N.C. R.Ph.s share experiences in drug therapy management

A group of pharmacists in North Carolina recently met to lay the groundwork for what may be the blueprint for the way pharmacy will be practiced nationwide in the not too distant future.

The R.Ph.s, most from the Greensboro area, met to exchange their experiences in setting up, or working in, drug therapy management clinics. In the formal presentations and lively hallway conversations during the breaks, the pharmacists spoke freely about not only their successes, but also the challenges of moving into this new practice arena, especially in the areas of drug therapy management and reimbursement. The meeting was made possible by an educational grant from Sankyo Pharma.

Kicking off the daylong presentations was Donald W. Moore, M.D., a family physician who practices at Western Rockingham Family Medicine. The practice has expanded over the years to serve the needs of a growing population from one or two physicians in the 1930s to seven physicians, four mid-level practitioners, and a clinical R.Ph. four days a week in 2002. He believes strongly that for the practice to maintain a high level of health care, the addition of clinical pharmacists for drug management is key.

"Having clinical pharmacists in the practice saves lives," said Moore, speaking on what makes a successful healthcare facility. He said three ingredients have to be present: "You must have receptive physicians, a willingness to refer patients for health-related education and share the management of patients with pharmacy professionals according to agreed protocols, and the clinical R.Ph. must develop a team approach with the physician in order to provide quality care to the patients."

Moore explained the clinical pharmacists associated with his practice predominantly handle drug therapy management in hyperlipidemia, anticoagulation, and diabetes. Other areas include weight control, polypharmacy, smoking cessation, osteoporosis, and pain management. The use of clinical pharmacists in his practice has resulted in above average testing rates in diabetics and better control in LDL cholesterol management, he said.

The clinics have been so successful that Michelle Bozovich, Pharm.D., a clinical pharmacist who participates on the healthcare teams at two medical practices, one specializing in cardiology and Moore's family practice, said often there is not enough time to see all the patients. "In the cardiology practice, we are seeing patients 23 hours a week, with a planned expansion to 30 hours. The lipid clinic patients are scheduled in the morning, and the anticoagulation patients are scheduled any time during the day. We are having trouble seeing all the hyperlipidemia patients because of our time constraints," she said.

Bozovich said that working in family medicine offers her a better opportunity to make other interventions that directly affect lipid levels. "The family practice setting offers me more variety. In cardiology, we deal with a very select group of patients. While we probably capture all patients with hyperlipidemia, we are often not able to affect other disease outcomes."

While working in a disease management clinic may be professionally fulfilling, getting paid for those services can be a source of frustration. "Customers are unaccustomed to paying for the services of clinical pharmacists," said Dawn Pettus, Pharm.D., Drug Therapy Management Inc. "Also, physicians may be reluctant because of a lack of vision, inconsistent services, or they may be unwilling to change or take chances."

Pettus' advice is to bill patients monthly for their drug therapy management and slowly move to a per-incident charge. "To bill for services, the clinical pharmacist must be under the direct supervision of a physician," she said. "The clinical pharmacists cannot see patients if the physician is not in the office, and the physician must be actively involved in one out of three visits, with each visit co-signed."

Pettus said pharmacists in North Carolina who want to broaden their professional horizons can become Clinical Pharmacist Practitioners (CPPs). The requirements are stiff and include the completion of a certificate program approved by the American Council on Pharmaceutical Education. She believes becoming a CPP advances the profession of pharmacy through collaborative practices, adds to "patient satisfaction, and paves the way for future reimbursement."

In this first meeting of its kind, Sankyo picked the Greensboro-area pharmacists to document their experiences in disease state and drug therapy management because of their knowledge base. "We believe this trend for pharmacy practitioners will quickly spread to other states, and we are pleased to support those efforts," said Jack Kelly, R.Ph., national account manager, Trade and Pharmacy Development, Sankyo Pharma. "We are pleased to offer our support in shaping the future of pharmacy."

Harold E. Cohen, R.Ph.

Harold Cohen. N.C. R.Ph.s share experiences in drug therapy management.

Drug Topics

2002;23:51.