Developing a Business-Practice Model for Pharmacy Services in Ambulatory Settings

Pharmacotherapy (Impact Factor: 2.66). 03/2008; 28(2):285. DOI: 10.1592/phco.28.2.285
Source: PubMed


A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.

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    ABSTRACT: Given the documented treatment gap for patients with cardiovascular disease, there are numerous opportunities for pharmacists to become more extensively involved in the delivery of care to these high-risk patients. In published trials, pharmacists have demonstrated improved surrogate outcomes for patients with cardiovascular disease by managing hyperlipidemia, hypertension, and secondary prevention medications. A concentrated effort by pharmacists in the inpatient setting, using a combination of direct provider and patient interventions, has been shown to improve adherence to evidence-based guidelines and to help optimize patient care outcomes for acute coronary syndromes. In ambulatory care, there are numerous examples of how pharmacists can help optimize medication regimens for cardiovascular disease and cardiovascular risk factor control. Community pharmacists have been successful in helping treat hyperlipidemia in patients with cardiovascular disease. While these studies have demonstrated that pharmacy-based interventions improve surrogate outcomes, there are limited well designed, randomized, controlled trials that have demonstrated that pharmacist-managed interventions improve clinical or humanistic outcomes in patients with cardiovascular disease or that such programs are cost effective. Opportunities for pharmacists exist at each stage of cardiovascular disease management. A needs assessment should be performed to determine the level of risk factor control and appropriate medication utilization within an organization, institution, or practice site. Physician support and collaboration among multidisciplinary teams are essential to the success of the service. Potential funding sources for establishing a service should be researched, and justification for the investment must be made. Limited time and compensation are likely to be the greatest obstacles to pharmacists instituting cardiovascular services. Other key elements include employing well trained, experienced staff, utilizing a medication protocol and patient tracking database, and implementing safety measures. An opportunity exists to conduct rigorous, well designed studies to evaluate the outcomes of pharmacist-led interventions for patients with cardiovascular disease.
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