AMBULATORY PHARMACY SERVICES AFFILIATED WITH ACUTE-CARE HOSPITALS

The extent to which hospital-based pharmacists provide ambulatory clin ical pharmacy services in-the United States is unknown. We evaluated p harmacists' activities in hospital-affiliated ambulatory clinics and h ome health services. A questionnaire was mailed to directors of pharma cy in one-half of the United States acute care general medical-surgica l hospitals with 50 or more licensed beds. The survey response rate wa s 56% (n=1174). In 19% of hospitals, pharmacists provided patient care (nondispensing activities) in ambulatory clinics. The most common cli nics with pharmacist involvement were diabetes (10% of hospitals), onc ology (9%), cardiology (6%), and geriatrics, infectious disease, and p ain (4% each). Nondispensing roles varied by clinic type; prescribing by protocol was performed in 57% of anticoagulation clinics and 7% of diabetes clinics. Home health care services, with pharmacists' activit y extending beyond providing drugs, were offered by 28% of the hospita ls. Thirty-six percent of the hospitals operated one or more outpatien t pharmacies. A statistically significant association was observed bet ween hospitals' inpatient clinical pharmacy services (as assessed by t he pharmaceutical care index) and the involvement of pharmacists in bo th ambulatory clinics and home health care services.