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Increasing the Authority for Pharmacist Collaborative Practice Agreements

State: Iowa

Submitted Date: 2018

Public Health Issue
  • One in three U.S. adults has hypertension. Successfully treating this condition often requires prescription medication.
  • Blood pressure control improves when pharmacists use a team-based approach to work collaboratively with doctors, nurses, and other providers to manage patient treatment, such as prescription medication..
  • A pharmacist collaborative practice agreement (CPA) is a formal agreement between a pharmacist and a prescribing healthcare provider. It specifies the functions the healthcare provider delegates to the pharmacist. For example, delegating functions related to initiating, modifying, or discontinuing medications for hypertension leverages the pharmacist’s expertise and eliminates extra steps for the patient and the prescribing provider.
  • Iowa regulates pharmacist-physician collaborative practice authority, but it does not permit advanced registered nurse practitioners (ARNP) to enter into CPAs. Because there are more ARNPs than physicians in parts of Iowa, a change in regulatory authority to permit pharmacists to enter into CPAs with ARNPs would expand the number of primary care practitioners working collaboratively with pharmacists, potentially benefitting many patients with hypertension not to mention other chronic diseases.
Program Action
  • NACDD, in coordination with the CDC Division for Heart Disease and Stroke Prevention, works with a state team from Iowa to accelerate team-based care using the Pharmacists’ Patient Care Process and collaborative practice agreements to manage high blood pressure. Team members, including the Iowa Department of Public Health and representatives from the Iowa Pharmacy Association, attended an NACDD workshop and participated in follow-up webinars to learn how to host trainings within the state for pharmacists and primary care providers.
  • As part of this project, the Iowa Department of Public Health collaborated with Iowa pharmacy and nursing stakeholders to promote a change in regulatory authority to permit pharmacists to enter into CPAs with ARNPs.
  • The Iowa Pharmacy Association worked to educate and advocate with the Iowa Board of Nursing on developing this regulatory authority.
  • The Iowa Pharmacy Association convened a group of representatives from the Iowa Nurse Practitioner Society, the Iowa Association of Nurse Practitioners, the Iowa Board of Pharmacy, and the Iowa Board of Nursing to review the history of collaborative practice agreements in the state. At this meeting, stakeholders presented data showing the need for regulatory authority that would permit pharmacists and ARNPs to enter into CPAs.
  • The consensus reached by the stakeholder group led them to submit a formal request to the Iowa Board of Nursing for proposed regulations granting collaborative practice authority to advanced registered nurse practitioners. The Iowa Board of Nursing expects to adopt final regulations to permit advanced registered nurse practitioners to enter into CPAs by summer 2018.
Terry Meek
Iowa Department of Public Health