Proposed ICD-10 framework for identifying emergency department visits that may be impacted by community pharmacy care clinics

Primary care is critical for supporting health, yet access to family physicians and nurse practitioners is less than ideal in many countries. One solution to improve access to primary care is to expand the scope of practice for other primary healthcare professionals, such as pharmacists. Building on this approach, some countries have created community pharmacy care clinics to further improve access to primary care services provided by pharmacists working to full scope of practice. As the role of pharmacists in primary care increases and community pharmacy care clinics become more prevalent, it is important to assess the effect on health service utilization and health outcomes. While the emergency department visit rate is a widely accepted indicator for access to primary care, there is currently no framework to evaluate the impact of pharmacists on emergency department visits. Frameworks based on International Classification of Diseases codes provide health services researchers with a standardized approach to present and analyze administrative health data. In this commentary, we describe the development of a framework to identify and classify emergency department visits that may be impacted by pharmacists providing primary care services in a community pharmacy care clinic. The framework covers three mutually exclusive groups of conditions: a subset of primary care sensitive conditions that can be managed by community pharmacists, conditions attributable to an adverse medication event, and conditions attributable to medically appropriate referrals to an emergency department. The conditions included within these groups provide a broad overview of potential benefits and unintended harms that may occur when pharmacists are involved in providing primary care services. This framework can be used to characterize changes in health service utilization and health outcomes that may occur as pharmacists become more actively involved in providing primary care services.