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class="title" itemprop="name">Planning and Developing a Clinical Pharmacy Practice</span></h1><p class="contribs">Farhat N, Abbas M.</p><p class="fm-aai"><a href="#_NBK604206_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-160731.s1"><h2 id="_article-160731_s1_">Definition/Introduction</h2><p>In contemporary healthcare systems, the role of pharmacists has expanded beyond traditional dispensing duties to encompass direct patient care services.<a class="bibr" href="#article-160731.r1" rid="article-160731.r1">[1]</a> While pharmacy practice has evolved across various settings, this activity focuses on the ambulatory care model. Ambulatory care pharmacy represents a progressive approach to healthcare delivery, emphasizing collaborative drug therapy utilizing a team-based approach. This in-depth discussion of ambulatory care pharmacy practice focuses on crucial elements such as establishing a sustainable model, identifying operational strategies, implementing marketing initiatives, developing policies and procedures, and fostering collaboration within multidisciplinary teams. </p><p>Ambulatory care pharmacy is a patient-centered, outcomes-based approach to pharmacy practice that involves the collaboration of a pharmacist with patients and clinicians. The objective is to optimize medication use by supporting preventative healthcare measures, monitoring medication safety and efficacy, and enhancing health outcomes.<a class="bibr" href="#article-160731.r2" rid="article-160731.r2">[2]</a> Ambulatory care settings encompass various healthcare environments, such as physician offices, health centers, community pharmacies, and institutional clinics, each serving diverse patient populations.<a class="bibr" href="#article-160731.r3" rid="article-160731.r3">[3]</a> In these clinics, services may be offered in person, telemedicine, or, most commonly, a hybrid model.  </p><p>The variety of ambulatory care pharmacy clinical services include but are not limited to cardiology (eg, anticoagulation, heart failure, hypertension, hyperlipidemia), endocrinology (ie, diabetes, osteoporosis), geriatrics, respiratory diseases (ie, asthma, chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis), hepatitis, human immunodeficiency virus (HIV), oncology, palliative care, pediatrics, primary care, psychiatry, smoking cessation, and transplant.<a class="bibr" href="#article-160731.r4" rid="article-160731.r4">[4]</a><a class="bibr" href="#article-160731.r5" rid="article-160731.r5">[5]</a><a class="bibr" href="#article-160731.r6" rid="article-160731.r6">[6]</a><a class="bibr" href="#article-160731.r7" rid="article-160731.r7">[7]</a></p></div><div id="article-160731.s2"><h2 id="_article-160731_s2_">Issues of Concern</h2><p>The foundation of a successful ambulatory care pharmacist-led clinic involves meticulous planning, starting with a comprehensive needs assessment. Initially, an internal institutional needs assessment identifies available resources to start the practice. The pharmacist must also perform an external environmental scan. An external environmental scan includes a thorough investigation of the literature to compare similar practice models and identify key aspects integral to the practice's success on a local, statewide, and national level. Understanding the healthcare landscape, patient demographics, and prevalent disease burden within the community is essential for tailoring pharmacy services to meet patient needs. </p><p>Once the needs are determined, the pharmacist can develop their practice mission, vision, and goals, drawing input from key stakeholders pivotal to their success. For instance, a physician plays a central role in advocating for the pharmacist-led clinic within the healthcare system. Other stakeholders include a billing specialist, a compliance officer, and a practice manager.<a class="bibr" href="#article-160731.r3" rid="article-160731.r3">[3]</a> Furthermore, collaboration from pharmacy managers, colleagues, physicians, nurses, administrators, and patients is indispensable for garnering support and fostering interprofessional teamwork. </p><p>The next steps include determining the specific practice model and emphasizing scalability and reproducibility. This may entail conducting a SWOT (strengths, weaknesses, opportunities, threats) analysis and a comprehensive financial assessment.<a class="bibr" href="#article-160731.r8" rid="article-160731.r8">[8]</a> Furthermore, assessing billing practices and staffing needs further solidifies the foundation, ensuring the model is financially stable and operationally efficient.<i> </i></p></div><div id="article-160731.s3"><h2 id="_article-160731_s3_">Clinical Significance</h2><p>
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<b>Operations</b>  </p><p>
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<b>Clinic workflow and staffing </b>
