Ambulatory Care Pharmacists Achieve Gains and Losses in Patient Care Roles
Ambulatory care pharmacists in health systems are expanding their leadership roles in patient care, as indicated by the 67 percent of health systems in which pharmacists conduct specialized clinics for patients with chronic diseases, according to the results of the 2001 ASHP Survey of Managed Care and Ambulatory Care Pharmacy Practice in Integrated Health Systems. This growth is tempered, however, by a reduction in the time these practitioners are able to devote to other clinical responsibilities.
The study found that pharmacist participation in specialized clinics had expanded significantly since 1999, moving from 38 percent to 67 percent of health systems. Pharmacists are most frequently involved in anticoagulation and oncology clinics (39 percent of health systems), as well as diabetes management clinics (36 percent of health systems). Other routinely performed activities include:
- Tracking adverse drug reactions
- Monitoring compliance with medication use
- Using pharmacoeconomic data to make formulary decisions, and
- Participating in medication errors reduction programs.
The survey also noted a steady decline in 20 of the 24 functions typically performed in ambulatory care settings. The greatest reductions in activity were reported in health systems in which pharmacists are negotiating pharmaceutical contracts (-28 percentage points); administering immunizations (-27 percentage points); and providing immunization screening (-24 percentage points).
Although the mean full-time pharmacy staff rose 33 percent between 1999 and 2001, 70% of respondents noted that the continuing national shortage of pharmacists is making it increasingly difficult to fill vacant slots. The lack of candidates may be forcing some health systems to reconfigure pharmacists activities and functions.
"What we see is a decision by integrated health systems to assign pharmacists to increasingly take on the more basic, essential functions," said ASHP Executive Vice President Henri R. Manasse, Jr., Ph.D., Sc.D. "This severely restricts opportunities for pharmacists to make broader contributions to the improvement of the medication-use system in their practice sites."
Only 30 percent of organizations reported having enough candidates to fill open positions despite the fact that 81 percent reported they offered competitive salaries and benefits. The disparity emphasizes the severity of the problem.
The survey also assessed the link between the presence of five "enabling factors" and pharmacist participation in ambulatory care. Respondents noted that they received a high level of support from senior management and medical staff (41 and 36 percent), which was linked to the performance of relatively more clinical activities. The factor having the greatest influence on increased performance of ambulatory care functions was pharmacist presence on multidisciplinary care teams, which occurred in 53 percent of systems surveyed, a slight drop from 1999 figures.
The survey results offer a mixed message, according to the studys lead author Katherine K. Knapp, Ph.D., Director of the Center for Pharmacy Practice Research and Development at Western Universitys College of Pharmacy. "During the last survey we saw an expansion in the activities of ambulatory care pharmacists, only to see it diminish two years later. It appears that when there are choices to be made about the scarce but valued pharmacist resource, integrated health systems are choosing to focus on managing chronic diseases and protecting core distributive functionsboth of which offer direct benefit to their patients. It remains to be seen, however, whether other solutions such as the use of ancillary personnel, automation and technology will be able to prevent further erosion of pharmacists contributions in the ambulatory care arena."
Conducted by the ASHP Center on Managed Care Pharmacy and supported by an unrestricted grant from Pfizer, the survey is the third in a series of reports that document and analyze national and regional trends in managed care and ambulatory care pharmacy practice. A new feature of the survey report allows pharmacists to compare the services offered at their practice sites with those offered by comparable health systems in their regions.
The full survey results are published in the November 15, 2001, issue of the American Journal of Health-System Pharmacy. Copies of a summary report of the results can be obtained by calling ASHP at (301) 657-3000, ext. 1282 or from the ASHP Web site at www.ashp.org.
ASHP is the 31,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. ASHP, which has a long history of medication error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. Assisting pharmacists in fulfilling this mission is ASHP's primary objective. The Society has extensive publishing and educational programs designed to help members improve their delivery of pharmaceutical care, and it is the national accrediting organization for pharmacy residency and pharmacy technician training programs