Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic.

The effects of pharmaceutical care on medication cost and quality of care in a university-based family-practice clinic were studied. Prognostic indicators were used to target patients who should receive pharmaceutical care. Those patients who received care. Those patients who received pharmaceutical care over a 14-month period during 1988-89 were included in the study. A pharmacist interviewed each targeted patient, obtained the patient's medication history, made therapeutic recommendations to the patient's physician, and counseled the patient on his or her therapy. The pharmacist's recommendations were noted, and the outcome of each recommendation was documented on subsequent patient visits. For each recommendation, drug cost avoidance was calculated and patient outcome was analyzed. For quality assessment, a panel of three health-care professionals reviewed the pharmacist's recommendations for 25% of the study patients (randomly selected) and noted their agreement or disagreement with the pharmacist's actions. Over the study period, 184 targeted patients received pharmaceutical care. Clinic physicians accepted 297 (82.5%) of 360 pharmacist recommendations. Annual extrapolated cost avoidance associated with the pharmacist's recommendations was $19,076. For 213 (80.4%) of the 265 accepted recommendations for which outcome data were available, improvement or resolution of the patient's disease state occurred. For 8 (16%) of 50 unaccepted recommendations, the patient's status declined. The peer review panel agreed with 86% of the pharmacist's recommendations. The provision of comprehensive pharmaceutical care in an ambulatory-care clinic can both reduce medication costs and improve quality of care.