In an education session during APhA2022 titled "Health-System and Community Pharmacy Collaboration," Tamara McCants, PharmD, assistant professor, Howard University, defined the differences between health systems and community pharmacies, described the types of opportunities for new collaboration, and identified ways to strengthen current pharmacy practice collaborations.

Laying the groundwork for a discussion about community and health system partnership, Dr. McCants said, "The term 'retail community pharmacy' means an independent pharmacy, a chain pharmacy, a supermarket pharmacy, or a mass merchandiser pharmacy that is licensed as a pharmacy by the state and that dispenses medications to the general public at retail prices. Such term does not include a pharmacy that dispenses prescription medications to patients primarily through the mail, nursing home pharmacies, long-term care facility pharmacies, hospital pharmacies, clinics, charitable or not-for-profit pharmacies, government pharmacies, or pharmacy benefit managers."

In contrast, she noted, "The Compendium of U.S. Health Systems, 2016, defines a health system as an organization that includes at least one hospital and at least one group of physicians that provides comprehensive care (including primary and specialty care) who are connected with each other and with the hospital through common ownership or joint management."

Dr. McCants acknowledged that a discussion of the financial ramifications of health system and community pharmacy collaborations is perfectly valid. "When talking about collaborative opportunities, it has to be something that is financially beneficial to both institutions. And there is nothing wrong about talking about finances." She continued, "When you are operating at your optimum, many patients are being taken care of."

This has not always been the case, she pointed out. "For a long time, we tried to separate the two, but you don't have to; they both can live in the same place." 

Transitioning individuals out of hospitals and other healthcare setting, noted Dr. McCants, presents an excellent opportunity for effective collaboration. "When talking about transitional care, we are talking about not readmitting people to the hospital within 30 days. When the hospital makes money doing that, then you, as an independent pharmacy or a pharmacy system, can have some type of financial relationship with the hospital to help to them meet that goal.

"The initial follow-up care for transitional care," she emphasized, "should occur within 48 hours." "Effective implementation of care transition can lead to decreased medication errors and hospital readmissions."

Dr. McCants explained that terms such as medication therapy management have evolved into "medication optimization," which she said is the best or most effective use of medication "and is extremely individualized." Medication optimization, she said, is part of "comprehensive medical management."

To ensure optimal medication delivery, Dr. McCants said, an individualized, culturally sensitive approach is needed. "Collaborations are strengthened by being intentional and identifying and reducing barriers." Collaboration, she added, involves a step-by-step process that begins with identifying patients who would benefit from health system and community pharmacy collaboration, including patients who utilize a clinic and a collaborating pharmacy, patients with identified gaps in care, and patients with complex/complicated medication problems.

Next, she said, effective communication must be established, including the identification of a contact person at the collaborating pharmacy/health system, an agreed-upon referral system, clear communication of patient information, and a clear communication chain with the patient.

The third step, Dr. McCants said, is establishing a goal and identifying the needs of each collaborating party based on priorities. The goal should be patient centered and consistent with clinical goals, and it should incorporate the role of population health.

Finally, she said, the collaboration should strive to promote shared trust and responsibility through a code of conduct and a "shared philosophy on care provision."

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