- Email: [email protected]
Collaborative practice agreements a useful tool for researchers
DEPARTMENTS K. Weaver et al. / Journal of the American Pharmacists Association 56 (2016) 616e619
APhAeASP chapter leaders were invited to join this committee and participate in the planning and implementation of the health fair. In addition to APhAeASP, student leaders from Kappa Psi Pharmaceutical Fraternity, Student National Pharmaceutical Association, WSU College of Nursing, WSU Nutrition and Exercise Physiology, WSU Department of Speech and Hearing, WSU Health Policy Administration, Eastern Washington University (EWU) Social Work Education, and EWU Occupational Therapy were called to serve on the planning committee. From the beginning of February to early April, the East Central Community Health Fair Planning Committee held weekly meetings with WSU and EWU administrators to organize the event. Each leader on the committee was delegated tasks to assist in designing the event, while also charged with recruiting student volunteers to deliver patient care services during the event. Committee leaders also conducted site visits at possible venues for the health fair (before ultimately choosing ECCC) and worked together to plan what screenings and health resources could be offered and available during the fair. During these visits, leaders also discussed the unique qualities that each professional program could bring to the event and how these qualities could be utilized to add greater value to patients in attendance. This allowed the committee to develop a floor plan for where each professional program would be located during the health fair, what service or education each program would conduct, and how foot traffic would flow through the venue. These discussions made the committee become more of a team. Marshel Renz, a WSU student nurse, described his experience in planning and implementing the health fair: “Our health fair gave nursing students an excellent opportunity to work interprofessionally with members of the health care team. As future nurses, we are advocates for our clients, and it is necessary to educate patients on the best plan of care. That best plan of care involves input from everyone, including physicians, pharmacists, occupational, speech, and physical therapists. The health fair provided a real-life experience to work with our future colleagues.” After 2 months of planning, the WSU interprofessional team and student
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volunteers hosted the East Central Community Health Fair on April 16, at ECCC. Thirty-one APhAeASP members participated in the fair, performing cholesterol and bone density screenings, as well as educating patients about the importance of vaccinations, signs and symptoms of stroke, healthy diet choices for diabetes, and over-thecounter medication safety. In addition, APhAeASP members worked alongside student nurses, who performed blood glucose and blood pressure screenings at nearby work stations. Student nurses educated patients receiving the screenings about what happens in the body with hypertension and diabetes, while student pharmacists counseled patients on ways to reduce their risk for developing diabetes and cardiovascular disease. This created a synergistic dynamic to deliver patient care services and was well received by community members attending the health fair, most of whom had not visited a health care provider in years. In total, 62 East Central community members received screenings and health education. Meanwhile, the additional health professional programs involved in the fair offered screenings in other spaces within the venue, such as hearing screenings from the WSU Speech and Hearing students and body mass index from Nutrition and Exercise Physiology students. Finally, a major component to the health fair was the presence of community vendors. Community Health Plan of Washington, Molina Healthcare of Washington, and United Health Care were a few of the vendors present during the fair and played an important role for East Central community members by helping them find affordable health insurance plans. With more than 100 East Central community members attending the event, APhAeASP members witnessed the impact of a coordinated team approach to delivering patient care, and a shining example of APhAeASP President Kelsea Gallegos’ “Together We Can” theme. Each health professional student offered unique qualities that further added to the value of the health fair. By working together, student pharmacists and other health professional students were able to see how a collaborative effort can allow them to better serve their patients.
