The demands of managed care have left doctors with less time to spend with each patient. As physicians play the role of “gatekeeper,” determining who will get what type of care for various insurance plans, details such as fine tuning drug therapies often get delayed or delegated to a nurse.
The trend is to bring pharmacists into this role to help doctors manage their workload and help patients get the personalized attention they need for successful drug therapy. This team approach is usually termed a “collaborative practice agreement.”
“It’s simply an agreement between a prescriber and a pharmacist to work together,” says William Fassett, professor and chair of the department of pharmacy at Drake University. “The pharmacist is given the authority to initiate or modify drug therapy, with the feedback and supervision of a physician. It’s a mutual involvement.”
With the aging population, the use of drug treatments is becoming more common, with some patients taking as many as 10 to 15 drugs per day. Monitoring dosages and adjusting them to lessen side effects is time consuming, and it’s not always easy for the patient to get an appointment with the doctor to make changes.
“The pharmacist is well trained to know what the goals are of the drug therapy,” says Fassett. “They can monitor some of the patient’s side effects and adjust the dose to get the desired effect.”
The pharmacist is working with the person’s physician, not overruling him or her. Pharmacists have always had the option of calling the doctor’s office to recommend changes, but under a collaborative agreement, the pharmacist can make changes he or she deems necessary, as long as they fall within boundaries agreed to by the doctor.
“Some medical clinics are finding that 70 percent of all calls are related to drug therapy,” says Fassett. “Most are handled by nurses acting under general guidelines given by the physician, but they cannot handle the volume of changes. In some cases, clinics are hiring pharmacists to work full time to handle all the drug therapy.”
Doctors set up parameters under which a pharmacist can make changes. These might be limited to dosage, or could include complete changes in prescription, depending on what is agreed to and what state law allows. Typically, a person seeing a pharmacist for a routine dosage adjustment is going to cost a medical plan less than someone seeing a physician. Patients also usually find it easier to get time with the pharmacist to discuss the particulars of their drug therapy.
