ASHP guidelines: Minimum standard for ambulatory care pharmacy practice

In recent years, there has been an increasing emphasis in health systems on the provision of ambulatory care services. Payers have created incentives to decrease hospitalization rates and length of stay, making way for a new shift toward pay-for-performance, outcomes-based reimbursement, and accountable care. There is also an increasing focus in medicine on preventive health, patient education, and care transitions. Yet, the number of patients with multiple chronic medical conditions that require longitudinal and integrated care management across a continuum of care settings is growing. Appropriate medication therapy in the ambulatory care setting is often the most common and most cost-effective form of treatment, yet the consequences of adverse drug events (ADEs) and the inappropriate use of medications in this setting can be catastrophic.1 Ambulatory care pharmacy services are therefore an essential component of any comprehensive healthcare delivery system. Pharmacists have become integral members of healthcare teams in a variety of settings, such as patient-centered medical homes, community health centers, long-term care facilities, hospital outpatient departments, and freestanding pharmacies, among others; the care they provide has enabled patients, other providers, and payers to achieve their clinical, humanistic, and economic goals.2,3 There is growing recognition and understanding that ambulatory care pharmacy services extend far beyond the dispensing of medications and include direct patient care and the design and management of complex medication regimens and care delivery systems. Current evidence demonstrates that the inclusion of pharmacists practicing in ambulatory care settings on the healthcare team improves quality of care, enhances patient outcomes, and contributes to cost avoidance.4 Most states now allow pharmacists to provide direct patient care services under a physician–pharmacist collaborative agreement, further supporting the expansion of ambulatory care pharmacy services.