Clinical pharmacy services in family practice: cost-benefit analysis. II. Referrals, appointment compliance, and costs.

The benefits, decreased referral rate and increased kept-appointment rate, and the costs that a family practice clinic could expect to incur by including a clinical pharmacist in the clinic are discussed. By using a clinical pharmacist as a consulting partner, the physician would have a decreased need to refer patients to specialists not affiliated with the medical practice. The benefit to the practice is the revenue from office and hospital visits that would not have been received had these patients been referred elsewhere. Involvement of a clinical pharmacist in providing drug therapy management for patients with selected chronic diseases results in an increase in office appointment compliance rates. The benefit to the practice is the revenue generated by the increased number of office visits per year. Costs that would be incurred by the practice include: physician time spent due to the increased number of office visits generated by the decreased referral rate and increased appointment compliance; increased operating expenses, including the clinical pharmacist's salary and fringe benefits; and the developmental expense of establishing a reference library for the clinical pharmacist.