Dynamics of pharmaceutical care

Collaborative relationships between pharmacists and physicians prove beneficial.

By BC Childress, PharmD, Joshua Montney, PharmD and Dan Fisher

Incidence estimates suggest that more than 1.5 million preventable medication-related adverse events occur each year in the United States, accounting for an excess of $177 billion in terms of medication-related morbidity and mortality. Drug-related morbidity and mortality in the ambulatory setting alone costs the nation $76.6 billion annually. Additionally, physicians are facing increases in time demands and liability for practice decisions, and decreases in insurance reimbursement for services.

Collaborative Drug Therapy Management (CDTM) is a solution that can aid practices in addressing these concerns while improving  patient care. CDTM is an agreement between a physician and a pharmacist that allows the pharmacist to initiate, modify, or continue drug therapy for specific patients as defined in a written guideline or protocol. CDTM improves patient adherence, optimizes drug therapy outcomes and saves the practice time and money. Evidence shows that CDTM is particularly successful when implemented in practices with high incidences of chronic conditions such as asthma, diabetes and dyslipidemia.

Currently 47 states and the District of Columbia authorize CDTM agreements between pharmacists and physicians, each with a different set of acts and regulations. In Kentucky, current regulations allow physicians to enter into collaborative practice agreements in any healthcare setting. These regulations permit pharmacists to perform physical assessments, order clinical tests, and initiate, modify, or stop drug therapy for chronic disease patients.

Features_State by state.jpg






States that authorize pharmacists to collaborate with physicians is shown in blue.
– Alliance for Pharmaceutical Care
Benefits Of CDTM
There is growing evidence to support the use of CDTM in clinical practice.

1. Improvement in therapeutic outcomes. A study published in the Archives of Internal Medicine found that CDTM reduced negative therapeutic outcomes by 53-63 percent and avoided $45.6 billion in direct healthcare costs.

2. Allows physicians to spend more time treating patients with urgent medical needs.

3. Increased patient access to healthcare.

4. Enhanced patient care through optimized drug therapy management.

5. Decreased drug-related problems (adverse drug reactions, drug interactions, poor compliance, etc.) through the use of scientifically designed drug therapy protocols and management.

6. Reduced costs through optimal use of medications and minimization of drug related problems.

7. Pharmacist identification of underlying conditions that require the care of a physician.

Practice Models
CDTM is emerging in various health practice settings, and it is not limited to any specific setting. Primary care clinics, long-term care facilities, and various service centers in hospitals are shifting to this model of practice. As physicians are increasingly pressed for time, patients inevitably receive less attention. Many repeat visits that cost a practice time and money can be prevented by using CDTM. Pharmacists are trained to manage drug therapy, improve patient adherence and follow evidence-based therapy guidelines. In collaboration with physicians and other healthcare providers, pharmacists add value to the patient care team.

Adopting CDTM

Hiring a pharmacist is an effective way for a practice to start saving time and money, but the pharmacist and the practice need to be on the same page. Without a plan, a detailed arrangement and a practice agreement, employing a pharmacist can create
chaos in the practice setting.

Many practices know where their patients fill prescriptions. If you have a pharmacy that you know and trust, approach them about how you can work together to achieve the goals that you have set for your patients.

There are many consultant pharmacists in practice today, and they specialize in optimizing drug therapy. Some work with nursing homes, long-term care facilities or independent pharmacies in the community. Often, these consultants have received special licenses or credentials. Look for one with the following credentials:
• Board Certification in pharmacotherapy or ambulatory care – BCPS, BCACP
• Certified Geriatric Pharmacist – CGP
• Certified or Licensed Diabetes Educator – CDE, LDE


Additional Resources for CDTM Implementation

3. American Society of Health-System Pharmacists on CDTM development  http://www.ashp.org/DocLibrary/Education/Webinars/Designing-Sustainable-Patient-Care-Services.aspx
5. For viewing sample agreements and arrangements, a couple of articles that talk about the process.  One is the 2012 Report to Surgeon General that details how CDTM has been successfully working throughout the VA and other federal systems.  For success stories, the VA, Bureau of Prisons, Indian Health Services, and Public Health Services are the best examples.  


BC Childress, PharmD, Joshua Montney, PharmD and Dan Fisher are with Sullivan University College of Pharmacy, The Center for Health & Wellness.