Page 39 - Management Theory 2023-2024 Edition

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26. Collaborative Practice Agreements

Collaborative practice agreements (CPAs) refer to the practice where prescribers (generally physicians)
authorize pharmacists to engage in specified activities, such as adjusting and/or initiating drug therapy, to help
patients achieve more effective and efficient drug therapy outcomes.

CPAs, which must be between a licensed practitioner and a licensed pharmacist, may include:

1. Initiating,
2. Modifying, and administering drug therapy;
3. Ordering and evaluating lab work;
4. Making physical assessments; and providing drug therapy and
5. Patient care management within the scope of practice and practice skills of the parties involved.

The CPAs documents often authorize activity for the specific duration (usually not exceeding two years).

Examples of where CPAs are being used successfully include immunizations, emergency contraception, asthma
therapy management, dyslipidemia therapy management, warfarin anticoagulant therapy management,
diabetes therapy management, smoking cessation therapy, and flu/antiviral therapy.

Currently, 45 states allow CPAs. Others are developing or reviewing proposed legislation or regulations that
would enable pharmacists to participate in CPAs. Most of the earlier CPA initiatives were more commonly
implemented in hospital or health-system pharmacy practices, where the oversight of the pharmacy and
therapeutics committee made such arrangements more desirable.

However, many states now authorize CPAs to be utilized in additional pharmacy practice settings outside of the
hospital, allowing pharmacists to play an increasingly important role in patient care. The types of disease that
are most frequently managed by pharmacists in collaboration with physicians are diabetes, asthma,
hyperlipidemia, and blood disorder.

The therapies listed as being most frequently the subject of CPAs between pharmacists and physicians are those
that can be monitored by the pharmacist through the test of drug efficacy (ie, blood glucose for diabetes, peak
flow meter for asthma, blood lipids for hyperlipidemia, and the INR [international normalized ratio] for
anticoagulation therapy).

CPAs allowing pharmacists to administer immunizations, especially in the community setting, are becoming an
increasing opportunity for pharmacists across the country. Currently, every state has laws or regulations in place
allowing pharmacists to administer immunizations. Pharmacists interested in this type of practice should contact
their state board of pharmacy and state and national pharmacy associations to learn the specifics of how this
particular value-added service can be incorporated into their practice setting.

Components of collaborative practice agreements (CPAs):

Traditional CPAs generally include a number of components. A common component is that one or more
pharmacists voluntarily agree to work with one or more prescribers under a written and signed agreement to
perform certain patient care functions under specified conditions. Furthermore, most CPAs require the patient
or patient’s authorized representative to grant his or her informed consent to the collaborative practice.

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