Hospitals moving to collaborative drug therapy management

Pharmacists join CDTM for infectious diseases, antibiotic therapy

Some 50% of hospitals responding to a survey have some pharmacists engaged in collaborative drug therapy management (CDTM). Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was seen as having a positive strategic impact by improving the perceptions of hospital administration of the value of pharmacists and facilitating implementation of other pharmacy services.

The Purdue University survey, reported in the American Journal of Health-System Pharmacy, says CDTM entails using a multidisciplinary process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing therapy outcomes.1 It has been suggested that CDTM by pharmacists could be a way to ensure that medications are used appropriately to improve patients' health status, maximize patients' health-related quality of life, reduce frequency of avoidable drug-related problems, and optimize societal benefits from pharmaceuticals. 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 positive effect of CDTM on patient outcomes, the study said, and there has been a steady growth in the number of state laws and regulations enabling pharmacists to engage in CDTM. The study intended to assess:

  1. The extent and scope of CDTM in U.S. hospitals;
  2. The association between hospital characteristics, pharmacy director characteristics, and CDTM;
  3. Pharmacy director perceptions of CDTM and associations between pharmacy director characteristics, hospital characteristics, and perceptions of CDTM;
  4. Hospitals' short- and long-term CDTM plans;
  5. And pharmacy directors' views about major facilitators and barriers for CDTM in hospitals.

Collaborative agreements with physicians

Study lead author Joseph Thomas III, PhD, a professor in the department of pharmacy practice at Purdue University's School of Pharmacy and Pharmaceutical Sciences, tells Drug Formulary Review that CDTM has been around for some time and has been used as part of strategies to improve patient care. Collaborative agreements with doctors, he says, allow pharmacists to see patients more frequently and to work together with physicians to develop a therapy plan.

The study found that about half of U.S. hospitals authorize some of their pharmacists to engage in CDTM. Although studies have demonstrated significant positive patient outcomes with CDTM, the extent of CDTM in hospitals has much room for growth. Most of the hospitals with CDTM authorize pharmacists to adjust a drug's strength, order laboratory or related tests, and change a drug's frequency of administration. But only 32% of the CDTM hospitals allow pharmacists to discontinue a drug, and less than half of the CDTM hospitals (42%) allow their pharmacists to initiate drug therapy.

Hospital pharmacists were most frequently involved in CDTM for infectious diseases or antibiotic therapy, anticoagulation, and parenteral nutrition. The extent of pharmacist CDTM activities varied by disease or treatment area. Hospitals located in cities with larger populations and hospitals having more beds were more likely to have CDTM. Thomas said this result was expected as larger or urban hospitals have larger patient volumes and CDTM may help to increase efficiency in these hospitals by pharmacists sharing the physician workload.

Pharmacy directors perceived positive hospital support for CDTM, and perceived support for CDTM in hospitals that had pharmacists engaged in CDTM was significantly higher than in hospitals that did not have pharmacists engaged in CDTM. Respondents from hospitals with CDTM perceived greater strategic impact for it than those from hospitals without CDTM.

Little or no financial impact

Little or no financial impact has been associated with implementation of CDTM. Just over 12% of hospitals engaging in CDTM charged patients a fee for pharmacists' CDTM activities. And only 11% of hospitals received insurance reimbursement for CDTM. However, CDTM was seen as having a positive strategic impact. Respondents agreed that CDTM activities enhance upper administration's perception of pharmacists' value and facilitate implementation of other pharmacy services.

Hospitals responding to the survey said they planned in both the short- and long-term for some increase in the number of staff pharmacists involved in CDTM, number of CDTM protocols, and number of diseases or areas for which pharmacists provide CDTM. Hospitals with CDTM indicated larger planned increases than did hospitals without CDTM, possibly due to positive experiences with it.

Respondents identified a shortage of pharmacists and lack of support from physicians and other medical staff as the major perceived barriers to CDTM. Paradoxically, Mr. Thomas said, physician and other medical staff support were perceived to be a major facilitator of CDTM. Thus, he said, it will be critical for pharmacists to get support from physicians and other healthcare providers to increase CDTM in hospitals.

Thomas tells Drug Formulary Review he's not sure why some hospitals have CDTM and others don't. He says those hospitals that do use CDTM are able to articulate the positive impact that it has and demonstrate why it should be in use in more facilities. With doctors and other medical staff seen as both facilitators of and barriers to CDTM, he says, hospitals need to be deliberate in developing a strategy for building support among other practitioners.

Pharmacist willingness to participate in collaborative programs is a facilitator to CDTM growth, he said, but staffing can be a problem. He expressed the hope that more pharmacists will be coming out of school with an expectation and desire to be involved in such programs.

[Editor's note: For more information contact Dr. Thomas at (765) 494-1477 or E-mail him at jt3@pharmacy.purdue.edu.]

Reference

  1. Thomas J, Murtuzza B, Shu-Wen L, et al. Survey of pharmacist collaborative drug therapy management in hospitals. Am J Health-Syst Pharm. 2006;63(24) 2489-2499.