Ambulatory care pharmacy services: Has the agenda changed?

OBJECTIVE: To provide an extensive review of ambulatory care clinical pharm acy services and evaluate the services and research data in the field. DATA SOURCES: MEDLINE was searched from January 1992 through July 1999. Sea rch terms included pharmacy, clinical pharmacy, and pharmaceutical care, cr oss-referenced with ambulatory care, primary care, family medicine, and man aged care. SELECTION SELECTION: Relevant peer-reviewed studies and reports since our p revious article in 1992 were selected and described. Literature prior to 19 92 was briefly reviewed. DATA SYNTHESIS: The relevant literature was reviewed and some examples from the authors' institutions are provided. Much research has continued to be published documenting the value of clinical pharmacy services in ambulatory care, including in community pharmacy, anticoagulation services, family me dicine, primary care clinics, Veterans Affairs Medical Centers, and managed care. However, these innovative services are underrepresented in the commu nity at large. The vast majority of the public does not have access to thes e types of services. CONCLUSIONS: There will be continued and dramatic expansion of ambulatory c are pharmacy services in the new decade beginning in the year 2000. It will be critical that standards of practice be very high. We believe there is a critical need for visible demonstration projects and large multicenter res earch projects that demonstrate the value of these services.