The functions and clinical impacts of a pharmacist practitioner have evolved immensely. One of the rapidly growing and exciting areas of practice is the ambulatory care. Ambulatory care system is an activity that is concerned with the provision of personal health care consultation, provision of treatment through the use of advanced medical technology and procedures that are delivered on an outpatient basis. This care encompasses facilities such as the primary care physician offices, private clinics, hospital-based outpatient clinics as well as community pharmacies to a certain extent. This healthcare centers are either hospital-based or freestanding.
Those that are freestanding appear to be classified into various levels unlike those that are hospital-base. In contrary to hospital-based ambulatory care centers, freestanding centers of the highest level are said to be able to provide emergency care (Debora et al 23). Therefore, such pharmacists are responsible in the optimization of the outcomes of medical therapy and coordinating with other healthcare professionals. This implies that ambulatory care pharmacist who works under collaborative practice agreement with other physicians possesses the autonomy of engaging in these practices within a defined scope of practice (Reinhold et al 2).
Nevertheless, pharmacist can interview the patient so as to assess the reasons for medication nonadherence, such as lack of understanding and affordability issues. In addition to that, he or she can necessitate administering medication through recommending immunizations which may be necessary in preventing further problems. Through considering the relation of patient care and ambulatory care, it stipulates that patients can sign up with more than one physician of their choice for the ambulatory care, although progressive health care by physicians, family and transferral hospitals to other specialists through them are advocated (Reichertz et al 34).
With regard to that, the diversity of the ambulatory setting which includes the use of varied conceptual models of healthcare and some evolving issues which involve the ambulatory care costs for the individual patient are also the functions of this healthcare. ambulatory care sensitive conditions (ACSC) are health conditions in which appropriate ambulatory care reduces the need for hospital admission for ailments such as chronic obstructive pulmonary disease or diabetes (Q. Ashton Acton 42). Through this type of health care system, numerous medical treatments and investigations for preventive health care and acute illness can be programmed, including minor surgical and medical procedures. Most types of dental services, dermatology services, and other types of diagnostic procedures are also addressed.
Despite that these medical care have evolved immensely, many aspect of health care that were once unique to hospitals are being included in the provision of Medicaid and Medicare. Nowadays, these services and procedures are commonplace in ambulatory, community health care and outpatient setting. These activities include emergency services, invasive procedures, rehabilitation visits and in some cases telephone consultations. Disease management, syndromic surveillance, documentation, teleheath practice and documentation challenges in the nursing practice which lead to a limited understanding of ambulatory practice is widely addressed as far as treatment is concerned (Perle & Sue 179 ).
Ambulatory care services represent the most significant contributor to increasing hospital expenditure and to the performance of the health care system in most countries including most developed ones. On the other hand, new patient centered models of this care are aimed at substituting better primary care with preventable acute care within practices that primarily exist. This means that primary care, as the subset of ambulatory care which provides patients with an initial point of contact with the Medicare, have specific philosophy and unique features. Practitioners who provide primary care serve patients who present a wide variety of diseases or multiple ailment state, many of which are rarely taken care of by tertiary or inpatient care (Brown & Thomas 60).
As an ambulatory care pharmacist, he or she should ensure that various components of ambulatory healthcare taken into consideration since they constitute part of the medical care that is given to patients. Along with hiring, the roles of the ambulatory care insists that the medical practitioner should ensure that the service offered to patients matches with the remuneration for associates since it is based on what the market would bear.
This is possibly done if you have a working knowledge of or responsibility towards the practice budget. For instance, Medical therapy management as one of the functions of these care, encompasses a wide range of professional activities or responsibilities within the licensed pharmacist’s and other qualified health care provider’s scope of practice. These services include obtaining or performing necessary assessments of the patient’s health status, selecting, modifying, initiating and administration of medication therapy (Wolters & Wilkins 264).
Evaluating and monitoring the patient’s response to therapy acts as the secondary role of ambulatory care system. For instance, safety and effectiveness, performing complete medication review so as to identify, prevent and resolve medication related problems-including adverse drug events are all the activities that are adhered to providing medication to patients (Wolper et al 641).
Nevertheless, patient care services aims in establishing a relationship with patients, obtain medical and medication histories, and assessing the appropriateness of the medication orders. Similarly, clinical care plans and disease management, as part of an interdisplinary team, develops and implements clinical plans of care and disease management programs that involves medication therapy, treatment protocol, collaborative practice, and medication error reduction (Mary & Tim 6).
Recognizing the intensive and extensive developments that are occurring in the health care system, facilities providing healthcare and treatment that are changing to match the new service models which support the level and type of patient care they are aiming to provide. This is to say that the system of delivering ambulatory has changed and is growing rapidly with the evolvement of its different organization models, including the new efforts of measuring quality relative to costs. The implementation of the Patient Protection and Affordable Care Act (ACA) accompanies proliferation of new models of healthcare delivery.
