Pharmacy News

Ambulatory Care Becomes Certifiable Specialty Practice

[August 1, 2009, AJHP News]

Cheryl A. Thompson

BETHESDA, MD 16 Jul 2009—The Board of Pharmaceutical Specialties (BPS) on June 15 announced it had approved the joint request from three national pharmacy groups to recognize ambulatory care pharmacy practice as a specialty.

Ambulatory care pharmacy practice, according to the groups’ petition, is a specialty in medication use for preventive and chronic care (see sidebar).

Definition of Ambulatory Care Pharmacy Practicea

"Ambulatory care pharmacy practice is the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management."

aFrom "A Petition to the Board of Pharmaceutical Specialties Requesting Recognition of Ambulatory Care Pharmacy Practice as a Specialty."

The decision brings to six the number of BPS-recognized specialties: ambulatory care pharmacy, nuclear pharmacy, nutrition support pharmacy, oncology pharmacy, pharmacotherapy, and psychiatric pharmacy.

Another specialty, geriatric pharmacy, is recognized by the Commission for Certification in Geriatric Pharmacy.

If requisite human and financial resources come through, BPS said, the first certification exam for ambulatory care pharmacy practice can be offered in two years.

A chance for recognition. BPS’s decision, said Tim R. Brown, 2009–10 chair of the ASHP Section of Home, Ambulatory, and Chronic Care Practitioners, means that ambulatory care pharmacists "are being recognized in their own right."

ASHP was one of the groups that submitted the joint petition. The other groups were the American College of Clinical Pharmacy (ACCP) and the American Pharmacists Association.

Brown said a lot of ambulatory care pharmacists have taken BPS’s exam in pharmacotherapy because it led to board certification.

But the content of the certification exam in pharmacotherapy, he said, focuses more on inpatient than ambulatory care issues.

For that reason, Brown, who has practiced 15 years at a family medicine center owned by Akron General Medical Center in Ohio, said he chose not to take the certification exam in pharmacotherapy. He does not deal with oncology, for example, and that topic is part of the pharmacotherapy certification exam.

Jennifer Wood at William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, took and passed the pharmacotherapy certification exam as soon she became eligible.

Although her background is in ambulatory care—she completed an ambulatory care residency at Middleton in 2007—Wood said she studied and took the exam because "I wanted to be good at what I do."

That was at a time when, as a new full-fledged staff member, she spent about 50% of her workweek in the inpatient setting and 50% in the clinics. Now, she said, her workload is about 20% inpatient care and 80% ambulatory care.

What she does next with regard to board certification is uncertain.

Wood said she spent a lot of time and effort preparing for the pharmacotherapy certification exam. But now, ambulatory care pharmacy practice at Middleton is expanding. In 2011, she wondered aloud, will she still be predominantly practicing in the clinics? How should she set herself apart from other ambulatory care specialists? How much work would it entail for her to maintain two board certifications?

"I think it’s going to be a hard decision," Wood said.

Certifications by BPS do not last a lifetime. BPS-certified pharmacists must undergo recertification every seven years.

For pharmacotherapy, according to the 2009 recertification guide, this means achieving a passing score on the 100-item, multiple-choice recertification examination or earning 120 hours of continuing-education credit through ACCP’s Pharmacotherapy Self Assessment Program.

Except for nutrition support pharmacy, there are continuing-education options for recertification in all BPS-recognized specialties.

Sara Milhans works full-time in Middleton’s clinics and, by e-mail, expressed support for the ambulatory care certification exam.

Board certification in ambulatory care pharmacy practice, she explained, would provide a credential specific to her practice interests.

Although she had studied for the pharmacotherapy certification exam, Milhans said she decided not to take it. She had heard rumors that BPS would be considering recognition of ambulatory care pharmacy practice as a specialty. Also, she perceived that the content of the pharmacotherapy certification exam was less relevant to her current practice than if she were an inpatient clinical specialist.

Milhans also said she looks forward to the "quality continuing education opportunities specific to pharmacists" whose focus is ambulatory care.

As is common with many exams, there are groups that sell review information, preparatory courses, and study guides. BPS itself does not provide such materials, but various pharmacy organizations, including ASHP, and a pharmacy college do.

Brown, the longtime family medicine practitioner, said board certification in ambulatory care pharmacy practice may offer an additional benefit: The credential may improve the chances of a pharmacist receiving reimbursement from Medicare and other third-party payers for professional services.

Complicated, lengthy, expensive process. It has been 13 years since BPS recognized a new specialty.

Terry L. Schwinghammer, the 2009 chair of the certification agency, called the process "complicated, lengthy, and expensive" and said that this is necessary in order to have credentials that are "high quality, psychometrically sound, and legally defensible."

According to the BPS website, the recognition process starts with a person or group of persons petitioning the certification agency to recognize a specific area of pharmacy practice as a specialty. The petition must be accompanied by a $7500 filing fee.

But BPS "jump-started" the process for ambulatory care pharmacy practice because pharmacy groups had mixed opinions on whether it was a specialty, Schwinghammer said.

BPS, he said, conducted the requisite "role delineation study," which establishes that an area of specialization is based on specialized knowledge and functions.

ASHP, ACCP, and the American Pharmacists Association then used the role delineation study in the groups’ joint 96-page petition and 886 pages of appendixes to BPS.

Each of those pharmacy groups has an organized subgroup of members who practice in the ambulatory care setting.

David R. Witmer, vice president of member services at ASHP, said members of the ambulatory care subgroup had increasingly expressed interest in having their practice recognized as a specialty.

Also, he said, ASHP has a growing interest in the development of appropriate credentials, such as board certification, to support the expansion of pharmacists’ roles in patient care.

BPS said it will now work with the three pharmacy groups to establish a specialty council on ambulatory care pharmacy. Other necessary tasks include defining the details of the certification process for the new specialty and preparing content for the certification exam.


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