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</p><p>The standard operations should be seamless and efficient for patients and staff. Before accepting new patients, several workflow components need to be addressed. These include incorporating technology, optimal staffing, and a conducive workspace environment. Technology integration is a crucial element to optimize workflow within the clinic. An electronic medical record (EMR) is pivotal to streamline operations and facilitate comprehensive care delivery. EMR facilitates better clinical documentation, efficient lab ordering, results retrieval, and prescribing.<a class="bibr" href="#article-160731.r9" rid="article-160731.r9">[9]</a></p><p>Through the EMR, pharmacists can identify specific clinic times to schedule patients, ensuring streamlined appointment management tailored to patient needs. For instance, a new patient visit may necessitate a more extended duration, typically around 1 hour, whereas a follow-up appointment could suffice with a 15- to 30-minute visit, contingent upon patient complexity. Pharmacists should allocate time for pre-visit workup, documentation, and administrative responsibilities (eg, meetings, billing coordination, professional development, student or resident precepting).<a class="bibr" href="#article-160731.r10" rid="article-160731.r10">[10]</a><a class="bibr" href="#article-160731.r11" rid="article-160731.r11">[11]</a></p><p>In addition to managing clinic scheduling, ambulatory care pharmacists should identify a space for a conducive workspace environment. When outlining the workspace, identifying private consultation areas ensures optimal conditions for patient assessments, maintains privacy, and facilitates consultations. Investing in a well-equipped private consultation space with adequate medical equipment and comfortable seating arrangements fosters an environment for open communication and optimal patient-centered care. </p><p>Staffing requirements constitute another critical facet of ambulatory care practice management. Pharmacists must collaborate with clinic leadership to delineate expectations and metrics essential for staffing. Engaging support staff such as receptionists can streamline visit registration, paperwork management, and clinic upkeep, enhancing operational efficiency and patient satisfaction. Other care team members, such as medical assistants, pharmacy technicians, nurses, and pharmacy learners, may also play a role.<a class="bibr" href="#article-160731.r12" rid="article-160731.r12">[12]</a> </p><p>
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<b>Outcomes assessment and financial sustainability </b>
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</p><p>A crucial element of an ambulatory care pharmacy practice's operations is assessing outcomes such as clinical, humanistic, and productivity measures. Benchmarks will vary by practice site and disease state. These outcomes may be tied to direct or indirect reimbursement, which can support the pharmacist’s position within the clinic. However, in many ambulatory care practices, demonstrating the direct impact of the pharmacist’s role may be challenging, especially since pharmacists often work within multidisciplinary care teams.</p><p>Although challenging, a method for efficient evaluation of ambulatory care pharmacist services is needed to ensure the sustainability of the practice. The use of a clinical performance dashboard is one example of evaluation. Many ambulatory care pharmacists manually extract chart data to demonstrate outcomes and therapeutic improvements initially. However, most institutions have a developed dashboard portal that can be adapted to pharmacy metrics. Common clinical indicators more easily adaptable to a dashboard include improving hemoglobin A1c, blood pressure, and lipid levels in the primary care setting. These outcomes are usually assessed over 6 to 12 months.<a class="bibr" href="#article-160731.r13" rid="article-160731.r13">[13]</a><a class="bibr" href="#article-160731.r14" rid="article-160731.r14">[14]</a><a class="bibr" href="#article-160731.r15" rid="article-160731.r15">[15]</a></p><p>In addition to identifying institutional or practice-based strategic priorities, national organizations that influence ambulatory care practice include the Agency for Healthcare Research and Quality (AHRQ), American Society of Health-System Pharmacists (ASHP), Accountability Measures Work Group, National Quality Forum (NQF), National Committee for Quality Assurance (NCQA), and Pharmacy Quality Alliance (PQA).<a class="bibr" href="#article-160731.r16" rid="article-160731.r16">[16]</a> These organizations focus on healthcare performance, which is useful in guiding outcomes assessments and potential revenue.</p><p>Reimbursement presents a significant challenge for pharmacists in ambulatory care settings. When devising compensation strategies for pharmacy services, factors such as service location (face-to-face or telehealth), billing provider, supervision requirements, and reimbursement rates must be considered. Before initiating billing, reviewing billing and documentation prerequisites with relevant stakeholders, including medical billing personnel, supervising clinicians, and third-party payers, is imperative. These requirements may encompass mandatory courses or training, both initially and continuously.