IHS NATIONAL CLINICAL PHARMACY SPECIALIST (NCPS)

NCPS PowerPoint Presentation

Issue

For decades, Indian Health Service (IHS) pharmacists have practiced in a variety of expanded clinical roles to provide primary care. IHS pharmacy is widely known (in the federal sector, private sector and academia) for its innovative pharmacy practice, which includes privileges in disease management. In many IHS facilities, it is common for patients to have pharmacists providing focused medical care through clinic visits very similar to that of any other primary care providers. With this advanced level of clinical care provided by pharmacists (through expanded scopes of practice agreements approved by local facilities), it is important to establish best practices, promote uniformity among credentials and competencies, and explore appropriate reimbursement for services.

Purpose

The Indian Health Service (IHS) established a national credentialing system for IHS, Tribal, and Urban (I/T/U) pharmacists in an effort to promote enhanced patient outcomes and address the following:

• Promote uniform clinical competency among I/T/U pharmacists;
• Define and recognize advanced scopes of practice for I/T/U pharmacists;
• Establish critical elements for developing clinical protocols / collaborative practice agreements (CPA)
• Develop a review process to approve clinical protocols and clinical pharmacy specialists by a national group of subject matter experts to help ensure uniformity of scope and competence;
• Review credentials, protocols, training, and education of I/T/U pharmacists and grant NCPS certification to recognize a pharmacist’s local privileges that meet the specified national standards for credentialing;
• Establish the above elements to help promote universal recognition of NCPS pharmacists as billable providers.

Background

The October 18, 1996 memorandum from the Indian Health Service Director established IHS pharmacists as primary care providers (PCPs) and allows for privileges to include prescriptive authority. In response to a growing interest in clinical practice nationwide and meetings with key stakeholders such as the Health Care Financing Administration (HCFA), the NCPSCC was established by the Chief Pharmacy Officer in 1997 to provide a mechanism to assure that all Clinical Pharmacy Specialists in the IHS display a uniform level of competency. The provision of advanced pharmacy care follows the IHS Pharmacy Standards of Practice as outlined in Chapter 7 of the Indian Health Manual. With this official charge and history of advanced clinical care spanning nearly 30 years, the scope of NCPS care includes all criteria and responsibilities covered in the Standards of Practice, as well as focused management of disease states for selected patients in whom medications are the principle method of treatment. Patient care may include a patient interview, chart review, ordering of laboratory tests, laboratory test interpretation, limited physical assessment (e.g. blood pressure, pulse, height, weight, point-of-care glucose and INR testing, foot assessment, etc.), prescribing medications, providing patient education, and patient follow-up. Treatment and management are performed through primary care protocols (collaborative practice agreements - CPA) approved by the local medical staff. If the pharmacist is a credentialed NCPS, the CPA has also been approved by the NCPSCC. NCPS credentialing is intended to uniformly recognize an advanced scope of practice locally aimed at managing one or more disease states and/or optimizing specific drug therapy. Pharmacists may practice disease state management at a facility after completing local requirements, however NCPS certification will only be granted after submission of an appropriate application and fulfillment of all national requirements. In order to promote uniform competency and consistency in the credentialing process, it is now strongly recommended that all facilities adopt, at a minimum, the national (NCPS) standards for local credentialing of pharmacists for this advanced scope of clinical care in disease state management.

Activity

An IHS/ Tribal/Urban (I/T/U) pharmacist may apply for IHS certification as a National Clinical Pharmacy Specialist (NCPS) if he/she meets the national qualifications. After 10 years, the program has credentialed over 200 I/T/U pharmacists – representing more than 20% of IHS pharmacists from 10 different states. The areas of disease management include eight distinct clinical services including diabetes, dyslipidemia, anticoagulation and hypertension management.

Additional Information

For additional information, please contact LCDR Mike Lee at 918-342-6298, CAPT(s) Scott Giberson at 301-443-2449, or visit the IHS intranet site at http://home.pharmacy.ihs.gov/index.cfm?module=gen_one&id=10