Hospitals across the U.S. are reporting better patient outcomes and lower drug spends when they give pharmacists greater control over medication management, according to recent research.
A variety of medication management techniques are driving this change, especially collaborative drug therapy management (CDTM) agreements. These agreements allow pharmacists to act in a variety of ways to improve patient care using set protocols, including:
- Ordering lab tests
- Adjusting or initiating drug therapy
- Changing frequency of administration
The diseases and treatment areas where pharmacists most often intervened were for anti-coagulation, infectious diseases, and parenteral nutrition, in a study from Purdue University.1
The 2017 study1 found that 77% of hospitals have protocols that give pharmacists authority for product selection and dosing, and 86% let pharmacists write medication orders. A 2018 survey by Pharmacy Practice News2 magazine verified similar results, finding that 70% of respondents write prescriptions under a CDTM and nearly 100% report changing prescriptions ordered by physicians.
In fact, 35% of pharmacists surveyed said they switched a patient to an alternative drug more than 20 times per week and more than 50% reported adjusting doses more than 20 times per week.
CDTMs improving patient care
Forty-eight of the 50 states allow CDTMs, and the actions these agreements allow varies dramatically from state-to-state. Some permit a very narrow set of actions while others give pharmacists broad control over medication management. The most-generous CDTMs give pharmacists the latitude to make prescription changes to either improve efficacy or to minimize adverse drug reactions.
Research shows that patients and hospitals benefit from pharmacist-led medication management in several ways, including:
- Reduced 30-day readmission rates
- Improved drug adherence
- Reduced poly-pharmacy
- Lower mortality in heart-failure patients
- Lowered costs for both patients and hospitals
- Strengthened antibiotic and other stewardship programs
- Freed physicians to attend to other aspects of patient care
CDTM agreements “allow my pharmacists to practice at the top of their license,” said Dr. Nancy A Huff, PharmD, the director of pharmacy services at Lahey Hospital & Medical Center, near Boston. “They are now empowered to help manage many challenging, chronic diseases such as diabetes, dyslipidemia, hypertension, COPD [chronic obstructive pulmonary disease], asthma, heart failure and others.”
References:
- Am J Health Syst Pharm 2017;74[21]:1791-1905. doi: https://doi.org/10.2146/ajhp151058.
- Pharmacists Flexing Their Med Management Muscles. Pharmacy Practice News. https://www.pharmacypracticenews.com/Operations-and-Management/Article/04-18/Pharmacists-Flexing-Their-Med-Management-Muscles/48601. Accessed June 28, 2018.
