In my journey as a student pharmacist and future practitioner, in addition to the “what,” I always want to know the “how” and “why” behind every concept. I look for tangible objectives, solid methodology, and clear purpose so I can accomplish specific goals. I have learned that the same principle applies to patient care. When patients take medications, their adherence is often dependent on their “how” and “why.” They have a better probability of improving their health if they are recommended specific tasks, such as a “how” of walking at least 30 minutes per week to fulfill their “why” of being healthy so they can be there for their loved ones. A well-defined purpose drives actionable steps for more favorable outcomes.
The significance of the “how” and “why” in pharmacy practice has been further elevated and broadened for me through my exposure to the Pharmacy Accountability Measures (PAM) initiative. The PAM Work Group provides pharmacy professionals with concrete areas of focus that demonstrate the unparalleled medication expertise pharmacists have to directly improve the quality of patient care. By understanding these measures (the “what”) and taking actionable steps in these specific areas in pharmacy practice (the “how”), we as members of the pharmacy profession can move forward with our purpose (the “why”), doing what is best for the patient. Just as Dr. John E. Murphy expressed his Harvey A.K. Whitney lecture, “our mission has always been about the patient; it was never about pharmacists”—so perfectly put.
In exploring this initiative with you this week, I must first start with the “what.” What are Pharmacy Accountability Measures, or PAM? As described by ASHP, the PAM Work Group “identif[ies] national quality measures that establish accountability and demonstrate improvements in clinical outcomes by health-system pharmacists.” In essence, PAM identifies areas of clinical focus where pharmacists can show impact and improve patient care. There are currently six therapeutic categories of measures identified by the PAM Work Group from measure developers such as the Centers for Medicare and Medicaid Services (CMS) and the Pharmacy Quality Alliance (PQA), and they are antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship.
The six measure categories described were selected because they are quantifiable, and can thus be tracked and monitored by a number of institutions nationwide to measure impact, or adherence to the measure and impact on the activity or outcome. By sifting through these measures on various measure databases, the PAM Work Group determines those that pharmacists have direct involvement in, updates the full table of measures as these categories continue to grow and change, and advocates for pharmacists to focus on improving specific performance improvement processes in patient care.
Now that we have established the “what” and reviewed PAM, we can delve into the “how.” I recently had the pleasure of talking with a number of pharmacy leaders within ASHP, who have shared many pearls of wisdom about pharmacy, and this particular pearl is one of my favorites: if you took 10 people on a random street corner aside and asked them what pharmacists do, what would they tell you? Most of them would respond, “Pharmacists provide me with my prescriptions,” and maybe some would add, “Pharmacists make sure that all the medications I’m taking don’t have any harmful interactions”—but there is so much more that a pharmacist does to provide quality patient care.
And this thought brings us to the “how” question—how can we increase the visibility of the profession? The PAM Work Group provides a framework for pharmacist involvement to improve quality measure performance and patient outcomes, and thereby demonstrate value within their organizations and to the patients they serve. In his Whitney lecture titled "The Visible Ingredient," Dr. John E. Murphy sheds light on areas of limited pharmacist visibility: 1) some pharmacies in community and hospital settings have pharmacists in dispensing-related roles who are not really seen by the public, 2) there is currently no requirement for a pharmacist to address the needs of every patient receiving complex medication therapy in health systems, 3) some pharmacists might not do patient rounds and therefore are not visibly seen by patients in a hospital, and 4) pharmacists are not commonly part of the discussion of healthcare reform to the extent that physicians and nurses are. Dr. Murphy delves into these subjects more in his full address and is more eloquent in his discourse, so I encourage you to read his lecture; but essentially, we can improve upon these areas by increasing direct patient care through rounds and complex medication monitoring, creating new clinical roles in models of care that value pharmacist services, and directly being involved in discussions of reforms that impact medication therapy—we improve through advocacy and proactivity. And PAM is a good place to start, as it targets specific measures where pharmacist involvement can improve patient outcomes.
With both the “what” and “how,” we move on to the inevitable inquiry of “why”—why are initiatives like PAM important? Demonstration of our medication expertise as pharmacists facilitates recognition of our value in health care and our direct ability to effect positive change of lower cost, better care, and better health outcomes. Pharmacists’ ability to optimize medication use at the highest level can decrease the length of patients’ stays at hospitals and improve their quality of life. Dr. Murphy augments this point with various recognitions of pharmacy practice by prominent organizations, such as the U.S. Public Health System’s support of the importance of pharmacists’ accessibility and need for healthcare reform with expanded patient care services, the CDC’s promotion of pharmacists’ leadership in antimicrobial stewardship, and Dr. Lucian Leape, an internationally respected physician, and his affirmation of pharmacists’ prevention of medication errors in the intensive care unit. Pharmacists complete rigorous schooling, post-graduate training programs, and continuing education, and have exhaustive knowledge of the entire pharmacopeia of drugs, so we have undeniable influence on the quality of patient care. Therefore, we must capitalize upon the opportunities presented to us and work interprofessionally to improve the health of millions of people firsthand.
I again invoke the wisdom of Dr. Murphy to drive this point home: “our mission has always been about the patient; it was never about pharmacists.” If we know our purpose and hold fast to it, we will drive our practice forward with the patient’s well-being at the forefront, with everything else falling into place.
Pharm.D. Candidate, Class of 2023
Purdue University College of Pharmacy