Reference 1. Spokane Regional Health District. Odds against tomorrow: health inequities in Spokane County. 2012. James Kent, Third-year PharmD Candidate, Washington State University College of Pharmacy, Pullman, WA
APhA-APRS Collaborative practice agreements a useful tool for researchers According to an APhA Foundation consortium report, collaborative practice agreements (CPAs) are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the health care team.1 At their core, CPAs provide an efficient arrangement for a physician, or other prescriber, to delegate some authority to the pharmacist for all patients meeting certain criteria rather than having a prior conversation about each Klepser case as it arises. CPAs can also be a useful tool for researchers seeking to implement and evaluate novel services. In fact, some states have mechanisms in place that allow for research or demonstration projects that would not otherwise be allowed under the state’s existing pharmacy practice act.2 To maximize the utility of CPAs for research, it is important for researchers to understand how they can be used, the challenges to implementation, and the role of the researcher in setting up a collaborative practice agreement. Research involving CPAs falls broadly into 2 categories: retrospective and prospective. The first is to retrospectively evaluate practice models, which include a CPA, that were developed at the practice site(s). These projects generally focus on the impact of expanded pharmacist involvement in patient care activities. Recent retrospective studies have demonstrated pharmacist involvement leads to improvements in
DEPARTMENTS K. Weaver et al. / Journal of the American Pharmacists Association 56 (2016) 616e619
patients' hemoglobin A1C in the Federal Bureau of Prisons,3 and confirmation that pharmacist-provided immunizations, much of which is conducted under CPAs, has had a positive impact on adult immunization rates.4 As with many retrospective research projects, these projects are usually descriptive in nature because they were designed as clinical services and not intended to test a hypothesis or answer a research question. The second type of research conducted with CPAs involves a researcher designing a prospective study that uses a CPA as the mechanism to implement a new service. Recent examples of these types of studies include the development of pharmacy-based influenza and group A streptococcus management programs.5,6 Prospective studies allow the researcher to use a more rigorous study design, including standardized protocols and data collection across sites, but there are still challenges to conducting research that is dependent on CPAs. One of the major challenges with research conducted using CPAs is the issue of scalability and, as a result, small sample sizes. Depending on state regulations, a CPA may require that patients covered by the CPA must have an existing relationship with the physician. In these cases, a pharmacy interested, for example, in offering a cholesterol management program to all of their patients with dyslipidemias, would likely have several similar CPAs in place to cover all providers in the community. Even then, the pharmacy would not be able to provide the service to patients without a primary care provider, which can be a particular challenge in developing acute care services. As a result, research studies employing CPAs in these states tend to have
small sample sizes, which limit the studies’ statistical power. Even in states that allow for broader collaborative practice agreements, each participating pharmacist is required to enter into a separate CPA, which can be a challenge when participating pharmacists are geographically dispersed and/or working for different organizations. The challenges of conducting research using CPAs are compounded when trying to conduct research in multiple states with different CPA rules and regulations. This can be particularly challenging for researchers working with chain pharmacies that may be hesitant to commit to research on a service that is only allowable in half of the markets where they operate, or that require significantly different designs for different locations. This can also create an issue of generalizability in CPArelated research if the results are dependent on the structure of the CPA. For example, our own research on an influenza model was successful in Michigan, Minnesota, and Nebraska, but can not currently be replicated in Ohio or Iowa because of differences in CPA rules. While CPA regulations in most states do allow for research opportunities, many pharmacists have limited experience with, or understanding of, their state CPA laws. This creates both opportunities and responsibilities for the researcher. All CPAs should reflect the physician’s and pharmacist’s mutually agreed upon protocol for caring for their patients, but the researcher will likely have to provide a template, or examples, to aid in the process and discussion. Moreover, the researcher should be prepared to not only assist the practitioners with filing the CPA with the appropriate professional boards, but also to appear before those boards to
explain the research and how it fits within the state’s pharmacy practice act. Collaborative practice agreements allow for the development, implementation, and study of unique and innovative pharmacy services. Ultimately, high quality, rigorous research of pharmacy services made possible through CPAs will lead to decisions about reimbursement, expansion, and, in some cases, opportunities to create independent pharmacy services. To that end, researchers should focus on well-designed and conducted studies demonstrating the value of CPAs and the services they allow. References 1. Bluml BM. Consortium recommendations for advancing pharmacists' patient care services and collaborative practice agreements. J Am Pharm Assoc (2003). 2013;53:e132ee141. 2. Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services. Pharmacy Pilot Project Procedures. Available at: https://www.michigan.gov/documents/lara/ lara_Pharm_Pilot_project_procedures_052015_ 488775_7.pdf. Accessed September 15, 2016. 3. Bingham JT, Mallette JJ. Federal Bureau of Prisons clinical pharmacy program improves patient A1C. J Am Pharm Assoc (2003). 2016;56:173e177. 4. Baroy J, Chung D, Frisch R, Apgar D, Slack MK. The impact of pharmacist immunization programs on adult immunization rates: a systematic review and meta-analysis. J Am Pharm Assoc. 2016;56:418e426. 5. Klepser ME, Klepser DG, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA. Implementation and evaluation of an innovative pharmacistphysician collaborative influenza disease state management program. J Am Pharm Assoc. 2016;56:14e21. 6. Klepser DG, Klepser ME, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA. Community pharmacist-physician collaborative streptococcal pharyngitis management programs. J Am Pharm Assoc. 2016;56:323e329. Donald G. Klepser, PhD, MBA, Associate Professor at the University of Nebraska Medical Center, Omaha, NE
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APhAeASP chapter leaders were invited to join this committee and participate in the planning and implementation of the health fair. In addition to APhAeASP, student leaders from Kappa Psi Pharmaceutical Fraternity, Student National Pharmaceutical Association, WSU College of Nursing, WSU Nutrition and Exercise Physiology, WSU Department of Speech and Hearing, WSU Health Policy Administration, Eastern Washington University (EWU) Social Work Education, and EWU Occupational Therapy were called to serve on the planning committee. From the beginning of February to early April, the East Central Community Health Fair Planning Committee held weekly meetings with WSU and EWU administrators to organize the event. Each leader on the committee was delegated tasks to assist in designing the event, while also charged with recruiting student volunteers to deliver patient care services during the event. Committee leaders also conducted site visits at possible venues for the health fair (before ultimately choosing ECCC) and worked together to plan what screenings and health resources could be offered and available during the fair. During these visits, leaders also discussed the unique qualities that each professional program could bring to the event and how these qualities could be utilized to add greater value to patients in attendance. This allowed the committee to develop a floor plan for where each professional program would be located during the health fair, what service or education each program would conduct, and how foot traffic would flow through the venue. These discussions made the committee become more of a team. Marshel Renz, a WSU student nurse, described his experience in planning and implementing the health fair: “Our health fair gave nursing students an excellent opportunity to work interprofessionally with members of the health care team. As future nurses, we are advocates for our clients, and it is necessary to educate patients on the best plan of care. That best plan of care involves input from everyone, including physicians, pharmacists, occupational, speech, and physical therapists. The health fair provided a real-life experience to work with our future colleagues.” After 2 months of planning, the WSU interprofessional team and student
618
volunteers hosted the East Central Community Health Fair on April 16, at ECCC. Thirty-one APhAeASP members participated in the fair, performing cholesterol and bone density screenings, as well as educating patients about the importance of vaccinations, signs and symptoms of stroke, healthy diet choices for diabetes, and over-thecounter medication safety. In addition, APhAeASP members worked alongside student nurses, who performed blood glucose and blood pressure screenings at nearby work stations. Student nurses educated patients receiving the screenings about what happens in the body with hypertension and diabetes, while student pharmacists counseled patients on ways to reduce their risk for developing diabetes and cardiovascular disease. This created a synergistic dynamic to deliver patient care services and was well received by community members attending the health fair, most of whom had not visited a health care provider in years. In total, 62 East Central community members received screenings and health education. Meanwhile, the additional health professional programs involved in the fair offered screenings in other spaces within the venue, such as hearing screenings from the WSU Speech and Hearing students and body mass index from Nutrition and Exercise Physiology students. Finally, a major component to the health fair was the presence of community vendors. Community Health Plan of Washington, Molina Healthcare of Washington, and United Health Care were a few of the vendors present during the fair and played an important role for East Central community members by helping them find affordable health insurance plans. With more than 100 East Central community members attending the event, APhAeASP members witnessed the impact of a coordinated team approach to delivering patient care, and a shining example of APhAeASP President Kelsea Gallegos’ “Together We Can” theme. Each health professional student offered unique qualities that further added to the value of the health fair. By working together, student pharmacists and other health professional students were able to see how a collaborative effort can allow them to better serve their patients.
