Organizations striving to implement comprehensive medication management (CMM) programs are increasingly turning to collaborative practice agreements (CPAs) to help accomplish objectives. CPAs are garnering significant attention for their ability to improve collaboration and enhance patient care.
In fact, the potential value of CPAs is so significant that organizations including the National Alliance of State Pharmacy Associations, American Pharmacists Association (APhA), American Medical Association, and the American Association of Nurse Practitioners collaborated with the Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention (DHDSP), in 2017 to create a guide to help with the development and execution of CPAs.
What is a Collaborative Practice Agreement?
Before we discuss CPAs any further, let's define the term. APhA says CPAs "… are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team. CPAs define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions."
The National Community Pharmacists Association describes CPAs as "… voluntary, formal relationships between pharmacists and physicians or other providers that allow for certain patient care functions, including but not limited to modification or initiation of drug therapy, performing, interpreting, or ordering laboratory tests, and conducting physical assessments, as authorized by the practitioner under specified situations and conditions."
Finally, a DHDSP report defines a pharmacist CPA as "A formal agreement in which a licensed provider makes a diagnosis, supervises patient care, and refers patients to a pharmacist under a protocol that allows the pharmacist to perform specific patient care functions."
Role of CPAs in Comprehensive Medication Management
Now that we have established a definition for a CPA, let's touch on a few of the core reasons why CMM programs benefit when providers working within the program establish CPAs with pharmacists.
1. Improve patient care
As a Pharmacy Times report notes, CMM is "… considered the standard of care that ensures a patient's prescription drugs, over-the-counter medicines, and nutritional supplements are each appropriate for the patient, effective for the condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended."
When a pharmacist is authorized under a CPA by a provider to perform new functions, the pharmacist gains an even greater ability to positively impact patient care in these and other areas.
While authorizable functions vary by state laws and regulations, CPAs, perhaps most significantly, often authorize pharmacists to modify a patient's current drug therapy, including initiating new therapy and discontinuing existing therapy. As a Pharmacy Today report notes, "When pharmacists are able to perform these functions under the conditions of the CPA instead of obtaining prescriber authorization in every instance, care delivery becomes more efficient by reducing repetitive communications between the pharmacist–prescriber team."
Note: Critical to making safe, appropriate changes to a patient's medication regimen is access to a current, accurate medication history. Providers and pharmacists should leverage tools such as the Meds 360° medication management app when modifying a regimen.
2. Improving timeliness of treatment
When pharmacists are empowered through CPAs, they can make decisions that reduce delays in patient care. For example, if a pharmacist is granted permission in the CPA to extend medication refills, this eliminates the need for consultation with the provider to receive refill authorization. Such authorization may take time if the provider is inaccessible. If a delay occurs, a patient may experience a medication interruption. Depending on the medication, this interruption could have significant mental and physical effects. Furthermore, adherence often becomes more difficult when a regimen undergoes a change. Unnecessary changes — including interruptions — should be avoided, whenever possible.
As another example, if a pharmacist is authorized under a CPA to order and interpret laboratory tests, this can help determine whether medications are having their intended effects and if patients are experiencing new health issues that may require a regimen change or new treatment.
3. Alleviate provider workload
One of the most significant challenges for providers striving to deliver CMM for their patients is time. Comprehensive medication management requires more tasks, oversight, patient engagement, and time that increase provider workload.
As an Elements article notes, CPAs can help reduce this workload. "Often, physicians are resource- and time-strained and can't fully provide the care each chronic patient needs. Pharmacists can fill that gap with accessible front-line care and medication management."
In the article, Jeff Durthaler, pharmacist consultant in DHDSP, is quoted as saying, "CPAs can increase patient access to health care by empowering pharmacists to practice as an extension of other healthcare professionals to help patients manage or prevent chronic diseases."
Elevating Medication Therapy Management Pharmacist Services
One final takeaway: A CPA can also help support the efforts of clinical pharmacists performing medication therapy management. As the CDC notes, "Medication therapy management (MTM) is a distinct service or group of services provided by healthcare providers, including pharmacists, to ensure the best therapeutic outcomes for patients. MTM includes five core elements: medication therapy review, a personal medication record, a medication-related action plan, intervention or referral, and documentation and follow-up."
CPAs can provide pharmacists with an enhanced ability to support and complete these elements. While the CDC states that MTM can be performed by pharmacists with or without a CPA, an agreement can remove potential restrictions that would make achieving effective MTM more difficult and time-consuming.