Collaborative practice agreements: Where we are and where we’re going

A decade ago, the Journal of the American Pharmacists Association published a study that examined the state of collaborative practice. In 2003, 32 states had pharmacist collaborative practice regulations. Of those, 23 states allowed pharmacists to initiate and modify drug therapy. The study found that collaborative practice had a positive effect on pharmacist-doctor relationships, and on patients’ perceptions of pharmacists.

The past decade has seen a wider adoption of collaborative practice. According to the National Alliance of State Pharmacy Associations, in 2012, a total of 46 states had some form of collaborative practice protocols between pharmacists and physicians. These agreements are typically regulated by state boards of pharmacy and medicine, or scope of practice acts. Collaborative practice agreements allow pharmacists to provide a wide range of clinical patient care services in partnership with other healthcare professionals, usually physicians. Patient care services may include selecting, initiating, administering, monitoring, modifying or discontinuing medication therapy, and much more. However, the exact extent to which a pharmacist can provide these services varies widely depending on state regulations.

The value of pharmacists as part of the healthcare team has been growing steadily, and the federal government (i.e., Centers for Medicare and Medicaid Services) has shown increasing interest in pharmacist-provided services to improve patient outcomes. With this backdrop, in January 2012, the American Pharmacists Association Foundation held a roundtable consortium to discuss the role of pharmacists in patient care and the increased use of collaborative practice agreements. The results of the roundtable, a white paper titled “Consortium recommendation for advancing pharmacists’ patient care services and collaborative practice agreements,” will appear in the March/April 2013 issue of JAPhA.   

The roundtable included participants from pharmacy, medicine and nursing from 12 different states. The purpose was to develop recommendations on how to adopt and integrate pharmacist patient care activities and CPAs into practice. The group came up with seven recommendations:

  1. Use consistent terminology and language that is readily understandable by all potential audiences.

  2. Allow healthcare providers who enter into the CPAs to define the details of each agreement. This may require regulatory or legislative changes to allow practitioners the flexibility to develop their own CPAs. Roundtable participants felt that current laws limiting the scope of CPAs also limited patient care.

  3. Create and expand an infrastructure that embeds pharmacists’ patient care services and CPAs into care, while creating ease of access for patients. In other words, make the process seamless and easy for patients, and create a business model supporting the pharmacists’ role.

  4. Incentivize and facilitate the adoption of electronic health records and the use of technology in pharmacists’ patient care services. Electronic health records and other technology will make it easier for healthcare providers to share information with each other.

  5. Encourage pharmacists to maintain strong, trusting and mutually beneficial relationships with patients, physicians and other providers; encourage those individuals to promote the pharmacist’s patient care services — networking, marketing and promotion.

  6. Properly align incentives based on meaningful process and outcome measures for patients, payers, providers and the healthcare system.

  7. Provide incentives, financial or otherwise, to patients and providers based on outcomes.

  8. Examine and redesign health professionals’ practice acts, education curriculums and operational policies to create synergy, promote collaboration and optimize support staff. For example, the whitepaper suggests that teaching providers about the roles of other health professionals can help build a team mentality and a focus on collaboration.  

Collaborative practice holds great promise for the future, particularly when it comes to chronic disease or patients with multiple health problems. The APhA Foundation roundtable was a great start in terms of recommendations; states, however, may need to change their policies and regulations to allow CPAs to be all that they can be.


Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.