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Political turmoil over healthcare continues to be a hot topic as it provokes a multitude of challenges including cost, quality, and access to healthcare. One domain of health care that is expanding particularly fast is ambulatory care. ASHP’s definition of Ambulatory Care Practitioners is: Ambulatory care practitioners are medication-use specialists and patient care providers working to improve patient care and health outcomes in a variety of ambulatory care settings.

How do we do this?

1. Pharmacists in the ambulatory practice setting may have a collaborative practice agreement with physicians allowing them to engage patients in the outpatient setting for management of conditions such hypertension, diabetes, cholesterol, and anticoagulation. Additionally, patients are referred to the pharmacist by a physician or other provider for comprehensive medication management. Pharmacists may interact with patients in person or virtually through telehealth visits.
2. Some organizations provide their pharmacist with a scope of practice for chronic disease state management such as anticoagulation, hypertension, and diabetes.
3. ASHP has created the Practice Advancement Initiative (PAI) to propel the pharmacy profession forward. As part of the there are 5 pillars to address the multifaceted progression of the pharmacy profession. The 5 pillars that should be incorporated into your practice Care Team Integration, Leveraging Pharmacy Technicians, Pharmacist Credentialing & Training, Technology, and Leadership in Mediation Use.
4. The pharmacy profession continues to advance pharmacy practice and has provided a certification for ambulatory care. The Board of Pharmaceutical Specialties has established a Board Certification in Ambulatory Care (BCACP) that evaluates proficiencies in five realms including pharmacotherapy, and patient advocacy, translation of evidence into practice, practice models and policies, and population and public health.

What will this allow us to do?

This grants pharmacist the ability to elevate their practice and have a higher accountability for patient outcomes. Ambulatory care would include interpretation of a variety of labs and vital signs such as hemoglobin A1C, heart rate, blood pressure, basic metabolic panel, lipid panel, and urine microalbumin. Pharmacists will have the ability to review these lab values and vitals for assessment of disease state management such as providing blood glucose readings, assessing current glycemic control and initiating, adjusting, and/or discontinue oral and injectable medications for diabetes. It also allows for pharmacists to be more involved in screening for disease states and calculating cardiovascular disease risk assessment to determine if statin therapy is appropriate. Ambulatory care allows for pharmacists to improve access, affordability, and quality of patient care.

Ambulatory care enables pharmacists to make a positive difference in patient care. As the future of healthcare unfolds, ambulatory care pharmacy practice holds the potential to ensure the continuity of quality care for patients.

For more information:

1. Ambulatory Care Career Tool
2. ASHP – Ambulatory Care Practitioner
3. BCACP Certification Resources
4. Practice Advancement Initiative

Giovanni K.

Pharm.D. Candidate 2018

VCU/MCV School of Pharmacy