Editor ial
E ditorial
ar Layar
Driving change in ambulatory care
A
historic event took place on March 3–4, 2014, in Dallas, Texas, that will shape the future of how pharmacy is practiced and patient care is delivered in ambulatory care settings. The Ambulatory Care Conference and Summit convened by the American Society of Health-System Pharmacists (ASHP) and the ASHP Research and Education Foundation brought together leaders in pharmacy, medicine, and nursing and other stakeholders to achieve consensus on a series of high-impact recommendations for forward-thinking ambulatory care pharmacy practice models. Before formulating these recommendations, a long-term vision for pharmacy practice models was developed. This vision describes an optimal future state for pharmacy practice, where pharmacists participate as members of the ambulatory health care team and are responsible and accountable for patient outcomes. The energy, passion, and commitment by participants at this sold-out event were truly inspiring. It was clear that everyone shared the belief that to achieve optimal care outcomes, interprofessional ambulatory care models that include pharmacists are necessary. Further, the system must be capable of doing so in ways that ensure that the knowledge, skills, and abilities of every member of the patient care team are being effectively utilized. Rising health care costs also must be strongly considered as we look for more efficient and effective ways to provide high-quality patient care. The consensus recommendations from the Summit fall into four categories:
1. 2. 3. 4.
Defining ambulatory care Patient care delivery and integration Sustainable business models Outcomes evaluation
Within these categories, Summit participants reached consensus on issues such as credentials and competencies, prescribing authority, standardized patient care processes, access to patient health information, use of health information technology and pharmacy technicians, provider status for pharmacists, quality measurement, and public health. All of the recommendations are published in their entirety in this issue of AJHP. It is heartening to see all of this come together in such collaborative and productive ways after so many years of discussion and evidence about the vital roles that pharmacists can and do play in ambulatory care settings. Many articles were written by people with a vision for ambulatory care-based pharmacy practice as early as the 1970s. We have vivid recollections of the groundbreaking piece by Greifenhagen and Pearlman1 when, in 1979, they described a system for screening ambulatory patients for pharmacy services. We also remember the two-part series by Helling2,3 in 1981 and 1982, in which he described the principles Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0802-1343$06.00.
and constructs of family practice pharmacy services. A seminal article in 1985 by Gray and colleagues4 demonstrated the improved therapeutic outcomes, cost savings, and decreased hospitalizations realized through a pharmacist-managed anticoagulation clinic. These practitioners inspired and continue to inspire all of us to work to expand the practice of pharmacy in our clinics and many other ambulatory care settings. As we move from the conceptualization and articulation of these recommendations to their universal implementation into practice, it is vital that we do the following: 1. Coordinate and align our efforts with the triple aim of providing better care for individuals, achieving better health for populations, and reducing healthcare costs.5 2. Partner with other healthcare organizations to develop new models of providing ambulatory care. These models should include expanded scopes of practice that allow all healthcare professionals to provide care at the “tops of their licenses,” thus maximizing care outcomes in a cost-effective way. 3. Greatly expand awareness among patients that the therapeutic expertise of pharmacists is critical to their care. 4. Identify methods to determine which patients in the ambulatory care setting are in the most need of pharmacists’ care. 5. Develop sustainable business models for the provision of ambulatory care pharmacy services. 6. Stimulate new research on ambulatory care pharmacy practice models, which the ASHP Foundation has committed itself to doing. 7. Expand education and training opportunities for pharmacists who want to care for patients in ambulatory care settings.
As ASHP and the ASHP Foundation move forward with our ongoing and enhanced efforts in the ambulatory arena, we look forward to working hand-in-hand with our members, patients, and other providers on the healthcare team to design a system that embraces the vision of and recommendations from the Summit and results in the best outcomes for the patients we serve. 1. Greifenhagen R, Pearlman JJ. Pharmacy system for screening ambulatory patients. Am J Hosp Pharm. 1979; 36:916-20. 2. Helling DK. Family practice pharmacy service: part 1. Drug Intell Clin Pharm. 1981; 15:971-7. 3. Helling DK. Family practice pharmacy service: part 2. Drug Intell Clin Pharm. 1982; 16:35-48. 4. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost-justification of a clinical pharmacist-managed anticoagulation clinic. Drug Intell Clin Pharm. 1985; 19:575-80. 5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008; 27:759-69.
