Survey of Pharmacist Collaborative Drug Therapy Management in Hospitals
Survey of Pharmacist Collaborative Drug Therapy Management in Hospitals
Purpose: The extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals and pharmacy directors' perceptions regarding CDTM were studied.
Methods: A survey was developed after reviewing the literature on CDTM. The sample for the study was obtained from the 2001 American Hospital Association Guide. The mail survey was pretested in January 2002 with 30 hospital pharmacy directors in Illinois, Indiana, and Michigan. A national random sample of 1000 hospital pharmacy directors stratified by state were mailed surveys in March 2003. Two follow-up surveys were mailed at approximately four-week intervals.
Results: Responses were received from 327 hospitals, a 32.7% response rate. A total of 158 respondents (49.7%) indicated that some pharmacists in their hospital were engaged in CDTM. Most hospitals with CDTM authorized pharmacists to adjust a drug's strength (86.7%), order laboratory or related tests (84.2%), and change a drug's frequency of administration (81.6%). The CDTM-related activities pharmacists performed varied with disease and treatment area. Payment or reimbursement for some CDTM was received by 12.7% of hospitals with CDTM. Respondents from hospitals with CDTM perceived significantly greater support for CDTM and greater strategic impact of CDTM than those from hospitals without CDTM. Respondents perceived positive support for CDTM but believed that CDTM had little or no financial impact on pharmacy departments.
Conclusion. Approximately 50% of respondent hospitals had some pharmacists engaged in CDTM. Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was perceived as having a positive strategic impact by improving the views of upper administration regarding the value of pharmacists and facilitating implementation of other pharmacy services.
Collaborative drug therapy management (CDTM) entails using a multidisciplinary process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy. CDTM by pharmacists has been advanced as a means of ensuring that medications are used appropriately to (1) improve patients' health status, (2) maximize patients' health-related quality of life, (3) reduce the frequency of avoidable drug-related problems, and (4) optimize societal benefits from pharmaceuticals. The scope of CDTM includes the initiation, modification, or discontinuation of a drug therapy; patient counseling and education; and the identification, resolution, and prevention of potential and actual drug-related problems.
Studies have demonstrated the effect of CDTM on patient outcomes. Hayes et al. reported that 11,969 prescriptions for emergency contraception were provided in Washington state as a result of collaborative practice agreements among 140 pharmacists and physicians, likely preventing over 700 unintended pregnancies. In a study involving quality assessment of collaborative practice agreements, Isetts et al. found an increase in the number of therapeutic goals achieved in patients when CDTM was used. In a study of health outcomes in hospitalized patients, Bjornson et al. reported a benefit:cost ratio of 6:1 among health care teams that included a pharmacist compared with teams that did not have a pharmacist.
There has been steady growth in the number of state laws and regulations enabling pharmacists to engage in CDTM. In 1996, Shefcheck and Thomas reported that 16 states had laws authorizing pharmacists to initiate and modify drug therapy in concert with prescribers, and 16 other states were pursuing such laws. Ferro et al., in 1998, reported that 21 states had pharmacist CDTM laws. More recently, in 2003, Punekar et al. reported that 32 states had such laws. However, little data are available on the extent and scope of CDTM occurring in U.S. hospitals.
Previous studies have examined the perceptions of various health care professionals regarding CDTM. In a survey of pharmaceutical company executives, 32% of company executives reported that their company takes a neutral position on pharmacist CDTM bills in their state legislatures, while 28% of the companies supported such legislation. Airmet and Adamcik reported that physicians consistently had more negative views about pharmacists providing clinical pharmacy services, providing pharmaceutical care, and engaging in collaborative drug practice agreements than did pharmacists.
Assessing the current opinions of pharmacy directors on various aspects of CDTM can help the pharmacy profession identify factors that act as potential barriers or facilitators to the growth of CDTM. In addition, a psychometrically sound instrument to measure perceptions regarding CDTM can help track changes in perceptions over time, further helping to identify means to facilitate CDTM in hospitals.
The objectives of this study were to assess (1) the extent and scope of CDTM in U.S. hospitals, (2) the associations between hospital characteristics, pharmacy director characteristics, and CDTM, (3) pharmacy directors' perceptions of CDTM and associations between pharmacy directors' characteristics, hospital characteristics, and perceptions of CDTM, (4) hospitals' short- and long-term plans regarding CDTM, and (5) pharmacy directors' views about major facilitators and barriers for CDTM in hospitals.
