Editor's Note: Pharmacy's Focus on Quality

NOVEMBER 01, 2007
James C. McAllister III, MS, FASHP

Mr. McAllister is a health-systems consultant based in Chapel Hill, NC.

Pharmacists who practice in hospitals have warmly embraced quality improvement initiatives, especially those promulgated by accreditation standards or by hospital leadership. Whereas virtually all hospital pharmacy departments are focused on medication safety in the hospital, some practice pioneers have become strong advocates for expanding the quality-focus well beyond patient safety to include many systems and quality-improvement strategies for processes both internal and external to the pharmacy department. Despite these efforts, as well as selected hospitals and health systems becoming nationally recognized as leaders in quality improvement, health care quality is not as high as our patients deserve, especially in the ambulatory care environment.

In the October 11, 2007, issue of the New England Journal of Medicine, researchers describe their findings in assessing the quality of ambulatory care delivered to children in the United States. Medical records for children from 12 metropolitan areas were examined for receiving indicated care. The complex analysis shows that, overall, only 45.6% of these children received the indicated care. While these patients received 67.6% of indicated care in acute problems, chronic care and preventive care followed with 53.4% and 40.7%, respectively. These data suggest that, collectively, the health care delivery system falls considerably short of optimal health outcomes. Previous studies reveal similar data for adult populations.

As I read the details of the findings, I was struck by the opportunities pharmacists have to improve health care quality, especially in the ambulatory care environment. Some of the indicators which fell well short of good care are taught as basics of care to pharmacy students and are routinely followed with inpatients. Pharmacists have a positive track record for identifying opportunities and initiating processes that improve care. The traditional focus of hospital pharmacists on acute care, however, has limited our effectiveness in clinic environments. In addition, dedicated staff who practice in outpatient environments are woefully inadequate and poorly reimbursed for their activities.

The authors of a companion editorial in the same issue state, ?Effecting change will require leadership across all levels and systems involving children?s health care and a wholehearted commitment by those who deliver care, pay for care, and receive care.?

We are about to elect new political leaders, and undoubtedly some type of reform will be promoted. Organized pharmacy needs to consider training students and residents for new roles, strongly encouraging integrated (even if informal) care networks with our colleagues in community pharmacy, becoming proactive advocates for expanding pharmacists? roles and touting our collective impact, and educating leaders in the public and private sectors about the considerable potential we offer to improve health care outcomes.

Are we poised for these potential changes? Will our national associations collaborate at this time of opportunity? Will our schools support the necessary education and training to help us lead reform? Can we develop strategies in our departments to be positive champions for change with hospital and medical staff leaders? What do you think?