Pharmacists in Ambulatory Clinics—Déjà Vu

APRIL 01, 2007
James C. McAllister III, MS, FASHP; Pharmacy Times Editor, Health-Systems Pharmacy Section

The term déjà vu describes an experience of feeling that one has previously witnessed or experienced a new situation. I got that feeling recently after a colleague and I met with a physician leader about expanding pharmacy services to our Family Medicine Clinic patients.

At University of North Carolina (UNC) Hospitals and Clinics, we have been slowly expanding pharmacist presence in the ambulatory care environment. For the most part, we have accomplished this with partial financial support from the School of Pharmacy, the Department of Medicine, and others. As the leader of our department, I have been less committed to the evolution of pharmacy services in the clinic environment than to competing inpatient initiatives. I have based this philosophy on the challenges for creating new or supplementing existing revenue streams to "justify" the assignment of staff in ambulatory care.

A handful of clinical specialists practice in our Internal Medicine, Family Medicine, Heart Failure, and Oncology clinics. I have followed the evolution of their practices, and I know they contribute to the improvement of the health of their patients. The success of these UNC practice pioneers has resulted in requests by multiple members of the medical staff to assign a pharmacist to many more clinics. It is a good problem to have!

As I reflected on the meeting with the chairman of Family Medicine, I experienced déjà vu. During the early stages of my career, we were enabling pharmacists to practice "clinically," and we did so creatively. These early practice pioneers worked long and hard to maximize their contributions and develop rapport with patients and physicians. I remembered the physician support we had and their demands for additional staff to collaborate on drugtherapy management on patient-care units as they became familiar with the contributions of clinicians on the pilot services. Even though the pharmacy could not charge inpatients for their nondistributive services, we found ways to enable the expansion of clinical pharmacy services by selling the concept of "clinical pharmacy" and its value to hospital administration.

Health-system pharmacy leaders need to realize that the time is here to make ambulatory-care pharmacy services a much higher priority. We need to set aside the reimbursement challenges for investing human resources in managing pharmacotherapy for outpatients as we did in the days of the birth of inpatient clinical practice. It will take creativity, entrepreneurship, and vision to make this happen, but I am convinced it can be done.

Health-system pharmacists have been shy about embracing wellness, health promotion, and disease prevention and managing our outpatients. We need to review the American Society of Health-System Pharmacists'2015 Initiatives, since 2 of the 6 primary goals relate to outpatients. We need to be leaders in our health systems to maximize pay-for-performance related to national goals and standards.

Finally, we need to assume responsibility for medication reconciliation collaboratively with any pharmacist who cares for outpatients, regardless of the practice setting. If we make these commitments, we will again be contributors to the evolution of the practice of pharmacy.

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.