AAFP Defines Role of Pharmacists, Family Physicians in Health Care Delivery System

The AAFP has issued a revised position paper that helps to define the professional relationship between pharmacists and family physicians in an integrated health care delivery system.

The AAFP recognizes the "evolving complexity and proliferation of pharmaceutical agents and (the) important role pharmacists play in the delivery of high quality health care," says the position paper. And "The AAFP supports arrangements where the pharmacist is part of an integrated team-based approach to care."

However, the paper adds, the AAFP believes "only licensed doctors of medicine, osteopathy, dentistry and podiatry should have the statutory authority to prescribe drugs for human consumption."

The revised position paper is a response to increased efforts by pharmacists to expand their influence and scope of practice.

"Expanded roles for pharmacists have been promoted via legislative and regulatory action," notes the Academy's position paper. "Currently, 46 states have collaborative drug therapy management legislation or regulations. These laws allow physicians and pharmacists to enter into voluntary written agreements to manage the drug therapy of a patient or a group of patients."

Activities that the American Pharmacists Association indicates may be included in these regulations or legislation include

This type of "fragmentation of care" is a substantial challenge in the American health care system, notes the paper, which points out that in response, patient-centered medical home (PCMH) and team-based models of care should be encouraged, and "development of islands of health care service or further fragmentation of care should be discouraged." The paper calls on pharmacists and physicians to work collaboratively "so that their combined expertise is used to optimize the therapeutic effect of pharmaceutical agents in patient care."

"In a collaborative environment, the pharmacist is the logical member of a team and is qualified to deal with issues of medication use, medication efficacy and patterns of medication use," says the paper. However, "independent prescription authority for pharmacists will further fragment the American health care system and will undermine the national goals of integrated, accountable care and models, such as the PCMH."

The paper also points out that the concept of coordinated and team-based care lies at the core of integrated care models, such as the PCMH and accountable care organizations. Within this framework, "there is a growing body of evidence that medication management programs can make positive contributions to patient health. (And) in many of these studies, pharmacists lead the medication management programs."

Moreover, according to the paper, pharmacists "have an important role in providing direction to patients seeking advice on over-the-counter medications. For the patient seeking nonprescription medication, the pharmacist is positioned to determine the presence of allergies as well as adverse reactions between prescription and over-the-counter medications," says the policy.

"However, the AAFP recommends that vaccine administration be provided in the medical home setting. When vaccines are administered elsewhere, the information should be transmitted back to the patient's primary care physician so that there is a complete vaccination record."