By: Shireen Farzadeh, PharmD Candidate c/o 2019

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Collaborative Drug Therapy Management (CDTM) began as a three year demonstration project in 2012. It was extended and passed as a bill in September 2015 by the New York State Assembly and Senate and signed into law by the Governor Andrew Cuomo. The CDTM authority was initially scheduled to sunset in September 2018 but as of March 2018, it has been delayed to sunset in July of 2020.¹

CDTM is a formal partnership between qualified pharmacists and physicians that allows pharmacists to manage drug therapies given consent by their patients which can be practiced in hospitals or nursing homes with an on-site pharmacy.² Pharmacists may adjust medication strength, frequency of administration or route of administration but are not permitted to substitute or select medications that differ from the medications that were initially prescribed unless substitutions are authorized by protocol. Upon making any changes to patients’ drug therapies or entering anything new into their health records, pharmacists are required to notify the patients’ physicians. The law states that pharmacists and institutions must report results of implementing CDTM to the State Education Department by September of 2018.³

CDTM is beneficial to patients, pharmacists, physicians, and health plans. Patients under CDTM have increased access to health care and are more likely to have optimal drug therapy regimens. As a result, patients save more money by having fewer drug related problems such as adverse drug reactions, drug interactions, and poor adherence.¹ CDTM also allows health education, health screening, and other services to extend to underserved populations with limited physician access by allowing pharmacists to identify underlying conditions of patients that require physician care.² Numerous surveys have reported patient satisfaction with CDTM and that patients have positive relationships with their pharmacists in this model of care.¹ Pharmacists under CDTM are also able to be less production-oriented and more patient-focused. By using their knowledge and clinical skills to improve patient outcomes, pharmacists demonstrate their integral role in the interprofessional team. Physicians benefit from having pharmacists and their unique drug knowledge supporting patients’ drug regimens because this collaborative form of health care leads to fewer preventable doctor visits, more physician-patient interaction and better management of complex cases. Additionally, physicians are more likely to be referred by pharmacists through CDTM and health plans benefit from the implementation of CDTM through optimized drug therapy regimens which reduces the cost of care.² According to a survey of CDTM in U.S. hospitals, the prevalence of CDTM increased significantly from fifty percent in 2003 to sixty six percent in 2013, indicating the success of collaborative health care practice.⁴

Disease conditions that are under CDTM include anticoagulation, diabetes, heart failure, human immunodeficiency virus (HIV), oncology, and asthma. In New York, Brooklyn Hospital Center has implemented  CDTM services for anticoagulation, diabetes, HIV, heart failure, and asthma. HIV-positive patients tend to be hesitant towards starting treatment because they are usually asymptomatic and because HIV medications are difficult to adhere to due to intolerable side effects. Pharmacists at the aforementioned institution help  break this barrier and allow patients to understand that although HIV has no cure, medications can slow its progression and prevent further complications. Additionally, half of New Yorkers with asthma are not well controlled mostly due to not knowing how to use their medications properly. CDTM implementation and management of asthma patients by collaborating pharmacists at Brooklyn Hospital Center have reduced emergency department visits for asthma exacerbations from thirty percent to seventy five percent between 2011 and 2014.¹

Kingsbrook Jewish Medical Center in Brooklyn, New York has implemented anticoagulation CDTM as well. Warfarin (Coumadin®) is the most commonly prescribed anticoagulant but has a complex monitoring regimen and puts patients at a high risk for bleeding. This increased risk makes collaboration between physicians and pharmacists imperative to the success of treatment. Rochester General Hospital in Rochester, New York has implemented diabetes CDTM.  Many diabetics do not receive guideline-recommended therapy, therefore, pharmacists at this institution play an integral role in adjusting patient regimens to achieve their HbA1c targets. Patients managed by collaborating pharmacists in four hospital-based ambulatory care clinics that are affiliated with Rochester General Hospital demonstrated an increase in achieving their therapeutic HbA1c targets of seven percent to ten percent from twenty two percent to thirty nine percent between 4 to 12 months.¹ Collaborating pharmacists also serve to manage patients with heart failure at Montefiore Medical Center and Bronx Lebanon Hospital in Bronx, New York. Pharmacists play an important role in optimizing patient medication, as poor adherence and inappropriate medication regimens worsen heart failure. Readmission rates have decreased significantly in the aforementioned  CDTM heart failure programs. Memorial Sloan Kettering Cancer Center in Manhattan, New York also has collaborating pharmacists managing cancer patients. Pharmacists help provide and manage supportive care necessary for patients with intense chemotherapy treatments to reduce complications. Overall, CDTM has allowed patients’ disease states to become better controlled and with fewer complications.¹

So far, CDTM is permitted in over 46 states.² New York State Council of Health System Pharmacists (NYSCHP) is currently working to add nurse practitioners to CDTM and is making the patient consent requirements less burdensome.¹ To become a CDTM pharmacist, one can apply at http://www.op.nysed.gov/prof/pharm/pharmcdtmapp.pdf. To be eligible, one must work in a facility regulated under article twenty-eight of public health law. For pharmacists with a PharmD, they must be licensed for at least two years, be clinically experienced for at least one year, and be board certified or have completed a residency.³ As pharmacy students, our role is to make CDTM permanent legislation without a future sunset-period. We can help by lobbying in the form of written letters or emails to our local state legislators.

SOURCES:

1. New York State Council of Health-system Pharmacists . Collaborative Drug Therapy Management (CDTM). NYSCHP. http://www.nyschp.org/collaborative-drug-therapy-mangement-cdtm-. Published 04/02/2018.
2. Academy of Managed Care Pharmacy . Practice Advisory on Collaborative Drug Therapy Management . AMCP. http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=14710. Published 02/01/2012.
3. University of the State of New York – New York State Education Department . Collaborative Drug Therapy Management (CDTM). NYSED.gov. http://www.op.nysed.gov/prof/pharm/pharmcdtm.htm. Published 11/30/2016.
4. Mishra P, Thomas J 3rd. Survey of collaborative drug therapy management in U.S. hospitals. Am J Health Syst Pharm. 2017;74(21):1791-1905. doi: 10.2146/ajhp151058.

Published by Rho Chi Post