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