Collaborative Practice Agreements (CPA) and Pharmacists’ Patient Care Services
What is a CPA?
What is it
Collaborative practice agreements (CPAs) are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team. CPAs define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions. Of important note, CPAs are not required for pharmacists to perform many patient care services (e.g., medication reviews, patient education and counseling, disease screening, referral).
In January 2012, the APhA Foundation convened a roundtable consortium in Washington, D.C., for the purposes of stimulating increased integration of collaborative practice agreements (CPAs) and pharmacists’ patient care services into practice. The healthcare environment in the United States is undergoing unprecedented change, with myriad healthcare reform initiatives, mounting evidence for the positive contributions of pharmacists, and federal government interest in pharmacist-provided services from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, and Surgeon General. Many individuals and groups have asserted that pharmacists are a dramatically underused resource that could help improve outcomes within our healthcare delivery system, if properly engaged as essential members of the healthcare team.
To develop consensus recommendations that provide principles and strategies for effectively implementing healthcare system changes, including an optimized role for pharmacists to engage in team-based, patient-centered care.
An interdisciplinary group of stakeholders representing 12 states and 10 pharmacy practice settings.
|First Name||Last Name||Organization/Affiliation||State Affiliation|
|John||Beckner||Martin's Pharmacy/Giant Foods, LLC||Virginia|
|Marialice||Bennett||The Ohio State University||Ohio|
|Marcie||Bough||American Pharmacists Association||National|
|Ernest||Boyd||Ohio Pharmacists Association||Ohio|
|Laura||Cole||St. Vincent's Health System||Alabama|
|Scott||Giberson||Public Health Service||National|
|Anita||Glicken||University of Colorado School of Medicine||Colorado|
|Michael||Hogue||Samford University McWhorter School of Pharmacy||Alabama|
|Jeffrey||Kelman||Center for Medicare and Medicaid Services||National|
|Sandra||Leal||El Rio Health Center||Arizona|
|J. Paul||Martin||Crescent Health Solutions||North Carolina|
|John||O'Brien||CMS Innovation Center||National|
|George||Oestreich||G.L.O. and Associates||Missouri|
|Rebecca||Snead||National Alliance of State Pharmacy Associations||National|
|Margie||Snyder||Purdue University College of Pharmacy||Indiana|
|Troy||Trygstad||Community Care of North Carolina||North Carolina|
|First Name||Last Name||Organization/Affiliation|
|Kristen||Betts||Division for Heart Disease and Stroke Prevention, CDC|
|Benjamin||Bluml||American Pharmacists Association Foundation|
|Anne||Burns||American Pharmacists Association|
|Siobhan||Gilchrist||Columbus Technologies and Services, Inc.|
|Dyann||Matson Koffman||Division for Heart Disease and Stroke Prevention, CDC|
|Lynette||Sappe-Watkins||American Pharmacists Association Foundation|
|Caroline||Shedlock||American Pharmacists Association Foundation|
|Mindy||Smith||American Pharmacists Association Foundation|
|Jim||Owen||American Pharmacists Association|
|Farah||Towfic||American Pharmacists Association Foundation|
|Lindsay||Watson||American Pharmacists Association Foundation|
The discussion at the consortium meeting revealed seven key themes for successfully implementing and creating infrastructure for empowering collaborative, interdisciplinary care:
- Use consistent terminology and language that is readily understandable by all potential audiences.
- Allow health care providers who enter into the CPA to define the details of each agreement.
- Create and expand an infrastructure that embeds pharmacists’ patient care services and CPAs into care, while creating ease of access for patients.
- Incentivize and facilitate the adoption of electronic health records and the use of technology in pharmacists’ patient care services.
- Encourage pharmacists to maintain strong, trusting, and mutually beneficial relationships with patients, physicians, other providers; encourage those individuals to promote pharmacists’ patient care services.
- Properly align incentives based on meaningful process and outcome measures for patients, payers, providers, and the health care system.
- Examine and redesign health professionals’ practice acts, education curriculums, and operational policies to create synergy, promote collaboration and optimize support staff
These recommendations and the supporting evidence for broad use of CPAs are encapsulated in a white paper titled, Consortium Recommendations for Advancing Pharmacists’ Patient Care Services and Collaborative Practice Agreements. This white paper was published in the Journal of the American Pharmacists Association in March of 2013. Read the full white paper here.
The APhA Foundation worked in partnership with representatives from the Centers for Disease Control Division of Heart Disease and Stroke Prevention to take the key recommendations from the white paper and develop an easy-to-understand tool kit for four target audiences. Access the tools published by the CDC:
Resources for Pharmacists
Resources for Physicians, Nurses, Physicians Assistants, and Other Providers
Resources for Government and Private Payers
Resources for Decision Makers
As the APhA Foundation was bringing together the consortium and synthesizing ideas into a white paper and translational tools, ICF Macro was studying the implementation of CPAs in three pharmacies. ICF developed in-depth case studies to report their findings and provide interested parties with an understanding of the various ways to effectively implement collaborative relationships. The case studies and a summary report will be available in 2014.
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