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Health Care > 14: Advanced Pharm Practice > Flashcards

14: Advanced Pharm Practice Flashcards

1
Q

Advanced Practice

A

-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

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2
Q

Advanced Pharm practice models where?

A

-New Mexico, NC, Montana, kind of california
-UK
-Canada

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3
Q

Collaborative Drug Therapy Management

A

-CDTM
-assume responsibility for pt assessments

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4
Q

CDTM vs APP

A

-CDTM assumes responsibility for performing assessments
-APP assumes responsibility for OUTCOMES
-APP requires special certification!!

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5
Q

New mexico

A

-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

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6
Q

North Carolina (CCPA)

A

-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

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7
Q

Montana

A

-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

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8
Q

California

A

-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

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9
Q

Why these states?

A

-limited resources
-limited primary care providers
-substantail rurality
-california might be having money probs
-Rph must obtain certification from the state

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10
Q

The key difference between CDTM and APP

A

-req for some sort of additional certification, supra-license, gov recognition of practitioner beyond the basic license
-some political consequences to that issue

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11
Q

Pharmacy Organization Support

A

-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

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12
Q

The UK (PSP)

A

-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

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13
Q

PSP

A

-may take an existing prescription and alter in response to lab results and/or pt issues

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14
Q

UK independent prescribers

A

-2006
-issue NEW prescriptions
-not allowed to prescribe controlled substances
-BUT it’s a NHS = full provider recognition and reimbursement

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15
Q

Canada

A

-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

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16
Q

Alberta Model

A

-two variants of prescribing
-decide whether or not to adopt prescribing authority, then:
1. adapt rx
2. initiate/manage drug therapy

17
Q

Adapting an Rx

A

-Alberta college req orientation and continuing education program
-pt assessment and rx therapy decided by physician/prescriber
-Rph MUST obtain pt informed consent

18
Q

Adapting

A

-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

19
Q

Adapting Model

A
  1. MD dx and starts therapy
  2. Rph uses judgement to optimize rx
    -change dose, duration, substitute
    -tailoring therapy
20
Q

Initiating/Managing Drug Therapy (IMDT)

A

-limited: Rphs permitted to do so are registered w Alberta College
-must demo competencies of education, training, experience, collaboration, practive
-MD diagnoses, Rph manages

21
Q

Alberta Model (IMDT)

A

-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)

22
Q

Snowballing

A

-Saskatchewan
-Manitoba: prescribe and order dx tests
-British Columbia wrote a lil letter once

23
Q

International Models of prescribing

A

-8 models across the world (Nilsen)
-limited to broad scopes

24
Q

8 International Pharmacist Prescribing Models

A
  1. Independent
  2. Collaborative
  3. Supplementary (manage)
  4. Pt Referral (manage)
  5. Formulary/Protocol (per list of tx symptoms)
  6. Pt group direction (protocol)
  7. Repeat (refill until next appointment)
  8. Admin (immediate effect)
25
Q

Most common disease states

A

-Diabetes
-Coagulation/lipid disorders
-HTN
-smoking cessation
-asthma/COPD
-pain
-heart failure

26
Q

APM Rphs are diff from Rphs in terms of

A

-autonomy
-direct pt care
-competence and confidence
-lack of dispensing
-collab

27
Q

Cost estimates

A

-50% savings of $1000 for all pt seen in a month
-$249 per pt seen
-would save US like half a mil/year

28
Q

Methods of justification

A

-cost
-cash-flow metrics
-outcomes and benefits

29
Q

barriers

A

-issues w acceptance
-reimbursement challenges
-admin issues
-pt acceptance and awareness

30
Q

Billing

A

-EM codes or “incident to” fees
-billing fees of 6500 a month for services, less than pay
-revenue is an issue

31
Q

APM characteristics

A

-11 practice before credentials
-NM grads all grad w training
-less than 40% did residency
-advanced training is not a prereq

32
Q

Final observation

A

-adoption by pharmacists is in the single digits
-even in the UK, where they HAVE status
-alberta prob most successful

Health Care (5 decks)

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