[e-drug] Pharmacists as members of the healthcare team (11)

e-drug
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E-DRUG: Pharmacists as members of the healthcare team (11)
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I've been reading your contributions on clinical pharmacy recognition by
medical practitioners.

Clinical pharmacy is a pharmacy discipline where a pharmacist as a member
of the healthcare team works to ensure safe efficacious and cost effective
drugs are available for the patient.

Clinical pharmacy practice is centered around the philosophy of
pharmaceutical care which is defined by Hepler and Strand as "the
responsible provision of drug therapy to achieve definite outcomes that
improve the patient's quality of life."

This means that it is a patient centred practice and the pharmacist is
responsible and accountable for all drug related needs of the patient.

The functions of a clinical pharmacist are summarised under activities like
identifying the need of drug, choosing appropriate drug while considering
patient and drug factors, providing the drug and ensuring it is
administered in the correct dose, dosage form and using the correct route.

Finally monitoring of the provided therapy is done which requires knowledge
of patient parameters, signs and symptoms of disease and lab parameters.
Patient education on drug use, side effects, use of drug administration
devices eg insulin pumps, inhaler devices etc together with counselling on
compliance and concordance to therapy are other important functions of a
clinical pharmacist.

In the health care team the pharmacist is an equal member who should be
viewed as an expert in drug therapy. A clinical pharmacist can make
effective contributions in any setting eg internal medicine, surgery, ICU,
paediatrics, oncology, gynaecology etc. The pharmacist will not in this
case carry out procedures or diagnose diseases but will carry out a
medication history and medical history which will help them select and
provide medication according to their specific needs. Clinical pharmacy
practice is patient specific and not disdease specific. Eg for a patient
with cardiovascular disease undergoing surgery a pharmacist should design a
pharmaceutical care plan that involves drugs to be stopped before surgery
and after surgery, point out the drugs that might interact with
anaesthetics and muscle relaxants, indicate the drugs that should or should
be given in the nil by mouth period and their routes, appropriate drug dose
adjustments etc.

When you look at the examples I've given the pharmacist does in no way take
the role of a medical doctors but works together with them to improve the
quality of life of the patient and sometimes lessen the burden of the
medics. It is a collaborative effort. Studies have been done and more are
still being done to show the impact of the pharmacist and most have shown
improved patient outcomes and overall reduced healthcare costs.

In summary
The pharmacist is an integral member of the healthcare team and offers
essential and not supportive services

The pharmacist collaborates with the medical doctor and does in no way aim
to replace them by diagnosing diseases and carrying out surgical procedures

Patient outcomes have been improved by pharmaceutical care

NB: clinical pharmacy practice can be carried out in both inpatient and
outpatient settings and ambulatory care clinics.

Dr Sylvia Opanga, B. Pharm, M. Pharm (Clinical Pharmacy), PhD Student.
Clinical pharmacy Specialist in Surgery and Infectious Diseases
Lecturer School of Pharmacy,
University of Nairobi
Kenya.
sylvia adisa <sylvia.adisa@gmail.com>

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E-DRUG: Pharmacists as members of the healthcare team (11)
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[Thank you Andy for taking the time to provide this detailed explanation!
Moderator]

Hi all

It has been intriguing to follow the evolution of the subject line in
this string:
* U.S. Surgeon General Supports Recognition of Pharmacists as Health
Care Providers
* Recognition of pharmacists as health care providers
* Recognition of Pharmacists as healthcare workers

What seems to have become lost is the nature of the initial problem,
and the reason for the proposal by the US authorities (from the Office
of the Chief Pharmacist, US Public Health Service), and the subsequent
endorsement by the US Surgeon-General. The citation for the initial
report is "Giberson S, Yoder S, Lee MP. Improving Patient and Health
System Outcomes through Advanced Pharmacy Practice. A Report to the U.S.
Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011."

It is accessible at
http://www.usphs.gov/corpslinks/pharmacy/comms/pdf/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf
The SG's letter is at
http://www.usphs.gov/corpslinks/pharmacy/comms/pdf/2011SupportLetterFromUSSG.pdf

What is in question here is not whether pharmacists have a clinical
role or not, or whether they can engage in collaborative practice
(including some prescribing actions) or not, but whether they are
legally recognised and reimbursed in terms of US law (specifically the
Social Security Act). Here is an excerpt from the report cited above
(CMS is the Centers for Medicare & Medicaid Services):

"The most significant and influential payer for these services is the
CMS. Many additional third party payers follow the CMS compensation
structures and guidance. Pharmacists are not currently recognized by CMS
as health care providers, potentially impeding some private and federal
sector patients from receiving optimal quality patient care services. As
a point of comparison, the Social Security Act appropriately recognizes
a number of other health care professionals as 'providers or
practitioners,'  including physician assistants, nurse practitioners,
certified nurse midwives, clinical social workers, clinical
psychologists, and registered dieticians or nutrition professionals.
Recognition of pharmacists as health care providers in the Social
Security Act under Title 18, Part E, Section 1861 is a critical addition
of language needed to sustain these services to meet the growing demands
of access to care as well as serving vulnerable and rural populations.
CMS payment policies and definitions can then parallel pharmacists'
current and critical role to improve health care delivery."

I have appended another excerpt below which covers the legislative
history of this issue and some proposals for resolution.

However illuminating the discussions have been (and at times they have
merely rehearsed well-worn paths and well-entrenched positions), the
issue is not about who is in or out, who can do what instead of or in
addition to another, but who gets paid, and for what services, in the
US. That said, reimbursement for non-distributive functions by
pharmacists in community and hospital settings is an issue in many
countries and many health systems. Can we re-focus the debate on that
issue, and perhaps get examples of good practice from different
settings?

In South Africa, the SA Pharmacy Council has listed professional
non-distributive services for which a pharmacist may levy a fee and
issued a Board Notice in this regard. Those fees linked to dispensing
are governed by the Regulations issued in terms of the Medicines Act, so
fall outside of the remit of the Pharmacy Council. However, there is
little evidence that insurers in the private sector (medical schemes in
local parlance) are willing to reimburse for these non-distributive
functions, even when they are rendered.

regards
Andy