The pharmacy clinic: a new approach to ambulatory care

A pharmacy clinic was established to provide consultation and services to practitioners and patients in the ambulatory care department of a Veterans Administration hospital. Among the services provided by the pharmacist are drug therapy consultations and monitoring, drug use review, drug information, and patient education. The pharmacy clinic assures the staff of the pharmacist's availability for consultation, allows the pharmacist to better organize the time required for consultation, makes the services of the pharmacist available to all outpatients, and provides a good training environment for students.     

Evaluation of an educational strategy to improve medication reconciliation in ambulatory care

BackgroundImproper medication reconciliation can result in inaccurate medication lists. When medication lists are inaccurate, it can result in drug-drug interactions, dosing errors, and medication duplication. Interventions targeting medication reconciliation have had varying levels of success.ObjectiveThis study aimed to describe the medication reconciliation educational program, its implementation in a health care system, pharmacist and clinic personnel perception of the program, and its impact on clinic personnel knowledge and practice.MethodsGuided by the Conceptual Model of Implementation Research, a partially mixed sequential dominant status evaluation of a pharmacist-led educational program on evidence-based practices for medication reconciliation implemented into all primary care clinic sites by examining implementation outcomes was conducted. The implementation outcomes measured include penetration, fidelity, acceptability, appropriateness, feasibility, and adoption. Data were collected through program data and direct observations, pre- and postsurveys, and semistructured interviews of pharmacists and clinic personnel.ResultsOf 46 primary care sites, 37 primary care sites (80%) implemented the pharmacist-delivered medication reconciliation education from April to June 2021 with representation from each of Geisinger’s regions. Ten clinic sites (27%) completed the medication reconciliation educational program as originally designed, with the remainder adapting the program. A total of 296 clinic personnel completed the presurvey, and 178 completed the postsurvey. There were no differences in baseline characteristics between clinic personnel who completed the pre- versus postsurvey. All clinic personnel interviewed felt satisfied with the educational program and felt it was appropriate because it directly affected their job. Clinic personnel felt the educational program was acceptable and appropriate; two major concerns were discussed: a lack of patient knowledge about their medications and a lack of time to complete the medication reconciliation. The adherence rate to the elements of the medication reconciliation that were covered in the education program ranged from 0% to 95% in the 55 observations conducted.ConclusionAn educational program for medication reconciliation was found to be acceptable and appropriate but was often adapted to fit site-specific needs. Additional barriers affected adoption of best practices and should be addressed in future studies.     

Integrating primary care and specialty pharmacy practice to improve ambulatory patient care services

This article describes the evolution of clinical pharmacy services in an outpatient setting over a 20-year period. An historical overview of the initiation of services, the state of current practices, and the development of a new clinical service--the medication management service (MMS)--to provide care for general medical patients is presented. Four case studies of recent patients managed by the MMS are given to illustrate the interrelationship between this service and the pharmacist-managed specialty clinics.