For example patient-centered medical homes (PCMHs) as well as accountable care organizations (ACCOs), which emphasize population health, the roles of primary and specialty ambulatory services have evolved rapidly along with their respective reimbursement systems (Sultz et al 166 ). In addition to that, many Medicare recipients can also carry supplemental private insurance contracts so as to reimburse the balances that were not covered by Medicare. In the private physician offices, the complexity, regulation as well billing volumes requirements are burgeoned (David et al 40).
Models of clinics have continued to evolve within the framework of the overall healthcare systems and reforms. Ambulatory care system has greatly increased the percentage of the total healthcare volume thus facilitating the decline of impatient care. Those diseases that were considered to be acute care are widely being addressed with current drugs and procedures hence achieving the decline of chronic diseases (Selker et al 24). Contrary to that, in addressing chronic diseases, emphasis on the wellness of individuals has evolved as a new focus in addressing the long-term nature and lifestyle related issues that surround one’s health. This means that managed healthcare plans in which financial incentives are in, plays a major role of promoting ambulatory care as well as preventive care (Tulchinsky et al 560). This represents the predominant priority of hospitals and ambulatory healthcare services based on the insured or personal outlay for services.
Nonetheless, changes concerning the assessment of private health insurance, expansion of the Medicaid programs and other Affordable Care Act (ACA) provisions are expected to reduce the number of those suffering with HIV/AIDS. This because most of these patients are in need of such medical services although they are not insured. This program also has the roles of assisting clients with health insurance premiums, copays, deductibles and other out-of-pocket expenses (Ford et al 88).
In addition to that, in order to compete for patients, healthcare organizations have recognized that they ought to provide consumer focused healthcare in all settings which are appropriate and convenient to patients. In order to achieve that, they supplies fund to patients who are in need of it. This funding is used in increasing residency training slots for primary healthcare physicians and establishment of nurse practitioner-led clinics. Such financial assistance also increases the training of primary healthcare assistants for the underserved among other initiatives (Sessums & Laura 122).
Nonetheless, in the old days the extension of a system that had the patient at its centre is what was lost in many of the ambulatory developments. The traditional patient experience in ambulatory or outpatient setting involved extending waiting as well as repetitive iteration of the same procedure. Patients were traditionary questioned more than three times during a normal visit. This process was time consuming and frustrating to patients and used to cause great inefficiency in the delivery of healthcare. Contrary to that, the current developments in the healthcare sector have brought it to light through refocusing the delivery of healthcare to patients.
With regard of the ambulatory care initiative of the ACA, ACA supports the teaching of various health centers that goes directly to CHCs, but not to teaching hospitals and exciting residency programs. This design helps in ensuring that CHCs becomes full partners in the investigation of residency training with their model of service delivery (Hall et al 188). This refocusing is aimed not only in providing the patient with better experience but also developing systems that are more cost-effective.
Reinhold, Jennifer A, and Grace Earl. Clinical Therapeutics Primer: Link to the Evidence for the Ambulatory Care Pharmacist. Burlington, MA: Jones & Bartlett Learning, 2014. Print.
Reichertz, Peter L, R Engelbrecht, and Ursula Piccolo. System Analysis of Ambulatory Care in Selected Countries: With Special Concern for Computer Support. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. Internet resource.
Sultz, Harry A, and Kristina M. Young. Health Care Usa: Understanding Its Organization and Delivery. Burlington, Mass: Jones & Bartlett Learning, 2014. Internet resource.
Tulchinsky, Theodore H, and Elena Varavikova. The New Public Health. , 2014. Internet resource.
Hall, Mark A, and Sara Rosenbaum. The Health Care “safety Net” in a Post-Reform World. New Brunswick, N.J: Rutgers University Press, 2012. Print.
Ford, Morgan A, and Carol M. Spicer. Monitoring Hiv Care in the United States: A Strategy for Generating National Estimates of Hiv Care and Coverage. , 2012. Internet resource.
Sessums, Laura. Health Care Advocacy: A Guide for Busy Clinicians. New York: Springer, 2011. Print.
Selker, Harry P, and June S. Wasser. The Affordable Care Act As a National Experiment: Health Policy Innovations and Lessons. , 2014. Internet resource.
Wolper, Lawrence F. Health Care Administration: Managing Organized Delivery Systems. Sudbury, Mass: Jones and Bartlett Publishers, 2011. Print.
Documentation. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007. Print.
Brown, Thomas R. Handbook of Institutional Pharmacy Practice. Bethesda, MD: ASHP, 2006. Print.
Perle Slavik Cowen, Sue Moorhead, Current Issues In Nursing, (2009). Elsevier Health Sciences.
Debora A. Slee, Vergil N. Slee, H. Joachim Schmidt. Slee’s Health Care Terms, (2009). Jones ; Bartlett Publishers.
David Edward Marcinko, Hope Rachel Hetico. Hospitals ; Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies, (2012)s. CRC Press.
Q. Ashton Acton, PhDMental Illness: New Insights for the Healthcare Professional, (2013). ScholarlyEditions.
Mary Ann Kliethermes, Tim R. Brown. Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists