Pharmacy and Ambulatory Care Flashcards
(26 cards)
Define AmCare
Medical care including diagnosis, observation, treatment and rehabilitation that is provided in an out-patient basis
Common Health Care Systems for AmCare
VA MD Practice/Office Health Sciences Center Clinics Federally qualified Health Centers Hospital-based clinics Community clinics Correctional health clinics
Why is pharmacy necessary in the AmCare Setting
- 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
Define Healthcare Reform
Moving towards pay-for-performance so quality over quantity
What is the IMPACT of pharmacy in AmCare
Improved quality of care
Enhanced patient outcomes
Cost-avoidance
What are the ROLES of pharmacy in AmCare
Drug information specialist Provider education Patient education Multidisciplinary teams Quality Improvement Collaborative drug therapy management Preceptor of students/residents Researcher
What are the RESPONSIBILITIES of pharmacist in AmCare
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
Pharmacy + AmCare in a nutshell?
Identify drug-related problems in the out-patient setting and fix them
Define Patient Centered Medical Home Model
- 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)
Define Medication Therapy Management
- 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
Define Shared Medical Appointments
- Patients are seen in a group with 8-10 patients with a similar diagnosis (asthma, diabetes, hypertension)
- Open conversations between providers and patients
Define Transitional Care Model
- Act as a patient-advocate on drug therapy while patient goes between health care settings
- Coordination and continuity of care
Define Collaborative Drug Therapy Management- CDTM (aka Comprehensive Medication Management- CMM)
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
Define Collaborative Drug Therapy Management (CTDM)
• 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
Acts allowed under Collaborative Practice Agreement?
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
***Basic required protocol elements
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
A pharmacist may implement or modify drug therapy under a protocol (including sign a prescription) IF:
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
Prescriptive Authority Requirements
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
Define Credentialling
Process organization collects, reviews, verifies your qualifications to provide patient care services
Define Privileging
Health care organizations authorization you can perform specific duties (scope) within that organization
Define Scope of Practice
What you can and cannot do where you practice (state and institution level)
- Defines activities and processes the pharmacist can provide
Define Federal/State Laws
Tell you what you can and cannot do legally
Clinical Pharmacy Services Billing
CMS does NOT recognize you as a provider
Easier in “closed health care systems”
• Amount of compensation tied to complexity of clinic visit
Define Incident to Physician Services
Most basic, minimal level of reimbursement from CMS for a simple visits
