Advancing Pharmacy Practice in a Rural Area

An analysis of the Northern Navajo Medical Center (NNMC) found that although opportunities grew due to provider shortages, pharmacists practicing at the top of their license have the ability to significantly improve access to care, particularly in areas revolving around medication management, according to a poster presented at the American Society of Health-System Pharmacists' (ASHP) virtual 2020 ASHP Midyear Clinical Meeting and Exhibition.

The NNMC is 1 of 5 facilities located within the Shiprock Service Unit, which is the largest service unit on the Navajo Nation, offering inpatient and ambulatory care services. Pharmacist involvement in ambulatory patient care includes anticoagulation, chronic care, epilepsy, and rheumatology, according to the study authors.

Specifically, in rural settings, growing primary care provider shortages impact patient access to care. At NNMC, pharmacist clinicians work under a collaborative practice agreement in which the pharmacist practitioners are credentialed as part of the medical staff and have diagnostic privileges. However, initial limitations to provider buy-in for pharmacy clinician/practitioner services included lack of comprehensive physical assessment training, poor verbal presentation skills, and inexperience in evaluating new acute complaints.

The objective of the study was to alleviate provider shortages by using pharmacist clinicians and practitioners for both chronic disease management and new complaint evaluation. Additionally, the researchers hoped to expand the availability of physical assessment training to federal pharmacists to include training to evaluate common new acute complaints, how to better communicate with medical providers, and to assess the usefulness of this training to pharmacists outside of this facility.

The results indicate that the use of pharmacist clinicians and practitioners allows for medical providers to spend more time with complex patients. Further, with regards to physical assessment training, the course is the first to teach pharmacists how to further work-up new acute complaints, which inevitably arise in chronic diseases management. The course is unique by requiring verbal presentation of patient cases to a provider or proctor, according to the study authors.

One of the findings outlined how limited access to advanced physical assessment training can hinder the growth of pharmacists. Additionally, course attendees improved from baseline in a survey assessing comfort in aspects of both chronic and acute management. Although the ability of pharmacists to diagnose may be site-specific, ruling out emergent situations, concisely presenting an evaluation to a provider and facilitating appropriate follow-up may help build rapport with medical providers, according to the study.

REFERENCE

McDermott K, Yang SM, Vodovoz KJ, et al. Advancing pharmacy practice in a rural area. Poster presented at American Society of Health-System Pharmacists' virtual 2020 ASHP Midyear Clinical Meeting and Exhibition; December 6-10, 2020. Accessed December 9, 2020.