiled a list of requirements for effective CDTM. These requirements include: collaborative practice environment, access to patients and medical records, education, training, knowledge, skills, and ability, documentation of activities and quality assurance, and payment for services.  

• Collaborative Practice Environment: It is important that all health care professionals on the team are aware of the knowledge and skills of the colleagues, so that they can better utilized to improve patient outcomes.
• Access to Patients and Medical Records: Pharmacists need access to the patient in order to develop a relationship that is a key component of CDTM. To determine the effectiveness of drug therapy, it is imperative that the pharmacist can speak to a patient to see and hear how the patient is doing. The pharmacist also needs access to medical records such as patient’s medical history, progress notes, laboratory and procedure results, and drug history.
• Education, Training, Knowledge, Skills, and Ability: All graduates of pharmacy now obtain a Doctor of Pharmacy degree. Graduates are trained by experimental rotations/externships which promote active learning. More knowledge and experience are obtained by enrolling in a residency program or fellowship. Other pharmacists enhance their skill by becoming certified by The Board of Pharmaceutical Specialists (offers certification in nuclear pharmacy, nutrition support, oncology, pharmacotherapy, and psychiatric pharmacy), The American Society of Consultant Pharmacists (offers certification in geriatric pharmacy), and the National Institute for Standards in Pharmacist Credentialing (offers certification in disease state management); see Specialty Certifications. The education and training of pharmacy graduates aids to identify those that have the knowledge and ability to participate in CDTM.    
• Documentation of Activities and Quality Assurance: Pharmacists must document all activities that they perform with the patient, which is shared with other health care professionals. As stated by the ACCP, a mechanism to measure and ensure quality should be developed as an integral part of CDTM agreement. Measuring adherence to practice guidelines and comparing patient outcomes to benchmark data or literature reports is essential and should be identical to the process developed for other health care professionals.
• Payment for Services: Payment will be made as pharmacists are more fully recognized as an essential part of CDTM. A reform in payment is necessary so that pharmacists will be reimbursed for their knowledge that they bring to the health care system.

According to the ACCP, it has been shown that pharmacists can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. “It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.” To find out more about CDTM in your state, visit your state board web site or www.accp.com.


References:

Hammond R, Schwartz A, Campbell MJ, et al. Collaborative Drug Therapy Management by Pharmacists—2003. Pharmacotherapy 2003; 23 (9):1210-1225.

Koch K. Trends in Collaborative Drug Therapy Management. Drug Benefit Trends 12(1):45-54, 2000.