AMBULATORY CARE SUMMIT
Introduction
A M B U L AT O R Y C A R E S U M M I T
ar Layar
Proceedings of the ASHP Ambulatory Care Summit Conducted by the American Society of Health-System Pharmacists and the ASHP Research and Education Foundation Dallas, Texas March 3–4, 2014
Introduction to the proceedings of the summit Am J Health-Syst Pharm. 2014; 71:1345-7
Background The ASHP–ASHP Foundation Ambulatory Care Summit, a component of the Pharmacy Practice Model Initiative (PPMI),1 was integrated with Please see the related editorial on page 1343.
an ASHP educational conference on ambulatory care pharmacy practice held in Dallas, Texas, on March 3–4, 2014. The more than 400 individuals who attended the conference participated in developing summit recommendations on advancing ambulatory care pharmacy practice.a The goal of the PPMI, a joint initiative of ASHP and the ASHP Foundation, is to significantly advance the health and well-being of patients in hospitals and health systems by developing and disseminating optimal pharmacy practice models that are based on the effective use of pharmacists as direct patient care providers. In November 2010, ASHP and the ASHP Foundation sponsored the Pharmacy Practice Model Summit (also held in Dallas), focusing primarily on hospital inpatient pharmacy practice. The proceedings of that summit,2 which strongly expressed
the urgency and rationale for reforming pharmacy practice models in general, are relevant to the current focus on ambulatory care pharmacy practice. The specific goal of the most recent summit was “to create a long-term vision for aspirational and forward-thinking pharmacy practice models that will ensure that pharmacists participate as members of patient care teams for ambulatory patients and are responsible and accountable for patient and population outcomes.” Summit planners selected the following four domains as the framework for summit discussions and recommendations: • Defining ambulatory care pharmacy practice, • Patient care delivery and integration, • Sustainable business models, and • Outcomes evaluation.
Briefing papers A comprehensive briefing paper was solicited for each domain of the conference and summit. These four briefing papers, which were made available in advance to all participants in the conference and summit, were consulted in the drafting of preliminary recommendations on
Components of the Proceedings of the ASHP Ambulatory Care Summit 1345 Introduction to the proceedings Briefing papers 1348 Defining and advancing ambulatory care pharmacy practice 1357 Patient care delivery and integration 1366 Sustainable business models 1375 Outcomes evaluation 1386 Welcome and introduction to the summit 1387 How the summit’s recommendations were developed 1390 Recommendations of the summit 1392 Building on the work of the summit 1393 Making the vision and recommendations of the summit a reality
advancing ambulatory care pharmacy practice. Defining ambulatory care pharmacy practice. In their review of this topic, Dennis K. Helling and Samuel G. Johnson discuss the public health need for and value of comprehensive medication management and Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0802-1345$06.00. DOI 10.2146/ajhp140296
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
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AMBULATORY CARE SUMMIT
the demonstrated improvement in health care outcomes from pharmacists’ services. They summarize the evidence that shows when ambulatory care pharmacists engage in patient care to their full capacity, physician time is saved, access to care is improved, and clinical and economic outcomes are enhanced. Helling and Johnson conclude that assertively advancing ambulatory care pharmacy practice will help achieve the national priorities of improving patient care, patient health, and affordability of care.