</p><p>For instance, in physician offices, billing for pharmacist services occurs through “incident to” billing, where services are billed under the clinician's name, particularly for comprehensive medication management (CMM) services provided under a collaborative practice agreement (CPA). In hospital-based clinics, reimbursement for CMM services generally involves a “technical or facility fee,” which considers the visit's duration and complexity using ambulatory payment classification codes. Medication therapy management (MTM) services can be billed directly by the pharmacist using current procedural terminology (CPT) codes: “initial,” “follow-up,” and “additional” at 15-minute increments.<a class="bibr" href="#article-160731.r17" rid="article-160731.r17">[17]</a> Other billing codes may fall under Medicare annual wellness visits (AWV), transitional care management (TCM), chronic care management (CCM), diabetes self-management, continuous glucose monitor (CGM), provider-delivered care management (PDCM), and telehealth services codes.<a class="bibr" href="#article-160731.r3" rid="article-160731.r3">[3]</a> Pharmacists can access information on reimbursement rates for specific billing codes via the Medicare physician fee schedule<i>.</i><i>  </i>  </p><p>
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<b>Policies and procedures  </b>
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</p><p>With the variability of ambulatory care practices, a policies and procedures manual describing the scope of practice and detailing the services provided should be developed in compliance with institutional department policies. The manual should be reviewed regularly and revised to stay consistent with changes in practice needs, scope of practice, and statewide policies.</p><p>Many state laws are ambiguous regarding ambulatory care practice beyond retail pharmacy settings. For example, in certain states, CPAs aren’t explicitly authorized. However, pharmacists may be granted prescriptive authority under physician supervision delegation, enabling them to enter into CPAs for ambulatory practice. Additionally, statewide policies will differ regarding the scope of practice and ambulatory care clinician responsibilities and privileges. Familiarity with state laws and regulations is important before developing the practice. This relates to prescriptive authority and billing and compliance requirements related to reimbursement. Statewide pharmacy associations and boards of pharmacy may be able to provide further guidance.<a class="bibr" href="#article-160731.r12" rid="article-160731.r12">[12]</a></p><p>Moreover, the criteria for pharmacists to practice in clinics should be well defined in the policies and procedure manual. Standardized benchmarks should be established for credentialing and training pharmacists, as they demonstrate qualifications to payers, with specialty board certification potentially serving as a means of recognition as direct patient care clinicians.<a class="bibr" href="#article-160731.r3" rid="article-160731.r3">[3]</a><a class="bibr" href="#article-160731.r18" rid="article-160731.r18">[18]</a> Most institutions favor a board-certified ambulatory care pharmacist to serve in their practice, although this recommendation is not uniform.<a class="bibr" href="#article-160731.r19" rid="article-160731.r19">[19]</a> To obtain board certification, most pharmacists complete either an ambulatory care-focused postgraduate residency or a traditional pharmacy practice residency, followed by a second year of specialized ambulatory care training. Further information regarding pharmacy residency training could be obtained through the Board of Pharmacy Specialties.</p><p>Lastly, given practice variability, the Joint Commission of Pharmacy Practitioners (JCPP) is an excellent resource outlining the consistent delivery of patient care across the pharmacy profession.<a class="bibr" href="#article-160731.r20" rid="article-160731.r20">[20]</a> To ensure standardized patient care, policies regarding documentation standards, emergency management, and patient education are important.</p><p>
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<b>Marketing </b>
