Review Article of Journal of eSciences
The Pharmacists in Ambulatory/Outpatient Care
Abdul Kader Mohiuddin
Department of Pharmacy, World University of Bangladesh, 151/8, Green Road, Dhanmondi, Dhaka – 1205, Bangladesh
Ambulatory care pharmacy practice is defined as the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population.
A variety of specialty clinics are available for allergy and immunology, pulmonology, endocrinology, cardiology, nephrology, neurology, behavioral health, and infectious disease. Such services for this population may exist as a primary care clinic or an independent specialty clinic, typically in a PCMH, which is instrumental in coordinating care between various providers. Once a practice site is identified, it is important to establish a strong, trusting, and mutually beneficial relationship with the various decision-makers (e.g., administrators, providers) involved with the clinic. If pharmacy services are currently in existence, the pharmacy director may be able to identify and initially contact the appropriate person. If another pharmacist is providing clinical services, this person would be a resource to help determine areas for expansion of patient care and to whom to direct the proposed business plan. Additional individuals to consider as an initial point of contact include the clinic manager, clinic medical director, or administrative assistant to either of these persons. If the clinic setting is affiliated with a medical school, it may be necessary to contact the Department of Family Medicine head.
Keywords: Community pharmacist; Provider; Medication; Outpatient; Care
How to cite this article:
Abdul Kader Mohiuddin. The Pharmacists in Ambulatory/Outpatient Care.Journal of eSciences, 2019, 2:7
1. Rondinelli JL, Omery AK, Crawford CL, Johnson JA. Self-reported activities and outcomes of ambulatory care staff registered nurses: an exploration. Perm J. 2014;18(1):e108-15.
2. Walus AN, Woloschuk DMM. Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program. Can J Hosp Pharm. 2017;70(6):435-442.
3. ASHP Foundation Trends Report. Pharmacy Forecast 2016–2020 Strategic Planning Advice For Pharmacy Departments In Hospitals And Health Systems. Available From: http://www.ashpfoundation.org/PharmacyForecast2016
4. Beans BE. Experts Foresee a Major Shift From Inpatient to Ambulatory Care. P T. 2016;41(4):231-7.
5. Knoer SJ. Healthcare delivery and financing: staying ahead of intense competition. In: Zellmer WA, editor. Pharmacy Forecast 2016–2020. Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems. Bethesda, Maryland: ASHP Research and Education Foundation; Dec, 2015. pp. 5–8
6. Zellmer WA, editor. Pharmacy Forecast 2016–2020. Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems. Bethesda, Maryland: ASHP Research and Education Foundation; Dec, 2015. Available at: www.ashpfoundation.org/PharmacyForecast2016 Accessed February 8, 2016.
7. Williams C. Pharmacy work force: market forces stimulate change in pharmacy practice models. In: Zellmer WA, editor. Pharmacy Forecast 2016–2020. Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems. Bethesda, Maryland: ASHP Research and Education Foundation; Dec, 2015. pp. 25–28.
8. Institute of Medicine (US) Committee on the Health Professions Education Summit; Greiner AC, Knebel E, editors. Health Professions Education: A Bridge to Quality. Washington (DC): National Academies Press (US); 2003. Chapter 3, The Core Competencies Needed for Health Care Professionals.
9. Kehrer JP, Eberhart G, Wing M, Horon K. Pharmacy’s role in a modern health continuum. Can Pharm J (Ott). 2013;146(6):321-4.
10. Manolakis PG, Skelton JB. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: the emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7.
11. Kiel WJ, Phillips SW. Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems. Pharmacy (Basel). 2017;6(1):2. Published 2017 Dec 31. doi:10.3390/pharmacy6010002
12. National Academy of Engineering (US) and Institute of Medicine (US) Committee on Engineering and the Health Care System; Reid PP, Compton WD, Grossman JH, et al., editors. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington (DC): National Academies Press (US); 2005. 2, A Framework for a Systems Approach to Health Care Delivery.
13. Hata M, Klotz R, Sylvies R, et al. Medication therapy management services provided by student pharmacists. Am J Pharm Educ. 2012;76(3):51.
14. Murphy-Menezes M. Role of the Pharmacist in Medication Therapy Management Services in Patients With Osteoporosis. Clin Ther. 2015 Jul 1;37(7):1573-86. doi: 10.1016/j.clinthera.2015.03.023. Epub 2015 Apr 23. Review. PubMed PMID: 25913920.
15. Hardavella G, Aamli-Gaagnat A, Saad N, Rousalova I, Sreter KB. How to give and receive feedback effectively. Breathe (Sheff). 2017;13(4):327-333.
16. Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling. Health Expect. 2017;20(5):1121-1132.
17. Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74(4):573-80.
18. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014;16(1):e12454.
19. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46. Published 2017 Jan 25. doi:10.2147/IPRP.S108047
20. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-9.
21. Omboni S, Caserini M. Effectiveness of pharmacist’s intervention in the management of cardiovascular diseases. Open Heart. 2018;5(1):e000687. Published 2018 Jan 3. doi:10.1136/openhrt-2017-000687
22. Keith C. Automated adverse drug reaction detection. Aust Prescr. 2018;41(5):138.
23. American Pharmacists Association (APhA). Pharmacists’ Impact on Patient Safety. A Joint Project of the American Pharmacists Association Academy of Pharmacy Practice and Management and Academy of Pharmaceutical Research and Science. Available From: https://www.pharmacist.com/sites/default/files/PharmacistsImpactonPatientSafety_Web.pdf
24. Gallagher HC. New fitness-to-practice requirements for pharmacists in Ireland: implications for undergraduate pharmacy education. Med Teach. 2010;32(2):e71-7. doi: 10.3109/01421590903199635. PubMed PMID: 20163219.
25. Haddad AM. Reflections on the Pharmacist-Patient Covenant. Am J Pharm Educ. 2018;82(7):6806.
26. Wolters M, van Hulten R, Blom L, Bouvy ML. Exploring the concept of patient centred communication for the pharmacy practice. Int J Clin Pharm. 2017;39(6):1145-1156.
27. Joint Commission of Pharmacy Practitioners. Pharmacists’ patient care process. Available From: http://www.amcp.org/patientcare-process/. Accessed December 19, 2017.
28. Bhimji SS, Scherbak Y. Medication Errors. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.
29. Veronin M. Packaging and labeling of pharmaceutical products obtained from the internet. J Med Internet Res. 2011;13(1):e22. Published 2011 Feb 15. doi:10.2196/jmir.1441
30. Pratt N, Roughead E. Assessment of Medication Safety Using Only Dispensing Data. Curr Epidemiol Rep. 2018;5(4):357-369.
31. Scott DM. United States Health Care System: A Pharmacy Perspective. Can J Hosp Pharm. 2016;69(4):306-15.
32. American College of Clinical Pharmacy. Hume AL, Kirwin J, Bieber HL, Couchenour RL, Hall Dl, Kennedy AK, LaPointe NM, Burkhardt CD, Schilli K, Seaton T, Trujillo J, Wiggins B. Improving care transitions: current practice and future opportunities for pharmacists. Pharmacotherapy. 2012;32(11):e326–e337. doi: 10.1002/phar.1215.
33. Sen S, Bowen JF, Ganetsky VS, et al. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings. Pharm Pract (Granada). 2014;12(2):439.
34. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18(8):646–651.
35. Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018 Aug 23;8:CD010791. doi: 10.1002/14651858.CD010791.pub2. Review. PubMed PMID: 30136718.
36. Digiantonio N, Lund J, Bastow S. Impact of a Pharmacy-Led Medication Reconciliation Program. P T. 2018;43(2):105-110.
37. Abdulghani KH, Aseeri MA, Mahmoud A, Abulezz R. The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. Int J Clin Pharm. 2018 Feb;40(1):196-201. doi: 10.1007/s11096-017-0568-6. Epub 2017 Dec 16. PubMed PMID: 29248986.
38. Mekonnen AB, McLachlan AJ, Brien JE, Mekonnen D, Abay Z. Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre-post study from Ethiopia. Int J Clin Pharm. 2018 Oct;40(5):1209-1216. doi: 10.1007/s11096-018-0722-9. Epub 2018 Aug 28. PubMed PMID: 30155773.
39. Cheema E, Alhomoud FK, Kinsara ASA, et al. The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2018;13(3):e0193510. Published 2018 Mar 28. doi:10.1371/journal.pone.0193510
40. Bonetti AF, Reis WC, Lombardi NF, Mendes AM, Netto HP, Rotta I, Fernandez-Llimos F, Pontarolo R. Pharmacist-led discharge medication counselling: A scoping review. J Eval Clin Pract. 2018 Jun;24(3):570-579. doi: 10.1111/jep.12933. Epub 2018 Apr 24. Review. PubMed PMID: 29691955.
41. Lampkin SJ, Gildon B, Benavides S, Walls K, Briars L. Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients. J Pediatr Pharmacol Ther. 2018;23(1):4-17.
