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Collaborative Drug Therapy Management in NYS: Impact on Pharmacy Practice. Kimberly Zammit, PharmD , BCPS, FASHP NYS Board of Pharmacy Chair, CDTM Implementation Committee September 23, 2014. Disclosures. None to report. Collaborative Drug Therapy Management ACCP Position Statement.

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collaborative drug therapy management in nys impact on pharmacy practice

Collaborative Drug Therapy Management in NYS:Impact on Pharmacy Practice

Kimberly Zammit, PharmD, BCPS, FASHP

NYS Board of Pharmacy

Chair, CDTM Implementation Committee

September 23, 2014

  • None to report
collaborative drug therapy management accp position statement
Collaborative Drug Therapy ManagementACCP Position Statement
  • Agreement between one or more physicians and pharmacists
  • Qualified pharmacists working within the context of a defined protocol are permitted to assume professional responsibility for:
    • Performing patient assessments
    • Ordering drug therapy-related laboratory tests
    • Administering drugs
    • Selecting, initiating, monitoring, continuing, and adjusting drug regimens. (aka prescribing)

Pharmacotherapy 2003;23:1210-1225

cdtm in the u s 2012
CDTM in the U.S. 2012

Very limited in any setting






Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General.

Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.

report to the surgeon general objectives
Report to the Surgeon GeneralObjectives
  • Obtain advocacy from the U.S. Surgeon General to:
    • Acknowledge pharmacists that manage disease through medication use and deliver patient care services, as an accepted and successful model of health care delivery in the United States, based on evidence-based outcomes, performance-based data and the benefits to patients and other health system consumers.
    • Recognize pharmacists, who manage disease and deliver many patient care services, as health care providers. One such action is advocate to amend the Social Security Act to include pharmacists among health care professionals classified as “health care providers.”
    • Have pharmacists recognized by CMS as Non-Physician Practitioners in CMS documents, policies, and compensation tables commensurate with other providers, based on the level of care provided.
  • Advance beyond discussion (and numerous demonstration projects) of the expanded roles of pharmacist-delivered patient care and move toward health system implementation
response from the surgeon general
Response from the Surgeon General
  • Publically supports the role of pharmacists in collaborative practice
  • Evidence and outcomes presented support the following:
    • Health-care leadership and policy makers should explore ways to optimize the role of pharmacists through collaborative practice
    • Collaborative practice will improve quality, contain costs and increase access to care
    • Recognition of pharmacists as health care providers, clinicians and an essential part of the health care team is appropriate given the level of care they provide in many settings
    • Compensation models reflective of the range of care provided are needed for sustainability

nys cdtm demonstration project report
NYS CDTM Demonstration Project Report
  • CDTM legislation passed in 2011required the development of a report:
    • Review the extent to which CDTM was implemented in New York State
    • Examine whether and the extent to which CDTM contributed to the improvement of quality of care for patients, reduced the risk of medication error, reduced unnecessary health care expenditures and was otherwise in the public interest.
    • Make recommendations regarding the extension, alteration and/or expansion of these provisions
    • Make any other recommendations related to the implementation of CDTM
cdtm report writing committee
CDTM Report Writing Committee
  • Board of Pharmacy
    • CDTM Implementation Committee
    • Kimberly Zammit, PharmD, BCPS, FASHP
    • Leigh Briscoe-Dwyer, PharmD, BCPS, FASHP
    • Lawrence Mohkiber, RPh, MS
    • Kimberly Leonard, RPh
  • Participant Representatives
    • Kelly Rudd, PharmD, BCPS,CACP
      • Bassett Healthcare
    • Lisa Phillips, PharmD, CACP, BAAP
      • Upstate Medical Center
    • Mark Sinnett, PharmD, FASHP
      • Montefiore Medical Center
cdtm demonstration sites
CDTM Demonstration Sites*

* Programs submitting data

anticoagulation management time in target range
Anticoagulation ManagementTime in Target Range

Rose AJ, et al. Circ CardiovascQual Outcomes. 2011; 4:416-424.