Reference 1. Spokane Regional Health District. Odds against tomorrow: health inequities in Spokane County. 2012. James Kent, Third-year PharmD Candidate, Washington State University College of Pharmacy, Pullman, WA
APhA-APRS Collaborative practice agreements a useful tool for researchers According to an APhA Foundation consortium report, collaborative practice agreements (CPAs) are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the health care team.1 At their core, CPAs provide an efficient arrangement for a physician, or other prescriber, to delegate some authority to the pharmacist for all patients meeting certain criteria rather than having a prior conversation about each Klepser case as it arises. CPAs can also be a useful tool for researchers seeking to implement and evaluate novel services. In fact, some states have mechanisms in place that allow for research or demonstration projects that would not otherwise be allowed under the state’s existing pharmacy practice act.2 To maximize the utility of CPAs for research, it is important for researchers to understand how they can be used, the challenges to implementation, and the role of the researcher in setting up a collaborative practice agreement. Research involving CPAs falls broadly into 2 categories: retrospective and prospective. The first is to retrospectively evaluate practice models, which include a CPA, that were developed at the practice site(s). These projects generally focus on the impact of expanded pharmacist involvement in patient care activities. Recent retrospective studies have demonstrated pharmacist involvement leads to improvements in
DEPARTMENTS K. Weaver et al. / Journal of the American Pharmacists Association 56 (2016) 616e619
patients' hemoglobin A1C in the Federal Bureau of Prisons,3 and confirmation that pharmacist-provided immunizations, much of which is conducted under CPAs, has had a positive impact on adult immunization rates.4 As with many retrospective research projects, these projects are usually descriptive in nature because they were designed as clinical services and not intended to test a hypothesis or answer a research question. The second type of research conducted with CPAs involves a researcher designing a prospective study that uses a CPA as the mechanism to implement a new service. Recent examples of these types of studies include the development of pharmacy-based influenza and group A streptococcus management programs.5,6 Prospective studies allow the researcher to use a more rigorous study design, including standardized protocols and data collection across sites, but there are still challenges to conducting research that is dependent on CPAs. One of the major challenges with research conducted using CPAs is the issue of scalability and, as a result, small sample sizes. Depending on state regulations, a CPA may require that patients covered by the CPA must have an existing relationship with the physician. In these cases, a pharmacy interested, for example, in offering a cholesterol management program to all of their patients with dyslipidemias, would likely have several similar CPAs in place to cover all providers in the community. Even then, the pharmacy would not be able to provide the service to patients without a primary care provider, which can be a particular challenge in developing acute care services. As a result, research studies employing CPAs in these states tend to have
small sample sizes, which limit the studies’ statistical power. Even in states that allow for broader collaborative practice agreements, each participating pharmacist is required to enter into a separate CPA, which can be a challenge when participating pharmacists are geographically dispersed and/or working for different organizations. The challenges of conducting research using CPAs are compounded when trying to conduct research in multiple states with different CPA rules and regulations. This can be particularly challenging for researchers working with chain pharmacies that may be hesitant to commit to research on a service that is only allowable in half of the markets where they operate, or that require significantly different designs for different locations. This can also create an issue of generalizability in CPArelated research if the results are dependent on the structure of the CPA. For example, our own research on an influenza model was successful in Michigan, Minnesota, and Nebraska, but can not currently be replicated in Ohio or Iowa because of differences in CPA rules. While CPA regulations in most states do allow for research opportunities, many pharmacists have limited experience with, or understanding of, their state CPA laws. This creates both opportunities and responsibilities for the researcher. All CPAs should reflect the physician’s and pharmacist’s mutually agreed upon protocol for caring for their patients, but the researcher will likely have to provide a template, or examples, to aid in the process and discussion. Moreover, the researcher should be prepared to not only assist the practitioners with filing the CPA with the appropriate professional boards, but also to appear before those boards to
explain the research and how it fits within the state’s pharmacy practice act. Collaborative practice agreements allow for the development, implementation, and study of unique and innovative pharmacy services. Ultimately, high quality, rigorous research of pharmacy services made possible through CPAs will lead to decisions about reimbursement, expansion, and, in some cases, opportunities to create independent pharmacy services. To that end, researchers should focus on well-designed and conducted studies demonstrating the value of CPAs and the services they allow. References 1. Bluml BM. Consortium recommendations for advancing pharmacists' patient care services and collaborative practice agreements. J Am Pharm Assoc (2003). 2013;53:e132ee141. 2. Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services. Pharmacy Pilot Project Procedures. Available at: https://www.michigan.gov/documents/lara/ lara_Pharm_Pilot_project_procedures_052015_ 488775_7.pdf. Accessed September 15, 2016. 3. Bingham JT, Mallette JJ. Federal Bureau of Prisons clinical pharmacy program improves patient A1C. J Am Pharm Assoc (2003). 2016;56:173e177. 4. Baroy J, Chung D, Frisch R, Apgar D, Slack MK. The impact of pharmacist immunization programs on adult immunization rates: a systematic review and meta-analysis. J Am Pharm Assoc. 2016;56:418e426. 5. Klepser ME, Klepser DG, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA. Implementation and evaluation of an innovative pharmacistphysician collaborative influenza disease state management program. J Am Pharm Assoc. 2016;56:14e21. 6. Klepser DG, Klepser ME, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA. Community pharmacist-physician collaborative streptococcal pharyngitis management programs. J Am Pharm Assoc. 2016;56:323e329. Donald G. Klepser, PhD, MBA, Associate Professor at the University of Nebraska Medical Center, Omaha, NE
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