Care Models
Johanna Taylor Katroscik, PharmD
The practice of pharmacy has evolved tremendously over the last hundred years. As this practice continues to grow and evolve, one of the next big steps is to expand pharmacists’ ability to practice at the top of their skill set and to incorporate a standard of care model for pharmacy practice.
In the early 1900s, pharmacists primarily acted as apothecaries and were responsible for compounding most medications for their patients.
In the 1950s, large-scale drug manufacturing changed the primary role of the pharmacist from being the compounder and dispenser of medications to acting solely as a dispenser.
On the tail of that change, a group of pharmacists in the 1960s started the push to expand pharmacists’ clinical roles.
In the 1990s, the pharmaceutical care model was developed and served as a foundation for the pharmacist’s patient care process that is still being taught in pharmacy curricula, and as of 2000, all pharmacy students are required to earn a PharmD to become pharmacists.
Standard of care model basics
Standard of care models already exist for other health care professions such as medicine and nursing, but still have not been adopted uniformly by the profession of pharmacy. The standard of care model includes and considers a practitioner’s education, training, experience, and practice setting. It allows practitioners to practice to the top of their skill level and acknowledges that different practitioners will have different skill levels and skill sets.
It’s important to note that practicing at the top of a skill level is different than practicing at the top of a license. For example, a newly graduated pharmacist who is currently in a residency training program has a different skill level than a pharmacist who has been practicing in a hospital setting for over 10 years. Likewise, a pharmacist who is practicing in an ambulatory care outpatient setting has a different skill set than a pharmacist who is practicing in a compounding pharmacy.
Why it’s important
Every state has different legislation that guides the practice of pharmacy. Pharmacists must work to get legislation passed every time they want to expand their roles or abilities. This can be frustrating and redundant to both pharmacists and legislators.
Idaho is a good example of a state that has broken the mold and implemented a standard of care model. Under their model, pharmacists’ scope of practice includes everything that has not been expressly prohibited by law as long as the licensee’s training, education, and experience is consistent with the act in question. The Idaho model was implemented in 2018 and continues to be one of the most progressive models of pharmacy practice in the United States.
Over the past few years APhA, the National Association of Boards of Pharmacy (NABP), and other pharmacy organizations have also taken a closer look at how they can support states and their pharmacists in implementing models similar to the one in Idaho. In 2018, NABP created a task force to develop regulations based on standards of care. After the task force meeting, they published a list of recommendations on how to move forward. NABP also updates their Model Pharmacy Act/Rules guidance each year that provides language to boards of pharmacy that can be used if they are creating or updating laws or rules. Hopefully, other states can use these models and examples to continue to break the mold and gain the ability for pharmacists to better care for patients. ■
NABP’s Model State Pharmacy Act definitions
- The ‘Practice of Pharmacy’ means, but is not limited to, the interpretation, evaluation, dispensing, and/or implementation of medical orders, and the initiation and provision of Pharmacist Care Services.
- ‘Standard of Care’ means the degree of care a prudent and reasonable licensee or registrant with similar education, training, and experience will exercise under similar circumstances.
Practice examples of how standard of care models could improve patient care
- Renew chronic medication prescriptions
- Change dosage form of a medication (i.e., tablet to liquid)
- Make therapeutic substitutions within the same drug class
- Write prescriptions for medications that do not require the pharmacist to make a diagnosis