ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems - 1999

The results of a 1999 national survey of the ambulatory care responsibiliti es of pharmacists in managed care organizations (MCOs) and integrated healt h systems are reported and compared with the results of a similar survey co nducted in 1997. Four hundred MCOs and integrated health systems participated in the telepho ne survey. The survey elicited data about organizational structure and phar macist functions in the ambulatory care environment. Survey recipients were asked about 24 specific ambulatory pharmacist functions. The performance of functions was related to five "enabling" factors: pharma cists on interdisciplinary teams, automated dispensing systems, integrated electronic medical records, and "very supportive" medical staff and senior management. Thirteen functions were reported to be routine activities for m ore than 50% of the respondents, compared with nine functions in 1997. The top four functions-using pharmacoeconomic data to make formulary decisions, conducting medication management programs, tracking adverse drug reactions , and providing written information with each new prescription-were perform ed in 75% or more of organizations. Some 15-18% of respondents indicated th ey would add specialized pharmacy-managed clinics, services to determine pa tient use of herbal products and dietary supplements, and Internet prescrip tion services within 12 months, suggesting this expansion is likely to cont inue. Enabling factors supported expansion. Two clusters of functions were identified that related to either population-focused or patient-focused act ivities, and these were supported differentially by enabling factors. Group -model and staff-model HMOs had the most enabling factors and the greatest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of pharmacist functions, with an empha sis on population-focused functions, suggesting that a second model of ambu latory care pharmacist activity may be emerging. Ambulatory care functions of pharmacists in integrated health-system settin gs have expanded broadly since 1997.