The Pharmacy Practice Model:
Where are we going and how will we
get there?
John B. Hertig, PharmD, MS
Medication Safety Project Manager
Assistant Clinical Professor of Pharmacy Practice
Center for Medication Safety Advancement
Purdue University College of Pharmacy
Indianapolis, IN
Disclosure
• Dr. John B. Hertig has no conflicts of interest
to disclose.
Learning Objectives
• Understand the current climate of health
professions’ practice model review and the role of
the ASHP Pharmacy Practice Model Initiative in
the Rural Hospital setting
• Review the recommendations from the Pharmacy
Practice Model Summit
• Identify how pharmacy practice model change in
rural hospitals supports improved quality,
accountability, and patient outcomes, and how a
multidisciplinary approach is key to success
Outline
• Background – why change?
• About the Pharmacy Practice Model
Initiative
• Impact on rural hospitals
• Next steps - summary
First Things First
• Who is in the audience?
• What practice types do
you represent?
• How many of you have
heard of the ASHP
Pharmacy Practice Model
Initiative?
Background – Why Change?
• Professions must continually assess their
practice to determine whether expertise is
being maximized
– Healthcare reform
– Quality and safety
– Social and economic influences
• Pharmacy practice changes
– Doctor of Pharmacy degree
– Residency training
Why Change?
• More patients, increased demand
– Payment tied to performance
– Move away from fee-for-service payments
– Pressure to reduce costs, reward performance
• Challenge to US health care system to
improve quality and cost effective care
– More quality, better reimbursement
• Better Care!
AJHP 2009;66:713
Factors Driving Practice Change
• Drug therapy is becoming more complex
with greater patient risk
• Pharmacists recognized as:
– drug therapy experts
– medication use process experts
• Patients are better served if pharmacists take
an active role as part of the care team
Why Pharmacists?
Pharmacists
• Moral, ethical and social
obligations
• Health system changes and
opportunities
• Rationale use of
pharmacist resources
• Impact of pharmacy
technicians and
technology
• Value of pharmacists
ASHP/ASHP Foundation
Pharmacy Practice Model Objectives
Pharmacists
Technicians & Technology
Pharmacists
Educational Factors Driving Change
http://www.aacp.org/Docs/MainNavigation/InstitutionalData/8921_DegreesConferred.pdf
Educational Factors Driving Change
Impact
• All these factors have combined to drive
critical discussions regarding change within
the health-system pharmacy profession
• But, where do we go from here?
Pharmacy Practice Model Initiative
(PPMI)
• Launched and coordinated by ASHP and the
ASHP Research and Education Foundation
• The goal of this initiative is to significantly
advance the health and well-being of
patients
– Develop and disseminate a futuristic practice
model that supports the most effective use of
pharmacists as direct patient care providers
PPMI. Available at <www.ashp.org>
The Purpose of the PPMI
• Describes how pharmacy department
resources are deployed to provide care
• One size does not fit all
• Does include:
– How pharmacists practice and provide care to patients
– How technicians are involved to support care
– Use of automation/technology in the medication use
system
AJHP 2010;67:542
The Purpose of the PPMI
•
•
•
•
•
Create a framework
Determine services
Identify emerging technologies
Develop a template
Implement change
PPMI. Available at <www.ashp.org>
The Purpose of the PPMI
• Create a Framework
– Create a framework for a pharmacy practice
models that ensure provision of safe, effective,
efficient, accountable, and evidence-based care
for all hospital/health system patients
• Determine Services
– Determine patient care-related services that
should be consistently provided by departments
of pharmacy in hospitals and health systems and
increase demand for pharmacy services by
patients/caregivers, healthcare professionals,
healthcare executives, and payer
PPMI. Available at <www.ashp.org>
The Purpose of the PPMI
• Identify Emerging Technologies
– Identify the available technologies to support
implementation of practice models, and identify emerging
technologies that could impact the practice model
• Develop a Template
– Support the optimal utilization and deployment of hospital
and health-system pharmacy resources through
development of a template for practice models that are
operational, practical, and measurable
• Implement Change
– Identify specific actions pharmacy leaders and staff should
take to implement practice model change including
determination of the necessary staff (pharmacy leaders,
pharmacists, and technicians) skills and competencies
required to implement this model)
PPMI. Available at <www.ashp.org>
Types of Models
• Drug-distribution centered model
– defined as “mostly distributive pharmacy with
limited clinical services”
• Patient-centered integrated model
– defined as a “clinical generalist model with limited
differentiation of roles”
– nearly all pharmacists have distributive and clinical
responsibilities
• Clinical-specialist-centered model
– defined as “separate distributive and clinical
specialist roles”
Major PPMI Themes
• Move pharmacists closer to the patient
– Multidisciplinary care
• Responsibility for safe use of medications
and ensuring quality
• Well-developed technician workforce
• Wide-spread use of technology
Considerations for the Rural
Hospital
• Rural hospitals face unique challenges in
implementing new and innovative practice
models
• “The capacity of 1”
– How much can we do with limited resources?
