March 22, 2017

Several of my colleagues have expressed concern about receiving faxes from pharmacists about medications their patients could be on. They question whether this is collaborative practice or solicitation of business. 

During the March 8 meeting of the Executive Council of the Medical Society, we heard from Robert Stout, PharmD, chair of the Board of Pharmacy for New Hampshire. He came to speak with us to clarify the differences between collaborative pharmacy practice and the frequently used tactics of sending solicitation regarding specific patients to physicians that suggest specific treatments based on patient diagnoses. This is not collaborative practice.

In the 2016 legislative season, a bill quietly passed that extended collaborative pharmacy practice from hospital and health center settings to more pharmacies, including retail pharmacies. In years prior, the more narrow collaborative practice helped many hospital-based physicians with gentamicin dosing, vancomycin dosing, and diabetes management in the community health center.

The bill had specifics of the contract that must be established with details to be determined in rule-making at the Board of Pharmacy. The proposed rules will likely be evaluated in April. They require the pharmacist to apply for collaborative practice privileges with the Board of Pharmacy. The medical provider and pharmacist must agree on specific parameters and medications. The contract may specify the laboratory monitoring, patient education, and return communication to the patient's other providers. The patient also has the option of participating or not.

In this era of team-based care, using a knowledgeable partner to assist with management between medical visits could greatly improve overall control of several chronic diseases like hypertension. There are some who are concerned about possible extension of this model outside the medical home and PCP/patient relationship, further fracturing care continuity. 

If you have an interest in learning more, please contact me or Jim Potter to obtain a copy of the proposed rules.

Regards,

Deb Harrigan, MD