Assessment of development and implementation of collaborative practice agreements in an integrated health system...

The purpose of this study was to describe the development and implementation of collaborative pharmacy practice agreements (CPPAs) in an integrated health-system specialty pharmacy (HSSP) using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.

An observational, cross-sectional, mixed-methods convergent study design was used to assess CPPA implementation in infectious diseases (ID), multiple sclerosis and neuroimmunology (MSN), hemostasis, hepatology, neurology-movement disorders, and cystic fibrosis (CF) clinics. For the qualitative phase, focus groups and semistructured interviews were conducted with HSSP leadership, clinical pharmacists, and physician champions. For the quantitative phase, data were collected retrospectively from the health system's electronic health record for the 6 months post CPPA implementation.

A total of 14 clinical pharmacists participated in focus groups across 6 different specialty clinics. Post-CPPA implementation themes highlighted improved patient care, including shorter time to treatment and better monitoring; high compatibility with existing clinic workflow; high acceptability by clinic staff; and the need for resources to support implementation. Pharmacists ordered 2,388 medications over the 6-month post-CPPA implementation time frame. Within clinics that implemented laboratory ordering to support medication management (the MSN, adult hepatology, and ID clinics), pharmacists ordered 764 laboratory tests.

Within an integrated HSSP, implementing CPPAs was well received by clinic staff, with notable perceptions of reductions in staff workload and improved patient care. HSSPs considering CPPAs should consider resources beyond clinical pharmacists alone to support development and implementation requirements.