Making a case for a patient-centered integrated pharmacy practice model

The two most recent American Society of Health-System Pharmacists (ASHP) national surveys1,2 of pharmacy practice in hospital settings defined practice models as “how pharmacy department resources are used to provide patient care services. This includes how pharmacists practice and what services are provided in the care of patients, the role of pharmacy technicians in supporting patient care, and the use of automation and technology in the medication-use process.”2 For the profession to achieve consensus and consistency, it is critical to establish a clear taxonomy of terms to describe our practice models. The authors of the aforementioned ASHP surveys have proposed terminology to describe what are believed to be the three most commonly used pharmacy practice models.1,2 These definitions are general, and we recognize that actual practice in most hospitals involves a blend of these models. Anderson3 noted that “the traditional structure of most pharmacy departments is built around drug distribution, acquisition, and control.” In this model, medication distribution and the processing of medication orders constitute the singular focus of the pharmacy department. There is little proactive involvement of pharmacists in medication selection or monitoring. In most cases, pharmacists are relegated to a central inpatient pharmacy and rarely involved with other members of the health care team. Because pharmacists are engaged predominantly in drug distribution activities, there may be minimal need for pharmacists with advanced training or credentials. Role definition between pharmacists and pharmacy technicians is blurry, as pharmacists are engaged in many functions that could be performed by well-trained technicians. Recruitment of new staff, especially new practitioners with advanced training, may be a challenge, as they may see little opportunity to use their clinical skills.4 Pharmacists in this model have little accountability for patient care outcomes beyond the timely delivery of medications.