Physicians and pharmacists collaborate on patient care
June 1, 2001
Physicians and pharmacists collaborate on patient care
Hospital pharmacists in ideal environment to expand role
Physicians and pharmacists are starting to talk to each other and plan ways to collaborate on aspects of patient care. Representatives from the Philadelphia-based American College of Physicians-American Society of Internal Medicine Foundation (ACP-ASIM) and representatives from national pharmacy organizations are meeting regularly to discuss topics such as collaboration on managing patient drug therapy.
C. Edwin Webb, director of government and professional affairs at the American College of Clinical Pharmacy (ACCP) in Washington, DC, addressed physicians at the March meeting of the ACP-ASIM board of governors. "Collaboration on management of patient drug therapy is already happening, to various degrees, in the hospital setting," reports Webb. "Generally speaking, the type of clinical practice hospital pharmacists are involved with is sometimes a formal process, other times an informal one. The close proximity of pharmacists to physicians in inpatient facilities readily provides the opportunity for collaboration, unlike the situation that community pharmacists face."
Even though hospitals are, in many cases, ahead of community pharmacies in efforts to collaborate with physicians, there are still obstacles that prevent some hospitals from maximizing these relationships. "Not everyone from the pharmacy staff is ready to perform at the clinical level required for this type of collaboration," says Webb. "In some cases, physicians still don’t fully appreciate the capabilities and skills that pharmacy staff possess. Sometimes, physicians simply don’t think to ask for help from pharmacists."
The continuing shortage of pharmacists affects collaboration efforts, too. "Because pharmacies are understaffed and pharmacists must then assume heavy workloads, the perception is that the time and energy of the pharmacy staff must be focused internally, rather than externally," he explains. "Both pharmacists and physicians perceive pharmacists’ time this way. Therefore, pharmacists don’t get as involved in direct patient care as they might otherwise."
Michael Rotblatt, MD, PharmD, assistant clinical professor of medicine at the University of California-Los Angeles and a physician at the Sepulveda VA Ambulatory Care Center in the LA area, has a unique perspective on the collaboration issue, having worked both as a pharmacist and now a physician. "The VA clinics rely on their pharmacists," he explains. "There are pharmacists in the centralized area who dispense and do patient counseling. Then there are clinical pharmacists on the floors who interact with physicians and patients."
Work in clinics exemplifies collaboration
"We really depend on pharmacists," Rotblatt continues. "The pharmacists function in clinics to fill or transmit prescriptions. They catch drug interactions and other potential errors that physicians sometimes miss. They counsel patients after they have been seen by physicians. Pharmacists have lots of responsibility in the clinic setting. For example, pharmacists in the Coumadin clinics see patients on their own and present proposed changes in drug regimens to the physicians. Pharmacists are integral parts of the team in diabetes, blood pressure, infectious disease clinics, and more."
Blood pressure clinics often are run by pharmacy residents, he adds. "A physician may start a patient on a new blood pressure medication and then refer that patient to the pharmacist. The physician doesn’t need to see the patient for a couple of months, but will refer the patient to the blood pressure clinic so that the patient can be seen by a pharmacist in a couple of weeks. In the clinic, the patient will have necessary labs drawn and will receive any necessary medication changes after the attending signs off on those changes."
Coumadin clinics are one of the best examples of physician and pharmacist collaboration on the management of patient drug therapy. "Satellite pharmacists develop intimate relationships with medical and nursing staff," Rotblatt notes. "Putting pharmacists into satellite pharmacies is one of the best ways to make the skills and strengths of pharmacists known to house staff. Blood pressure clinics and any area where medication pharmacology is complicated — as with cancer chemotherapy and treatment of HIV/AIDS — make good places for pharmacists to step in and show their value to the rest of the medical team." Management of drugs that require pharmacokinetic manipulation, such as antibiotics, also provides good opportunities for pharmacists to show their skills.
Pharmacists often find that inservices provide answers to problems. Education of nursing and medical staff can, indeed, serve in some situations. "Demonstrating pharmacy skills firsthand to the nursing staff is one of the best ways to get pharmacists out of the basement," suggests Rotblatt. "It can be a double-edged sword, though. If a pharmacist is not sufficiently skilled or trained, these attempts can negatively affect the image of pharmacy staff."
Another way for pharmacists to prove their value to house staff is to provide education, such as in teaching Advanced Cardiac Life Support classes. "When pharmacy provides needed services and does a good job of it, more services will be asked for," encourages Rotblatt.
Performance is the answer’
"However, inservices are not the only answer in this situation," Webb says. "When building relationships, performance is the answer. Being available, being visible on the floor, offering services — that’s how pharmacists can better show physicians that they are capable and willing to help manage patient drug therapy. In some cases, working with the nursing staff is the best way to get a foot in the door. Pharmacists need to be available to nurses; they need to start building credibility. Start with basic services, and then build over time so that your judgment is trusted and sought by the medical staff."
"Collaboration on management of patient drug therapy is only part of a broader issue," says Webb. Webb looks to organizations like the ACP-ASIM Health and Public Policy Committee to identify more opportunities for pharmacist and physician interaction, he explains. "The responsibility of the committee is to build quarterly meetings so that national pharmacy associations can have discussions with physicians."
Webb was invited to make a presentation at the March meeting, but the group focuses on other issues such as patient safety, seamless formulary use, electronic prescribing, and more. There is a quarterly forum to identify areas where pharmacy departments and medical staff might work together better, and where there are agreements and disagreements. The referral of a patient from the physician to a pharmacist for drug therapy management is just one piece of it. "The meetings have been productive for both sides," he says. "We’ll continue these meetings and will begin looking at the patient bill of rights, too."
Sources
• C. Edwin Webb, PharmD, MPH, Director of Government and Professional Affairs, the American College of Clinical Pharmacy, 1101 Pennsylvania Avenue, Suite 700, Washington, DC 20004-2514; Telephone: (202) 756-2227.
• Michael Rotblatt, MD, PharmD, Assistant Clinical Professor of Medicine, UCLA, Sepulveda VA Ambulatory Care Center (OOP-R), 16111 Plummer St., North Hills, CA 91343; Telephone (818) 891-7711, ext. 5200.
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