Collaborative Drug Therapy Management by Pharmacists

The practice of pharmacy and the provision of health care in the United States have changed dramatically over the past 60 years. Reports in the literature documenting pharmacists functioning in primary care roles and as prescribers of medications appeared as early as the 1970s. Reports of these early efforts, now renamed as efforts in collaborative drug therapy management, have demonstrated increased efficiencies in the health care system, while maintaining quality of care and patient satisfaction. At least 14 states and the federal government have authorized some form of pharmacist involvement in collaborative drug therapy management, and many other states are seeking to institute enabling legislation and regulations. Opportunities for pharmacists to increase efficiencies, decrease drug-related morbidity, and improve patient outcomes are abundant. Not only has the role of the pharmacist evolved, but market-driven forces have caused the entire health care system in the United States to become more collaborative in nature. Pharmacists now have an opportunity to participate in collaborative drug therapy management and contribute to the quality of patient care in concert with other health care professionals. In order to function successfully in a collaborative environment, the pharmacist must practice in a setting where teamwork is fostered, be able to establish a covenantal relationship with patient, and have access to the patient's medical records. Because collaborative drug therapy management involves multiple complex tasks, the process may be more easily defined by describing the activities involved in the process - selecting, initiating, monitoring, continuing, modifying, and administering drug therapy. Ideally, these responsibilities should also include ordering, performing, and interpreting medication-related laboratory tests and procedures, along with performing patient assessment tasks related to drug therapy. By virtue of their extensive training in all relevant aspects of drug therapy management, pharmacists are well qualified and well equipped to provide collaborative drug therapy management services to patients. Collaborative drug therapy management is most successful when the nature of the collaborative arrangement, the competencies and credentialing required, and the quality assurance checks that will be used to assess performance are defined at the outset in each specific setting. In this era of rapid evolution in health care, the provision of