Practice Guidelines for Pharmacotherapy Specialists

A Position Statement of the American College of Clinical Pharmacy

The ACCP Clinical Practice Affairs Committee, Subcommittee B, 1998–1999

(Pharmacotherapy 2000;20(4):487–490)

Preamble specialist is a licensed pharmacist and graduate of

an accredited college or school of pharmacy.
The purpose of these practice guidelines is to
The pharmacotherapy specialist is recognized
describe the level of clinical pharmacy practice,
by the pharm a c y, medical, and allied health
knowledge, specialized skills, and unique
professions and by society in general as an expert
functions that characterize the pharmacotherapy
in the area of applied pharmacotherapeutics and
specialist.
as an integral member of the health care team.
P h a rmacotherapy is that area of pharm a c y
Regardless of whether the specialist practices in
practice that ensures the safe, appropriate, and
acute or ambulatory care, the pharmacotherapy
economical use of medications. To function in
specialist meets the guidelines outlined in this
this capacity re q u i res specialized education
document by the routine perf o rmance of the
and/or structured training in the clinical sciences.
activities described in the assessment factors as
The pharmacotherapy specialist possesses unique
part of daily pharmacy practice responsibilities.
professional knowledge and skills gained through
advanced training in the biomedical, pharma-
ceutical, and clinical sciences, as well as through Guideline I
practice experiences. The pharm a c o t h e r a p y The pharmacotherapy specialist designs,
specialist is skilled in the use of sound judgment implements, monitors, evaluates, and modifies
in the collection, interpretation, and application patient pharmacotherapy to ensure effective, safe,
of patient-specific data that are used to assist and economical patient care.
with the design, implementation, and monitoring
of therapeutic regimens. Knowledge and skills of Rationale
the pharmacotherapy specialist may be acquired
t h rough primary academic curricula, post- Using specialized knowledge of pharmacology,
graduate residency or fellowship training, or pharmacokinetics, pathophysiology, pharmaco-
innovative and extensive pharmacy practice economics, and therapeutics, the pharm a c o -
experiences. The skills of the pharmacotherapy therapist takes responsibilit y for patient
specialist, when applied across the entire outcomes. The pharmacotherapy specialist
continuum of the health care system, benefit manages pharmacotherapy by evaluating
individual patients, health care organizations, therapeutic agents in the context of patients and
and society in general. The pharmacotherapy populations and working collaboratively to
assure their effective, safe, and economical use.
This document was approved by the ACCP Board of
Regents on Ja nuary 17, 200 0. It replaces “Practice
The pharmacotherapy specialist makes clinical
Guidelines for Pharmacotherapy Specialists” o b s e rvations and incorporates them with
(Pharmacotherapy 1990;10:308–311). i n f o rmation gained from other health care
A d d ress reprint requests to the American College of providers to optimize therapeutic decisions. The
Clinical Pharmacy, 3101 Broadway, Suite 380, Kansas City, pharmacotherapy specialist participates in the
MO 64111.
A complete list of the members of the ACCP Clinical evaluation of drug efficacy; identifies, reports,
Practice Affairs Committee, Subcommittee B, for 1998–1999 prevents, and participates in the management of
appears in the Acknowledgment section of this paper. adverse reactions; and initiates appro p r i a t e
488 PHARMACOTHERAPY Volume 20, Number 4, 2000

