Pharmacist Collaborative Practice Privileges in Diabetes Management

1. Pharmacist Collaborative Practice Privileges in Diabetes Management Nisha Patel, PharmD PGY1 Pharmacy Resident El Rio Community Health Center, Tucson, AZ 5/20/11

2. El Rio Community Health Center • A private, non-profit community health center since 1969 • The largest provider of medical and dental services to the uninsured and Medicaid populations of Pima County, Arizona. • 75% live below Federal Poverty Level • 78% are Hispanic and American Indian • Member of the Patient Safety and Clinical Pharmacy Services Collaborative sponsored by the Health Resources and Services Administration (HRSA)

3. El Rio Community Health Center • The first sight in state of Arizona to receive collaborative practice agreement • Collaborative practice started in 2001 • diabetes, hypertension, and cholesterol management • A total of four clinical pharmacists working in collaboration with approximately 50 providers

4. El Rio Community Health Center • A total of 2200are managed by the clinical pharmacists • Patient-Centered Medical Home

5. Collaborative Drug Therapy Management (CDTM) • Collaborative Drug Therapy Management (CDTM) is a type of collaborative practice where a provider and one or more pharmacists have jointly agreed, on a voluntary basis, to work together under protocolwhere the pharmacist may perform certain patient care functions authorized by provider subject to specific conditions and/or limitations.

6. Collaborative Drug Therapy Management (CDTM) • The duties of the pharmacists involved in CDTM may include • Patient assessment • Ordering drug therapy-related lab tests • Administering drugs • Selecting, initiating, monitoring, and adjusting drug regimens

7. Collaborative Drug Therapy Management (CDTM) • 45 out of 50 states now have provisions for CDTM • However, authorized abilities allowed under CDTM vary from state to state • Involves written protocols between prescribers and pharmacists • These protocols may be required to be specific for disease, for patient, or for both. In Arizona the protocols are specific for disease.

8. Collaborative Drug Therapy Management (CDTM) • State laws or boards of pharmacy usually spell out what needs to be included in the protocol • Depending on practice setting, there can be different requirements for pharmacists engaging in CDTM

9. Collaborative Drug Therapy Management (CDTM) • States might also require pharmacists to have special training or approval/certification by the state board of pharmacy • Typically focuses on managing complex medication regimens or chronic disease medication therapies for diabetes, hypertension, dyslipidemia, anticoagulation, or asthma

10. Protocol Agreements Regardless of Practice Site • CDTM agreements between a pharmacist and a provider, or group of providers, are voluntary agreements • CDTM agreements provide delegated authority by the providerand increase the opportunity for pharmacists to contribute their specialized expertise to a patient’s drug therapy • CDTM agreements should be between the provider and the pharmacistNOT the provider and the practice sites.

11. CDTM in State of Arizona • CDTM is guided by board-approved drug therapy management agreement • No location restrictions • Allows CDTM agreements with physicians and nurse practitioners

12. CDTM in State of Arizona • Authorized abilities per practice agreement for pharmacists • Implement, monitor, and modify drug therapy • The protocol has to be renewed annually • Pharmacists have to complete 6 hours of CE per disease state annually Adapted from Arizona Administrative Code. Available at: http://www.azsos.gov/public_services/Title_04/04-23.htm Adapted from Arizona Administrative Code. Available at: http://www.azsos.gov/public_services/Title_04/04-23.htm

13. El Rio Community Health center • The CDTM includes diabetes, blood pressure and cholesterol management • Patients have to have diagnosis • Patients are referred to clinical pharmacist by primary care providers • Pharmacist processes the referral

14. El Rio Community Health Center • Yearly monofilament test • Yearly eye screening • Depression screening • On board Nutritionist • Referrals

15. El Rio Community Health Center • Several project involvement to improve outcomes and expand program • Cardinal Foundation Grant • EDGE Grant • Project IMPACT Diabetes

16. Considerations before Entering a CDTM Agreement • Agreements are voluntary and entered into on an individual basis • Provider and pharmacist should identify specific communication responsibilities for sharing information and improving patient’s continuity of care • Provider and pharmacist should discuss how often and in what form (electronic, phone etc.) they should communicate regarding patient monitoring and CDTM activities

17. Conclusion • CDTM arrangements can be a powerful and positive way to improve patient care and build inter-professional relationships • Allow providers and pharmacists to make the most of their respective education and training for patients’ best interests

18. Conclusion • A comprehensive approach to healthcare, encouraging the collaboration of health care providers, improves the quality, efficiency and cost-effectiveness of medical care • The growing body of literature supporting the role of pharmacists in diabetes care • Provide “continuity of care”

19. QUESTIONS!!