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Leadership Roundtable June 2011
Leadership Roundtable June 2011
RADM Scott Giberson, RPh, PhC, NCPS-PP, MPHU.S. PHS Chief Professional Officer, Pharmacy U.S. Assistant Surgeon General
Accelerating Effective Pharmacy Practice Models
Panel ObjectivesPanel Objectives
Expand Pharmacy’s Scope and Impact Expand Pharmacy’s Scope and Impact
The Nation has needs:– Access– Quality– Cost– Safety
The Profession has capacity and skill:
– Direct Care– Public Health– Health Leadership
The Nation has needs:– Access– Quality– Cost– Safety
The Profession has capacity and skill:
– Direct Care– Public Health– Health Leadership
Great disparity exists between the goal of optimal health outcomes and maximal use of all health professionals
Great disparity exists between the goal of optimal health outcomes and maximal use of all health professionals
May become an under-resourced and overburdened healthcare delivery system
May become an under-resourced and overburdened healthcare delivery system
Diverse Scopes 2011 and Beyond Diverse Scopes 2011 and Beyond Pu
blic
Hea
lth S
cope
Clinical (‘Primary’ Care) ScopeClinical (‘Primary’ Care) Scope
• What process was employed to make the pharmacist-delivered service consistent in process and quality?
• How did the service transition from a local practice model to a national level program?
• Who were the champions of the practice model? How did you get their buy-in?
• What are the processes for continuous innovation, improvement?
• What lessons were learned from the process of developing a national program?
• What were the roadblocks?
• What process was employed to make the pharmacist-delivered service consistent in process and quality?
• How did the service transition from a local practice model to a national level program?
• Who were the champions of the practice model? How did you get their buy-in?
• What are the processes for continuous innovation, improvement?
• What lessons were learned from the process of developing a national program?
• What were the roadblocks?
Practice ModelsPractice Models
National Clinical Pharmacy Specialist (NCPS) ProgramNational Clinical Pharmacy Specialist (NCPS) Program
• Reviews and recognizes credentials of local Clinical Pharmacy Specialist (CPS)
• Assures and promotes uniformity of clinical competence through national certification
• Serves to promote universal recognition of pharmacists as billable health care providers
• Captures value and impact from those services• Continues program expansion and innovation
• Reviews and recognizes credentials of local Clinical Pharmacy Specialist (CPS)
• Assures and promotes uniformity of clinical competence through national certification
• Serves to promote universal recognition of pharmacists as billable health care providers
• Captures value and impact from those services• Continues program expansion and innovation
To develop and implement a national program and process that:
ScopeScope• Intended to recognize advanced scopes of practice at
local level that satisfy uniform national guidelines• Involve management of disease through therapy • Care/Privileges must include:
– Interview, chart review– Laboratory privileges– Prescriptive authority– Physical assessment– Patient education and follow up
• NCPS grants a certification
• Privileges are granted locally by medical staff
• Intended to recognize advanced scopes of practice at local level that satisfy uniform national guidelines
• Involve management of disease through therapy • Care/Privileges must include:
– Interview, chart review– Laboratory privileges– Prescriptive authority– Physical assessment– Patient education and follow up
• NCPS grants a certification
• Privileges are granted locally by medical staff
Certification Process: Local vs. NationalCertification Process: Local vs. NationalPharmacists locally
privileged. Work to satisfy national requirements
Pharmacists locally privileged. Work to satisfy
national requirements
Re-certification every 3 yrs: ongoing practice hours and CE
Re-certification every 3 yrs: ongoing practice hours and CE
Continue to practice locally, now as NCPS pharmacists assuring similar scope and quality
Continue to practice locally, now as NCPS pharmacists assuring similar scope and quality
Submit credentials to NCPS Committee for review
Submit credentials to NCPS Committee for review
1. Experiential components:
i. 2-4 yrs in clinical PHS pharmacy practice
ii. > 1 year in clinical practice with requested privileges as local clinical pharmacy specialist
2. Attestation letters from physician
3. Didactic Credentials
4. Annual patient contact hours
