Assessing the structure and process for providing pharmaceutical care in Veterans Affairs medical centers

The structure and process used in providing pharmaceutical care to ambulato ry care patients at nine Veterans Affairs medical centers (VAMCs) were stud ied. Institutions participating in the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Cent ers) study were selected. To assess the level of pharmaceutical care servic es provided to ambulatory care patients, 10 critical domains were identifie d. Six instruments with questions related to each domain were then designed , including a clinical pharmacist survey and an outpatient survey and an ou tpatient pharmacist survey. Each center was assessed through three surveys and an onsite visit. The investigators used both direct observation and a c onsensus approach to score the level of ambulatory care pharmaceutical serv ices provided. The clinics in which IMPROVE study patients would be seen were run by pharm acists (33%), physicians (44%), and multidisciplinary teams (22%). Of the 5 1 clinical pharmacists surveyed, 23 (45%) had prescribing authority via pro tocols, 14 (28%) had unrestricted prescribing privileges, and 14 did not ha ve prescribing authority. The sites varied greatly in referral patterns, me thods of identifying patients, and whether patient visits were scheduled or on a walk-in basis. There was a strong correlation between observed activi ties by clinical pharmacists and their self-reports and between observed ac tivities by outpatient pharmacists and their self-reports. Activities repor ted by clinical pharmacists were moderately but not significantly correlate d with consensus scores,and activities reported by outpatient pharmacists w ere poorly correlated with consensus scores. The structure and process for providing pharmaceutical care to ambulatory c are patients at VAMCs were evaluated with surveys, direct observation, and a consensus-based scoring system.