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The Pharmacy Practice Model: Where are we going and how will we get there? John B. Hertig, PharmD, MS Medication Safety Project Manager Assistant Clinical Professor of Pharmacy Practice Center for Medication Safety Advancement Purdue University College of Pharmacy Indianapolis, IN. Disclosure.

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The Pharmacy Practice Model: Where are we going and how will we get there?John B. Hertig, PharmD, MSMedication Safety Project ManagerAssistant Clinical Professor of Pharmacy PracticeCenter for Medication Safety AdvancementPurdue University College of PharmacyIndianapolis, IN


  • Dr. John B. Hertig has no conflicts of interest to disclose.

Learning objectives
Learning Objectives

  • Understand the current climate of health professions’ practice model review and the role of the ASHP Pharmacy Practice Model Initiative in the Rural Hospital setting

  • Review the recommendations from the Pharmacy Practice Model Summit

  • Identify how pharmacy practice model change in rural hospitals supports improved quality, accountability, and patient outcomes, and how a multidisciplinary approach is key to success


  • Background – why change?

  • About the Pharmacy Practice Model Initiative

  • Impact on rural hospitals

  • Next steps - summary

First t hings first
First Things First

  • Who is in the audience?

  • What practice types do you represent?

  • How many of you have heard of the ASHP Pharmacy Practice Model Initiative?

Background why change
Background – Why Change?

  • Professions must continually assess their practice to determine whether expertise is being maximized

    • Healthcare reform

    • Quality and safety

    • Social and economic influences

  • Pharmacy practice changes

    • Doctor of Pharmacy degree

    • Residency training

Why change
Why Change?

More patients, increased demand

Payment tied to performance

Move away from fee-for-service payments

Pressure to reduce costs, reward performance

Challenge to US health care system to improve quality and cost effective care

More quality, better reimbursement

Better Care!

AJHP 2009;66:713

Factors driving practice change
Factors Driving Practice Change

Drug therapy is becoming more complex with greater patient risk

Pharmacists recognized as:

drug therapy experts

medication use process experts

Patients are better served if pharmacists take an active role as part of the care team

Why pharmacists
Why Pharmacists?


  • Moral, ethical and social obligations

  • Health system changes and opportunities

  • Rationale use of pharmacist resources

  • Impact of pharmacy technicians and technology

  • Value of pharmacists

Ashp ashp foundation pharmacy practice model objectives
ASHP/ASHP Foundation Pharmacy Practice Model Objectives


Technicians & Technology


Educational factors driving change
Educational Factors Driving Change


  • All these factors have combined to drive critical discussions regarding change within the health-system pharmacy profession

  • But, where do we go from here?

Pharmacy practice model initiative ppmi
Pharmacy Practice Model Initiative (PPMI)

  • Launched and coordinated by ASHP and the ASHP Research and Education Foundation

  • The goal of this initiative is to significantly advance the health and well-being of patients

    • Develop and disseminate a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers

  • PPMI. Available at <>

The purpose of the ppmi
The Purpose of the PPMI

Describes how pharmacy department resources are deployed to provide care

One size does not fit all

Does include:

How pharmacists practice and provide care to patients

How technicians are involved to support care

Use of automation/technology in the medication use system

AJHP 2010;67:542

The purpose of the ppmi1
The Purpose of the PPMI

  • Create a framework

  • Determine services

  • Identify emerging technologies

  • Develop a template

  • Implement change

  • PPMI. Available at <>

The purpose of the ppmi2
The Purpose of the PPMI

  • Create a Framework

    • Create a framework for a pharmacy practice models that ensure provision of safe, effective, efficient, accountable, and evidence-based care for all hospital/health system patients

  • Determine Services

    • Determine patient care-related services that should be consistently provided by departments of pharmacy in hospitals and health systems and increase demand for pharmacy services by patients/caregivers, healthcare professionals, healthcare executives, and payer

  • PPMI. Available at <>

The purpose of the ppmi3
The Purpose of the PPMI

  • Identify Emerging Technologies

    • Identify the available technologies to support implementation of practice models, and identify emerging technologies that could impact the practice model

  • Develop a Template

    • Support the optimal utilization and deployment of hospital and health-system pharmacy resources through development of a template for practice models that are operational, practical, and measurable

  • Implement Change

    • Identify specific actions pharmacy leaders and staff should take to implement practice model change including determination of the necessary staff (pharmacy leaders, pharmacists, and technicians) skills and competencies required to implement this model)

  • PPMI. Available at <>

Types of models
Types of Models

  • Drug-distribution centeredmodel

    • defined as “mostly distributive pharmacy with limited clinical services”

  • Patient-centeredintegrated model

    • defined as a “clinical generalist model with limited differentiation of roles”

    • nearly all pharmacists have distributive and clinical responsibilities

  • Clinical-specialist-centered model

    • defined as “separate distributive and clinical specialist roles”

Major ppmi themes
Major PPMI Themes

Move pharmacists closer to the patient

Multidisciplinary care

Responsibility for safe use of medications and ensuring quality

Well-developed technician workforce

Wide-spread use of technology

Considerations for the rural hospital
Considerations for the Rural Hospital

Rural hospitals face unique challenges in implementing new and innovative practice models

“The capacity of 1”

How much can we do with limited resources?