42. Hirko N, Edessa D, Sisay M. Exit-Knowledge of Ambulatory Patients About Medications Dispensed in Government Hospital in Eastern Ethiopia: The Need for Focused Patient Counseling. Front Public Health. 2018;6:254. Published 2018 Sep 5. doi:10.3389/fpubh.2018.00254
43. Australian Pharmaceutical Advisory Council (APAC) Guiding Principles to Achieve Continuity in Medication Management. Camberra, ACT: Commonwealth of Australia; (2005). p. 1–52.
44. Utilization Review Accreditation Commission (URAC) Supporting Patient Medication Adherence: Ensuring Coordination, Quality and Outcomes. Columbia, WA: URAC; (2011). p. 1–22.
45. Gu H, Sun L, Jin R, Li F, Wei Y, Xie Z. Evaluation of counseling environmental alteration on pharmacy-patient communication qualifications: A case-control study. Medicine (Baltimore). 2016;95(52):e5738.
46. Ensing HT, Vervloet M, van Dooren AA, Bouvy ML, Koster ES. Patient-pharmacist communication during a post-discharge pharmacist home visit. Int J Clin Pharm. 2018;40(3):712-720.
47. Basheti IA, Qunaibi EA, AbuRuz S, Samara S, Bulatova NR. Home medication reviews in a patient care experience for undergraduate pharmacy students. Am J Pharm Educ. 2013;77(8):173.
48. Ahn J, Park JE, Anthony C, Burke M. Understanding, benefits and difficulties of home medicines review – patients’ perspectives. Aust Fam Physician. 2015 Apr;44(4):249-53. PubMed PMID: 25901411.
49. Dhillon AK, Hattingh HL, Stafford A, Hoti K. General practitioners’ perceptions on home medicines reviews: a qualitative analysis. BMC Fam Pract. 2015;16:16. Published 2015 Feb 7. doi:10.1186/s12875-015-0227-8
50. Swain L, Barclay L. Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews. BMC Health Serv Res. 2015;15:366. Published 2015 Sep 10. doi:10.1186/s12913-015-1029-3
51. Chen TF. Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model. Drugs Aging. 2016 Mar;33(3):199-204. doi: 10.1007/s40266-016-0357-2. PubMed PMID: 26961696.
52. El Hajj MS, Hammad AS, Afifi HM. Pharmacy students’ attitudes toward pharmaceutical care in Qatar. Ther Clin Risk Manag. 2014;10:121-9. Published 2014 Feb 18. doi:10.2147/TCRM.S56982
53. Okonta JM, Okonta EO, Ofoegbu TC. Barriers to Implementation of Pharmaceutical Care by Pharmacists in Nsukka and Enugu metropolis of Enugu State. J Basic Clin Pharm. 2012;3(2):295-8.
54. Acheampong F, Anto BP. Perceived barriers to pharmacist engagement in adverse drug event prevention activities in Ghana using semi-structured interview. BMC Health Serv Res. 2015;15:361. Published 2015 Sep 7. doi:10.1186/s12913-015-1031-9
55. Wick JY. 5 Tips for Improving Communication in the Pharmacy. Pharmacy Times® June 18, 2015
56. Phokeo V, Hyman I. Provision of pharmaceutical care to patients with limited English proficiency. Am J Health Syst Pharm. 2007 Feb 15;64(4):423-9. PubMed PMID: 17299181.
57. Fakeye TO, Adisa R, Olukotun RT, Morawo PK. Hospital and community pharmacists’ perception of the scope, barriers and challenges of pharmacy practice-based research in Nigeria. Pharm Pract (Granada). 2017;15(1):881.
58. Committee on Optimizing Scheduling in Health Care; Institute of Medicine; Kaplan G, Lopez MH, McGinnis JM, editors. Transforming Health Care Scheduling and Access: Getting to Now. Washington (DC): National Academies Press (US); 2015 Aug 24. 2, Issues in Access, Scheduling, and Wait Times.
59. Newton GD. Chapter 123. Ambulatory Patient Care. In: David B. Troy, Paul Beringer. Volume 2 of Remington The Science And Practice Of Pharmacy 21st Edition. Lippincott Williams & Wilkins, 2006
60. van Baal P, Morton A, Severens JL. Health care input constraints and cost effectiveness analysis decision rules. Soc Sci Med. 2018;200:59-64.
