CCPP Certification Review

CCPP Certification Review

A Review Guide for the Certified Collaborative Practice Pharmacist (CCPP) Exam

AHRQ: Agency for Healthcare Research and Quality

BOP: Board of Pharmacy

CCM: Chronic Care Management

CDTM: Collaborative Drug Therapy Management

CMM: Comprehensive Medication Management

CPA: Collaborative Practice Agreement

CPT: Current Procedural Terminology

E&M: Evaluation and Management

EHR: Electronic Health Record

HEDIS: Healthcare Effectiveness Data and Information Set

HIPAA: Health Insurance Portability and Accountability Act

ICD-10: International Classification of Diseases, 10th Rev.

JCPP: Joint Commission of Pharmacy Practitioners

MACRA: Medicare Access and CHIP Reauthorization Act

MIPS: Merit-based Incentive Payment System

MTM: Medication Therapy Management

NABP: National Association of Boards of Pharmacy

NPI: National Provider Identifier

PCMH: Patient-Centered Medical Home

PCP: Primary Care Provider

PDSA: Plan-Do-Study-Act

PHQ-9: Patient Health Questionnaire-9

PPCP: Pharmacists' Patient Care Process

QI: Quality Improvement

SOAP: Subjective, Objective, Assessment, Plan

  • Definition: A formal partnership between one or more pharmacists and one or more prescribers, where the pharmacist is permitted to perform specific patient care functions delegated by the prescriber under a written protocol.
  • Collaborative Practice Agreement (CPA): The legal, written document that outlines the terms of the collaboration. It defines the patients, disease states, and specific functions the pharmacist is authorized to perform.
  • Scope of Practice: The specific patient care activities defined in the CPA, which may include initiating, modifying, and discontinuing medication therapy, ordering and interpreting lab tests, and performing physical assessments.
  • State Law & Regulations: Understanding that the authority for pharmacists to enter into CPAs and the specific functions they can perform are dictated by individual state pharmacy practice acts and board of pharmacy regulations.
  • The Pharmacists' Patient Care Process (PPCP): The foundational framework for delivering patient care services, consisting of five steps: **Collect, Assess, Plan, Implement, and Follow-up: Monitor and Evaluate.**
  • Needs Assessment: Identifying a clinical need within a patient population or practice setting that could be met by pharmacist-led services (e.g., uncontrolled diabetes, high hospital readmission rates).
  • Building the Relationship: Establishing trust and a strong working relationship with a potential physician or provider partner, which is the foundation of a successful collaboration.
  • Essential Elements of a CPA: Key components that must be included in the written agreement, as defined by state law, such as names of participants, authorized functions, specific protocols, and documentation requirements.
  • Developing Clinical Protocols: Creating clear, evidence-based, and mutually agreed-upon algorithms and protocols that will guide the pharmacist's clinical decision-making for the specific disease states covered in the CPA.
  • Credentialing & Privileging: The process by which a healthcare organization verifies a pharmacist's qualifications (education, training, licensure) and grants them the authority to provide specific patient care services within the institution.
  • Implementation & Workflow Integration: Designing a practical workflow for the collaborative practice, including patient identification, referral processes, scheduling, and communication between the pharmacist and provider.
  • Comprehensive Medication Management (CMM): The standard of care for collaborative practice. A systematic process of assessing all of a patient's medications to ensure they are individually appropriate, effective, safe, and able to be taken by the patient as intended.
  • Subjective & Objective Data Collection: Gathering information through patient interviews (subjective) and reviewing medical records, lab results, and performing physical assessments (objective).
  • Identifying Medication-Related Problems (MRPs): The core analytic function of CMM. Categorizing MRPs, such as unnecessary drug therapy, wrong drug, dose too low/high, adverse drug reaction, and non-adherence.
  • Developing the Care Plan: Creating a patient-centered, evidence-based plan in collaboration with the patient and provider that outlines specific goals of therapy and the actions needed to resolve MRPs.
  • Physical Assessment Skills: The ability to perform focused physical assessments relevant to medication management, such as measuring blood pressure, checking for edema, and performing a monofilament foot exam.