Introduction
Patient care delivery and integration. In her briefing paper, Kelly T. Epplen discusses how to plan and implement an ambulatory care pharmacist service, with particular attention to the hospital and healthsystem setting. She includes considerations related to patient-centered medical homes, accountable care organizations, preventive care and wellness programs, and continuityof-care initiatives. She concludes that ambulatory care pharmacists must assertively promote appropriate medication use, provide patient-
Ambulatory Care Conference and Summit Advisory Group Tim Brown, Pharm.D., BCACP, FASHP, Director, Clinical Pharmacotherapy in Family Medicine, Center for Family Medicine, Akron General Medical Center, Akron, OH Jannet M. Carmichael, Pharm.D., BCPS, FAPhA, FCCP, Director, VISN 21 Pharmacy, Executive and Residency Program, Veterans Affairs Sierra Pacific, Network, Reno, NV Ashley Feist, Pharm.D., BCPS, Pharmacy Specialist, Solid Organ, Transplantation, University of California San Diego Medical Center, San Diego, CA Susan Goodin, Pharm.D., Deputy Director and Assistant Director for Clinical Science, Rutgers Cancer Institute of New Jersey; Professor of Medicine, Medical Oncology, Robert Wood Johnson Medical School, New Brunswick, NJ Seena Haines, Pharm.D., BCACP, BC-ADM, CDE, FAPhA, FASHP, Professor of Pharmacy Practice and Associate Dean for Faculty, Palm Beach Atlantic University, West Palm Beach, FL Dennis K. Helling, Pharm.D., D.Sc., FAPhA, FASHP, FCCP, Executive Director Emeritus, Pharmacy Operations and Therapeutics, Kaiser Permanente, Denver, CO Christopher Herndon, Pharm.D., BCPS, FASHP, Associate Professor, School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, IL Mary Ann Kliethermes, B.S.Pharm., Pharm.D., Vice-Chair of Ambulatory Care and Associate Professor, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL Sandra Leal, Pharm.D., M.P.H., FAPhA, CDE, Director of Clinical Pharmacy, Broadway Clinic, El Rio Community Health Center, Tucson, AZ
1346
CDR Michael Lee, USPHS, Pharm.D., NCPS, BCPS, Chief of Pharmacy Services and Vice-Chair, National Pharmacy and Therapeutics Committee, Indian Health Service, Claremore Indian Hospital, Claremore, OK Melissa Somma McGivney, Pharm.D., FCCP, Associate Professor, Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA LCDR Matthew D. Olson, USPHS, Pharm.D., NCPS, Pharmacy Informaticist and Postgraduate Year 1 Pharmacy, Residency Program Director, Choctaw Nation Health Services Authority, McAlester Health Clinic, McAlester, OK Allison Paquin, Pharm.D., Department of Pharmacy, Veterans Affairs Boston Healthcare System, Boston, MA Steve Riddle, Pharm.D., Vice President of Clinical Affairs, PharmacyOneSource Inc., Bellevue, WA Gloria Sachdev, B.S.Pharm., Pharm.D., Clinical Assistant Professor, Primary Care, College of Pharmacy, Purdue University, Wishard Health Services, Indianapolis, IN; President, Sachdev Clinical, Pharmacy Inc., Carmel, IN James G. Stevenson, Pharm.D., FASHP, Chief Pharmacy Officer, University of Michigan Health Systems, Ann Arbor, MI CDR Sherri Yoder, Pharm.D., BCPS, Chief of Pharmacy Service, Crow Service Unit, Crow Agency, MT
ASHP Staff
Daniel J. Cobaugh, B.S.Pharm., Pharm.D., FAACT, DABAT, Vice President, ASHP Research and Education Foundation Justine Coffey, J.D., LL.M., Director, ASHP Section of Ambulatory Care Practitioners Steven P. Nelson, B.S.Pharm., M.S., Director, Center on Pharmacy Practice Advancement
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Sustainable business models. How to develop ambulatory care pharmacist services to, ideally, generate a margin that allows for service expansion is the focus of the briefing paper by Gloria Sachdev. She elaborates on four pillars of business sustainability—leadership, staffing, information technology, and compensentation—and outlines eight steps for the successful design and implementation of an ambulatory care pharmacist service program. Key challenges include determining which services yield a positive return on investment and demanding payment for value-added services. Outcomes evaluation. In this briefing paper, Mary Ann Kliethermes discusses key issues in measuring and improving the quality of healthcare, with an emphasis on applying quality-improvement principles to ambulatory care pharmacy practice. Progress in improving the quality of healthcare has been slow because of lack of patient engagement, use of improvement methods that have not been fully tested, and inadequate attention to the systems of providing care. Ambulatory care pharmacists have important opportunities to improve healthcare quality by reducing adverse drug events, improving transitions of care, fostering medication adherence, improving patient self-management, providing immunization services, and reducing disparities in access to care. Opening the summit ASHP President Gerald E. Meyer welcomed participants to the conference and summit, emphasizing the public need for ambulatory care pharmacist services and the new opportunities for advancing this sector of the profession in the face of various healthcare reform initiatives such
AMBULATORY CARE SUMMIT
At the start of the summit, authors of briefing papers presented a synopsis of their respective papers and the related preliminary recommendations developed by a consensus panel. Dennis K. Helling (top left) covered the domain “defining ambulatory care pharmacy practice”; Kelly T. Epplen (top right), “patient care delivery and integration”; Gloria Sachdev (bottom left), “sustainable business models”; and Mary Ann Kliethermes (bottom right), “outcomes evaluation.”
