VSHP, among others, supports collaborative practice agreements for patient health care between pharmacists, physicians, and the patient.^1,2,3 The voluntary collaborative practice agreements are characterized by an interdisciplinary approach between health care practitioners toward patient care. Their goal is the provision of optimal patient care which requires maximizing drug therapy management while minimizing untoward side effects. The overall objective in collaborative health care management is to improve patient outcome and quality of life in an efficient and cost effective manner. All practitioners in collaborative agreements are interdependent and function in an integrated fashion with shared responsibility and risks.

"Collaborative agreement" means a voluntary, written agreement between one or more pharmacists involved directly in patient care and one or more practitioners of medicine, osteopathy, podiatry involved directly in patient care which authorizes cooperative practice procedures with respect to patients of such practitioners. Collaborative procedures shall be related to treatment using drug therapy or medical devices, under defined conditions or limitations, for the purpose of improving patient outcomes. A collaborative agreement is not required for the management of patients of an inpatient facility. Collaborative agreements may include the [initiation], modification, continuation, or discontinuation of drug therapy (pursuant to written protocols); the ordering [and performing] of laboratory [and related tests]; or other patient care management measures related to monitoring or improving [the response and] outcomes of drug or device therapy. [Other activities of a pharmacist in collaborative drug therapy management may include counseling and educating a patient on medications and administering medications].⁴ No such collaborative agreements shall exceed the scope of practice of the respective parties.

The practice of pharmacy, by pharmacists, is critical component to collaborative health care management. Pharmacists provide specialized knowledge and skills, which influence patient drug therapy outcomes. Many responsibilities in the pharmacist-patient relationship extend beyond the sole provision of a drug. They may include, but are not limited to: individualized patient drug dosing in kidney or liver failure, prevention of drug interactions, education for asthma, diabetes, and other acute or chronic disease requiring drug therapy.

Other states, along with the Veterans Health Administration, have pharmacists established in collaborative practice agreements due to improved patient and economic benefits.^5,6 One study indicates a pharmacist's role in patient care management would produce a cost avoidance of over 45 million dollars per year if there are provisions for preventing and resolving medical related problems.⁷

The fundamental relationship in collaborative health care management is a mutually beneficial exchange of specialized skills by pharmacists and other providers to give competent care to the patient. VSHP advocates successful collaborative practice agreements requiring:

• Constant communication between physician-pharmacist regarding patient care.
• A written practice agreement between pharmacist and physician.
• Quality assurance programs to evaluate patient care.
• Appropriate pharmacist experiential training in drug therapy management.

VSHP supports collaborative practice agreements as a tool that will enable physicians and pharmacists to more efficiently address patient care needs. Furthermore, VSHP concurs with the American College of Clinical Pharmacy that "collaborative practice agreements should be endorsed as a way to enhance the quality of patient care within the health care system".⁸

VSHP Position statement: Collaborative Practice Agreement References:

1. Pharmaceutical care and professional maturation. TalleyCR. AJHP 1993:50:158.
2. PEW Health Professions Commission. Critical challenges revitalizing the health professions for the twenty-first century. San Francisco. USCF Center for Health Professions,1995.
3. Pharmacy in integrated health care systems. Oddis JA. Am JHealth-System Pharm. 1996;53(supp1):51.
4. Collaborative Drug Therapy Management . ASHP Issue Paper, 1998.
5. Effect of pharmacists on health care outcomes in hospitalized patients. Bjornson DC et al. AJHP 1993;50:1875.
6. Economic evaluations of clinical pharmacy services:1988-1995. Schumock GT et al. Pharmacotherapy 1996;16:1188.
7. Drug related mortality and morbidity and pharmaceutical care: a pharmacoeconomics analysis. Bootman JL. Arch Intern Med 1995:115.
8. CollaborativeDrugTherapyManagementbyPharmacist.ACCPPositionStatement.Pharmacotherapy1997;17(5):1050.

Approved by Board of Directors 06/26/99

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