Pharmacists (Position Paper)
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. The pharmacy professional and physician can and should work collaboratively so that their combined expertise is used to optimize the therapeutic effect of pharmaceutical agents in patient care. It is the intent of this document to define the nature of that relationship.
The increased complexity of pharmaceutical applications is at least partially reflected in the pharmacy profession's decision to upgrade its educational standards. Until July 1, 2000, an individual who wished to become a pharmacist could enroll in a program of study that would lead to either a bachelor of science degree or a doctor of pharmacy degree. As of July 1, 2000, the doctor of pharmacy became the only degree accredited by the American Council for Pharmaceutical Education (ACPE). PharmD programs take six years to complete and usually involve two years of preprofessional coursework and four years of professional education.1 For the purposes of this document, the terms pharmacist, PharmD, and pharmacy professional are interchangeable.
Expanded Scope of Practice
Like other health professionals, pharmacists are seeking to expand their influence and scope of practice. Expanded roles for pharmacists have been promoted via legislative and regulatory action. Currently, 46 states have collaborative drug therapy management (CDTM) legislation or regulations.2 These laws allow physicians and pharmacists to enter into voluntary written agreements to manage the drug therapy of a patient or group of patients. The American Pharmacists Association outlined the activities that CDTM may include:
- Initiating, modifying, and monitoring a patient's drug therapy
- Ordering and performing laboratory and related tests
- Assessing patient response to therapy
- Counseling and educating patients about their medications
- Administering medications
Benefits of Collaborative Arrangements
At the core of integrated care models such as the patient-centered medical home (PCMH) and the accountable care organization is the concept of coordinated and team-based care. There is a growing body of evidence that medication management programs can make positive contributions to patient health. In many of these studies, pharmacists lead the medication management programs.
Additionally, 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. 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 and their state registry when one exists so that there is a complete vaccination record to assure continuity of the patient's medical record.
Relationship with Physicians
Fragmentation of care is one of the challenges in the American health care system. The PCMH and other such efforts to improve collaboration and team-based care models should be encouraged, whereas the development of islands of health care service or further fragmentation of care should be discouraged. In a collaborative environment, the pharmacist is a logical member of a team. Although pharmacists should not independently diagnose, they are qualified to deal with issues of medication use, medication tolerability, patterns of medication use, assessment of therapeutic response, and dosing adjustments.4 Although the AAFP supports health professionals working together, current policy says that "...interests of patients are best served when their care is provided by a physician or through an integrated practice supervised directly by a physician."3 This defines the family physician as the coordinator and the pharmacy professional as a member of an integrated team.
The AAFP supports arrangements where the pharmacist is part of an integrated, team-based approach to care. The AAFP believes that 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 Council on Credentialing in Pharmacy, "Credentialing in Pharmacy," September 2000.
- American Pharmacists Association, "Pharmacists Finding Solutions Through Collaboration," www.pharmacist.com(www.pharmacist.com).
- The American Academy of Family Physicians, "Team-Based Care" Policy.
- The American Academy of Family Physicians, "Drugs, Prescribing" Policy.
(2002) (2018 February BOD)