Pharmacists become clinical service providers
Compensation for clinical pharmacy services key
The American College of Clinical Pharmacy (ACCP) believes that within 20-30 years, most clinical pharmacy specialists will be board-certified specialists. A paper published in Pharmacotherapy outlines a rationale for the need for board-certified specialists, describes specialty board certification, and gives recommendations for attaining the vision.
Members of the 2005-2006 ACCP Certification Affairs Committee wrote that a consensus document prepared by the Joint Commission of Pharmacy Practitioners (ACCP, the Academy of Managed Care Pharmacy, the American College of Apothecaries, the American Pharmacists Association, the American Society of Consultant Pharmacists, the American Society of Health-system Pharmacists, and the National Community Pharmacists Association) expresses a shared vision that "pharmacists will be the healthcare professionals responsible for providing patient care that ensures optimal medication therapy outcomes."
It is clear from that Joint Commission of Pharmacy Practitioners vision that most pharmacists of the future are expected to be clinical pharmacy practitioners who provide advanced patient care services, the report says. That vision is consistent with the ACCP vision that in 20-30 years most clinical pharmacy practitioners will be board-certified specialists.
Three types of credentials available to pharmacists are identified in the report as 1) credentials needed to prepare for practice, such as academic degrees; 2) credentials needed to enter practice, such as licensure, and to update professional knowledge and skills, such as relicensure under state law; and 3) credentials that pharmacists voluntarily earn to document their specialized or advanced knowledge and skills, such as postgraduate degrees, certificates, and certification.
Several types of credentials are voluntarily sought by pharmacists to demonstrate specialized skills and knowledge. Credentials in the pharmacy profession can be obtained through a variety of ways, such as a certificate awarded at the completion of a lengthy and targeted disease state-specific continuing education program or the examination process required to become board-certified by the Board of Pharmaceutical Specialties (BPS).
Certificate vs. certification vs. licensure
The ACCP committee members draw a distinction between certificate programs and certification and licensure. Certificate programs are a mechanism for pharmacists to receive credentials. The Accreditation Council on Pharmaceutical Education defines pharmacy certificate programs as "structured and systematic postgraduate continuing education experiences for pharmacists that are generally smaller in magnitude and shorter in time than degree programs, and that impart knowledge, skills, attitudes, and performance behaviors designed to meet specific pharmacy practice objectives."
Compared with other forms of continuing pharmaceutical education, pharmacy certificate programs are designed to instill, expand, or enhance practice competencies through systematic acquisition of specified knowledge, skills, attitudes, and performance behaviors. Certificate programs are educational activities undertaken by individuals.
In comparison, certification is a process by which a non-governmental agency such as a professional association grants recognition, after assessment, to an individual who has met certain predetermined qualifications specified by that organization. The formal recognition of certification is granted to an individual to designate to the public that the person is competent to practice in the designated area of certification.
And as with certification, licensure relates to the recognition of an individual and involves predetermined qualifications, but the granting agency is governmental, and licensure provides a legal basis for practice.
According to the ACCP committee, the history and evolution of specialists in pharmacy are much shorter than for those in medicine and other health care disciplines. Only since the late 1960s and early 1970s have various pharmacy visionaries and organizations encouraged and proposed development of specialty practitioners to benefit patient care and the profession. The American Pharmaceutical Association established the Board of Pharmaceutical Specialties in 1976 to grant specialty certification to qualified pharmacists. Since then, five specialty practice areas have been established—nuclear pharmacy, nutrition support pharmacy, pharmacotherapy, psychiatric pharmacy, and oncology pharmacy. As of December 2005, more than 5,000 pharmacists have been BPS-certified.
The committee says the value of BPS certification is evident on many levels. Thus, although the fundamental intent of certification has been to enhance patient care, current board-certified pharmacists have experienced a number of personal and professional benefits, including increased marketability and acceptance by other health care professionals, improved feelings of self-worth, and a feeling that they are seen as set apart from general practice pharmacists. Some board-certified pharmacists have received financial rewards, including salary increases, job promotion, bonus pay, and direct compensation for services. In some states, BPS certification enables pharmacists to participate in collaborative drug therapy management.
Significant changes need to achieve vision
If pharmacists are to move into a role as providers of clinical pharmacy services, several factors will need to be considered. First, most other health care professionals who are considered providers of direct patient care are required to be board certified and are expected to maintain their credentials. Second, recognition of the pharmacist as a provider may influence reimbursement for cognitive services. And third, pharmacists in advanced practiced roles have increased professional liability as a consequence of providing clinical services. "A standardized system of credentialing, such as certification by the BPS, may provide a mechanism to address these concerns," the committee said.
A significant barrier to achieving the vision of credentialing is the lack of dependence of compensation for clinical pharmacy services on BPS certification. "Payers have not yet used board certification as a criterion for compensation," the report noted. "Although board certification may not be the sole criterion for compensation eligibility, it certainly should be used as a defensible means of demonstrating advanced knowledge in pharmacotherapy."
[More information is available on-line at www.accp.com.]
The American College of Clinical Pharmacy (ACCP) believes that within 20-30 years, most clinical pharmacy specialists will be board-certified specialists.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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