61. Gobis B, Yu A, Reardon J, Nystrom M, Grindrod K, McCarthy L. Prioritizing intraprofessional collaboration for optimal patient care: A call to action. Can Pharm J (Ott). 2018;151(3):170-175. Published 2018 Apr 2. doi:10.1177/1715163518765879
62. Lyngsø AM, Godtfredsen NS, Frølich A. Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System. Int J Integr Care. 2016;16(1):4. Published 2016 Mar 31. doi:10.5334/ijic.2449
63. Kaiser L, Bartz S, Neugebauer EAM, Pietsch B, Pieper D. Interprofessional collaboration and patient-reported outcomes in inpatient care: protocol for a systematic review. Syst Rev. 2018;7(1):126. Published 2018 Aug 21. doi:10.1186/s13643-018-0797-3
64. Miller CJ, Kim B, Silverman A, Bauer MS. A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Serv Res. 2018;18(1):146. Published 2018 Mar 1. doi:10.1186/s12913-018-2961-9
65. Houle SK, Grindrod KA, Chatterley T, Tsuyuki RT. Paying pharmacists for patient care: A systematic review of remunerated pharmacy clinical care services. Can Pharm J (Ott). 2014;147(4):209-32.
66. Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists’ practice: implications for physicians. CMAJ. 2013;185(14):1228-32.
67. Kliethermes MA. Understanding health care billing basics. Pharm Today. 2017;23(7):57–68
68. Schepel L, Lehtonen L, Airaksinen M, Ojala R, Ahonen J, Lapatto-Reiniluoto O. Medication reconciliation and review for older emergency patients requires improvement in Finland. Int J Risk Saf Med. 2018;30(1):19-31.
69. Lenssen R, Schmitz K, Griesel C, et al. Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial. BMC Geriatr. 2018;18(1):135. Published 2018 Jun 4. doi:10.1186/s12877-018-0814-3
70. Earls G, Reinhold JA. Chapter 1. Approach to the patient and patient centered care process. In: Jennifer A. Reinhold, Grace Earl. Clinical Therapeutics Primer: Link to the Evidence for the Ambulatory Care Pharmacist, published by Jones & Bartlett Publishers, Oct 3, 2012, pp-10.
71. Problem identification and prioritization. Available From: http://www.pharmpress.com/files/docs/pcme_sample_ch.pdf
72. Vadher D, Cannon BC. Chapter 122. Development of a Pharmacy Care Plan and Patient Problem Solving. In: David B. Troy, Paul Beringer. Volume 2 of Remington The Science And Practice Of Pharmacy 21st Edition. Lippincott Williams & Wilkins, 2006
73. Wheeler AJ, Scahill S, Hopcroft D, Stapleton H. Reducing medication errors at transitions of care is everyone’s business. Aust Prescr. 2018;41(3):73-77.
74. Viswanathan M, Kahwati LC, Golin CE, et al. Medication Therapy Management Interventions in Outpatient Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Nov. (Comparative Effectiveness Reviews, No. 138.) Appendix A, Literature Search Strategies.
75. Littauer SL, Dixon DL, Mishra VK, Sisson EM, Salgado TM. Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review. Pharm Pract (Granada). 2017;15(4):1134.
76. Telehealth: Increasing Access to High Quality Care by Expanding the Role of Technology in Correctional Medicine. J Clin Med. 2017;6(2):20. Published 2017 Feb 13. doi:10.3390/jcm6020020
77. eVisit. What is the difference between telemedicine, telecare and telehealth? Available From: https://evisit.com/what-is-the-difference-between-telemedicine-telecare-and-telehealth/
78. American Telemedicine Association. Telemedicine Glossary. Available From: http://thesource.americantelemed.org/resources/telemedicine-glossary
79. Center for Connected Health Policy at the National Telehealth Policy Resource Center. NC State Law Telemedicine/Telehealth Definition. Available From: http://www.cchpca.org/nc-state-law-telemedicinetelehealth-definition
80. Vogenberg FR, Santilli J. Healthcare Trends for 2018. Am Health Drug Benefits. 2018;11(1):48-54.
81. Parker S, Prince A, Thomas L, et al. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open. 2018;8(8):e019192. Published 2018 Aug 29. doi:10.1136/bmjopen-2017-019192
82. Stefano GB, Kream RM. The Micro-Hospital: 5G Telemedicine-Based Care. Med Sci Monit Basic Res. 2018;24:103-104. Published 2018 Jul 14. doi:10.12659/MSMBR.911436
83. Clarke JL, Bourn S, Skoufalos A, Beck EH, Castillo DJ. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions. Popul Health Manag. 2017;20(1):23-30
84. Leuck S. 6 Tips to Align an Outpatient Pharmacy with Its Associated Hospital. Pharmacy Times® January 27, 2016