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</p><p>When a robust business plan is finalized, the service should be marketed within the practice and/or institution. This can be accomplished using the 7 P’s of marketing, often applied in a business setting. Marketing nurtures trust and collaboration, fostering long-lasting relationships with patients and clinicians. The 7 P’s of marketing represent product, price, place, promotion, people, packaging, and process (see <b>Table</b> <b>1</b>).<a class="bibr" href="#article-160731.r21" rid="article-160731.r21">[21]</a><a class="bibr" href="#article-160731.r22" rid="article-160731.r22">[22]</a><a class="bibr" href="#article-160731.r23" rid="article-160731.r23">[23]</a><a class="bibr" href="#article-160731.r24" rid="article-160731.r24">[24]</a></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160731table0"><a href="/books/NBK604206/table/article-160731.table0/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160731table0"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160731.table0"><a href="/books/NBK604206/table/article-160731.table0/?report=objectonly" target="object" rid-ob="figobarticle160731table0">Table</a></h4><p class="float-caption no_bottom_margin">Table 1. The The 7 P’s of marketing. </p></div></div></div><div id="article-160731.s4"><h2 id="_article-160731_s4_">Nursing, Allied Health, and Interprofessional Team Interventions</h2><p>Interprofessional communication is vital to the success of an ambulatory care pharmacy. Using a patient-centered approach, a physician usually leads the care team, utilizing the support of other team members. Clinicians diagnose patients, refer them to the pharmacist and other support personnel for additional care, and then cosign medication orders prescribed by the ambulatory care pharmacist through a formal agreement.</p><p>Establishing Collaborative Practice Agreements (CPAs) between pharmacists and other clinicians is central to effective practice in the ambulatory care setting. The CDC defines a CPA as a formal arrangement where a licensed clinician diagnoses, supervises, and refers patients to a pharmacist, permitting them to assume professional responsibility for specific functions under a designated protocol. CPAs include disease-specific management and education to achieve favorable clinical outcomes. Different terms describe CPAs nationwide, and the practice laws vary from state to state. The agreement, contingent on state laws, extends the pharmacist’s scope to select, initiate, discontinue, continue, monitor, modify medication regimens, perform patient assessments, counsel, order laboratory tests, and administer drugs. CPAs foster trust between collaborating physicians and pharmacists, ensuring continuity of care, strengthening relationships, and streamlining workflows. Furthermore, they enable clinicians to effectively leverage their skills to deliver direct patient care.<a class="bibr" href="#article-160731.r25" rid="article-160731.r25">[25]</a></p><p>The National Association of Boards of Pharmacy outlines 8 essential elements of CPAs, including identification of involved parties, decision-making authority for pharmacists, monitoring mechanisms, provisions for agreement termination, and ability to override collaborative practice divisions as necessary, effective date, and signatures of all parties.<a class="bibr" href="#article-160731.r3" rid="article-160731.r3">[3]</a> To optimize the ambulatory care practice’s overall efficiency and effectiveness, pharmacist extenders such as students, residents, and interns may be able to support clinical and non-clinical tasks.</p><p>The interprofessional team may assist in tasks ranging from care transitions, such as previsit medication history and completion of medication reconciliation processes, to disease state management activities, such as patient interviews, medication recommendations, and education. Additionally, they can handle tasks such as data collection, insurance formulary navigation, and prior authorization requests.</p></div><div id="article-160731.s5"><h2 id="_article-160731_s5_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-160731.s6"><h2 id="_article-160731_s6_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-160731.r1">Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. <span><span class="ref-journal">Am J Hosp Pharm. </span>1990 Mar;<span class="ref-vol">47</span>(3):533-43.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2316538" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2316538</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-160731.r2">Hawes E, Tong G. 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Diabetes-Related Patient Outcomes through Comprehensive Medication Management Delivered by Clinical Pharmacists in a Rural Family Medicine Clinic. <span><span class="ref-journal">Pharmacy (Basel). </span>2020 Jul 09;<span class="ref-vol">8</span>(3)</span> [<a href="/pmc/articles/PMC7558112/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7558112</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32660091" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32660091</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-160731.r15">Rondeaux S, Braeckman T, Beckwé M, El Oueriaghli El Ghammaz D, Devroey D, De Vriese C. Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy. <span><span class="ref-journal">Int J Environ Res Public Health. </span>2023 Feb 05;<span class="ref-vol">20</span>(4)</span> [<a href="/pmc/articles/PMC9956138/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9956138</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36833517" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36833517</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-160731.r16">Carmichael J, Jassar G, Nguyen PA. Healthcare metrics: Where do pharmacists add value? <span><span class="ref-journal">Am J Health Syst Pharm. </span>2016 Oct 01;<span class="ref-vol">73</span>(19):1537-47.