anticoagulation participants
Anticoagulation Participants
  • Kelly Rudd, PharmD, BCPS,CACP
    • Bassett Healthcare
  • Valery L. Chu, PharmD, BCACP, CACP
    • Kingsbrook Jewish Medical Center
  • Henry Cohen, MS, PharmD, FCCM, BCPP, CGP
    • Kingsbrook Jewish Medical Center
  • Lindsey Wormuth, PharmD
    • United Health Services Hospitals
  • Rebecca Arcebido, PharmD, BCACP
    • Patient Centered Medical Home
    • The Brooklyn Hospital Center
  • Julie Anne Billedo, PharmD, BCACP
    • Patient Centered Medical Home
    • The Brooklyn Hospital Center
  • Robert DiGregorio, PharmD, BCACP
    • The Brooklyn Hospital Center
diabetes participants
Diabetes Participants
  • Lisa Phillips, PharmD, CACP, BAAP
    • St John Fisher College / WSOP
    • Upstate Medical University
  • Mary Jo Lakomski, BS Pharm, CDE, BCACP
    • Upstate University Hospital
  • Robert DiGregorio, PharmD, BCACP
    • The Brooklyn Hospital Center
  • Alex DeLucenay, PharmD, BCACP
    • St John Fisher College, WSOP
    • Rochester General Hospital
  • Asim M. Abu-Baker, PharmD, CDE
    • St. John Fisher College, WSOF
    • Anthony Jordan Health Center
re hospitalization
  • 30 days
    • Among 22 patients who were seen at the clinic within two weeks after discharge, the 30-day readmission rate was 9% (2 /22).
  • 90 days
    • 42 patients had at least one hospitalization in the prior 3 mos
      • Five patients (12%) have not reached the three month time point
    • 28 patients (67%) were not hospitalized
    • In comparison to the previous 3 months:
      • Three patients (7%) had one less hospitalization
      • Two patients (4.5%) had one more hospitalization
      • Four patients (9.5%) had one hospitalization prior to and one hospitalization after their clinic visits
heart failure participants
Heart Failure Participants
  • Angela Cheng, PharmD, BCPS
    • Montefiore Medical Center
  • Danielle Garcia, PharmD, BCPS
    • Montefiore Medical Group – Bronx East
  • Charnicia E. Huggins, PharmD, MS
    • Touro College of Pharmacy
    • Bronx Lebanon Hospital
patient satisfaction
Patient Satisfaction

1 = Strongly disagree 2 = Somewhat disagree 3 = Somewhat agree 4 = Strongly agree

hiv participant
HIV Participant
  • Agnes Cha, PharmD, AAHIVP, BCACP
    • Arnold and Marie Schwartz School of Pharmacy and Health Sciences / Long Island University
    • The Brooklyn Hospital Center
oncology participants
Oncology Participants
  • Elizabeth Hansen PharmD, BCOP
    • Roswell Park Cancer Institute
  • Richard Tizon, PharmD, BCOP
    • Memorial Sloan-Kettering Cancer Center
asthma participant
Asthma Participant
  • Robert DiGregorio, PharmD, BCACP
    • The Brooklyn Hospital Center
  • Collaborative management drug therapy services provided in this pilot program demonstrated:
    • Ability of pharmacists to meet or exceed efficacy endpoints
    • Reduced risk of adverse reactions and hospitalizations
    • Optimized medication management
    • Reduced expenditures to the health care system
    • High rates of satisfaction by both patients and physicians
  • Recommendations
    • CDTM should be expanded to allow all qualified pharmacists to participate
collaborative drug therapy management in nys proposed legislation

