Prescribing Rights: Worth it?
Pharmacists are now recognized as providers nearly everywhere—here’s a look at what this could mean for you.
Trisha Jordan, PharmD, MS is the Associate Director of Pharmacy at Ohio State University Medical Center in Columbus, where 100 acute-care pharmacists and 25 ambulatory pharmacists perform clinical pharmacy services. In Ohio, Jordan practices under a consult agreement that allows pharmacists to order blood and urine tests, analyze those tests, and adjust medication regimens. “The law allows pharmacists to practice at the top of their license, which in turn helps the doctor to be more efficient,” she said. She noted that the law may be expanded in her state to give the pharmacist more independent prescribing authority.
Jordan sees emergency medicine and ambulatory clinics as “areas of opportunity within the health system to improve patient care.” Lab results are sent to the pharmacist for recommendation or modification of drug therapies. The pharmacist will also be the point person who will follow up with the patient after discharge, she explained.
Jordan said that in the inpatient setting, pharmacists will “round with the medical team” and make recommendations in just about every therapeutic area, excluding chemotherapy, which is still “physician-driven.” The pharmacists’ input in the infectious disease area can be critical, she said.
The pharmacy team initially faced resistance from the chief medical information officer regarding access to electronic medical records. “We did our due diligence; we met with the leaders and explained what the pharmacist can do.”
At Kaiser Permanente Colorado, Brittany A. Todd, PharmD, BCPS, CLS, is a Clinical Pharmacy Specialist in the Clinical Pharmacy Cardiac Risk Service (CPCRS). “We are very lucky because our collaborative drug therapy management agreement allows us to prescribe any medication appropriate for lipids, hypertension, and diabetes. It is a very broad scope of practice.”
At CPCRS, she explained, clinical pharmacy specialists are required to have two years of post-graduate residency training and be board-certified within two years of hire. “All of us are either board-certified in pharmacotherapy or ambulatory care.” KPCO has a post-graduate year 2 (PGY2) residency program that trains residents in ambulatory care, she said.
“All patients with a history of atherosclerotic cardiovascular disease (ASCVD) are referred to CPCRS where a pharmacist determines need for long-term management and enrolls the patient in the service,” Todd said.
Providers rely on CPCRS to manage their ASCDV patients. CPCRS focuses on the management of lipids, blood pressure, diabetes/prediabetes, smoking cessation, and hypothyroidism. “I may have a patient with a new heart attack and a drug-eluting stent placed last week. I ensure that the patient is on appropriate therapy such as a high-intensity statin, beta-blocker, ACE inhibitor/ARB (if indicated), and dual antiplatelet therapy. As a pharmacist, I review renal function and possible drug-drug interactions and adjust doses as needed. I order follow-up to ensure adequate response to therapy, as well as meeting safety parameters,” said Todd.
CPCRS published a study in 2007 that demonstrated that enrolling a patient in this service within 90 days of an event (heart attack, stent, coronary artery bypass) resulted in an 89% reduction in all- cause mortality and an 88% reduction in cardiovascular-related mortality, said Todd. “Delayed enrollment still resulted in a 76% reduction in all cause mortality and 73% reduction in cardiovascular-related mortality,” she added.
“Providers expect CPCRS to manage their ASCVD population and trust that the care that patients receive is exceptional,” Todd said.
One area that still needs work is collaborating with external providers. Todd said that some patients still receive care from providers outside of KPCO as well as in. For example, a patient may have KPCO as their insurance plan, but still see a non-KPCO cardiologist. “These ‘external’ providers are not as familiar with the care our clinical pharmacy specialists provide and may be hesitant to hand off their patients to KPCO pharmacists. Since these are external providers, they often do not share the electronic medical record, which makes communication slightly more difficult,” Todd explained.