Where do our priorities lie?

Ensuring we practice at “the top of our license”

Teamwork among all professions is essential!

Rural health today current state
Rural Health Today –Current State

  • Pharmacy in rural health settings differs from larger settings

    • Limited personnel

    • Limited hours of operation

    • Limited technology

  • But, boundless opportunity!

    • Need to be strategic on how to adapt principles of PPMI to rural settings

  • But first…where are we now?

Where are we going
Where Are We Going?

  • PPMI Summit

    • November 2010

  • Summit recommendations and voting record published February 2011

    • Lists all consensus pharmacy services that all patients have the right to receive

    • Outlines requirements of pharmacy departments

    • Reviews barriers to improvement

  • Rural Hospitals were represented at the Summit, but many recommendations still pose challenges to small institutions

    • Let’s review a few

The ppmi summit
The PPMI Summit

Imperatives for new pharmacy practice models
Imperatives for New Pharmacy Practice Models

  • There is opportunity to significantly advance the health and well being of patients in hospitals/health systems by changing how pharmacists, pharmacy technicians, and technology resources are deployed

    Vote 100%

Imperatives for new pharmacy practice models1
Imperatives for New Pharmacy Practice Models

  • In the next 5-10 years, hospital/health system executives and medical staff leaders will expect pharmacists to help ensure compliance with quality-of-care standards

    Vote 93%

Optimal pharmacy practice models certifications
Optimal Pharmacy Practice Models: Certifications

  • Pharmacists who provide drug therapy management should be certified through the most appropriate Board of Pharmacy Specialties board certification process.

    Vote 82%

Pharmacy technicians
Pharmacy Technicians

  • All distributive functions that do not require clinical judgment should be assigned to technicians.

    Vote 93%

Additional recommendations
Additional Recommendations

Every pharmacy department should:

B24g. Play a critical role in ensuring that the hospital or health system adheres to medication-related evidence-based practice guidelines

B24h. Track and trend adverse drug events in the hospital or health system

B24i. Manage prospective medication-use evaluation programs to improve prescribing

B24j. Manage retrospective medication-use evaluation programs to improve prescribing.

B24k. Identify problem-prone and high-risk therapies using pre-established criteria

B24l. Routinely review hospital or health-system antibiotic resistance patterns

B24m. Track and trend pharmacist interventions

  • B24a. Identify drug therapy management services that should be provided consistently by its pharmacists

  • B24b. Develop a plan to reallocate resources to devote significantly more pharmacist time to drug therapy management services

  • B24c. Develop a plan to allocate pharmacy student time to drug therapy management services

  • B24d. Develop, maintain, and update medication-use policies

  • B24e. Ensure institutional safe medication use

  • B24f. Play a critical role in ensuring that the hospital or health system adheres to medication-related national quality indicators

Am J Health-Syst Pharm. 2011. 68:1148

Make providing pharmacy cognitive services a priority
Make Providing Pharmacy Cognitive Services a Priority

  • Drug distribution is still essential

  • Increased pharmacist contact with providers and patients have evidence-based benefits

    • Lower costs

    • Higher quality and safety

    • Improved patient satisfaction

  • Expand the role of technicians

    • Consider additional training and responsibilities for technicians

    • Use technicians in non-traditional roles

  • Technology


  • Technology can help move the pharmacist closer to the patient without compromising quality

    • Automated dispensing cabinets

    • Barcode systems

    • Remote verification and order-entry

  • Improves access to information for all health professionals

    • Improved timeliness of care

    • Retrievable information for quality improvement

  • Increases safety and quality


  • Healthcare is a team sport

    • Advancing pharmacy practice takes acceptance and dedication by the entire team

  • Work together to develop standard processes, protocols, and policies that support improved pharmacy services

  • Continuous feedback and improvement

  • Develop a care model that places the patient at the center

Considerations for rural hospitals
Considerations for Rural Hospitals

  • Leadership support is crucial

  • Multidisciplinary collaboration

    • Don’t go it alone

  • Remember scope!

    • Select those pharmacy services that your institution deems absolutely critical; make those a priority

    • Small wins

  • It’s a journey

    • Continually evaluate your direction and progress

    • Small tests of change


  • The health-system pharmacy profession is undergoing a major practice model evaluation

    • Goal is to improve medication use

    • Improve patient care

  • Rural hospitals are a key part of this effort

  • Use PPMI recommendations to develop focused improvement efforts

  • Limited resources can still make a large impact for our patients!

The Pharmacy Practice Model: Where are we going and how will we get there?John B. Hertig, PharmD, MSMedication Safety Project ManagerAssistant Clinical Professor of Pharmacy PracticeCenter for Medication Safety AdvancementPurdue University College of PharmacyIndianapolis, IN