changes in the pharmacotherapeutic management 11. Establishes pro c e d u res for detecting
of patients. This may include the discontinuation significant dru g - d rug, dru g - l a b o r a t o ry,
of drug treatment regimens, the prevention of drug-food, and drug-herbal interactions,
u n n e c e s s a ry or potentially harmful tre a t m e n t and develops the necessary means to
regimens, individualized adjustment of therapy minimize adverse patient consequences
in patients having unstable disease entities, that might result from such interactions.
management and monitoring of chronic dru g 12. E ffectively communicates oral and/or
therapy, or management of the drug formulary. written therapeutic recommendations or
other aspects of drug therapy to health
Assessment Factors professionals, peers, patients, the public,
and health care managers.
1. Collaborates with other health professionals
13. Assesses and participates in the manage-
to make therapeutic decisions such as drug
ment of patients with drug overdose and
and drug product selection, therapeutic patients exposed to poisons.
drug monitoring, and drug dosing. 14. P e rf o rms basic cardiac life support, and
2. Participates in the planning and development assesses and participates in drug therapy
of patient treatment. management during medical emergencies.
3. Investigates therapeutic alternatives and 15. In conjunction with licensed medical
recommends or initiates the management practitioners, develops, manages, and
of patient-related problems based on assists in the implementation of pharmaco-
i n t e r p retation of relevant literature and therapeutic protocols.
clinical experience. Communicates the 16. Works with other health care providers and
results of these investigations to health care relevant committees to develop programs
practitioners in a manner appropriate to for improving drug use and quality of
the training, skill, and need of that health patient care.
professional. 17. Documents the economic impact of clinical
4. Assists in the management, monitoring, pharmacy activities for use by organized
and modification of drug therapy in health care managers, practitioners,
patients with chronic disease. institutions, and providers.
5. Reviews patient re c o rds and ord e r s 18. Identifies therapeutic categories or indi-
regarding drug therapy and recommends vidual therapeutic agents warranting drug
and initiates changes as appropriate. utilization evaluation. Develops and
6. Evaluates patients by means of interview conducts drug utilization evaluation in
and, when appropriate, physical assessment these targeted areas.
to determine past medical history, previous 19. Coordinates the timely, accurate delivery of
medication use, present medical history, medications to patients in conjunction
present medication use, present medical with other pharmacy practitioners.
condition, and response to therapy. The 20. Utilizes pharmacokinetic principles in the
p h a rmacotherapy specialist perf o rm s formulation of therapeutic drug regimens.
accurate and re p roducible physical 21. Coordinates the timing and collection of
examination in accordance with their d rug concentration samples in biologic
formal training and experience. fluids, interprets drug concentration
7. I n t e r p rets laboratory and other patient- results, m akes recommend ations to
specific data to aid in determ i n i n g physicians regarding dosage adjustments,
treatment plans and monitoring response and monitors response to recommended
to therapy. dosage regimens.
8. Solves therapeutic queries posed by 22. I n t e r p rets patient-specific data, physical
physicians and other health care providers. findings, medical histo ry, and other
9. Identifies complications resulting fro m pertinent information to aid in designing
drug therapy and recommends or initiates treatment plans, and monitors the patient’s
the necessary treatment alternatives to response to the recommended dosage
minimize or negate them. regimen.
10. Utilizes available state-of-the-art knowledge 23. Evaluates the biomedical literature to
and technology to assess, improve, and d e t e rmine optim al t herapeutic dru g -
monitor drug therapy regimens. monitoring strategies and population
 PRACTICE GUIDELINES FOR PHARMACOTHERAPY SPECIALISTS ACCP 489

pharmacokinetic parameters. the generation of new knowledge relevant to the

24. Interprets and applies population pharmaco- practice of pharmacotherapy, clinical pharmacy,
kinetic data to the design of patient- and medicine.
specific drug dosage regimens.
25. D e t e rmines patient-specific pharm a c o - Rationale
kinetic parameters on the basis of measured
d rug concentrations and pro s p e c t i v e l y The pharm acotherapy specialist has
applies these data to dosage regimen design. responsibility for the continuing development
26. Educates health professionals, students, and refinement of knowledge re g a rding the
patients, and the public re g a rding the appropriate use of medications. This knowledge
utility of clinical pharmacokinetics. may be generated by conducting research and
clinical experimentation of therapeutic agents, by
devising new and innovative approaches to
Guideline II
p h a rmacotherapy practice, or by evaluating
The pharmacotherapy specialist re t r i e v e s , outcomes of new and innovative roles of pharma-
analyzes, evaluates, and interprets the scientific cotherapy specialists. The pharm a c o t h e r a p y
literature as a means of providing patient- and specialist has the responsibility to eff e c t i v e l y
population-specific drug information to health convey the results of pharm a c o t h e r a p e u t i c
professionals and patients. re s e a rch to health professionals, patients, the
public, and health care managers.
Rationale
Assessment Factors
Having expertise in literature evaluation and
specialized training in therapeutics enables the 1. Identifies pharmacotherapeutic questions to
pharmacotherapy specialist to retrieve and apply be studied or problems to be solved within
d rug treatment information. The pharm a c o - the realm of pharmacotherapy practice.
therapy specialist will interpret the primary 2. Develops, implements, evaluates, and
l i t e r a t u re, evaluate its applicability to given p a rticipates in scientifically valid and
patient care situations, and apply it in the ethically designed studies.
synthesis of a solution to patient-specific drug 3. Supports internal and external mechanisms
therapy problems. for review of research protocols with regard
to study design and protection of human
Assessment Factors subjects.
4. Collects data re g a rding the outcomes of
1. Identifies and retrieves the best available patients managed by the pharmacotherapist.
i n f o rmation about pharmacotherapy by 5. P resents re s e a rch results at scientific
s e a rching appropriate tert i a ry, secondary, meetings and publishes results in t he
and primary sources. The pharmacotherapist scientific literature.
is adept at using computer technology to
collect information.
Guideline IV
2. Evaluates biomedical and pharm a c o -
economic literature to determine criteria for The pharmacotherapy specialist educates
optimal use and monitoring of therapeutic health care professionals and students, patients,
agents. and the public regarding rational drug therapy.
3. Routinely reviews biomedical and pharmaco-
economic literature relevant to the pharmaco- Rationale
therapeutic management of patient populations.
4. Evaluates the literature with regard to study Experience and training in educat ion
design and methodology, statistical analysis, combined with specialized knowledge and skills
and significance of re p o rted data so that in pharmacotherapeutics render the pharmaco-
a p p ropriate assessments and conclusions therapy specialist uniquely qualified to educate
may be applied to the solution of dru g health care providers and consumers regarding
therapy problems. effective, safe, and economical use of drugs. The
specialist may teach in either the classroom or
the clinical environment (e.g., instruction during
Guideline III
hospital rounds, patient conferences, primary
The pharmacotherapy specialist participates in c a re settings, ambulatory clinics, emerg e n c y
490 PHARMACOTHERAPY Volume 20, Number 4, 2000

