Collaborative Care is ‘Essential’ Between Nurses and Pharmacists

• The American Nurses Foundation and American Society of Health System Pharmacists recently announced the 2024 recipients of the Collaborative Care Grant for Nurses and Pharmacists.
• Several studies over the years have indicated that collaboration among nurses and pharmacists, as well as other healthcare professionals, leads to better patient outcomes.
• The American Pharmacists Association has issued guidance for establishing collaborative practice agreements (CPAs).

Successful collaboration between nurses and pharmacists is “essential” for improving health outcomes and optimizing medication use, according to the chief executive officer of the American Society of Health System Pharmacists.

“It is critical that we establish evidence-based models that support our joint efforts to deliver seamless transitions of care; identify and resolve barriers to medication effectiveness, adherence, and access; and boost health literacy,” Paul W. Abramowitz, PharmD, ScD (Hon.), also an American Nurses Foundation (ANF) board member, said three years ago when announcing a new ANF and ASHP Foundation grant geared toward collaborative care research.

To establish a formal relationship, pharmacists enter a collaborative practice agreement (CPA) to define the additional services they’re allowed to provide.  

The Latest Collaboration

The ANF/ASHP Foundation’s Collaborative Care Grant for Nurses and Pharmacists, established in 2021, was most recently awarded to Virginia Commonwealth University’s Dana Burns, DNP, FNP-BC, BC-ADM, and Evan M. Sisson, PharmD, MSHA, BCACP, CDCES. They’re investigating the Comprehensive Overweight/Obesity Management Pre-Kidney Transplant (COMPKT) Program. 

Roughly 30% of VCU Health System patients who are slated for a kidney transplant have their evaluation delayed because their body mass index (BMI) is too high to meet eligibility criteria, according to the health system. 

Burns and Sisson’s project team — clinical pharmacist, a family nurse practitioner, and a dietitian in the VCU Division of Endocrinology, Diabetes, and Metabolism — will “create a treatment program to reduce a patient’s BMI using medications for weight loss, patient education, and technology tools for making healthy lifestyle choices,” the ANF release stated. 

“There are many unique aspects of this program,” Sisson said. “By capitalizing on interprofessional expertise, this innovative collaboration combines patient education and biofeedback to promote weight loss. The goal is to not only improve the chances for people to receive a lifesaving organ, but also to decrease morbidity and mortality related to excess weight after transplantation.” 

The study is expected to take 18 months, including creation and patient evaluation. 

Where We’ve Seen Collaborative Care Before

Several studies have investigated the correlation between collaborative care among nurses and pharmacists and an increase in patient outcomes. 

Most recently, a study protocol published in March 2024 in “Addiction Science and Clinical Practice” discussed plans to explore this dynamic in relation to treating opioid use disorder. Pharmacists, according to the study, are “well-positioned” to increase their role beyond consultations and be more directly involved across the “continuum of care” as it relates to opioid use.

A 2017 “Journal for Nurse Practitioners” report argued that improvements are needed when it comes to managing medication in primary care, and pharmacists are well-equipped to do just that. 

“Pharmacists have generally partnered and collaborated with physicians to provide comprehensive medication management. Care provided to the patient in the context of a physician-pharmacist partnership has resulted in decreased overall costs and improved care based on multiple outcomes,” the report stated.

Three years earlier, the same journal published a study on collaboration between family nurse practitioners and pharmacists for medication counseling with diabetic patients.  

Medication regimens were reviewed by a pharmacist, with suggested change implemented by the NP, with noted improvements in A1C levels six months later. 

Dynamics of Collaborative Care

Researchers who analyzed more than 34 reviews of interprofessional care (including not only nurses and pharmacists, but specialty care providers and primary care physicians) determined that “interprofessional collaboration can be effective in primary care,” though more research is needed on specific processes and how they’re implemented. 

The American Pharmacists Association outlined in a white paper its guidance for establishing CPAs and increasing collaboration: 

1. Use consistent terminology and language that’s understandable by all potential audiences. 
2. Allow healthcare providers who enter into the CPA to define the details of each agreement.
3. Create and expand an infrastructure that embeds pharmacists’ patient care services and CPAs into care, while creating ease of access for patients.
4. Incentivize and facilitate the adoption of electronic health records and the use of technology in pharmacists’ patient care services. 
5. Encourage pharmacists to maintain strong, trusting, and mutually beneficial relationships with patients, physicians, other providers; encourage those individuals to promote pharmacists’ patient care services. 
6. Properly align incentives based on meaningful process and outcome measures for patients, payers, providers, and the health care system. 
7. Examine and redesign health professionals’ practice acts, education curriculums, and operational policies to create synergy, promote collaboration and optimize support staff 

 In establishing these relationships, outside of a CPA, all parties should set a baseline standard for communication, competence, respect, and collaboration, according to a “Journal for Nurse Practitioners” article.

“Pharmacists are an excellent example of a highly educated group of professionals whose talents may be underutilized, possibly from misunderstanding and even mistrust between providers and pharmacists,” the article authors stated. “This is unfortunate because the pharmacist is a professional whose contribution to the interdisciplinary team could be invaluable. Integrating the bodies of expertise to coordinate, collaborate, and communicate with one another would result in optimized care for shared patients.”

Increased awareness of roles and responsibilities for pharmacists and NPs would also aid with coordination and collaboration, according to the article. 

The Bottom Line

Collaborative care has been proven to increase the quality of patient outcomes. A grant that funds collaborative research is one more step toward further improving healthcare experiences, particularly between nurses and pharmacists. Establishing open communication and displaying a willingness to learn about the processes outside of your specialty also will enhance the collaborative approach to care. 

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