Paul W. Abramowitz, Pharm.D., Sc.D.(Hon), FASHP, Chief Executive Officer ASHP Stephen J. Allen, B.S.Pharm., M.S., Chief Executive Officer ASHP Research and Education Foundation The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140316 Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
1343
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
E ditorial
ar Layar
Driving change in ambulatory care
A
historic event took place on March 3–4, 2014, in Dallas, Texas, that will shape the future of how pharmacy is practiced and patient care is delivered in ambulatory care settings. The Ambulatory Care Conference and Summit convened by the American Society of Health-System Pharmacists (ASHP) and the ASHP Research and Education Foundation brought together leaders in pharmacy, medicine, and nursing and other stakeholders to achieve consensus on a series of high-impact recommendations for forward-thinking ambulatory care pharmacy practice models. Before formulating these recommendations, a long-term vision for pharmacy practice models was developed. This vision describes an optimal future state for pharmacy practice, where pharmacists participate as members of the ambulatory health care team and are responsible and accountable for patient outcomes. The energy, passion, and commitment by participants at this sold-out event were truly inspiring. It was clear that everyone shared the belief that to achieve optimal care outcomes, interprofessional ambulatory care models that include pharmacists are necessary. Further, the system must be capable of doing so in ways that ensure that the knowledge, skills, and abilities of every member of the patient care team are being effectively utilized. Rising health care costs also must be strongly considered as we look for more efficient and effective ways to provide high-quality patient care. The consensus recommendations from the Summit fall into four categories:
1. 2. 3. 4.
Defining ambulatory care Patient care delivery and integration Sustainable business models Outcomes evaluation
Within these categories, Summit participants reached consensus on issues such as credentials and competencies, prescribing authority, standardized patient care processes, access to patient health information, use of health information technology and pharmacy technicians, provider status for pharmacists, quality measurement, and public health. All of the recommendations are published in their entirety in this issue of AJHP. It is heartening to see all of this come together in such collaborative and productive ways after so many years of discussion and evidence about the vital roles that pharmacists can and do play in ambulatory care settings. Many articles were written by people with a vision for ambulatory care-based pharmacy practice as early as the 1970s. We have vivid recollections of the groundbreaking piece by Greifenhagen and Pearlman1 when, in 1979, they described a system for screening ambulatory patients for pharmacy services. We also remember the two-part series by Helling2,3 in 1981 and 1982, in which he described the principles Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0802-1343$06.00.
and constructs of family practice pharmacy services. A seminal article in 1985 by Gray and colleagues4 demonstrated the improved therapeutic outcomes, cost savings, and decreased hospitalizations realized through a pharmacist-managed anticoagulation clinic. These practitioners inspired and continue to inspire all of us to work to expand the practice of pharmacy in our clinics and many other ambulatory care settings. As we move from the conceptualization and articulation of these recommendations to their universal implementation into practice, it is vital that we do the following: 1. Coordinate and align our efforts with the triple aim of providing better care for individuals, achieving better health for populations, and reducing healthcare costs.5 2. Partner with other healthcare organizations to develop new models of providing ambulatory care. These models should include expanded scopes of practice that allow all healthcare professionals to provide care at the “tops of their licenses,” thus maximizing care outcomes in a cost-effective way. 3. Greatly expand awareness among patients that the therapeutic expertise of pharmacists is critical to their care. 4. Identify methods to determine which patients in the ambulatory care setting are in the most need of pharmacists’ care. 5. Develop sustainable business models for the provision of ambulatory care pharmacy services. 6. Stimulate new research on ambulatory care pharmacy practice models, which the ASHP Foundation has committed itself to doing. 7. Expand education and training opportunities for pharmacists who want to care for patients in ambulatory care settings.
As ASHP and the ASHP Foundation move forward with our ongoing and enhanced efforts in the ambulatory arena, we look forward to working hand-in-hand with our members, patients, and other providers on the healthcare team to design a system that embraces the vision of and recommendations from the Summit and results in the best outcomes for the patients we serve. 1. Greifenhagen R, Pearlman JJ. Pharmacy system for screening ambulatory patients. Am J Hosp Pharm. 1979; 36:916-20. 2. Helling DK. Family practice pharmacy service: part 1. Drug Intell Clin Pharm. 1981; 15:971-7. 3. Helling DK. Family practice pharmacy service: part 2. Drug Intell Clin Pharm. 1982; 16:35-48. 4. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost-justification of a clinical pharmacist-managed anticoagulation clinic. Drug Intell Clin Pharm. 1985; 19:575-80. 5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008; 27:759-69.
Paul W. Abramowitz, Pharm.D., Sc.D.(Hon), FASHP, Chief Executive Officer ASHP Stephen J. Allen, B.S.Pharm., M.S., Chief Executive Officer ASHP Research and Education Foundation The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140316 Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
1343
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
