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Leadership Roundtable June 2011

Accelerating Effective Pharmacy Practice Models. RADM Scott Giberson, RPh, PhC, NCPS-PP, MPH U.S. PHS Chief Professional Officer, Pharmacy U.S. Assistant Surgeon General. Leadership Roundtable June 2011. Panel Objectives. The Nation has needs: Access Quality Cost Safety

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Leadership Roundtable June 2011

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  1. Accelerating Effective Pharmacy Practice Models RADM Scott Giberson, RPh, PhC, NCPS-PP, MPH U.S. PHS Chief Professional Officer, Pharmacy U.S. Assistant Surgeon General Leadership Roundtable June 2011

  2. Panel Objectives

  3. The Nation has needs: Access Quality Cost Safety The Profession has capacity and skill: Direct Care Public Health Health Leadership Great disparity exists between the goal of optimal health outcomes and maximal use of all health professionals Expand Pharmacy’s Scope and Impact May become an under-resourced and overburdened healthcare delivery system

  4. Diverse Scopes 2011 and Beyond Public Health Scope

  5. Clinical (‘Primary’ Care) Scope

  6. Practice Models • What process was employed to make the pharmacist-delivered service consistent in process and quality? • How did the service transition from a local practice model to a national level program? • Who were the champions of the practice model? How did you get their buy-in? • What are the processes for continuous innovation, improvement? • What lessons were learned from the process of developing a national program? • What were the roadblocks?

  7. National Clinical Pharmacy Specialist (NCPS) Program To develop and implement a national program and process that: • Reviews and recognizes credentials of local Clinical Pharmacy Specialist (CPS) • Assures and promotes uniformity of clinical competence through national certification • Serves to promote universal recognition of pharmacists as billable health care providers • Captures value and impact from those services • Continues program expansion and innovation

  8. Scope • Intended to recognize advanced scopes of practice at local level that satisfy uniform national guidelines • Involve management of disease through therapy • Care/Privileges must include: • Interview, chart review • Laboratory privileges • Prescriptive authority • Physical assessment • Patient education and follow up • NCPS grants a certification • Privileges are granted locally by medical staff

  9. Pharmacists locally privileged. Work to satisfy national requirements Re-certification every 3 yrs: ongoing practice hours and CE Submit credentials to NCPS Committee for review Continue to practice locally, now as NCPS pharmacists assuring similar scope and quality • Experiential components: • 2-4 yrs in clinical PHS pharmacy practice • > 1 year in clinical practice with requested privileges as local clinical pharmacy specialist • Attestation letters from physician • Didactic Credentials • Annual patient contact hours • NCPS-approved Collaborative Practice Agreement (CPA) Certification Process: Local vs. National

  10. Collaborative Practice Agreements (CPAs) • NCPS approves a CPA for each NCPS pharmacist, to assure uniformity in process, scope and quality • CPAs are reviewed for these critical elements: • Rationale (Justification), Purpose • Clinic Policy and Procedures (CDTM+) • Clear Indication of Privileges (the “Big 3” scope) • Performance: QA and Outcomes • Training and Local Attestation • Privileging/Re-Privileging • Clinical Information: National Guidelines • Appropriate Signatures • The “rationale” for CPA

  11. Process and Patient Impact • Process • Uniformity of scope and documented outcome • Best practice model standardization • Uniform process that reviews training, attests to knowledge and education • Helps to assure clinical competence • External expansion was another step to uniformity • Patient • Access to care • Quality care (clinical/admin outcome, safety) • Inter-professional support

  12. Example of Physician Survey Results(n=117 physicians) • 96% of respondent-physicians reported benefit(s): • improved outcomes • increased return on investment • allowing for physician shift in workload • increased patient access to care

  13. Continuous Innovation • Change the Paradigm: • Value local privileging based on practice setting • Assurance of competency • Involve physicians and patients in planning and marketing • Illustrate patient AND administrative outcomes • Base service on need • Report to the Surgeon General • Federal Pharmacist Vision

  14. Critical Conversation • We ARE health care providers • We ARE public health professionals • We ARE part of national health leadership Challenges (‘Roadblocks’) • Compensation based on level of service • Uniformity of message – lack of common vision • Dispelling the myths • Territory? • Education Level? • Outcomes? • Practice setting • Legal barriers

  15. Call-to-Action • Continue to have uniform message • Keep all the doors open for pharmacists • Lead change for patients and health systems • Focus efforts on broad concepts • Leverage federal pharmacy practice • We shouldn’t be our harshest critics

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