Magazine article Drug Topics

Collaborative Practice Gains

Magazine article Drug Topics

Collaborative Practice Gains

Article excerpt

More states allow pharmacists greater role in patient care

Community pharmacists in a retail setting are in a strong position to work collaboratively with physicians to help patients with their drug therapy management.

Over the last decade, lawmakers in several states - Kansas, Maine, Massachusetts, Missouri, New Jersey, Tennessee, West Virginia, Wisconsin, and Virginia - have approved legislation that would permit pharmacists in any practice setting to implement collaborative drug therapy management (CDTM) provisions or expand existing CDTM provisions, notes "Collaborative Drug Therapy Management and Comprehensive Medication Management - 2015," a white paper produced by the American College of Clinical Pharmacy (ACCP).

At present 48 states and the District of Columbia allow pharmacists and physicians some degree of collaboration in the provision of advanced patient care under collaborative practice agreements (CPAs), said Krystalyn Weaver, PharmD, director of policy and state relations for the National Alliance of State Pharmacy Associations (NASPA).

According to Weaver, NASPA's research shows that 38 states permit pharmacists to initiate drug therapy through a CPA, and 45 allow pharmacists to modify existing therapy. However, in 29 states, the CPA must specify the medications or specific disease states that can be managed by the pharmacist.

Collaboration in public health

Community pharmacists have a number of opportunities to collaborate with physicians on public health initiatives. Immunizations, such as those for seasonal influenza, provide an opportunity for retail pharmacists working in some states under a CPA to administer vaccines, Weaver noted.

"Pharmacists have the education and training needed to assess a patient's immunization status and administer vaccines that are needed. Eliminating the extra barrier of a prescription from another provider can help to increase immunization rates," she said.

Independent pharmacies are also offering immunizations with the use of CPAs, according to Christy Truong, administrator of the collaborative practice agreement program for immunizations at AmerisourceBergen.

"Each state's regulatory and licensure requirements for immunization vary. Our program, depending on each state, enables the pharmacist to enter into a partnership with a physician to coordinate immunization administration, pursuant to the applicable state regulations and requirements," she said. "Our program helps to reduce the administrative fragmentation and the administrative burden for the pharmacist by looking for local physicians that satisfy the state's requirements, so that they have more time to spend with the patient to do the patient counseling and education."

CPAs for naloxone therapy

Some states allow pharmacists to provide other public health services, such as testing for tuberculosis, support for smoking cessation, and now the dispensing of naloxone (Narcan), the life-saving medication that reverses opiate overdose.

In 2012, Washington state saw the first collaborative drug therapy agreement that allowed a retail pharmacy to prescribe and dispense under a written guideline for naloxone. According to "Using Law to Support Pharmacy Naloxone Distribution," an issue brief published by the Network for Public Health Law, other parties to the protocol were the public health agency of Seattle, Washington, and King County, and the University of Washington Alcohol and Drug Abuse Institute.

In 2013, a Rhode Island hospital physician, Josiah Rich, entered into a CPA with Walgreens to conduct a pilot project that allowed pharmacists to identify patients eligible for naloxone and to start the therapy, guided by a written protocol. This process requires the pharmacist to fax a note to the prescriber when naloxone is dispensed; the patient must sign a consent form giving the provider access to the patient's medical record.

In March 2014, when the state's Department of Health released regulations pertaining to naloxone, single prescribers were enabled to authorize a non-patient-specific order, allowing police departments access to the opioid antagonist, the issue brief stated. …

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