5. NCPS-approved Collaborative Practice Agreement (CPA)
1. Experiential components:
i. 2-4 yrs in clinical PHS pharmacy practice
ii. > 1 year in clinical practice with requested privileges as local clinical pharmacy specialist
2. Attestation letters from physician
3. Didactic Credentials
4. Annual patient contact hours
5. NCPS-approved Collaborative Practice Agreement (CPA)
Collaborative Practice Agreements (CPAs)Collaborative Practice Agreements (CPAs)
• NCPS approves a CPA for each NCPS pharmacist, to assure uniformity in process, scope and quality
• CPAs are reviewed for these critical elements:– Rationale (Justification), Purpose– Clinic Policy and Procedures (CDTM+)– Clear Indication of Privileges (the “Big 3” scope)– Performance: QA and Outcomes– Training and Local Attestation– Privileging/Re-Privileging – Clinical Information: National Guidelines– Appropriate Signatures
• The “rationale” for CPA
• NCPS approves a CPA for each NCPS pharmacist, to assure uniformity in process, scope and quality
• CPAs are reviewed for these critical elements:– Rationale (Justification), Purpose– Clinic Policy and Procedures (CDTM+)– Clear Indication of Privileges (the “Big 3” scope)– Performance: QA and Outcomes– Training and Local Attestation– Privileging/Re-Privileging – Clinical Information: National Guidelines– Appropriate Signatures
• The “rationale” for CPA
Process and Patient ImpactProcess and Patient Impact• Process
– Uniformity of scope and documented outcome
– Best practice model standardization– Uniform process that reviews training,
attests to knowledge and education– Helps to assure clinical competence– External expansion was another step to
uniformity• Patient
– Access to care– Quality care (clinical/admin outcome,
safety)– Inter-professional support
• Process– Uniformity of scope and documented
outcome – Best practice model standardization– Uniform process that reviews training,
attests to knowledge and education– Helps to assure clinical competence– External expansion was another step to
uniformity• Patient
– Access to care– Quality care (clinical/admin outcome,
safety)– Inter-professional support
Example of Physician Survey Results(n=117 physicians)
Example of Physician Survey Results(n=117 physicians)
96% of respondent-physicians reported benefit(s):• improved outcomes• increased return on investment• allowing for physician shift in workload• increased patient access to care
• Change the Paradigm:1. Value local privileging based on
practice setting2. Assurance of competency3. Involve physicians and patients
in planning and marketing4. Illustrate patient AND
administrative outcomes5. Base service on need
• Report to the Surgeon General• Federal Pharmacist Vision
• Change the Paradigm:1. Value local privileging based on
practice setting2. Assurance of competency3. Involve physicians and patients
in planning and marketing4. Illustrate patient AND
administrative outcomes5. Base service on need
• Report to the Surgeon General• Federal Pharmacist Vision
Continuous InnovationContinuous Innovation
• We ARE health care providers• We ARE public health professionals• We ARE part of national health leadershipChallenges (‘Roadblocks’)
1. Compensation based on level of service2. Uniformity of message – lack of common vision3. Dispelling the myths
• Territory?• Education Level?• Outcomes?
4. Practice setting5. Legal barriers
• We ARE health care providers• We ARE public health professionals• We ARE part of national health leadershipChallenges (‘Roadblocks’)
1. Compensation based on level of service2. Uniformity of message – lack of common vision3. Dispelling the myths
• Territory?• Education Level?• Outcomes?
4. Practice setting5. Legal barriers
Critical ConversationCritical Conversation
• Continue to have uniform messageContinue to have uniform message• Keep all the doors open for pharmacistsKeep all the doors open for pharmacists• Lead change for patients and health systemsLead change for patients and health systems• Focus efforts on broad conceptsFocus efforts on broad concepts• Leverage federal pharmacy practice Leverage federal pharmacy practice • We shouldn’t be our harshest criticsWe shouldn’t be our harshest critics
• Continue to have uniform messageContinue to have uniform message• Keep all the doors open for pharmacistsKeep all the doors open for pharmacists• Lead change for patients and health systemsLead change for patients and health systems• Focus efforts on broad conceptsFocus efforts on broad concepts• Leverage federal pharmacy practice Leverage federal pharmacy practice • We shouldn’t be our harshest criticsWe shouldn’t be our harshest critics
Call-to-Action Call-to-Action