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Ambulatory Care Pharmacy Practice Expansion during a Pandemic

By Rachel Steele posted 03-29-2021 14:47


Over this last year of the COVID-19 pandemic, the questions and unknowns that arrived with the reality of practicing in a new context have prompted many practice advancements while perhaps pausing others – such as the expansion of disease states within one’s collaborative practice agreement for those in ambulatory care

Within ambulatory pharmacy at my health system, our model of care quickly evolved to prioritize safety while optimizing patient care. Initially, face-to-face visits transitioned to telephonic visits. Shortly thereafter, virtual visits were added as another opportunity. Now a year later, we provide ambulatory pharmacy care utilizing a hybrid mix of all three visit types. Additionally, a year later, we have been able to further our practice advancement through the addition of disease states within our collaborative practice agreement. It has been exciting to be a part of this expansion at my practice site and to implement many principles that I learned about at the onset of my career when reading “Building a Successful Ambulatory Care Practice” by Mary Ann Kliethermes and Tim R. Brown.

In developing my service expansion proposal, one of the first items I considered was how could I bring value to my current practice site. Finding out what my providers wanted and needed was key to helping foster buy-in and support. Since I have been at my practice site for several years and was focusing on an expansion to services, I was able to assess my “side-line” question types to help tailor my ideas. I also was able to utilize the relationships I had developed with each team-member to determine the accuracy of my assessment. 

After the service expansion idea was conceptualized, I shifted my focus to the logistics. Specifically, this involved research and creation of a disease state exhibit document for our collaborative practice agreement that defined the scope of pharmacy’s role, development of a note template, and assembling the official proposal presentation for my providers. To complete these items, I reviewed current guidelines, gathered data, and utilized collaborative resources for note development. Key pieces of data gathered related to the burden of the disease state, literature on the role and impact that the pharmacist can have in collaborative management of the disease state, and a review of the patient population my team serves to more clearly delineate how many may benefit from the service. I also had to think through what would be appropriate for the scope of pharmacy and define the logistics of patient recruitment, visit scheduling, and follow-up care. Since I was already established at my clinic, development of a billing strategy was not necessary as my current approach would apply to the new service. However, I did have to compile a list of appropriate outcome metrics for the new service. These metrics included both quantitative variables, such as the number of referrals and visits, and qualitative variables, items looking at therapeutic outcome markers and insurance/health system quality metrics being met. Finally, after completing this preparation work, I was able to produce the deliverables – the disease state exhibit document for our collaborative practice agreement, note template, and proposal presentation.

Next, I scheduled time to present the proposal presentation. For my clinic, the clinic leadership and the providers, including a physician champion of the pharmacy team, have monthly meetings. I was able to secure a place on the agenda at one of these meetings which ensured all the stakeholders were present. Given the working relationships and value of pharmacy that already was established at the practice site, the providers were all in agreement with the service expansion idea. Additionally, several other areas of interest were brought to the forefront for further pharmacy expansion.

Finally, we were almost ready to start the new service. The last step in the process was coordination with IT to build the referral within the electronic medical record. I am thrilled with the outcome and excited to begin the process again for the next requested service expansion area.

If you have felt like some of your targeted practice advancements were paused by the COVID-19 pandemic, I would encourage each of you to re-examine your practice site for growth areas. Then conceptualize, research, create, and present your service plan. For further guidance and resources, I would recommend checking into the July 2019 ASHP FAQ entitled “Basics of Ambulatory Care Pharmacy Practice” as well as “Building a Successful Ambulatory Care Practice” by Mary Ann Kliethermes and Tim R. Brown.