How to Integrate Clinical Pharmacists Into Primary Care
Clinical pharmacists can take team-based care to the next level.
Fam Pract Manag. 2021 May-June;28(3):12-17.
In today's practice environment, with increased demands on physicians' time, increased complexity of medication management, and increased performance expectations, primary care physicians need not go it alone. Collaborating with clinical pharmacists is a promising way to expand team-based care.
Clinical pharmacists are among the least understood and most underrated members of health care teams. The duration of their education and clinical training surpasses that of nurse practitioners and physician assistants, yet clinical pharmacists are too often relegated to episodic consultations for individual patients or tinkering at the edges of clinical care in supply-based assignments calibrated below their doctorate degrees. With high ratios of education and training to sphere of practice, clinical pharmacists are capable of stepping into the challenges of daily clinical care, making substantial contributions to care teams, and building robust population health programs. (See “Get to know clinical pharmacists.”)
Options for collaboration include employing a clinical pharmacist whose time can be shared by the physicians in your group, contracting with a clinical pharmacist in the community, or partnering with a nearby school of pharmacy.
A good way to begin collaboration with a clinical pharmacist is by making referrals for medication safety reviews for at-risk patients.
As confidence in the team approach grows, you can extend your collaborations into more complex areas such as drug monitoring, chronic care management, deprescribing, and population health.
This article shares practical ideas for collaboration, assuring clinical pharmacists are working at the top of their licenses while expanding the ability of primary care doctors to resolve complex clinical challenges and enhance quality of care for their patients. (See “Three prerequisites for working with clinical pharmacists.”)
THREE PREREQUISITES FOR WORKING WITH CLINICAL PHARMACISTS
Medium and large medical groups may employ a clinical pharmacist whose time is shared among several clinics. Smaller groups could consider contracting with a clinical pharmacist in the community or partnering with a nearby school of pharmacy to provide part-time clinical space and patient access while expanding patient care services to include clinical pharmacy.
With either approach, three ingredients are a must for working effectively with clinical pharmacists.
A Collaborative Practice Agreement (CPA) is a written statement, guided by federal law, your state board of pharmacy's regulations, and your organization's defined scope of practice for clinical pharmacists. It outlines the inclusion and exclusion criteria for clinical pharmacists' interventions, the classes of drugs clinical pharmacists may prescribe, and the degree of oversight from participating physicians. This agreement enables incident-to billing for clinical pharmacists' patient care services and assures stakeholders that the collabo
1. Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H. Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials. BMJ. 2005;331(7512):321–327.
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