as patient-centered medical homes and accountable care organizations. He highlighted the role of members of the ASHP Section of Ambulatory Care Practitioners in planning the conference and summit. Summit recommendations The process used to plan the summit and develop consensus recommendations, which involved two practitioner advisory bodies, is described in an article by Daniel J. Cobaugh. Twenty-five recommendations for advancing ambulatory care
pharmacy practice were strongly endorsed by conference participants and subsequently validated in a large survey of practitioners. The recommendations deal with a wide range of topics, including pharmacist roles and competencies, pharmacist integration with patientcentered healthcare teams, pharmacist provider status, technology support for ambulatory care pharmacy practice, expanding external recognition of the value of ambulatory care pharmacists, the need for a standardized patient care process,
Introduction
and developing appropriate outcome metrics related to the contributions of ambulatory care pharmacists. Concluding the summit Stephen J. Allen, chief executive officer of the ASHP Foundation, outlined important follow-up activities to the summit and ways in which the Foundation will support the summit’s recommendations. He encouraged participants in the Dallas program to build on the insights they gained about advancing ambulatory care pharmacy practice. Paul W. Abramowitz, chief executive officer of ASHP, reviewed primary themes from summit discussions, including the importance of deep awareness of the immense needs that ambulatory patients—and the interprofessional teams that care for them—have for the expertise of pharmacists. In issuing a three-point call to action based on the recommendations of the summit, he said, “Keep in mind that the healthcare team needs you, the healthcare system needs you, and, most importantly, your patients need you.” a These proceedings concentrate on the summit and do not discuss the educational program.
References 1. American Society of Health-System Pharmacists. Pharmacy Practice Model Initiative overview. www.ashpmedia.org/ppmi/ overview.html (accessed 2014 Apr 24). 2. Zellmer WA, ed. Proceedings of the Pharmacy Practice Model Summit: an invitational consensus conference conducted by ASHP and the ASHP Research and Education Foundation, November 7-9, 2010, Dallas, Texas. Am J Health-Syst Pharm. 2011; 68:1077-160.
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
1347
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.
Introduction
A M B U L AT O R Y C A R E S U M M I T
ar Layar
Proceedings of the ASHP Ambulatory Care Summit Conducted by the American Society of Health-System Pharmacists and the ASHP Research and Education Foundation Dallas, Texas March 3–4, 2014
Introduction to the proceedings of the summit Am J Health-Syst Pharm. 2014; 71:1345-7
Background The ASHP–ASHP Foundation Ambulatory Care Summit, a component of the Pharmacy Practice Model Initiative (PPMI),1 was integrated with Please see the related editorial on page 1343.
an ASHP educational conference on ambulatory care pharmacy practice held in Dallas, Texas, on March 3–4, 2014. The more than 400 individuals who attended the conference participated in developing summit recommendations on advancing ambulatory care pharmacy practice.a The goal of the PPMI, a joint initiative of ASHP and the ASHP Foundation, is to significantly advance the health and well-being of patients in hospitals and health systems by developing and disseminating optimal pharmacy practice models that are based on the effective use of pharmacists as direct patient care providers. In November 2010, ASHP and the ASHP Foundation sponsored the Pharmacy Practice Model Summit (also held in Dallas), focusing primarily on hospital inpatient pharmacy practice. The proceedings of that summit,2 which strongly expressed
the urgency and rationale for reforming pharmacy practice models in general, are relevant to the current focus on ambulatory care pharmacy practice. The specific goal of the most recent summit was “to create a long-term vision for aspirational and forward-thinking pharmacy practice models that will ensure that pharmacists participate as members of patient care teams for ambulatory patients and are responsible and accountable for patient and population outcomes.” Summit planners selected the following four domains as the framework for summit discussions and recommendations: • Defining ambulatory care pharmacy practice, • Patient care delivery and integration, • Sustainable business models, and • Outcomes evaluation.
