Indian Health Service IHS National Clinical Pharmacy Specialist NCPS

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Indian Health Service (IHS) National Clinical
Pharmacy Specialist (NCPS)
Re May 2008
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Overview

• For decades, Indian Health Service (IHS)
  pharmacists across the nation have practiced in a
  variety of expanded clinical roles to provide
  primary care
• IHS pharmacy is widely known (in both the private
  sector and academia) for its innovative pharmacy
  practice, which includes privileges in disease
  management
• The provision of pharmaceutical care follows the
  IHS Pharmacy Standards of Practice Chapter 7 of
  the Indian Health Manual
• The Indian Health Service (IHS) officially
  recognizes IHS pharmacists as primary care
  providers. Refer SGM 10-18-96

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Expanded Practice Evolution

• In 1996, the scope of pharmacy practice in the
  IHS was officially broadened to include
  prescriptive authority. Dr. Michael Trujillo
  (former IHS Director) recognized IHS pharmacists
  as primary care providers in his October 18, 1996
  memorandum
• Clinical Pharmacy Specialists (CPS) will be
  included in
• the IHS definition of a primary care provider
  (PCP)
• for the purposes of workload reporting, program
• planning, and reimbursement from all third
• party payers. An appropriate primary provider
• code will be assigned to CPS.

Pharmacy Code 067
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Evolution of Expanded Practice IHS Innovation
1931
1955
1962
1969
1974
1983
1988
1990
Edwin M. Holt is the first commiss-ioned officer
to be assigned to the Office of Indian Affairs,
Department of Interior.
Allen J. Brands becomes the first CPO for IHS
IHS shift from distribution to clinical services.
Begins to counsel patients and use health record,
not Rx form. Such practice does not exist before
this time
IHS begins Pharmacy Practitioner Program
teaching IHS pharmacists physical assessment and
disease management
IHS establish-ment of the IHS Clinical Pharmacy
Training Program (CPTP ) training pharmacists
in managing chronic disease
IHS Program Planning meeting in Rockville
pharmacists start serving as primary care
providers in many IHS facilities
IHS Standards of Practice to provide
pharmaceutical care to patients. Coined the term.
IHS distributes Patient Consultation videos to
academia nationwide.
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Evolution of Expanded Practice IHS Innovation
1995
1996
1997-98
2001
2008
1998
2007

• - IHS and PHS leadership meet with HCFA to
  discuss IHS pharmacy practice and potential for
  pharmacist reimbursement.
• - First group of IHS pharmacists receive NCPS
  and NCPS-PP credentials.
• - IHS receives the APhA Pinnacle Award for IHS
  contributions to pharmacy profession

Director of Indian Health Service, RADM Michael
Trujillo, signs special memorandum, which
codifies Clinical Pharmacy Specialists (CPS) as
primary care providers (PCPs) with prescriptive
authority.
The IHS National Clinical Pharmacy Specialist
Credentialing Committee (NCPSCC) is born out of
discussions surrounding decades of expanded
practice
IHS receives Roche D.R.E.A.M. award for
NCPS-pharmacist managed Traineeship in
Anticoagulation Management
IHS completes 10-years of national credentialing
through NCPS. Nearly 200 pharmacists credentialed
(over 100 currently active) across 40 states and
8 different disease state areas.
IHS receives the ASHP Award of Excellence for
the implementation of a pharmacist CHF clinic
IHS Business Committee meetings to discuss
reimbursement for services and contacts HCFA (now
CMS)
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Committee Charge

• National Clinical Pharmacy Specialist
  Credentialing Committee (NCPSCC) - officially
  est. 1998 by Chief Professional Officer in
  response to IHS Business Committee meetings and
  interest in recognition
• of expanded scope
• Promote uniform clinical competency of I/T/U
  pharmacists on a national basis.
• Define advanced scopes of practice for I/T/U
  pharmacists.
• Serve as the body that reviews the credentials,
  training, and education of I/T/U pharmacists and
  grants NCPS certification
• Establish the above elements to help promote
  universal recognition of NCPS pharmacists as
  billable providers
• Current activity to capture impact of workload
  reduction, patient outcomes, and cost-savings
  derived from clinical pharmacy services

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Scope

• Intended to recognize advanced scopes of practice
  at local level that satisfy uniform national
  guidelines
• Includes NCPS and NCPS- Pharmacist Practitioner
  (NCPS-PP)
• Involve focused management of disease states (may
  involve established or new patients)
• Care/Privileges to include
• Interview, chart review
• Laboratory privileges
• Prescriptive Authority
• Limited (or potentially more general) physical
  assessment
• Patient education and follow up
• NCPS grants certification. Privileges are granted
  locally.

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Impact by the numbers

• Cumulative Pharmacists Credentialed 200
• Cumulative Non-Redundant 156
• Active, Non-Redundant Certifications 100
• Currently, 100 IHS pharmacists credentialed out
  of 452 IHS pharmacists.
• NCPS IHS pharmacists 22 of
• IHS pharmacists!
• Many more practice as CPS
• at local levels
• Denominator (n452) includes all IHS positions
  including non-clinical, multidisciplinary and
  those in administrative roles.

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Disease States with Credentialed Pharmacists

• Anticoagulation
• Nicotine Dependence
• Diabetes
• Dyslipidemia
• Asthma
• Hypertension
• Pain Management
• Primary Care/Family Med (NCPS-PP)

• Disease State with the highest number of
  credentialed
• NCPS pharmacists

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NCPS Credentials By IHS Area
(Cumulative)
(Active)
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NCPS Credentials By IHS Facility
(Cumulative)
(Active)
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Critical Elements of Protocol

• For each NCPS pharmacist, the NCPSCC also
  approves a collaborative practice agreement (CPA)
  to assure national uniformity/standards are met
• CPAs are reviewed for
• Rationale, Purpose
• Clinic (Policy and Procedures)
• Clear indication of pharmacist privileges
  (advanced scope)
• QA and outcomes
• Training and Local Attestation/Privileging/Re-Priv
  ileging
• Clinical Information Accordance with National
  Guidelines
• Appropriate Signatures

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Impact on Pharmacy Practice

• Uniformity of expanding scope and local
  documentation of outcomes
• Collection of best practice models and
  standardization could enhance quality of care.
• Improved patient access to care clinics
  available in over 40 hospitals and clinics across
  10 states
• Provides a national uniform system for
  pharmacists that reviews training, attests to
  knowledge/education, and helps assure clinical
  competency at the local level
• Expansion will be another step to uniformity of
  clinical practice and promotion of competence
  across agencies

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Contact Information / NCPS Committee

• Committee Members
• LCDR Mike Lee, Chair michael.lee_at_ihs.gov
• CAPT Don Ahrens, Ex-Officio don.ahrens_at_ihs.gov
• CAPT1 Scott Giberson scott.giberson_at_ihs.gov
• CDR Linda Schrand-Crosby linda.schrand_at_ihs.gov
• LCDR Brian Campbell brian.campbell_at_ihs.gov
• LCDR Maya Thompson maya.thompson_at_ihs.gov
• Dr. Charles Rhodes, MD
• CAPT Marty Smith, Consultant
• CDR Chris Lamer, Consultant
• For additional information, please email or phone
• LCDR Mike Lee _at_ [phone] or
• CAPT1 Scott Giberson _at_ [phone]
• 1 Effective 1 Oct 2008