Saturday, October 27, 2012

Clinical pharmacy services: but what shall we call it?

The opening session of this past week's 2012 Annual Meeting of the American College of Clinical Pharmacy (ACCP) focused on advancing a comprehensive and consistent practice for clinical pharmacy, a topic that often generates significant -- if not heated -- debate among practitioners and professional organizations alike.  In her opening remarks, Dr. Linda Strand, one of four panel members selected to share their perspectives on the topic, laid out what she considers the five "rules" necessary for the success of clinical pharmacy services.
In order to be successful, these services must be:
  1. Described simply, in terms of what they can do for the patient;
  2. Based on standards of care so that they can be delivered consistently from one practitioner to the next, and from one patient to the next;
  3. Integrated within the rest of the health care team in terms of consistent terminology, philosophy, care process, and standards of practice;
  4. Able to generate measurable results that are reproducible;
  5. Paid for in the same way that other patient care is reimbursed.

While the latter four rules are all concepts that the whole profession is likely to support, the first, or what shall we call it? is one that we have struggled with for decades. I couldn't help but get the sense that even the four members of the panel did not agree entirely on what we should call it.

I thought -- perhaps mistakenly -- that we had largely laid this issue to rest with the coining of the term medication therapy management, which was meant to describe clinical pharmacy services in a way that pharmacists, patients, providers, and payers could intuitively understand.  This feature gave it several advantages over pharmaceutical care, a term favored by many individuals across the profession of pharmacy, but one that never seemed to catch on outside of it.  Unfortunately, medication therapy management coincided with the development of the Medicare Part D benefit (of which it is an integral part), so it has been viewed by many as being only a component of what pharmacists can do rather than the comprehensive services described by the Core Elements document, or the consensus definition of medication therapy management, which is already supported by nine national professional pharmacy organizations (including ACCP):
A distinct service or group of services that optimizes drug therapy with the intent of improved therapeutic outcomes for individual patients.
So rather than moving us forward, I am concerned that reverting back to arguing over what we should call it will only distract us from the most important issues at-hand -- the last four of those five rules necessary for our collective success. While we still have a long way to go, the momentum generated by the medication therapy management movement arguably took us farther in a few years than previous efforts did over the course of decades, largely because it took an idea mostly relegated to members of the pharmacy profession and put it in the minds of the people responsible for consuming it, legislating it, and paying for it.

And we can't afford to go back now.

Is medication therapy management the right term? I don't know -- that is for the profession to decide. But we need to decide quickly, because the latter four of Strand's rules may slip through our fingertips while we waste time arguing over what to call it.

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