Practice Issues: Ethics and Issues - How should we define pharmacist-delivered patient care?

Q. In your June column you stated that pharmacists must “define exactly what it means to provide patient care…and then we all need to start providing patient care the same way.” So how should we define pharmacist-delivered patient care?A. The answer is simple, although many of you will not like it. There is only one definition of patient care and it is completely non-negotiable. The medical profession defined what it means to provide patient care more than 150 years ago and it is a practice that has since been adopted by every other health profession. So if we want the ‘big kids’ to let us play the ‘patient care game,’ then our practice must look, sound and feel like the patient care everyone else provides.The definition of patient care is met when there is a patient in need and a practitioner who agrees to take responsibility for their needs. The practitioner provides patient care by meeting with the patient (on several occasions) to: perform assessments of the patient; develop care plans and interventions that ensure the patient’s needs are met; and perform follow-up evaluations. This process must not be provided only for ‘selected’ patients—it must be available to all. This process also cannot be provided only when the practitioner ‘feels like it’ or when he isn’t ‘busy doing something else.’ Patient care practitioners provide patient care as their first priority. This is what physicians do with medical problems and it is what dentists do with dental problems. If pharmacists want to be accepted and respected as patient care providers, this is what we need to do for patients’ drug-related needs. We simply have no choice. The rules of the game have already been written.I acknowledge the monumental shift this means for our profession. Most of us probably can’t comprehend what it would even mean for us to begin taking responsibility for ensuring patient’s drug therapy needs are met. We are all comfortable taking responsibility for ensuring a patient’s medication orders have been filled appropriately and we are answerable to our professional associations if we do this poorly. Imagine if you were also answerable for ensuring a patient’s medications were indicated, effective and safe? This will be required of pharmacists if we want to become patient care providers.The good news is that once we start following these simple rules, physicians and patients will understand and value what we do and payers will be more willing to remunerate our services. An enormous amount of work has recently gone into planning the first steps towards building this kind of practice and some pharmacists are already doing it.(1,2) Fairview Health Services in Minneapolis employs more than 20 pharmacists who meet the exact definition of patient care practitioners—and they bill the American Medicaid system for their services. It is now time for the masses to decide whether or not the profession of pharmacy is interested in playing the patient care game.

Practice Issues: Ethics and Issues - How should we define pharmacist-delivered patient care?

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