14: Advanced Pharm Practice Flashcards
Advanced Practice
-broad responsibility and authority
-autonomy
-includes some form of formal recognition of the pharmacist’s status in excess of standard licensure requirements
-less oversight of RPh decisions
-allowed to prescribe
Advanced Pharm practice models where?
-New Mexico, NC, Montana, kind of california
-UK
-Canada
Collaborative Drug Therapy Management
-CDTM
-assume responsibility for pt assessments
CDTM vs APP
-CDTM assumes responsibility for performing assessments
-APP assumes responsibility for OUTCOMES
-APP requires special certification!!
New mexico
-CDTM legistaltion PPAA
-invented “pharmacist clinician”
-required physician assistant training
-60 hours school 9 months experience
-register with DEA
-use all legend agents in all settings to assess therapy
North Carolina (CCPA)
-Clinical Pharmacist Practioner Act
-CPP designation
-individual and protocols adopted must be approved by and registered w both medical and pharmacy board
-similar to NM
Montana
-limited population of state and limited number of pharmacists
-there’s only one small Pharmacy college, we wont be getting data for a hot min
California
-similar legislations
-dovetails with Accountable Care Organizations (ACO) and ACPPA (Obama Care)
-may include reducing costs to state medicaid program as motivation
-emerging, evolving story
Why these states?
-limited resources
-limited primary care providers
-substantail rurality
-california might be having money probs
-Rph must obtain certification from the state
The key difference between CDTM and APP
-req for some sort of additional certification, supra-license, gov recognition of practitioner beyond the basic license
-some political consequences to that issue
Pharmacy Organization Support
-APhA and ACCP have language in their charters that they can only support legislation that applies to ALL pharmacists as long as they are licensed by their states
-ASHP had same issue so they just rewrote they charter
-others pursuing federal provider status
The UK (PSP)
-Rph may obtain prescribing privileges after the completion of a training program recognized by the NHS
-Pharmacist Supplementary Prescriber (PSP) in 2001
-expanded in 2006: supplementary prescribers and independent prescribers
PSP
-may take an existing prescription and alter in response to lab results and/or pt issues
UK independent prescribers
-2006
-issue NEW prescriptions
-not allowed to prescribe controlled substances
-BUT it’s a NHS = full provider recognition and reimbursement
Canada
-2000: prescribe emergency contraception
-Alberta: PPR to HPA expanded scope of practice
-prescribe schedule 1 drugs and blood products
-admin meds for SC and IM injection
-Pharmacy and drug act defines new standards for pharmacy practice
Alberta Model
-two variants of prescribing
-decide whether or not to adopt prescribing authority, then:
1. adapt rx
2. initiate/manage drug therapy
Adapting an Rx
-Alberta college req orientation and continuing education program
-pt assessment and rx therapy decided by physician/prescriber
-Rph MUST obtain pt informed consent
Adapting
-may change original Rx but NOT renewals
-generic/therapeutic subs/changes to dose or form allowed due to needs of pt
-Rph required to notify og prescriber
-may provide interim Rx refills
-accepts responsibility for refill but must refer for reassessment and evaluation
Adapting Model
- MD dx and starts therapy
- Rph uses judgement to optimize rx
-change dose, duration, substitute
-tailoring therapy
Initiating/Managing Drug Therapy (IMDT)
-limited: Rphs permitted to do so are registered w Alberta College
-must demo competencies of education, training, experience, collaboration, practive
-MD diagnoses, Rph manages
Alberta Model (IMDT)
-assess pt, determine need for therapy
-may collab w PCP
-assume responsibility for management
-pt may be referred to authorized Rph by a physician to select appropriate drug, dose, and form req to treat the condition (comprehensive drug management)
Snowballing
-Saskatchewan
-Manitoba: prescribe and order dx tests
-British Columbia wrote a lil letter once
International Models of prescribing
-8 models across the world (Nilsen)
-limited to broad scopes
8 International Pharmacist Prescribing Models
- Independent
- Collaborative
- Supplementary (manage)
- Pt Referral (manage)
- Formulary/Protocol (per list of tx symptoms)
- Pt group direction (protocol)
- Repeat (refill until next appointment)
- Admin (immediate effect)
