Annie Ottney, Pharm.D., BCPS, associate professor and ambulatory care pharmacist, Ferris State University/Sparrow Health, Lansing, Mich. and Jodie Elder, Pharm.D., professor and ambulatory care pharmacist, Ferris State University/Metro Health, Wyoming, Mich.
"I need you." This is a statement I was greeted with while working at my desk in a family medicine office on a Wednesday afternoon when I was introduced to an internal medicine practice manager taking an informal tour of our facility. She didn't need me specifically, but more generally, a pharmacist. On a number of levels, the statement took me aback as I realized that perhaps the time has come when healthcare leadership recognizes a pharmacist in an ambulatory care office has become the "standard of care." The idea that a pharmacist should be an expected member of the healthcare team at every provider office, similar to a nurse or mental health professional, has been a dream of ambulatory care pharmacy leaders for many years.1
The field of ambulatory care pharmacy represents a diverse area of practice that ranges widely in populations served and disease states managed. Ambulatory care embodies one of the fastest growing specialty areas within the profession of pharmacy. The most recent report from the Board of Pharmacy Specialties indicated that board certification in ambulatory care was the third most common certification, behind pharmacotherapy and geriatrics.2 Driven largely by the realization that physicians, nurse practitioners and physician assistants can't "do it alone" pharmacists have become a natural fit to supplement the increasingly complex care of patients in the outpatient setting while also helping to achieve the "quadruple aim" (see Figure 1).3
Figure 1. The Quadruple Aim to Optimize Health System Performance
In order to better grasp the state of ambulatory care practice in Michigan, a survey was sent out in early 2019 to ambulatory care pharmacists and health system pharmacy managers across the state. Twenty-one responses were collected from the survey. The majority of those surveyed practice in a primary care setting (67 percent) with the most common services provided including disease state management (76 percent), medication access/prior authorization/patient assistance (71 percent), and medication therapy management (67 percent). Most of the respondents bill for their services (62 percent), have prescriptive authority under a collaborative practice agreement (93 percent), and track performance metrics (81 percent), such as interventions, number of patient contacts per day, and productivity. Just over half of respondents are tracking clinical outcomes (52 percent), such as hemoglobin A1c or blood pressure and only 47 percent are using a pharmacy extender (student, resident or technician) in their practice.
Although limited by a small sample size and response bias, results from the survey indicate that survey respondents (ambulatory care pharmacists in Michigan) are practicing at a high level. As evidenced by the survey, pharmacy extenders, such as student pharmacists, pharmacy residents and pharmacy technicians could be leveraged to improve workflow efficiency and increase tracking of patient-centered clinical outcomes. Interestingly, this also aligns with what survey respondents found to be the most important opportunity to advance ambulatory care practice in Michigan: to demonstrate the value of ambulatory care practitioners. The state of ambulatory care pharmacy practice in Michigan is looking good and the time is now to get on board. The only question left is how you will respond the next time someone says, "I need you."
1. Homsted FA, Chen DF, Knoer SJ. Building value: expanding ambulatory care in the pharmacy enterprise. Am J Health Syst Pharm. 2016;73:635-641.
2. Board of Pharmacy Specialties. BPS 2018 Annual Report. Available at: https://board-of-pharmacy-specialties.dcatalog.com/v/2018-Annual-Report/?page=6. Accessed May 17, 2019.
3. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12:573-576.