Creating an Ambulatory Care Pharmacy Practice
In order to build a sustainable ambulatory care pharmacy practice, a variety of factors must be in place. Outlined below are some of the elements that need to be considered.
For those currently working in an ambulatory care environment, ASHP's Ambulatory Care Self Assessment Tool can help identify ways to improve your practice.
Collaborative Practice Agreements
Collaborative practice agreements (CPAs) allow specific duties typically carried out by a prescriber to be conducted by a collaborating pharmacist. State laws vary greatly in terms of how CPAs can be utilized. In Michigan, the “delegation of authority” provision allows physicians to delegate certain functions to pharmacists. The specifics of what and how those functions are delegated are determined by the parties involved. CPAs may allow pharmacists to initiate, change or discontinue certain medications under an agreed upon protocol. Examples of CPAs can be found in these resources:
Documentation is a key component of providing patient care services in order to communicate with other healthcare providers and bill for services. The resources below can be tailored to the needs of your practice.
Patient Medication Access
For a variety reasons, patients may have trouble affording their medications. Pharmacists working in an ambulatory care environment often work with patients and other healthcare providers to identify affordable medication options.
- Prior Authorization Resources
- Patient Assistance Programs
The following tools can assist with patient assessment in a variety of areas.
Medication Adherence Assessments
The most common indirect methods for measuring medication adherence include patient self-report, pill count and pharmacy refill records. Each method has strengths and weaknesses.
- Health Literacy Assessment
Understanding how well a patient understands health information is important so that you can tailor your information to the appropriate level.
- Pharmacy Health Literacy Toolkit
- This online database developed by the Agency for Healthcare Research & Quality (AHRQ) contains health literacy tools specific to pharmacy including a pharmacy staff assessment tool, information about implementing ‘universal precautions’ in the pharmacy, and how to create a patient-friendly pill card.
- Medication Safety in Older Adults
- Beers List: Provides list of potentially inappropriate medications that should be avoided or used cautiously in patients 65 years of age and older
- START (Screening Tool to Alert doctors to Right Treatment): Tool that provides 22 situations where medications are indicated in older adults (> 65 years old)
- STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): List of medications that may not be appropriate to prescribe in patients > 65 years of age