Briefing papers A comprehensive briefing paper was solicited for each domain of the conference and summit. These four briefing papers, which were made available in advance to all participants in the conference and summit, were consulted in the drafting of preliminary recommendations on
Components of the Proceedings of the ASHP Ambulatory Care Summit 1345 Introduction to the proceedings Briefing papers 1348 Defining and advancing ambulatory care pharmacy practice 1357 Patient care delivery and integration 1366 Sustainable business models 1375 Outcomes evaluation 1386 Welcome and introduction to the summit 1387 How the summit’s recommendations were developed 1390 Recommendations of the summit 1392 Building on the work of the summit 1393 Making the vision and recommendations of the summit a reality
advancing ambulatory care pharmacy practice. Defining ambulatory care pharmacy practice. In their review of this topic, Dennis K. Helling and Samuel G. Johnson discuss the public health need for and value of comprehensive medication management and Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0802-1345$06.00. DOI 10.2146/ajhp140296
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
1345
AMBULATORY CARE SUMMIT
the demonstrated improvement in health care outcomes from pharmacists’ services. They summarize the evidence that shows when ambulatory care pharmacists engage in patient care to their full capacity, physician time is saved, access to care is improved, and clinical and economic outcomes are enhanced. Helling and Johnson conclude that assertively advancing ambulatory care pharmacy practice will help achieve the national priorities of improving patient care, patient health, and affordability of care.
Introduction
Patient care delivery and integration. In her briefing paper, Kelly T. Epplen discusses how to plan and implement an ambulatory care pharmacist service, with particular attention to the hospital and healthsystem setting. She includes considerations related to patient-centered medical homes, accountable care organizations, preventive care and wellness programs, and continuityof-care initiatives. She concludes that ambulatory care pharmacists must assertively promote appropriate medication use, provide patient-
Ambulatory Care Conference and Summit Advisory Group Tim Brown, Pharm.D., BCACP, FASHP, Director, Clinical Pharmacotherapy in Family Medicine, Center for Family Medicine, Akron General Medical Center, Akron, OH Jannet M. Carmichael, Pharm.D., BCPS, FAPhA, FCCP, Director, VISN 21 Pharmacy, Executive and Residency Program, Veterans Affairs Sierra Pacific, Network, Reno, NV Ashley Feist, Pharm.D., BCPS, Pharmacy Specialist, Solid Organ, Transplantation, University of California San Diego Medical Center, San Diego, CA Susan Goodin, Pharm.D., Deputy Director and Assistant Director for Clinical Science, Rutgers Cancer Institute of New Jersey; Professor of Medicine, Medical Oncology, Robert Wood Johnson Medical School, New Brunswick, NJ Seena Haines, Pharm.D., BCACP, BC-ADM, CDE, FAPhA, FASHP, Professor of Pharmacy Practice and Associate Dean for Faculty, Palm Beach Atlantic University, West Palm Beach, FL Dennis K. Helling, Pharm.D., D.Sc., FAPhA, FASHP, FCCP, Executive Director Emeritus, Pharmacy Operations and Therapeutics, Kaiser Permanente, Denver, CO Christopher Herndon, Pharm.D., BCPS, FASHP, Associate Professor, School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, IL Mary Ann Kliethermes, B.S.Pharm., Pharm.D., Vice-Chair of Ambulatory Care and Associate Professor, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL Sandra Leal, Pharm.D., M.P.H., FAPhA, CDE, Director of Clinical Pharmacy, Broadway Clinic, El Rio Community Health Center, Tucson, AZ
1346
CDR Michael Lee, USPHS, Pharm.D., NCPS, BCPS, Chief of Pharmacy Services and Vice-Chair, National Pharmacy and Therapeutics Committee, Indian Health Service, Claremore Indian Hospital, Claremore, OK Melissa Somma McGivney, Pharm.D., FCCP, Associate Professor, Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA LCDR Matthew D. Olson, USPHS, Pharm.D., NCPS, Pharmacy Informaticist and Postgraduate Year 1 Pharmacy, Residency Program Director, Choctaw Nation Health Services Authority, McAlester Health Clinic, McAlester, OK Allison Paquin, Pharm.D., Department of Pharmacy, Veterans Affairs Boston Healthcare System, Boston, MA Steve Riddle, Pharm.D., Vice President of Clinical Affairs, PharmacyOneSource Inc., Bellevue, WA Gloria Sachdev, B.S.Pharm., Pharm.D., Clinical Assistant Professor, Primary Care, College of Pharmacy, Purdue University, Wishard Health Services, Indianapolis, IN; President, Sachdev Clinical, Pharmacy Inc., Carmel, IN James G. Stevenson, Pharm.D., FASHP, Chief Pharmacy Officer, University of Michigan Health Systems, Ann Arbor, MI CDR Sherri Yoder, Pharm.D., BCPS, Chief of Pharmacy Service, Crow Service Unit, Crow Agency, MT
ASHP Staff
