The practice of pharmacy in the ambulatory care setting is as old as the profession. Pharmacy practice for the majority of patients outside of the hospital/inpatient care setting is honestly best described by the overarching term ambulatory care. The term ambulatory care includes “all health-related services in which patients walk to seek their care.”1 These services include; private offices, patient care clinics, community pharmacies, and urgent/emergent care services. With this broad definition a specialty certification for ambulatory care pharmacists has been debated. Following a role delineation study in the early 2000s the Board of Pharmacy Specialties agreed that Ambulatory Care Practice was a specialty.
In November of 2009 the initial meeting of the Board of Pharmacy Specialties (BPS) ambulatory care council was held. The nine member council worked on credentialing details including exam development over the following 22 months with the first ambulatory care pharmacist specialty examination occurring in October of 2011. The first group 510 Board Certified Ambulatory Care Pharmacists (BCACP) were credentialed in late 2011.
There are now 1,956 BPS Board Certified Ambulatory Care Pharmacists (BCACP) since the first specialty exam. Ambulatory Care is now the second largest BPS specialty.
At this time, just three years after the inaugural examination every state in the country has at least one Ambulatory Care credentialed pharmacist. Three states have over 100 Board Certified Ambulatory Care Pharmacists (BCACP). California has 186 BCACP, followed by the states of Florida with 106 and North Carolina with 101.
Internationally, there are a total of 75 Board Certified Ambulatory Care Pharmacists. These BCACP come from 14 different countries. Singapore has the largest group outside the US with a total of 24 BCACP. Canada has the second largest with 12 BCACP.
The growth of certified ambulatory care pharmacists has been steady and will likely parallel the expansion of pharmacist services. Board Certification should be considered strongly advisable for pharmacists with an advanced scope of practice who are seeking clinical privileges. As the profession of pharmacy evolves and the responsibilities for patient care increase, the need for Board Certification, specifically Ambulatory Care Board Certification has tremendous potential for growth.
If the profession of pharmacy realizes the full opportunities outlined in the “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice” report to the U.S. Surgeon General 2011 document, the need for Board Certification appears more obvious.2 Efforts to expand ambulatory care initiatives have long been the focus of efforts by professional associations. One initiative by the American Society of Health-System Pharmacists (ASHP) and ASHP Foundation was the Ambulatory Conference and Summit in March of 2014 which developed Consensus Recommendations. The very first domain:Defining Ambulatory Care Pharmacy Practice states:
“To provide optimal patient-centered care, pharmacists who provide ambulatory care services must attain and maintain appropriate competencies and credentials.
Competency, sufficient for board eligibility as defined by the Board of Pharmacy Specialties for Ambulatory Care, for example, is attained through training and/or commensurate experience. Examples of credentials include BCACP….”3
The Specialty of Ambulatory Care within the framework of the Board of Pharmacy Specialties has seen tremendous growth. However, there is great need and potential for incredible growth if more pharmacists in the ambulatory care realm advance their practice models to those outlined in the Surgeon General document or the ASHP/ASHP foundation document.
Locally, in my own practice setting I have encouraged multiple pharmacists working in our ambulatory clinics and employee pharmacies to attain the BCACP credential. Once credentialed however support is also necessary to help with institution credentialing, legal/regulatory, and direct patient care issues including documentation standards. Suffice it to say that there are numerous steps to take in developing advanced practice models.
One large step forward for the ambulatory care pharmacy practice included the development of the Board Certified Ambulatory Care Pharmacists credential. I have professionally enjoyed working through the development process of the BCACP credential. I am excited about the opportunities for the evolution of pharmacy practice and I look forward to seeing how the Board Certified Ambulatory Care Pharmacists help walk the profession forward.
Peter G. Koval, PharmD, BCPS, CPP
Associate Professor of Clinical Education, UNC Eshelman School of Pharmacy
Director of Pharmacy Education Greensboro AHEC
Cone Health Family Medicine Center and Residency Program
- Carter BL. Ambulatory Care. In: Brown TR, ed. Handbook of Institutional Pharmacy Practice, 3rd edition. Bethesda: American Society of Hospital Pharmacists, 1992:367-73.
- Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.
- Ambulatory Care Summit. Recommendations of the Summit. Am J Health-Syst Pharm. 2014; 71:1390-1