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Expansion of Pharmacists' Services Linked to Critical Factors

Katherine M. Bennett

Support from medical staff and senior management are just two of the factors that empower ambulatory care pharmacists to conduct direct patient care, according to a new ASHP study.

The 1999 "Survey of Managed Care and Ambulatory Care Pharmacy Practice in Integrated Health Systems," which queried 400 pharmacy managers and administrators on issues such as how pharmacists within the systems spent their time, unveiled compelling evidence of new opportunities for enhanced patient care.

Supported by an unrestricted grant from Pfizer, the study found that since 1997, the amount of time pharmacists spend in ambulatory care has expanded dramatically in breadth and scope. For example, more than half of the respondents indicated that of 24 functions typically performed in ambulatory care settings, 13 are now considered routine activities (up from nine in 1997). Topping the list are:


  • Using pharmacoeconomic data to make formulary decisions, 
  • Conducting medication management programs, and 
  • Tracking patients' adverse drug reactions.


Eighty percent of the surveyed sites already offer the above services. Growth areas for the next year include conducting specialized pharmacy-managed clinics, determining patients' use of herbal products and dietary supplements, and providing Internet prescription services.

"We were surprised at the extent to which ambulatory pharmacy roles have grown since the last survey," said study co-author Katherine K. Knapp, Ph.D., professor and dean, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, Calif. "Managed care and other market forces such as workforce shortages apparently have not curtailed the progress of pharmaceutical care into new areas."


Critical to that expansion are enabling factors often found in settings that allow pharmacists more latitude in providing direct patient care. In addition to "very supportive" medical staff and senior management, pharmacy services were enhanced in ambulatory care settings that had:


  • Integrated electronic medical records, 
  • Automated dispensing systems, and 
  • Pharmacists on interdisciplinary care teams.


"Members who want to expand services within their settings can use this survey as a tool to educate administrators," said Colleen H. O'Malley, director of ASHP's Center on Managed Care Pharmacy. "They can also use the data as a benchmark in assessing current services or as a source of ideas for 'next steps.'"