THE IMPROVE STUDY - BACKGROUND AND STUDY DESIGN

An ongoing study of the impact of ambulatory care clinical pharmacists on patient outcomes at selected Veterans Affairs medical tenters (VAM Cs) is described. The IMPROVE (Impact of Managed Pharmaceutical Care o n Resource Utilization and Outcomes in Veterans Affairs Medical Center s) study will examine the effects of referring patients at high risk f or drug-related problems to a pharmacist-managed monitoring program. N ine study sites from diverse geographic locations and small and large urban areas have been selected. Investigators visited each site to eva luate the structure of care, observe pharmacist-patient interactions, and assess the level and documentation of pharmacists' activities. A c oordinating center will collect and process patient-specific data from the study sites to identify high-risk patients. It is expected that 5 00 intervention patients and 500 control patients from the nine VAMCs will complete all portions of the study. Intervention patients will be scheduled for medication assessments by ambulatory care pharmacists a nd will be monitored by pharmacists for at least 12 months. The coordi nating center will track refill histories for intervention patients. I nvestigators will assess the activities performed by ambulatory care p harmacists to determine predictors of successful patient outcomes. The two groups will be compared with respect to change from baseline in q uality of life and satisfaction with health care providers. A cost-ben efit analysis will be undertaken to determine the impact of pharmaceut ical care relative to total patient care costs. The main outcome resul ts of the IMPROVE study are expected to be available in 1999. The IMPR OVE project will be the first study of the impact of ambulatory care c linical pharmacists on patient outcomes.