Clinical Pharmacy Practice Models relation to this - PDF document

9/21/2016 Disclosure • I have no actual or potential conflict of interest in Clinical Pharmacy Practice Models relation to this program/presentation. in Oncology Patient Care Rachel Matthews, PharmD, BCOP Objectives • Understand what published literature says about the role of oncology clinical pharmacists in patient care • Identify current gaps in oncology patient care Roles of Clinical Oncology Pharmacists • Discuss the Pharmacy Practice Model Initiative and implications for oncology practice • Recognize practice site characteristics that will affect the type of model that may work for you • Identify types of inpatient oncology practice models • Identify types of outpatient oncology practice models ACCP: Clinical Pharmacist ACCP: Clinical Pharmacist • Comprehensive Medication Management (CMM) • Patient assessment : review medical records, discuss medication history with patient/caregivers, prioritize [aka MTM/DTM] problems/needs • Individualized care plan • Medication evaluation : optimize therapy • Care coordination in various settings (appropriateness, effectiveness, safety, affordability, • Ability to practice in team based care and direct adherence) • Plan of care : team collaboration; formulate plan and patient care environment implement; patient/caregiver education; measurable • Completion of residency training or equivalent outcomes and follow up practice experience • Monitoring : monitor and evaluate therapy; collaborate • Board certification by Board of Pharmacy Specialties with team continually; assess and adjust therapy as needed (BPS) American College of Clinical Pharmacy Pharmacotherapy 2014;34(8):794 ‐ 97 American College of Clinical Pharmacy Pharmacotherapy 2014;34(8):794 ‐ 97 1

9/21/2016 ASHP Ambulatory Care Summit Pharmacist ACCP: Clinical Pharmacist Role (Recommendation 1.2) • Documentation : document in patient’s medical • Perform patient assessments record assessments, plan of care, follow up • Prescribing authority • Develop collaborative drug therapy management • Collaborative drug therapy management agreements with physicians, medical groups, or • Order, interpret, and monitor medication therapy ‐ health systems related tests • Participation in continuing professional • Coordinate care for wellness and disease prevention development, research, education of other • Patient and caregiver education healthcare providers or students • May also have roles as administrators, managers, • Document in medical record policy development, consultations American College of Clinical Pharmacy Pharmacotherapy 2014;34(8):794 ‐ 97 ASHP. Am J Health ‐ Syst Pharm 2014; 71:1390 ‐ 1 Clinical Oncology Specialist Roles Clinical Oncology Specialist Roles • Order set, policy, procedure, and guideline • Investigational drug services development • Research • Chemotherapy counseling (patients/caregivers) • Education (residents, students, peers) • Discharge education for medication therapy • Chemotherapy order verification/writing • Formulary management • Coordination of care • Patient care: CMM, medication reconciliation, team • Cost effectiveness analysis rounding • Tumor boards* • Anticoagulation services • Targeted therapies & Pharmacogenomics* • Pharmacokinetic services • Optimize clinical decision support technology* HOPA. Scope of Hematology/Oncology Pharmacy Practice. HOPA. Scope of Hematology/Oncology Pharmacy Practice. http://www.hoparx.org/uploads/files/2013/HOPA13_ScopeofPracticeBk.pdf http://www.hoparx.org/uploads/files/2013/HOPA13_ScopeofPracticeBk.pdf Select Recommendations from ASHP Practice Model Summit • All patients have a right to the care of a pharmacist • Hospital and health ‐ system pharmacists must be responsible & accountable for patients’ medication ‐ Implications for oncology practice related outcomes • Every pharmacy department should identify drug therapy management (DTM) services provided consistently by its pharmacists • Pharmacist completion of ASHP ‐ accredited residency training or equivalent experience is essential to DTM in optimal pharmacy practice models Zellmer WA. Ann Pharmacother. 2012;46(suppl 1):S41 ‐ 5; ASHP. Am J Health ‐ Syst Pharm . 2011;68:1148 ‐ 52 2

9/21/2016 Select Recommendations from ASHP Select Recommendations from ASHP Practice Model Summit Practice Model Summit • Optimal pharmacy practice models • Pharmacists providing DTM should be certified ▫ Pharmacists have oversight and responsibility for through the most appropriate BPS certification medication distribution • Sufficient pharmacy resources must be available for ▫ Pharmacist role should not be limited to distribution and technology ‐ related medication ‐ use safety standards reactive order processing • Uniform national standards should apply to ▫ Individual pharmacists should not engage in drug therapy management without understanding and responsibility for education and training of pharmacy technicians medication use and delivery systems • Distributive functions not requiring clinical ▫ Individual pharmacists accept responsibility for clinical and judgement should be delegated to technicians distributive activities of the department ▫ Clinical specialist positions are necessary to advance practice, education, and research activities Zellmer WA. Ann Pharmacother. 2012;46(suppl 1):S41 ‐ 5; ASHP. Am J Health ‐ Syst Pharm . 2011;68:1148 ‐ 52 Zellmer WA. Ann Pharmacother. 2012;46(suppl 1):S41 ‐ 5; ASHP. Am J Health ‐ Syst Pharm . 2011;68:1148 ‐ 52 Current Practice Models in Hospitals Clinical Pharmacy Specialist ‐ Centered • Drug ‐ distribution centered • Division of pharmacy staff into teams of distribution ▫ Mostly distributive pharmacists pharmacists and clinical pharmacists ▫ Limited clinical services • Clinical staffs’ role is primarily consultations and • Patient ‐ centered integrated patient ‐ focused activities (ex. interdisciplinary ▫ clinical generalist model, limited role differentiation rounds) ▫ Nearly all pharmacists participate in distribution and • May be conflict within the department clinical roles • Inconsistent pharmacy coverage in clinical patient • Clinical ‐ specialist centered ▫ Separation of distribution and clinical roles care activities resulting in fragmented care ▫ Defined roles with little overlap Zellmer WA. Ann Pharmacother 2012;46(suppl 1):S41 ‐ 5 Woods TM, et al. Am J Health ‐ Syst Pharm . 2011;68:259 ‐ 63; Jacobi J, et al. Pharmacotherapy . 2016;36(5):e40 ‐ e49 Patient ‐ Centered Integrated Practice(PCIP) Patient ‐ Centered Integrated Practice(PCIP) • Thought to best support high ‐ quality patient care per • Clinical specialists’ concerns with this model the ASHP Pharmacy Practice Model Initiative (PPMI) ▫ Compression of roles and loss of specialty • Proactive, comprehensive, flexible, adaptable, and ▫ Limit opportunities for directing and optimizing care of efficient for patient ‐ focused care high ‐ risk, complex patients (ICU, Cardiology, Oncology, • Larger number of pharmacists with clinical and Pediatrics) operational roles • Potential barriers to this model • Easier recruitment and retention of engaged staff ▫ Training of pharmacy staff with advanced training ▫ Optimizing care of high ‐ risk patients • Cross ‐ training of staff provides clinical patient care ▫ Resources, $$ consistently, eliminating fragmented care Woods TM, et al. Am J Health ‐ Syst Pharm . 2011;68:259 ‐ 63; Jacobi J, et al. Pharmacotherapy . 2016;36(5):e40 ‐ e49 Woods TM, et al. Am J Health ‐ Syst Pharm . 2011;68:259 ‐ 63; Jacobi J, et al. Pharmacotherapy . 2016;36(5):e40 ‐ e49 3