Abstract and Introduction
Abstract
Purpose: The extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals and pharmacy directors' perceptions regarding CDTM were studied.
Methods: A survey was developed after reviewing the literature on CDTM. The sample for the study was obtained from the 2001 American Hospital Association Guide. The mail survey was pretested in January 2002 with 30 hospital pharmacy directors in Illinois, Indiana, and Michigan. A national random sample of 1000 hospital pharmacy directors stratified by state were mailed surveys in March 2003. Two follow-up surveys were mailed at approximately four-week intervals.
Results: Responses were received from 327 hospitals, a 32.7% response rate. A total of 158 respondents (49.7%) indicated that some pharmacists in their hospital were engaged in CDTM. Most hospitals with CDTM authorized pharmacists to adjust a drug's strength (86.7%), order laboratory or related tests (84.2%), and change a drug's frequency of administration (81.6%). The CDTM-related activities pharmacists performed varied with disease and treatment area. Payment or reimbursement for some CDTM was received by 12.7% of hospitals with CDTM. Respondents from hospitals with CDTM perceived significantly greater support for CDTM and greater strategic impact of CDTM than those from hospitals without CDTM. Respondents perceived positive support for CDTM but believed that CDTM had little or no financial impact on pharmacy departments.
Conclusion. Approximately 50% of respondent hospitals had some pharmacists engaged in CDTM. Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was perceived as having a positive strategic impact by improving the views of upper administration regarding the value of pharmacists and facilitating implementation of other pharmacy services.
Introduction
Collaborative drug therapy management (CDTM) entails using a multidisciplinary process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy. CDTM by pharmacists has been advanced as a means of ensuring that medications are used appropriately to (1) improve patients' health status, (2) maximize patients' health-related quality of life, (3) reduce the frequency of avoidable drug-related problems, and (4) optimize societal benefits from pharmaceuticals. The scope of CDTM includes the initiation, modification, or discontinuation of a drug therapy; patient counseling and education; and the identification, resolution, and prevention of potential and actual drug-related problems.
Studies have demonstrated the effect of CDTM on patient outcomes. Hayes et al. reported that 11,969 prescriptions for emergency contraception were provided in Washington state as a result of collaborative practice agreements among 140 pharmacists and physicians, likely preventing over 700 unintended pregnancies. In a study involving quality assessment of collaborative practice agreements, Isetts et al. found an increase in the number of therapeutic goals achieved in patients when CDTM was used. In a study of health outcomes in hospitalized patients, Bjornson et al. reported a benefit:cost ratio of 6:1 among health care teams that included a pharmacist compared with teams that did not have a pharmacist.
There has been steady growth in the number of state laws and regulations enabling pharmacists to engage in CDTM. In 1996, Shefcheck and Thomas reported that 16 states had laws authorizing pharmacists to initiate and modify drug therapy in concert with prescribers, and 16 other states were pursuing such laws. Ferro et al., in 1998, reported that 21 states had pharmacist CDTM laws. More recently, in 2003, Punekar et al. reported that 32 states had such laws. However, little data are available on the extent and scope of CDTM occurring in U.S. hospitals.
Previous studies have examined the perceptions of various health care professionals regarding CDTM. In a survey of pharmaceutical company executives, 32% of company executives reported that their company takes a neutral position on pharmacist CDTM bills in their state legislatures, while 28% of the companies supported such legislation. Airmet and Adamcik reported that physicians consistently had more negative views about pharmacists providing clinical pharmacy services, providing pharmaceutical care, and engaging in collaborative drug practice agreements than did pharmacists.
Assessing the current opinions of pharmacy directors on various aspects of CDTM can help the pharmacy profession identify factors that act as potential barriers or facilitators to the growth of CDTM. In addition, a psychometrically sound instrument to measure perceptions regarding CDTM can help track changes in perceptions over time, further helping to identify means to facilitate CDTM in hospitals.
The objectives of this study were to assess (1) the extent and scope of CDTM in U.S. hospitals, (2) the associations between hospital characteristics, pharmacy director characteristics, and CDTM, (3) pharmacy directors' perceptions of CDTM and associations between pharmacy directors' characteristics, hospital characteristics, and perceptions of CDTM, (4) hospitals' short- and long-term plans regarding CDTM, and (5) pharmacy directors' views about major facilitators and barriers for CDTM in hospitals.
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