Prescribing pharmacists in the ambulatory care setting: Experience at the University of North Carolina Medical Center.
OBJECTIVE
The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described.


CONCLUSIONS
North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision. The University of North Carolina Medical Center has approximately 30 CPPs deployed across a wide range of ambulatory care clinical practice sites. This article describes (1) the pharmacy department's implementation of an ambulatory care practice model, (2) the credentialing and privileging process leading to granting of prescribing privileges, (3) metrics used to demonstrate the impact of CPP activities, (4) recommended general criteria for ambulatory care practice site identification, and (5) strategies for overcoming barriers to successful implementation of ambulatory care-focused clinical pharmacist services. Aggregated intervention-tracking data compiled by seven of the medical center's CPP ambulatory care practice sites indicate extensive CPP involvement in direct patient care encounters and patient or provider consultations, with large numbers of medication-related interventions to support institutional cost-avoidance and revenue goals.


CONCLUSIONS
CPPs deployed at the medical center's ambulatory care clinics have had a positive impact on clinical and cost outcomes, improving patient care through interventions, contributing to readmission reduction efforts, generating indirect revenue through cost avoidance, and generating new revenue through billing for patient visits.
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCDepartment of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, NCDepartment of Family Medicine, UNC School of Medicine, Chapel Hill, NC.
Emily M
EM
Hawes
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCUNC Hospitals Diabetes and Endocrinology Clinic, Chapel Hill, NC.
Caron
C
Misita
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCUNC Geriatric Specialty Clinic, Chapel Hill, NC.
Jena Ivey
JI
Burkhart
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCDepartment of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, NCUNC Hospitals Pain Management Center, Chapel Hill, NC.
Lauren
L
McKnight
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCDepartment of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, NCUNC Health Care Heart and Vascular Center at Meadowmont, Chapel Hill, NC.
Zachariah M
ZM
Deyo
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCUNC Solid Organ Transplant Clinic, Chapel Hill, NC.
Ruth-Ann
RA
Lee
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCCarolina Advanced Health, Chapel Hill, NC.
Caroline
C
Howard
Department of Pharmacy, UNC Medical Center, Chapel Hill, NCDepartment of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC. seckel@unc.edu.
Stephen F
SF
Eckel
D000046:Academic Medical Centers / Q000379:methods / Q000592:standards / Q000639:trends*; D000553:Ambulatory Care / Q000379:methods / Q000592:standards / Q000639:trends*; D003406:Credentialing / Q000592:standards / Q000639:trends*; D011307:Drug Prescriptions / Q000592:standards; D006801:Humans; D009657:North Carolina; D010595:Pharmacists / Q000592:standards / Q000639:trends*; D024382:Professional Role