Barriers to Ambulatory Care Pharmacy


Ambulatory care pharmacy practice is the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. It involves being an integral part of an outpatient, multidisciplinary healthcare team to improve quality and patient outcomes by focusing on medication management.

When ambulatory care pharmacists engage in inpatient care to their full capacity, physician time is saved, access to care is improved, and clinical and economic outcomes are enhanced. There is a need for ambulatory care pharmacists to work toward optimizing safe medication use and optimizing medication therapy for patients with diabetes, asthma, cardiovascular disease, and renal disease. Other opportunities for the development of ambulatory care pharmacy services exist in preventive care, precision therapeutics, medication therapy management, mitigation of healthcare disparities, and implementation of national healthcare reform.

Barriers to Ambulatory Care Pharmacy

As you work to establish your clinical practice, there are a number of barriers that should be expected and worked to proactively address. First, challenges exist with defining the pharmacist’s role within the clinic. While ambulatory care practice is becoming more common, each practice setting is unique, and therefore the role the pharmacist will play in each setting is slightly different. To address this, You can:

  • Start by discussing the workflow of the clinic with the healthcare providers and staff;
  • Identify issues in the practice, such as gaps in care, and determine if those voids can be filled through ambulatory care pharmacy services;
  • Through this process, focus on developing relationships with the clinic staff and your healthcare colleagues to ensure an open dialogue.

A second barrier to be considered is compensation for your time, both as it relates to reimbursement but also in terms of salary. Many institutions are now utilizing a salary sharing model between the department of pharmacy and the medical group or department in which the pharmacist is providing services. Salary may further be offset by reimbursement for services provided. It is important to clearly establish the funding source from the outset. Some examples of metrics include readmission rates, provider time savings, and prescription capture.

Another challenge that may be encountered is related to the documentation of services provided. The ambulatory healthcare record is often different from the inpatient record and it may take time to learn the new system, perhaps requiring extra training courses in order to receive access. When documenting services rendered by you, using a documentation template may increase efficiency and ensure comprehensive documentation. It is important to understand the requirements for documentation as it relates to reimbursement and ensure those are met.

Lastly, as your practice and responsibilities grow, time management will become essential. Once established and the value of ambulatory care pharmacy services has spread, you may be asked to expand the scope and/or availability of your services. While this is a great opportunity, you must reflect on the goals of the service and the ability to provide the range of services, without negatively impacting your wellness and the quality of the ambulatory care pharmacy services.