Increased involvement of clinical pharmacists in patient care may offer increased access to health care and improved patient outcomes. Defined by Hepler and Strand in 1989, pharmaceutical care involves pharmacist collaboration with health team members to optimize therapeutic outcomes by identifying, solving, and preventing actual and potential drug therapy problems. Since 1995, the Department of Veterans Affairs has allowed Clinical Pharmacy Specialists (CPS) an expanded scope of practice with independent prescribing privileges. In this capacity, CPS have been detailed to perform "pharmaceutical care" or comprehensive medication management along with chronic disease state management services, in addition to less complex services such as patient medication counseling or responding to drug information questions. In the VA primary care setting, CPS are likely to be responsible for therapeutic outcomes for a multitude of conditions for any patient referred to CPS or proactively identified by CPS as a high-risk patient.
The purpose of this review is to determine the effectiveness and harms of pharmacist-led chronic disease management for community-dwelling adults. Chronic disease management aims to control symptoms and slow or stop disease progression. Chronic disease management is typically a multi-component intervention that includes medication therapy review, patient medication education, medication monitoring, immunizations, disease self-care and support, and/or prescribing authority.
This topic was nominated by Heather Ourth, PharmD, VACO Pharmacy Benefits Management Program Manager, on behalf of the National Clinical Pharmacy Research Group, chartered by the VACO Clinical Pharmacy Practice Office of VACO Pharmacy Benefits Management (PBM). We address the following key question developed with input from the topic nominator and a technical expert panel (TEP).
Key Question: What are the effectiveness and harms of pharmacist-led chronic disease management compared to usual care?