The Patient Protection and Affordable Care Act (PPACA) of 2010 creates several opportunities for pharmacist-engagement in the provision of services . Moreover, many of these opportunities created new avenues for pharmacists to be reimbursed or receive payment for providing services. One such opportunity, found in Title IV, Subtitle B, and Section 4107 of the legislation, authorizes the coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women. Specifically, the legislation now requires these services and products to be covered by Medicaid.
In assessing how this opportunity might be implemented in a manner that would allow the University of Southern Nevada (USN) College of Pharmacy to engage the issue, College administration looked to already existing collaborations with its community partners. Currently, the College of Pharmacy has a very strong collaboration with the Southern Nevada Health District (SNHD), with the College of Pharmacy providing all pharmacy-related support to SNHD clinics throughout the Las Vegas Valley through a clinical services agreement that includes a College of Pharmacy faculty member assigned to SNHD as a practice site. In return, the College uses the clinics as ambulatory care training sites for its students. Moreover, SNHD and the College have agreed to add another faculty member in the next fiscal year. Although several of the specialized clinics currently are supported by the one USN faculty member assigned to SNHD (including the tuberculosis, HIV/AIDS, Immunization, and STD clinics), SNHD currently does not have a smoking cessation clinic. Moreover, although SNHD does have a family planning clinic for women, it does not currently have any programs supporting pregnant women, nor does it have a smoking cessation program as part of its portfolio. Thus, for SNHD, initiating a tobacco cessation program for pregnant women as described in the PPACA is an opportunity to provide new services that would be supported through Medicaid reimbursement. For the College of Pharmacy, initiating a new service at SNHD with the pharmacist as the primary provider of services represents an opportunity to engage further in provision of services to the community, to increase ambulatory care rotation options for students, and perhaps most importantly, to advocate for the role of the pharmacist as central to patient counseling and pharmacotherapy and to support pharmacist reimbursement for services. Currently, discussions are ongoing with SNHD with respect to this initiative, and initial responses have been positive.
In addition to providing a practice site, creating additional experiential opportunities for students, and advocating for the profession, this initiative also has the potential create research opportunities for the College. The College’s curriculum includes a requirement for all students to complete the CEASE (Continuing Education Aimed at Smoking Elimination—formerly known as Rx for Change) program. Thus, the potential to explore how students incorporate this didactic training into an actual smoking cessation program as part of an ambulatory care Advanced Pharmacy Practice Experience would be of value. Additionally, ample research into the pharmacist-led smoking cessation services in terms of patient satisfaction, economic impact, and patient outcomes would also be possible.
There is ample evidence that the academy has engaged in and continues to engage in generation of data supporting the pharmacists’ role in tobacco cessation programs. Much of this comes from within the academy itself with research focusing on on-line tobacco cessation courses for health professions students (Purdue University), as well as train-the-trainer programs for tobacco cessation for pharmacy school faculty (University of California-San Francisco and Purdue University) . Additionally, there is evidence that the academy collaborates with its community partners in providing pharmacist-based tobacco cessation programs and have done research that substantiates the positive patient outcomes resulting from pharmacist-led tobacco cessation services (University of Texas Health Science Center, University of Houston, Virginia Commonwealth University, and University of Montana) .
In addition to existing resources, it would be helpful for AACP to develop a compilation of “best practices” for pharmacist/pharmacy faculty providing tobacco cessation services as well as incorporation of students into tobacco cessation clinics as part of experiential learning. The academy should encourage its members involvement in provision of tobacco cessation programs to analyze not only patient outcomes, but also the pharmacoeconomic impact of faculty-run, student-supported clinics and to publish their data. These practical and research-based resources would further other schools’ efforts to advocate for the role of the pharmacist in tobacco cessation clinics and reimbursement for those services as outlined in the PPACA.