Collaborative Practice Agreements gain popularity along path to team-based health care
May 04, 2017
By Brian Whepley
In clinics, classrooms and pharmacies, the Wichita branches of the KU Schools of Medicine and Pharmacy are teaching physicians, pharmacists, medical students and residents about the work each does, all with the goal of improving patient care.
The collaboration often occurs with the help of community partner Health ICT, a program funded by the Centers for Disease Control and Prevention that endeavors to prevent heart disease, stroke, diabetes and obesity.
Chronic disease management is a particular focus of the work, and overall the approaches reflect the growing emphasis on a team approach to medical care and improving quality. The efforts include:
- Medical students will have the option of, as part of the new KU curriculum launching this summer, taking a one-week enrichment course called Clinical Experience in Pharmacy-Medicine Collaborative Practice. One of about 80 enrichment options available to first- and second-year KU medical students, the course will come at the end of the curriculum's nine-week, case-based learning modules.
- KU Family and Community Medicine residents work alongside KU pharmacy faculty and pharmacy students "embedded" in resident-staffed Via Christi and Wesley family practice clinics. The residents, faculty and students consult about patients and medications, while learning more about what each profession can bring to the team. Most of the faculty work within collaborative practice agreements, formal written arrangements between doctors and pharmacists that set out what care and medications the pharmacists are empowered to manage independently. Via Christi Health is an early adopter of the agreements, using them in a growing number of its primary care clinics.
- Health ICT is consulting with both schools on collaborative practice between physicians and pharmacists, as well as working with private medical practices and others in the community to promote and implement collaborative practice agreements. Health ICT, an affiliate of the Medical Society of Sedgwick County, uses a wide variety of approaches to confront diabetes, obesity, heart disease and stroke, including promoting worksite wellness, healthy eating and active lifestyles. Collaborative practice agreements are part of its clinical focus, and last summer the organization, along with the pharmacy school and others, held a Collaborative Practice Agreement Symposium. Health ICT's medical director, Dr. Justin Moore, helped formulate the objectives of the enrichment course for KU medical students.
"One of the big strategies in our grant is to engage pharmacists more in the care of patients," said Matt Thibault, Health ICT project coordinator. "Our big push with that is collaborative practice agreements. By training them and familiarizing medical students with these ideas early on, our hope is they will implement a CPA in their practice."
"The ultimate end game is the betterment of patient care and outcomes and cost savings in health care," said Robert Emerson, associate dean of KU School of Pharmacy-Wichita. "It is a movement that you're seeing. The younger generation of practitioner both in medicine and pharmacy is open to the concept. It definitely falls in line with the team approach and how we're trying to educate our students."
K. James Kallail, associate dean of research at KU School of Medicine-Wichita, coordinates development of enrichment courses, including working with Emerson and Moore on the pharmacy course.
Medical students will have four chances to take enrichment courses in each of their first two years. In the pharmacy one, students will observe a pharmacist during patient care coordination, with a focus on chronic conditions. They will also see a pharmacist during a patient consultation in settings that could include a retail pharmacy, a medical clinic or a hospital. The final objective involves observing the workflow of a pharmacy, including paperwork, filling prescriptions and database management.
"It's really providing the future physician with an overview of pharmacy and how physicians might interact in a positive way with the pharmacy, because you have a better understanding of it," Kallail said.
"We're arming the new medical work force," Thibault said.
Collaboration and interprofessional training are increasingly emphasized in both the health care system and medical training, reflecting the evolution toward team care as well as the shift to compensating providers for outcomes and away from a fee-based model.
Collaborative practice agreements are one tool. The agreements, formally allowed under Kansas law just last year, can be broad or narrow, depending on the comfort levels and expertise of the doctors and pharmacists involved. They can be between one doctor and one pharmacist or between numbers of each. One in effect at Via Christi Clinics is between three pharmacists and over 40 physicians.
Often, they cover care managing medications and even ordering labs for chronic conditions such as diabetes, hypertension, depression and high cholesterol. They can also cover immunizations and medication management for such things as the common cold, said Lyndsey Hogg, a Via Christi primary care clinical pharmacist who has worked under a CPA for four-plus years and who helped craft the state's regulatory language governing them.
"When I first walked in, most physicians had never worked with a pharmacist in a clinic setting. They said, 'What can you do for me?' It took some convincing," she said, adding that the agreements now cover about half of the Via Christi clinics.
"Some of the other physicians are picking up on what their colleagues have and saying, 'I want that,'" Hogg said. "All of the physicians are being pushed on quality measures. They realize they cannot be a man on an island and they need to function on the team. They are seeing how other members of the team can improve their patient's health."
In her work, she's seen doctors-to-be embrace collaboration. "Many of the medical students and residents are on working on teams with a pharmacist. Those medical students are likely to go to the pharmacy student to discuss medications. It's a great way to build those collaborative relationships and help them build those relationships of knowledge and trust."
Moore of Health ICT is an endocrinologist and volunteer faculty at KU School of Medicine-Wichita, where he went to medical school. Health ICT is working to educate community pharmacists about collaborative practice agreements, and helping implement them as well. They have worked with Wichita's Preston Pharmacy to create one with a hospitalist group.
Emerson said the program, existing outside the academic and health system settings, can play a valuable role. "A partnership with Health ICT helps us get that message out to the medical community, to others in the medical community. It gives us a CPA champion within the medical community speaking about the benefits of pharmacy-medical collaboration."
Moore said the approach allows doctors and pharmacists to focus on what they do best.
"Moving forward, the role of physicians is evolving not only to being the chief science officer but to be leader of a team of providers who all bring different skill sets to the table," Moore said. "Pharmacists get really good training, and a lot of them end up in settings where they don't get to use all the skills they've developed. CPAs harness that skill and knowledge and apply it to patient care."
"The wrong way to think about this from the physician side is to say that where we are now is as good as we can do, that any responsibility going to the pharmacist is something the physician is losing," he said. "The healthier angle is that we haven't reached the pinnacle of patient care. Doctors and pharmacists can design protocols together to take care of common, everyday things that we often see - blood pressure, blood sugars, cholesterol, depression. It opens up a whole range of opportunities for the physicians to do more with their day, while taking advantage of the pharmacists' skills."
KU School of Medicine-Wichita