– Where do our priorities lie?
• Ensuring we practice at “the top of our license”
• Teamwork among all professions is essential!
Beyond the Rhetoric
Rural Health Today –Current State
• Pharmacy in rural health settings differs
from larger settings
– Limited personnel
– Limited hours of operation
– Limited technology
• But, boundless opportunity!
– Need to be strategic on how to adapt principles
of PPMI to rural settings
• But first…where are we now?
Rural Hospital Practice Models
AJHP 2010;67:542
AJHP 2010;67:542
Where Are We Going?
• PPMI Summit
– November 2010
• Summit recommendations and voting record
published February 2011
– Lists all consensus pharmacy services that all patients
have the right to receive
– Outlines requirements of pharmacy departments
– Reviews barriers to improvement
• Rural Hospitals were represented at the Summit, but
many recommendations still pose challenges to small
institutions
– Let’s review a few
The PPMI Summit
http://www.ashp.org/DocLibrary/PPMI/Summit-Recommendations.aspx
Imperatives for
New Pharmacy Practice Models
• There is opportunity to
significantly advance the health
and well being of patients in
hospitals/health systems by
changing how pharmacists,
pharmacy technicians, and
technology resources are
deployed
Vote 100%
Imperatives for
New Pharmacy Practice Models
• In the next 5-10 years,
hospital/health system
executives and medical staff
leaders will expect
pharmacists to help ensure
compliance with quality-ofcare standards
Vote 93%
Optimal Pharmacy Practice Models:
Certifications
• Pharmacists who provide
drug therapy management
should be certified through
the most appropriate Board
of Pharmacy Specialties
board certification process.
Vote 82%
Pharmacy Technicians
• All distributive functions
that do not require clinical
judgment should be
assigned to technicians.
Vote 93%
Additional Recommendations
Every pharmacy department should:
•
•
•
•
•
•
B24a. Identify drug therapy
management services that should be
provided consistently by its pharmacists
B24b. Develop a plan to reallocate
resources to devote significantly more
pharmacist time to drug therapy
management services
B24c. Develop a plan to allocate
pharmacy student time to drug therapy
management services
B24d. Develop, maintain, and update
medication-use policies
B24e. Ensure institutional safe
medication use
B24f. Play a critical role in ensuring that
the hospital or health system adheres to
medication-related national quality
indicators
•
•
•
•
•
•
•
B24g. Play a critical role in ensuring that
the hospital or health system adheres to
medication-related evidence-based
practice guidelines
B24h. Track and trend adverse drug
events in the hospital or health system
B24i. Manage prospective medication-use
evaluation programs to improve
prescribing
B24j. Manage retrospective medicationuse evaluation programs to improve
prescribing.
B24k. Identify problem-prone and highrisk therapies using pre-established
criteria
B24l. Routinely review hospital or healthsystem antibiotic resistance patterns
B24m. Track and trend pharmacist
interventions
Am J Health-Syst Pharm. 2011. 68:1148
Moving Forward
Make Providing Pharmacy
Cognitive Services a Priority
• Drug distribution is still essential
• Increased pharmacist contact with providers and
patients have evidence-based benefits
– Lower costs
– Higher quality and safety
– Improved patient satisfaction
• Expand the role of technicians
– Consider additional training and responsibilities for
technicians
– Use technicians in non-traditional roles
• Technology
Technology
• Technology can help move the pharmacist closer to
the patient without compromising quality
– Automated dispensing cabinets
– Barcode systems
– Remote verification and order-entry
• Improves access to information for all health
professionals
– Improved timeliness of care
– Retrievable information for quality improvement
• Increases safety and quality
Teamwork
• Healthcare is a team sport
– Advancing pharmacy practice takes acceptance and
dedication by the entire team
• Work together to develop standard processes,
protocols, and policies that support improved
pharmacy services
• Continuous feedback and improvement
• Develop a care model that places the patient at
the center
Considerations for Rural Hospitals
• Leadership support is crucial
• Multidisciplinary collaboration
– Don’t go it alone
• Remember scope!
– Select those pharmacy services that your institution
deems absolutely critical; make those a priority
– Small wins
• It’s a journey
– Continually evaluate your direction and progress
– Small tests of change
Summary
• The health-system pharmacy profession is
undergoing a major practice model evaluation
– Goal is to improve medication use
– Improve patient care
• Rural hospitals are a key part of this effort
• Use PPMI recommendations to develop
focused improvement efforts
• Limited resources can still make a large
impact for our patients!
Questions?
The Pharmacy Practice Model:
Where are we going and how will we
get there?
John B. Hertig, PharmD, MS
Medication Safety Project Manager
Assistant Clinical Professor of Pharmacy Practice
Center for Medication Safety Advancement
Purdue University College of Pharmacy
Indianapolis, IN