Collaborative Drug Therapy Management in NYS:Proposed Legislation

Leigh Briscoe-Dwyer, PharmD, BCPS, FASHP

NYS Board of Pharmacy

CDTM Implementation Committee

September 23, 2014

proposed legislation
Proposed Legislation
  • Would add additional practitioners who may enter into CDTM agreements with pharmacists
    • NPs
    • PAs
    • Adds the term “Facility”
proposed legislation1
Proposed Legislation
  • CDTM can take place in any facility or practice
  • Facility is defined as
    • Hospital
    • Diagnostic Center
    • Treatment Center
    • Hospital based outpatient department
    • Residential Health Care Facility
    • Nursing Home
  • Practice shall mean a place or situation in which physicians, physician assistants and nurse practitioners, either alone or in group practices, provide diagnostic and treatment care for patients
proposed legislation2
Proposed Legislation
  • Includes verbiage on “prescribing” in order to adjust or manage a drug regimen of a patient, pursuant to a patient specific order or non-patient specific protocol.
  • Evaluating and ordering disease state and laboratory tests related to drug therapy management of the disease or disease states specified within a protocol
  • Performing routine patient monitoring functions as may be necessary (Vitals)
  • No Informed Consent
  • No Sunset
pharmacist credentials
Pharmacist Credentials
  • Must have a current unrestricted license in NY
  • Satisfy any two (2) of the following:
    • Certification in a relevant area of practice from an organization recognized by ACPE or another entity recognized by the State Education Department
    • Postgraduate residency through an accredited postgraduate institute
      • At least 50% of the experience includes the provision of direct patient care with interdisciplinary teams
    • Have provided clinical services to patients for at least 1 year
  • Pharmacists who meet the experience requirements will be certified by State Education Department to enter into CDTM agreements
pharmacist credentials experience
Pharmacist Credentials: Experience
  • Provision of clinical services to patients for at least one year
    • Under a collaborative practice agreement with a physician or other recognized provider, OR
    • Has documented experience in the provision of clinical services to patients for at least one year and deemed acceptable to the department upon recommendation of the board of pharmacy
    • A licensed pharmacist may engage in CDTM under the supervision of a CDTM pharmacist in order to gain experience necessary to qualify to participate
why credentialing in pharmacy
Why credentialing in pharmacy?
  • Increasing complexity in healthcare
    • Technology advancement
    • Expectation of pharmacist involvement in patient care teams
    • Participation / management of advanced practice activities
  • Demand for safe, effective and high quality care
    • IOM report – licensure/CE inadequate
    • Consumer group/public demand
    • Scrutiny by hospital quality and risk departments
  • Credentialing “Ensures”:
    • Documented evidence of professional qualifications
    • Demonstration that they possess the knowledge to manage certain disease states
    • Examples:
      • Academic degrees
      • State licensure
      • Residency diplomas
      • Certifications
      • Certificate Programs
          • (ASHP, ACCP, NYSCHP)
board certification
Board Certification
  • Pharmacist-only
    • Board of Pharmaceutical Specialties (BPS)
      • Ambulatory, Cardiology (AQ), ID (AQ), Nuclear, Nutrition Support , Oncology, Pharmacotherapy, Psychiatry
      • BPS is by the National Commission for Certifying Agencies
      • Pediatric and Critical Care Fall 2015
    • Commission for Certification in Geriatric Pharmacy
      • Certified Geriatric Pharmacist
  • Multidisciplinary
    • Various certification bodies
      • Anticoagulation, Asthma, BLS/ACLS, Clinical Pharmacology, Diabetes (education and management), Health Information Technology, HIV, Lipids, Pain (education and management), Poison information, Toxicology


spectrum of clinical practitioners
Spectrum of Clinical Practitioners



Breadth of patient / practice focus

Entry level

Level of knowledge, skills and experience


why residency training
Why Residency Training?
  • Allows training as a licensed practitioner under the supervision of an experienced preceptor
  • Develops skills specific to the management of drug therapy in a systematic fashion
    • Direct patient care and practice management
  • Supported by ACCP and ASHP
    • 2020 Goal: All pharmacists that provide direct patient care will have completed a PGY1 residency
  • Expansion of residency programs will be necessary to achieve this goal
  • Residency equivalency process / practice portfolio

Pharmacotherapy 2009;29(12):399e–407e