Over the past decade, physician-pharmacist collaborative practices have gained traction in primary care as a way to implement team-based-care models. And there is evidence pointing to the effectiveness of this multidisciplinary heath care team approach, in which pharmacists are typically responsible for such things as obtaining medication histories, identifying barriers to adherence, and adjusting medication regimens.
Several studies have shown the significant impact that physician-pharmacist collaborative management (PPCM) can have on blood pressure (BP) control among patients with hypertension (HTN).1-8 Additionally, PPCM may have positive effects on HbA1c reduction and diabetes control,9-11 suggesting that benefits may extend to other chronic diseases, too.
In the review that follows, we’ll detail the impact that PPCM can have on patient care, health-care utilization, and cost effectiveness. (For a look at PPCM “in action,” see the sidebar below.) We’ll also review the challenges of implementing this model that, at present, is mostly found in academically-affiliated clinics and large health systems.
The physician-pharmacist collaborative care model in actionFor patients with chronic diseases such as hypertension and diabetes, pharmacists can be invaluable members of multidisciplinary health care teams by providing direct consultation to optimize pharmacotherapy. Although their particular role and responsibilities can vary widely from one primary care setting to the next, the following describes the general workflow of a physician-pharmacist collaborative care model in action.
The patient, 60-year-old Isabel B, arrives for an appointment for pharmacotherapy management of her hypertension. After checking in, a registered nurse (RN), medical assistant (MA), or the pharmacist obtains her vital signs, height, and weight prior to rooming. Additionally, any necessary point-of-care lab tests are obtained at this time.
Once the patient is roomed, the pharmacist collects a thorough medication history from Ms. B, verifying and updating her current medication list, confirming the dose and frequency of each medication, and gathering information regarding adverse effects and barriers to adherence. The pharmacist may also review current laboratory results and vital signs to assess the appropriateness and therapeutic efficacy of the current drug therapy regimen.
Depending upon the collaborative practice plan in place, one of the following steps may occur:
A. The pharmacist makes a change to Ms. B's medication regimen and orders any necessary laboratory tests for monitoring. A progress note is forwarded to Ms. B's primary care provider (PCP) to inform him/her of the changes made to the regimen and the follow-up interval.
B. The pharmacist presents pharmacotherapy recommendations to the attending physician or Ms. B's PCP. The therapeutic and monitoring plans are discussed and approved as a team at the time of Ms. B's visit.
C. The pharmacist sends a message to Ms. B's PCP regarding information discovered during the interview and provides recommendations for a treatment plan based on the visit. The PCP reviews the recommendations, and can either 1) send approval to the pharmacist through a message or 2) implement the appropriate drug therapy changes at Ms. B's next visit.
In Cases A and B, the pharmacist then reviews the final pharmacotherapy plan with Ms. B, discusses the medication and monitoring parameters, answers any questions related to the new treatment regimen, and schedules a follow-up visit. In Case C, the pharmacist may still provide medication counseling and answer questions related to drug therapy during the visit; however, review of the final pharmacotherapy plan may be done over the telephone after approval by the PCP. Alternatively, a follow-up appointment with Ms. B's PCP can be scheduled shortly after the visit with the pharmacist to discuss any recommended drug therapy changes.