d e p a rtments, etc.). The pharm a c o t h e r a p y 2. Increases personal level of knowledge and

specialist is experienced in behavior modification skills by reading professional journals, and
and communication with patients, peers, and attending or participating in pro f e s s i o n a l
students. When applied appro p r i a t e l y, these seminars, professio nal symposia, and
skills may result, for example, in impro v e d national and international conferences.
patient compliance with drugs and altere d 3. Obtains board certification.
physician prescribing habits.
Acknowledgments
Assessment Factors
Prepared by the 1998–1999 ACCP Clinical Practice
1. Assumes responsibility for the education of Affairs Committee, Subcommittee B: Terry L. Seaton,
all members of the health care team involved Pharm.D., BCPS, St. Louis College of Pharmacy, St.
in patient pharmacotherapy. Louis, MO; Aileen Bown-Luzier, Pharm . D . ,
2. Participates in continuing education programs Department of Pharmacy Practice, SUNY at Buffalo,
concerning pharmacotherapeutics. Buffalo, NY; Catherine E. Cooke, Pharm.D., BCPS,
3. Develops patient education materials and School of Pharm a c y, University of Mary l a n d ,
participates in patient instruction programs B a l t i m o re, MD; John F. DeConinck, B.S.,
to facilitate appropriate medication therapy O w e n / C a rdinal Healthcare Corp., Desert Springs
and compliance. Hospital Pharmacy, Las Vegas, NV; Robert E. Dupuis,
Pharm.D., BCPS, School of Pharmacy, University of
N o rth Carolina, Chapel Hill, NC; Rex W. Forc e ,
Guideline V
P h a rm.D., BCPS, Department of Family Medicine,
The pharmacotherapy specialist continually Idaho State University, Pocatello, ID; Peter Gal,
develops his/her knowledge and skills in P h a rm.D., BCPS, FCCP (Chair), Gre e n s b o ro Are a
applicable practice areas and demonstrates a Health Center, Gre e n s b o ro, NC; Darrell Hulisz,
commitment to continued professional growth by P h a rm.D., BCPS, Department of Family Medicine,
engaging in a lifelong process. University Hospitals of Cleveland, Cleveland, OH;
Nathan L. Kanous, II, BCPS, School of Pharm a c y,
Rationale University of Wisconsin–Madison, Madison, WI;
Dannielle C. O’Donnell, Pharm.D., BCPS, College of
The frequent introduction of new pharmaco- Pharmacy, The University of Texas at Austin, Austin,
therapeutic agents into practice, the increasing TX; Eric Racine, Pharm.D., Pharmacy Department,
complexity and technicality of new drugs and Harper Hospital, DMC, Detroit, MI; Theresa Salazar,
biologic products, and the evolution of P h a rm.D., School of Pharmacy and Pharm a c a l
pharmacotherapy practice necessitate that the Sciences, Purdue University, West Lafayette, IN; Allen
pharmacotherapy specialist continually refine, F. Shaughnessy, Pharm.D., FCCP, BCPS, Harrisburg
improve, and expand the unique, advanced skills Hospital Family Practice; Harr i s b u rg, PA; Ronald
which he/she possesses. Taniguchi, Pharm.D., Pharmacy Services, Kaiser
Permanente, Hawaii Region, Honolulu, HI; and Kay
Assessment Factors M. Uttech, Pharm.D., BCPS, College of Pharm a c y,
University of Illinois at Chicago, Chicago, IL.
1. P a rticipates in professional org a n i z a t i o n s Significant contributions to the development of this
related to areas of expertise, thereby nurturing paper were made by Karen S. Oles, Pharm.D., BCPS,
and enhancing personal knowledge and Wake Forest University School of Medicine, Winston-
leadership skills. Salem, NC.