  • Diabetes: Initiating and titrating oral agents, insulin, and GLP-1 agonists based on national guidelines. Ordering and interpreting A1c, glucose logs, and other relevant labs.
  • Hypertension: Initiating and adjusting antihypertensive medications to achieve goal blood pressure, based on guideline recommendations (e.g., ACC/AHA).
  • Dyslipidemia: Managing statin and non-statin therapies to achieve lipid goals, including assessing for and managing statin-associated muscle symptoms.
  • Anticoagulation: Managing warfarin therapy via an anticoagulation clinic, including dose adjustments based on INR. Also involves managing DOACs, including periprocedural planning.
  • Asthma/COPD: Assessing control, optimizing inhaler technique, and adjusting controller and rescue medications based on guidelines (e.g., GINA, GOLD).
  • Heart Failure: Titrating the four pillars of guideline-directed medical therapy (GDMT) for HFrEF.
  • Clinical Documentation: The importance of clear, concise, and timely documentation of all patient encounters, typically using the SOAP note format, within a shared EHR.
  • Billing for Services: Understanding the mechanisms for pharmacist reimbursement, including "incident-to" billing under a physician, facility fees, and CPT codes for MTM and CCM.
  • "Incident-to" Billing: A Medicare rule that allows a pharmacist's services to be billed under a physician's NPI if specific criteria are met (e.g., physician on-site, patient is established with the practice).
  • Liability & Risk Management: Understanding that pharmacists practicing under a CPA are professionally liable for their own actions. Maintaining adequate professional liability insurance is essential.
  • HIPAA: Ensuring the privacy and security of Protected Health Information (PHI) when communicating with patients and other providers.
  • Provider Communication: Developing a consistent and efficient method for communicating care plan recommendations and patient updates to the collaborating provider.
  • Patient Communication: Using patient-centered communication techniques like motivational interviewing and shared decision-making to build rapport and engage patients in their own care.
  • Team-Based Care: Functioning effectively as a member of the interprofessional team, respecting the roles and expertise of other disciplines like nursing, social work, and dietetics.
  • Conflict Resolution: The ability to professionally and respectfully address disagreements with providers or other team members regarding the plan of care.
  • Demonstrating Value: The critical importance of tracking and reporting data to demonstrate the clinical, economic, and humanistic value of the collaborative practice service.
  • Clinical Outcomes: Tracking improvements in clinical markers, such as A1c reduction, blood pressure control, or reductions in asthma exacerbations.
  • Economic Outcomes: Measuring the financial impact of the service, such as reductions in hospitalizations, ED visits, or overall cost of care.
  • Humanistic Outcomes: Assessing the impact on patient-reported outcomes, such as quality of life, patient satisfaction, and medication adherence.
  • Quality Improvement (QI): Using QI methodologies like the Plan-Do-Study-Act (PDSA) cycle to systematically test and implement changes to improve the efficiency and effectiveness of the service.
  • Trust is the Currency of Collaboration: The understanding that a successful collaborative practice is built on a foundation of mutual trust and respect between the pharmacist and the provider partner.
  • The Pharmacist as a Provider: A fundamental shift in identity from a dispenser of products to a provider of direct patient care, with a focus on taking responsibility for patient outcomes.
  • Top of License Practice: The goal of designing collaborative practice models that allow pharmacists to use the full extent of their clinical knowledge and skills to meet patient needs.
  • Proactive, Not Reactive: Moving from a reactive role (addressing problems after they occur) to a proactive role (anticipating and preventing medication-related problems).
  • Data-Driven Practice: The commitment to using evidence-based guidelines to inform clinical decisions and using patient-specific data to personalize care.
  • The Patient is the Center of the Team: The core belief that the patient is the most important member of the healthcare team, and that all collaborative activities should be designed to meet their needs and goals.
Return to CCPP Certification Hub