Pharmacist
Collaborative Practice
Privileges in Diabetes
Management
Nisha Patel, PharmD
PGY1 Pharmacy Resident
El Rio Community Health Center, Tucson, AZ
5/20/11
El Rio Community Health
Center
 A private, non-profit community health
center since 1969
 The largest provider of medical and dental
services to the uninsured and Medicaid
populations of Pima County, Arizona.

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75% live below Federal Poverty Level
78% are Hispanic and American Indian
 Member of the Patient Safety and Clinical
Pharmacy Services Collaborative
sponsored by the Health Resources and
Services Administration (HRSA)
El Rio Community Health
Center
 The first sight in state of Arizona to
receive collaborative practice agreement
 Collaborative practice started in 2001

diabetes, hypertension, and cholesterol
management
 A total of four clinical pharmacists
working in collaboration with
approximately 50 providers
El Rio Community Health
Center
 A total of 2200 are managed by the
clinical pharmacists
 Patient-Centered Medical Home
Collaborative Drug Therapy
Management (CDTM)
 Collaborative Drug Therapy
Management (CDTM) is a type of
collaborative practice where a provider
and one or more pharmacists have
jointly agreed, on a voluntary basis, to
work together under protocol where the
pharmacist may perform certain patient
care functions authorized by provider
subject to specific conditions and/or
limitations.
Collaborative Drug Therapy
Management (CDTM)
 The duties of the pharmacists involved in
CDTM may include
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
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Patient assessment
Ordering drug therapy-related lab tests
Administering drugs
Selecting, initiating, monitoring, and
adjusting drug regimens
Collaborative Drug Therapy
Management (CDTM)
 45 out of 50 states now have provisions
for CDTM
 However, authorized abilities allowed
under CDTM vary from state to state
 Involves written protocols between
prescribers and pharmacists

These protocols may be required to be specific for
disease, for patient, or for both. In Arizona the
protocols are specific for disease.
Collaborative Drug Therapy
Management (CDTM)
 State laws or boards of pharmacy
usually spell out what needs to be
included in the protocol
 Depending on practice setting, there can
be different requirements for
pharmacists engaging in CDTM
Collaborative Drug Therapy
Management (CDTM)
 States might also require pharmacists to
have special training or
approval/certification by the state board
of pharmacy
 Typically focuses on managing complex
medication regimens or chronic disease
medication therapies for diabetes,
hypertension, dyslipidemia,
anticoagulation, or asthma
Protocol Agreements
Regardless of Practice Site
 CDTM agreements between a pharmacist and
a provider, or group of providers, are voluntary
agreements
 CDTM agreements provide delegated
authority by the provider and increase the
opportunity for pharmacists to contribute their
specialized expertise to a patient’s drug therapy
 CDTM agreements should be between the
provider and the pharmacist NOT the
provider and the practice sites.
CDTM in State of Arizona
 CDTM is guided by board-approved drug
therapy management agreement
 No location restrictions
 Allows CDTM agreements with
physicians and nurse practitioners
CDTM in State of Arizona
 Authorized abilities per practice
agreement for pharmacists

Implement, monitor, and modify drug
therapy
 The protocol has to be renewed annually
 Pharmacists have to complete 6 hours of
CE per disease state annually
Adapted from Arizona Administrative Code. Available at:
http://www.azsos.gov/public_services/Title_04/04-23.htm
El Rio Community Health
center
 The CDTM includes diabetes, blood
pressure and cholesterol management
 Patients have to have diagnosis
 Patients are referred to clinical
pharmacist by primary care providers
 Pharmacist processes the referral
El Rio Community Health
Center
 Yearly monofilament test
 Yearly eye screening
 Depression screening
 On board Nutritionist
 Referrals
El Rio Community Health
Center
 Several project involvement to improve
outcomes and expand program
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Cardinal Foundation Grant
EDGE Grant
Project IMPACT Diabetes
Considerations before
Entering a CDTM Agreement
 Agreements are voluntary and entered into on
an individual basis
 Provider and pharmacist should identify specific
communication responsibilities for sharing
information and improving patient’s continuity of
care
 Provider and pharmacist should discuss how
often and in what form (electronic, phone etc.)
they should communicate regarding patient
monitoring and CDTM activities
Conclusion
 CDTM arrangements can be a powerful
and positive way to improve patient care
and build inter-professional relationships
 Allow providers and pharmacists to
make the most of their respective
education and training for patients’ best
interests
Conclusion
 A comprehensive approach to
healthcare, encouraging the
collaboration of health care providers,
improves the quality, efficiency and costeffectiveness of medical care
 The growing body of literature supporting
the role of pharmacists in diabetes care
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Provide “continuity of care”
QUESTIONS!!