oct 8th ambulatory care

what is ambulatory care?

refers to healthcare services that are provided on an outpatient basis, meaning that patients receive care without staying overnight in a healthcare facility

• ambulatory care provides accessible, convenient and cost-effective care while reducing the need for hospitalizations

common ambulatory care services

• Primary Care

• Specialty Care - cardiologists, dermatologists, or orthopedic surgeons.

• Urgent Care

• Outpatient Surgery

• Diagnostic Services - X-rays, MRI scans, and blood tests

• Rehabilitation Services - physical therapy and occupational therapy.

• Chronic Disease Management - ongoing care and monitoring for individuals

• Preventive Care - immunizations and health screenings.

• Mental Health Services – counseling therapy

ambulatory care settings

• Physician Offices & Private Clinics

• Hospital-Based Outpatient Services

• Community Health Centers and Clinics

• Urgent Care and Retail Clinics

• Other Outpatient Settings

Patient Centered Medical Home is a model primary care that provides comprehensive, coordinated and patient-centered care through a team-based approach

role of pharmacists in ambulatory care

• Disease state management

• Chronic diseases

• Nonemergent acute conditions

• Medication management and patient counseling

• Monitor medication safety and effectiveness

• Collaborate with the healthcare team

• Administer immunizations

• Prescribe and adjust medications*

• Order laboratory tests*

within applicable scope of practice, Collaborative Practice Agreement (CPA) and institutional policies

collaborative pharmacy practice

A Collaborative Practice Agreement (CPA) is a formal agreement between a pharmacist and one or more authorized healthcare providers that defines the pharmacist's responsibilities and scope of practice.

CPA enables Collaborative Drug Therapy Management (CDTM) under a defined protocol

Considerations:

• State scope-of-practice laws

• Reimbursements

pharmacist in ambulatory care

within CPA

• Manage specified disease states

• Initiate medications

• Adjust or discontinue medications

• Order and monitor laboratory tests

• Monitor treatment response and adverse effects

• Provide ongoing follow-up

• Document care in the electronic health record

general pharmacist role

• Perform medication reconciliation

• Assess medication therapy

• Identify medication-related problems

• Provide recommendations to prescribers

• Provide patient education and counseling

• Answer drug information questions

• Address medication access and coverage issues

• Communicate with other members of the healthcare team

Massachusetts requirements for CDTM/CPA

MA Pharmacist License in Good Standing

Completed five years of experience as a licensed pharmacist, OR:

• Earned a Pharm D and have entered into a CPA on or before June 30, 2017; OR

• Completed such other education or residency criteria that the Board determines to be the equivalent of five-years of experience as a licensed pharmacist

Mass Controlled Substance Registration in Good Standing 

• "State DEA"

Complete at least five additional contact hours of yearly CE that address areas specific to the pharmacist's area of practice

Maintain at least $1,000,000 (per occurrence) of professional liability insurance

sample cardiac pharmacist role (under CDTM/CPA)

Referral by Cardiologist (or Cardiology NP)

Must Have a Diagnosis for Treatment (Pharmacists do NOT diagnose)

Conditions Managed (Guideline Driven)

• Hypertension (HTN)

• Lipids/Cholesterol

• Anticoagulation and Rate Control for Atrial Fibrillation (Afib)

• Coronary Artery Disease (CAD)

Prescribe, Adjust, Discontinue Medications within the CPA

• Blood Pressure Medications, Lipid Medications, Anticoagulants, Heart Rate Lowering Medications, Anti-Anginal Medications, Antiplatelet Agents, etc.

Order Tests within the CPA

• Labs  and Tests – BMP, LFTs, Lipids, CBC,  24-hour-BP monitoring, EKG, etc.

Educate the Patient about Medications, Tests, Goals, Expectations

Monitor and Follow-up with Patient on a Regular Basis

DOCUMENT the Visit/Patient Interaction in the Medical Record