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27521240" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27521240</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-160731.r17">American College of Clinical Pharmacy. McBane SE, Dopp AL, Abe A, Benavides S, Chester EA, Dixon DL, Dunn M, Johnson MD, Nigro SJ, Rothrock-Christian T, Schwartz AH, Thrasher K, Walker S. Collaborative drug therapy management and comprehensive medication management-2015. <span><span class="ref-journal">Pharmacotherapy. </span>2015 Apr;<span class="ref-vol">35</span>(4):e39-50.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25884536" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25884536</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-160731.r18">American College of Clinical Pharmacy. Blair MM, Freitag RT, Keller DL, Kiser TH, Marrs JC, McGivney MS, Mohammad RA, Twedt EL., ACCP Certification Affairs Committee. Proposed revision to the existing specialty and specialist certification framework for pharmacy practitioners. <span><span class="ref-journal">Pharmacotherapy. </span>2009 Apr;<span class="ref-vol">29</span>(4):3e-13e.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19323626" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19323626</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-160731.r19">Lampkin SJ, Gildon B, Benavides S, Walls K, Briars L. Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients. <span><span class="ref-journal">J Pediatr Pharmacol Ther. </span>2018 Jan-Feb;<span class="ref-vol">23</span>(1):4-17.</span> [<a href="/pmc/articles/PMC5823491/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5823491</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29491747" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29491747</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-160731.r20">Zellmer WA. JCPP plans for following up on the conference. Joint Commission of Pharmacy Practitioners. <span><span class="ref-journal">Am J Health Syst Pharm. </span>2000 Mar 15;<span class="ref-vol">57</span>(6):596-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10754772" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10754772</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-160731.r21">Abedi G, Malekzadeh R, Moosazadeh M, Abedini E, Hasanpoor E. Nurses' Perspectives on the Impact of Marketing Mix Elements (7Ps) on Patients' Tendency to Kind of Hospital. <span><span class="ref-journal">Ethiop J Health Sci. </span>2019 Mar;<span class="ref-vol">29</span>(2):223-230.</span> [<a href="/pmc/articles/PMC6460454/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6460454</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31011270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31011270</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-160731.r22">Whiteley JA, Faro JM, Mavredes M, Hayman LL, Napolitano MA. Application of social marketing to recruitment for a digital weight management intervention for young adults. <span><span class="ref-journal">Transl Behav Med. </span>2021 Mar 16;<span class="ref-vol">11</span>(2):484-494.</span> [<a href="/pmc/articles/PMC7963283/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7963283</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32293670" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32293670</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-160731.r23">Doucette WR, McDonough RP. Beyond the 4Ps: using relationship marketing to build value and demand for pharmacy services. <span><span class="ref-journal">J Am Pharm Assoc (Wash). </span>2002 Mar-Apr;<span class="ref-vol">42</span>(2):183-93; quiz 193-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11926661" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11926661</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-160731.r24">Ravangard R, Khodadad A, Bastani P. How marketing mix (7Ps) affect the patients' selection of a hospital: experience of a low-income country. <span><span class="ref-journal">J Egypt Public Health Assoc. </span>2020 Sep 29;<span class="ref-vol">95</span>(1):25.</span> [<a href="/pmc/articles/PMC7524944/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7524944</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32990885" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32990885</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-160731.r25">Cernasev A, Aruru M, Clark S, Patel K, DiPietro Mager N, Subramaniam V, Truong HA. Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S. <span><span class="ref-journal">Pharmacy (Basel). </span>2021 Mar 09;<span class="ref-vol">9</span>(1)</span> [<a href="/pmc/articles/PMC8005938/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8005938</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33803293" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33803293</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Nada Farhat declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Malak Abbas declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK604206_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Nada Farhat</span><sup>1</sup>; <span itemprop="author">Malak Abbas</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Michigan Medicine</div><div class="affiliation"><sup>2</sup> Corewell Health</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">June 8, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Farhat N, Abbas M. Planning and Developing a Clinical Pharmacy Practice. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobarticle160731table0"><div id="article-160731.table0" class="table"><h3><span class="title">Table 1. The The 7 P’s of marketing</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604206/table/article-160731.table0/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160731.table0_lrgtbl__"><table style="width: 700px; height: 500px;" cellspacing="1" cellpadding="2" class="no_top_margin"><tbody><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>"P" Acronym</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Description</b>
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</td></tr><tr style="height: 13.0625px;"><td rowspan="1" colspan="1" style="height: 13.0625px;height: 13.0625px;vertical-align:top;">
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<b>Product</b>
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</td><td rowspan="1" colspan="1" style="height: 13.0625px;height: 13.0625px;vertical-align:top;">In ambulatory care pharmacy, the product refers to the services offered to the patients and clinicians. This may include medication therapy, chronic disease management, immunizations, and other clinical interventions to optimize health outcomes. The goal is to define the services and persuade the customer that the newly established clinic offers more distinguished solutions.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Price</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">The price involves determining how the pharmacy services will be reimbursed. This entails considerations for billing codes, reimbursement from payers, and any out-of-pocket expenses for patients. Pharmacists should incorporate a cost-benefit analysis and appropriate corresponding compensation, avoiding undervaluation.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Place</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">The place refers to the practice's location and accessibility, such as face-to-face visits and telehealth platforms. This may include off-hours communication strategies and visibility or availability to patients and clinicians.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Promotion</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">Promotion consists of advertisements to appropriate stakeholders and patients, outreach to clinicians, community education initiatives, and leveraging digital marketing channels to reach potential patients. Effective promotion strategies increase referrals and attract a broader range of patients.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>People</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">The people component focuses on the personnel delivering ambulatory care services, such as pharmacists and pharmacy extenders. To ensure high-quality service, appropriate training must be completed initially and annually. Clinic personnel should possess essential qualities like empathy, honesty, strong communication skills, positive attitudes, calm demeanor, and robust knowledge.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Packaging</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">Packaging refers to the physical and digital presentations of the services offered and the intangible quality of services. Examples are educational pamphlets for patients, documentation, EMR, user-friendly platforms, etc. The intangible packaging is how a patient is greeted upon arrival or first contact. Additionally, the upkeep of the clinic environment, such as reducing clutter and organization, is important to create a comfortable environment.</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">
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<b>Process Management</b>
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</td><td rowspan="1" colspan="1" style="height: 13px;height: 13px;vertical-align:top;">The process encompasses the workflows implemented to deliver effective services. This involves patient scheduling, medication reconciliations, documentation, and communication pathways with other clinicians. Procedures should be clear and comprehensible, ensuring ease and efficiency. </td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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