Pharmacist collaborative practice and the development and implementation of team-based care in outpatient healthcare settings: A case study at El Rio Community Health Center

Background: The United States is experiencing a primary care physician shortage that will grow in the next decade as demand for primary care services is projected to increase. The growth in physician, Nurse Practitioner, and Physician Assistant supply alone will not be adequate to meet the demand for primary care services by 2020. Creating pharmacist-inclusive collaborative care teams for outpatient clinical care can help alleviate this health care delivery shortage. Methods: A qualitative mixed-methods case study was conducted in Tucson, Arizona to determine the supports and structures behind the Pharmacy-Based Diabetes Management Program (PBDMP) at El Rio Community Health Center. Using key informant interviews from El Rio, other outpatient clinical pharmacy programs (OCPPs), and the Tucson Accountable Care Organization, coupled with Lean Management brainstorming group sessions, the study elicited information about how the experience of El Rio with the PBDMP can inform nationwide development and implementation guidelines for other OCPPs. Results: The PBDMP at El Rio provides a blueprint for other programs interested in creating an OCPP. Key contributing factors to program success within El Rio and the other OCPPs interviewed included a focus on six key practices. Challenges inhibiting success were pharmacist provider status and reimbursement of clinical services provided. Translation: Three public health practice products were developed as a framework to provide future OCPPs interested in implementing a pharmacist-inclusive practice model: 1) implementation guidelines, 2) a self-assessment outpatient clinical pharmacy program worksheet for clinics looking to create or expand an OCPP, and 3) a student management decision case study. Conclusion: This study demonstrates the value of considering all potential members of a care team for diabetes care management. The decision by a clinic to create an OCPP should be based on team-based approaches to patient-centered chronic disease care management. Clinics looking to participate in a CDTM model OCPP need to identify if organizational transformation is needed for program buy-in and consider relational coordination between clinical roles as a major component of the coordinated work needed for a successful OCPP