Daniel J. Cobaugh, B.S.Pharm., Pharm.D., FAACT, DABAT, Vice President, ASHP Research and Education Foundation Justine Coffey, J.D., LL.M., Director, ASHP Section of Ambulatory Care Practitioners Steven P. Nelson, B.S.Pharm., M.S., Director, Center on Pharmacy Practice Advancement
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Sustainable business models. How to develop ambulatory care pharmacist services to, ideally, generate a margin that allows for service expansion is the focus of the briefing paper by Gloria Sachdev. She elaborates on four pillars of business sustainability—leadership, staffing, information technology, and compensentation—and outlines eight steps for the successful design and implementation of an ambulatory care pharmacist service program. Key challenges include determining which services yield a positive return on investment and demanding payment for value-added services. Outcomes evaluation. In this briefing paper, Mary Ann Kliethermes discusses key issues in measuring and improving the quality of healthcare, with an emphasis on applying quality-improvement principles to ambulatory care pharmacy practice. Progress in improving the quality of healthcare has been slow because of lack of patient engagement, use of improvement methods that have not been fully tested, and inadequate attention to the systems of providing care. Ambulatory care pharmacists have important opportunities to improve healthcare quality by reducing adverse drug events, improving transitions of care, fostering medication adherence, improving patient self-management, providing immunization services, and reducing disparities in access to care. Opening the summit ASHP President Gerald E. Meyer welcomed participants to the conference and summit, emphasizing the public need for ambulatory care pharmacist services and the new opportunities for advancing this sector of the profession in the face of various healthcare reform initiatives such
AMBULATORY CARE SUMMIT
At the start of the summit, authors of briefing papers presented a synopsis of their respective papers and the related preliminary recommendations developed by a consensus panel. Dennis K. Helling (top left) covered the domain “defining ambulatory care pharmacy practice”; Kelly T. Epplen (top right), “patient care delivery and integration”; Gloria Sachdev (bottom left), “sustainable business models”; and Mary Ann Kliethermes (bottom right), “outcomes evaluation.”
as patient-centered medical homes and accountable care organizations. He highlighted the role of members of the ASHP Section of Ambulatory Care Practitioners in planning the conference and summit. Summit recommendations The process used to plan the summit and develop consensus recommendations, which involved two practitioner advisory bodies, is described in an article by Daniel J. Cobaugh. Twenty-five recommendations for advancing ambulatory care
pharmacy practice were strongly endorsed by conference participants and subsequently validated in a large survey of practitioners. The recommendations deal with a wide range of topics, including pharmacist roles and competencies, pharmacist integration with patientcentered healthcare teams, pharmacist provider status, technology support for ambulatory care pharmacy practice, expanding external recognition of the value of ambulatory care pharmacists, the need for a standardized patient care process,
Introduction
and developing appropriate outcome metrics related to the contributions of ambulatory care pharmacists. Concluding the summit Stephen J. Allen, chief executive officer of the ASHP Foundation, outlined important follow-up activities to the summit and ways in which the Foundation will support the summit’s recommendations. He encouraged participants in the Dallas program to build on the insights they gained about advancing ambulatory care pharmacy practice. Paul W. Abramowitz, chief executive officer of ASHP, reviewed primary themes from summit discussions, including the importance of deep awareness of the immense needs that ambulatory patients—and the interprofessional teams that care for them—have for the expertise of pharmacists. In issuing a three-point call to action based on the recommendations of the summit, he said, “Keep in mind that the healthcare team needs you, the healthcare system needs you, and, most importantly, your patients need you.” a These proceedings concentrate on the summit and do not discuss the educational program.
References 1. American Society of Health-System Pharmacists. Pharmacy Practice Model Initiative overview. www.ashpmedia.org/ppmi/ overview.html (accessed 2014 Apr 24). 2. Zellmer WA, ed. Proceedings of the Pharmacy Practice Model Summit: an invitational consensus conference conducted by ASHP and the ASHP Research and Education Foundation, November 7-9, 2010, Dallas, Texas. Am J Health-Syst Pharm. 2011; 68:1077-160.
Am J Health-Syst Pharm—Vol 71 Aug 15, 2014
1347
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.
