Integration of pharmacists into team-based ambulatory care practice models

The provision of healthcare in the United States is undergoing dramatic changes due to the escalating healthcare costs in our country. New models of healthcare based on patient-centeredness, coordination of information, and multidisciplinary care teams are emerging in response to the triple aim of improving the patient experience, increasing patient quality of care, and decreasing healthcare costs.1 Many people agree that pharmacists are critical members of care teams, with a variety of roles focusing on medication use, including direct patient care, population management activities (e.g., immunization, annual wellness screening), and education of other team members.2,–8 Benefits of integrating pharmacy services into direct patient care are well documented in the literature in a wide range of studies evaluating various disease states and practice models.1,9–15 One meta-analysis examined 30 randomized trials and concluded that pharmacist-directed care improved the management of major cardiovascular risk factors in outpatients, with demonstrated reductions in blood pressure, total cholesterol, and low-density lipoprotein cholesterol.10 Another meta-analysis (of 298 studies) concluded that pharmacist-provided direct patient care led to improvements in a wide range of therapeutic and humanistic endpoints, including patient outcomes in chronic disease states such as diabetes and hypertension as well as patient safety.9 Pharmacists’ initiatives have been able to reduce costs for health systems in a multitude of areas, including initiatives to decrease readmission rates by ensuring improved transitions of care for high-risk patients and to establish generic drugs on hospital formularies.1