Pharmacy and Ambulatory Care

Question 1

Define AmCare

Answer 1

Medical care including diagnosis, observation, treatment and rehabilitation that is provided in an out-patient basis

Question 2

Common Health Care Systems for AmCare

Answer 2

VA
MD Practice/Office
Health Sciences Center Clinics
Federally qualified Health Centers
Hospital-based clinics
Community clinics
Correctional health clinics

Question 3

Why is pharmacy necessary in the AmCare Setting

Answer 3

• Significant need for preventative care
• Most chronic diseases are not well controlled
• Aging populations/complex comorbidities
• Slew of medications and increased medication use
• Poor medication adherence
• Decreasing number of MDs going into AmCare and increasing patients
• Healthcare reform

Question 4

Define Healthcare Reform

Answer 4

Moving towards pay-for-performance so quality over quantity

Question 5

What is the IMPACT of pharmacy in AmCare

Answer 5

Improved quality of care
Enhanced patient outcomes
Cost-avoidance

Question 6

What are the ROLES of pharmacy in AmCare

Answer 6

	Drug information specialist
	Provider education
	Patient education
	Multidisciplinary teams
	Quality Improvement
	Collaborative drug therapy management
	Preceptor of students/residents
	Researcher

Question 7

What are the RESPONSIBILITIES of pharmacist in AmCare

Answer 7

 Review medical records to gather relevant info on patient drug therapy
 Prospectively monitor drug therapy for efficacy, safety, drug interactions, etc
 Lab interpretation
 Limited physical assessment
 Immunizer
 Formulate patient-specific drug therapy regimens based on purpose, concurrent diseases, pharmacokinetics, cost and patient’s overall needs
 Communicate to patients and other health care providers
 Develop criteria for safe and effective drug use, coordinate drug use evaluations and evaluate quality of care

Question 8

Pharmacy + AmCare in a nutshell?

Answer 8

Identify drug-related problems in the out-patient setting and fix them

Question 9

Define Patient Centered Medical Home Model

Answer 9

• Team-based care led by a physician
• Provide these five functions: Patient centered, Comprehensive care, Coordinated care, Access to Care, Evidence based care (quality/safe)

Question 10

Define Medication Therapy Management

Answer 10

• Comprehensive review patient’s medications, including herbals, OTC’s for duplications, drug interactions, adverse effects, etc. (Anything you do that is beyond the distribution process)
• Medicare Part D MTM is required but not necessarily by a pharmacist

Question 11

Define Shared Medical Appointments

Answer 11

• Patients are seen in a group with 8-10 patients with a similar diagnosis (asthma, diabetes, hypertension)
• Open conversations between providers and patients

Question 12

Define Transitional Care Model

Answer 12

• Act as a patient-advocate on drug therapy while patient goes between health care settings
• Coordination and continuity of care

Question 13

Define Collaborative Drug Therapy Management- CDTM (aka Comprehensive Medication Management- CMM)

Answer 13

o Uses pharmacists as “Physician Extenders / Enhancers” or “Mid-level Practitioner”
o Implementing or modifying drug therapy
o Any other drug therapy related act delegated by a physician

Question 14

Define Collaborative Drug Therapy Management (CTDM)

Answer 14

• Voluntary written agreement between pharmacist and prescriber (“Written Protocols” or “Collaborative Practice Agreements”)
o Designates what you can and cannot do with patients on behalf of a physician

Question 15

Acts allowed under Collaborative Practice Agreement?

Answer 15

o Drug Histories
o Physical / Laboratory Assessment
o Implementing / modifying drug therapy following diagnosis, initial assessment by a MD
o ‘Other acts’ as delegated by a MD

Question 16

***Basic required protocol elements

Answer 16

o Names of the MD and RPh
o Types of drug therapy decisions RPh authorized to perform
o Disease states
o Drugs / Type of drug management authorized
o Procedures / Plans
o Documentation
o Communication / Feedback between MD-RPh

Question 17

A pharmacist may implement or modify drug therapy under a protocol (including sign a prescription) IF:

Answer 17

o Follows an MD’s diagnosis, initial patient assessment, and drug therapy order
o Pharmacist is practicing in a hospital, hospital-based clinic, or an academic health care institution
o Institution has bylaws and medical staff policy permitting physician delegation to pharmacist

Question 18

Prescriptive Authority Requirements

Answer 18

o Prescription contains all the usual legal requirements
o Must be on behalf of collaborative agreement (CDTM)
o Notification to TSBP by application provided by the Board
o Notification repeated annually
o Includes a copy of the written protocol

Question 19

Define Credentialling

Answer 19

Process organization collects, reviews, verifies your qualifications to provide patient care services

Question 20

Define Privileging

Answer 20

Health care organizations authorization you can perform specific duties (scope) within that organization

Question 21

Define Scope of Practice

Answer 21

What you can and cannot do where you practice (state and institution level)
- Defines activities and processes the pharmacist can provide

Question 22

Define Federal/State Laws

Answer 22

Tell you what you can and cannot do legally

Question 23

Clinical Pharmacy Services Billing

Answer 23

CMS does NOT recognize you as a provider
Easier in “closed health care systems”
• Amount of compensation tied to complexity of clinic visit

Question 24

Define Incident to Physician Services

Answer 24

Most basic, minimal level of reimbursement from CMS for a simple visits

Question 25

Define MTM codes

Answer 25

• Some have been successful in community pharmacies using MTM codes to bill for patient care activities outside of dispensing

Question 26

DefinePharmacy and Medically Underserved Areas Enhancement Act

Answer 26

Get pharmacists recognized as providers under CMS Part B to patients of underserved populations