Drug Topics - October 8, 2007 - (Page 34)

34 DRUG TOPICS OCTOBER 8, 2007 www.drugtopics.com LEGAL Q&A John E. Dinardo, R.Ph., J.D. How to set up a collaborative practice Modern pharmacy practice has grown professionally to unprecedented levels—from traditional dispensing functions to sophisticated clinical roles. One important area is collaborative drug therapy management (CDTM), whereby, according to the National Association of Boards of Pharmacy (NABP), a pharmacist has voluntarily agreed to work with a practitioner under a protocol within which the pharmacist may perform certain patient care functions authorized by the practitioner under specified conditions and/or limitations. A collaborative pharmacy practice agreement, signed among one or more pharmacists and one or more practitioners, provides for collaborative drug therapy management of patients. Drug therapy management implies review of a patient’s drug therapy regimen by a pharmacist for the purpose of evaluating and rendering advice to a practitioner regarding adjustTo participate in ment of the regimen, with decisions inCDTM, a pharmacist volving drug therapy management made in the best interest of the patient. Such must adhere to a management may include (1) implementparticular state’s ing, modifying, and managing drug therapy according to the terms of the collaborequirements for rative pharmacy practice agreement, (2) such practice. collecting and reviewing patient histories, (3) obtaining and checking vital signs, (4) ordering and evaluating the results of laboratory tests directly to drug therapy, when performed in accordance with approved protocols applicable to the practice setting, and (5) such other patient care services allowed by law. To participate in CDTM, a pharmacist must adhere to a particular state’s requirements for such practice. Although the vast majority of states have established some level of CDTM, there are many variations and important differences among the states’ pharmacy practice acts. Attributes of state regulations governing CDTM include: (1) types of collaborative practice agreements, (2) levels of review of approval required, (3) medications included, (4) practice environments, (5) educational requirements/demonstrated competencies, and (6) other aspects addressed by the state. Some states require a written protocol for each patient; others require only a general written protocol. Some states limit the type of practice agreement to an administration of injectables (medications, biologics, and vaccines) Q How do I set up a collaborative practice protocol with a physician? A protocol, or to an emergency-contraceptive protocol only. Most states do not specify a limitation. The required levels of review of approval also vary from the physician, to the board of pharmacy, to the board of medical examiners, the facility itself, or various combinations. A few states require no level of review of approval. While most states allow CDTM in all practice settings, some limit it to the institutional setting. Some states have additional educational requirements, such as the Pharm.D. degree, specialty certification, disease state management credentialing, accredited residency credentialing, or minimum clinical experience; some states have no additional requirements. Other aspects addressed by various states include specific pharmacist duties—initiating and modifying drug therapy, ordering lab tests, changing duration of therapy, altering drug strengths, modifying or discontinuing drug therapy, monitoring drug therapy, and patient assessment. It is imperative that the individual pharmacist adhere to his or her state’s specific regulations. In general, a pharmacist would first need to identify a physician who wishes to collaborate with the pharmacist. This could be accomplished in several ways, either on an individual, institutional, or corporate basis. The physician and pharmacist would then define the various parameters of the CDTM, based on the state’s pharmacy practice act; they would eventually execute a collaborative pharmacy practice act agreement, specifying the various duties and functions of each practitioner, including the various procedures necessary for performance. The agreement would also include the patient, since the pharmacist-patient relationship is a key element of CDTM. The patient would need to consent to the CDTM, thereby complementing and enhancing the patient-physician relationship and improving overall patient therapy. Moreover, the agreement would also include specific provisions addressing patient privacy and confidentiality issues. Obviously, adequate quality assurance is a critical component to the success of any CDTM protocol. Documentation of all activities related to CDTM needs to be followed according to state regulations and will need to be shared with and made available to the physician and other providers associated with the protocol, in accordance with HIPAA regulations. Additionally, compliance with the corporate pharmacy and/or institution’s own policies and regulations will be required. THE AUTHOR pharmacy. practices law in Pennsylvania and has 14 years of experience in http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics - October 8, 2007

Drug Topics - October 8, 2007 Latebreakers Latebreakers in Depth Letters Rx Care Community Practice JP at Large 150 Years of American Pharmacy Hospital Practice Are You Getting Pharmacy's Message Across? Self-Care Government and Law Legal Q&A The Pharmacist as First Responder in Disaster Relief Technology Update New Products Advertisers Index Statement of Ownership Classified Viewpoint

Drug Topics - October 8, 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.