Indian Health Service (IHS) National Clinical Pharmacy Specialist

(NCPS)

Re: May 2008

Overview

For decades, Indian Health Service (IHS) pharmacists across the nation have practiced in a variety of expanded clinical roles to provide primary care

IHS pharmacy is widely known (in both the private sector and academia) for its innovative pharmacy practice, which includes privileges in disease management

The provision of pharmaceutical care follows the IHS Pharmacy Standards of Practice: Chapter 7 of the Indian Health Manual

The Indian Health Service (IHS) officially recognizes IHS pharmacists as primary care providers. Refer SGM 10-18-96

Expanded Practice Evolution

In 1996, the scope of pharmacy practice in the IHS was officially broadened to include prescriptive authority. Dr. Michael Trujillo (former IHS Director) recognized IHS pharmacists as primary care providers in his October 18, 1996 memorandum:

“Clinical Pharmacy Specialists (CPS) will be included in

the IHS definition of a primary care provider (PCP)

for the purposes of workload reporting, program

planning, and reimbursement from all third

party payers. An appropriate primary provider

code will be assigned to CPS.”

Pharmacy Code 067

Evolution of Expanded Practice: IHS Innovation

1931

Edwin M. Holt is the first commiss-ioned officer to be assigned to the Office of Indian Affairs, Department of Interior.

Allen J. Brands becomes the first CPO for

IHS

1955 1962 1969 1974 1983 1988 1990

IHS shift from distribution to clinical services. Begins to counsel patients and use health record, not Rx form. Such practice does not exist before

this time

IHS Program Planning meeting in Rockville – pharmacists start serving as primary care providers in many IHS facilities

IHS begins Pharmacy Practitioner Program – teaching IHS pharmacists physical assessment and disease management

IHS establish-ment of the IHS Clinical Pharmacy Training Program (CPTP ) – training pharmacists in managing chronic disease

IHS Standards of Practice to provide pharmaceutical care to patients. Coined the term.

IHS distributes Patient Consultation videos to academia nationwide.

Evolution of Expanded Practice: IHS Innovation

1995

IHS Business Committee meetings to discuss reimbursement for services and contacts HCFA (now CMS)

Director of Indian Health Service, RADM Michael Trujillo, signs special memorandum, which codifies Clinical Pharmacy Specialists (CPS) as primary care providers (PCPs) with prescriptive

authority.

1996 1997-98 2001 2008

The IHS National Clinical Pharmacy Specialist Credentialing Committee (NCPSCC) is born out of discussions surrounding decades of expanded practice

- IHS and PHS leadership meet with HCFA to discuss IHS pharmacy practice and potential for pharmacist reimbursement.

- First group of IHS pharmacists receive NCPS and NCPS-PP credentials.

- IHS receives the APhA Pinnacle Award for IHS’ contributions to pharmacy profession

IHS receives Roche D.R.E.A.M. award for

NCPS-pharmacist managed Traineeship in Anticoagulation Management

IHS completes 10-years of national credentialing through NCPS. Nearly 200 pharmacists credentialed (over 100 currently active) across 40 states and 8 different disease state areas.

1998 2007

IHS receives the ASHP Award of Excellencefor theimplementationof a pharmacist CHF clinic

Committee Charge

National Clinical Pharmacy Specialist Credentialing Committee (NCPSCC) - officially est. 1998 by Chief Professional Officer in response to IHS Business Committee meetings and interest in recognition of expanded scope:

Promote uniform clinical competency of I/T/U pharmacists on a national basis.

Define advanced scopes of practice for I/T/U pharmacists.

Serve as the body that reviews the credentials, training, and education of I/T/U pharmacists and grants NCPS certification

Establish the above elements to help promote universal recognition of NCPS pharmacists as billable providers

Current activity to capture impact of workload reduction, patient outcomes, and cost-savings derived from clinical pharmacy services

Scope

Intended to recognize advanced scopes of practice at local level that satisfy uniform national guidelines

Includes NCPS and NCPS- Pharmacist Practitioner (NCPS-PP) Involve focused management of disease states (may

involve established or new patients) Care/Privileges to include:

Interview, chart review Laboratory privileges Prescriptive Authority Limited (or potentially more general) physical

assessment Patient education and follow up

NCPS grants certification. Privileges are granted locally.

Impact by the numbers…

Cumulative Pharmacists Credentialed ~ 200 Cumulative Non-Redundant ~ 156 Active, Non-Redundant Certifications ~ 100 Currently, 100 IHS pharmacists credentialed

out of ~452 IHS pharmacists. NCPS IHS pharmacists ~ 22% * of IHS pharmacists! Many more practice as CPS

at local levels

* Denominator (n=452) includes all IHS positions including non-clinical, multidisciplinary and those in administrative roles.

Disease States with Credentialed Pharmacists

Anticoagulation* Nicotine Dependence Diabetes Dyslipidemia Asthma Hypertension Pain Management Primary Care/Family Med (NCPS-PP)

•Disease State with the highest number of credentialed

NCPS pharmacists

NCPS Credentials By IHS Area

Oklahoma 38

Phoenix 33

Alaska 15

Albuquerque 14

Navajo 11

Aberdeen 8

Bemidji 8

Nashville 7

Portland 4

Billings 2

HQ and Tucson

2

(Cumulative) (Active)

Oklahoma 30

Phoenix 23

Alaska 12

Albuquerque 9

Navajo 8

Bemidji 6

Aberdeen 5

Nashville 4

Portland 2

HQ-Rockville 1

NCPS Credentials By IHS Facility

Tahlequah 15

Whiteriver 15

Claremore 13

Phoenix 11

Talahina 11

Cherokee 7

Gallup, Idabel,

Juneau, Pine Ridge, San Fidel, Warm Springs, Zuni

4

Many facilities with <4

QS to ~ 200

(Cumulative) (Active)

Whiteriver 14

Claremore 10

Anchorage 9

Tahlequah 9

Phoenix 5

Talihina 5

Many facilities with

< 4

QS to ~ 100

Critical Elements of Protocol

For each NCPS pharmacist, the NCPSCC also approves a collaborative practice agreement (CPA) to assure national uniformity/standards are met

CPAs are reviewed for: Rationale, Purpose Clinic (Policy and Procedures) Clear indication of pharmacist privileges (advanced

scope) QA and outcomes Training and Local Attestation/Privileging/Re-Privileging Clinical Information: Accordance with National

Guidelines Appropriate Signatures

Impact on Pharmacy Practice Uniformity of expanding scope and local

documentation of outcomes Collection of best practice models and standardization could enhance quality of care. Improved patient access to care – clinics available in over 40 hospitals and clinics across

10 states Provides a national uniform system for pharmacists

that reviews training, attests to knowledge/education, and helps assure clinical competency at local level

Expansion will be another step to uniformity of clinical practice & promotion of competence across agencies

Contact Information / NCPS Committee

Committee MembersLCDR Mike Lee, Chair michael.lee@ihs.gov CAPT Don Ahrens, Ex-Officio don.ahrens@ihs.gov CAPT1 Scott Giberson scott.giberson@ihs.gov CDR Linda Schrand-Crosby linda.schrand@ihs.gov LCDR Brian Campbell brian.campbell@ihs.gov LCDR Maya Thompson maya.thompson@ihs.gov Dr. Charles Rhodes, MDCAPT Marty Smith, ConsultantCDR Chris Lamer, Consultant

For additional information, please email or phone

LCDR Mike Lee @ (918) 222-2222 orCAPT1 Scott Giberson @ (301) 443-2449

1 Effective 1 Oct 2008