Hospital-based outpatient clinics

Most of the strategies discussed thus far can be applied to community pharmacy settings. However, this is not the only setting in which pharmacists offer value-added services. There are two specific practice settings that offer unique compensation strategies for ambulatory care pharmacists the physician office and the hospital-based outpatient clinic. 

Hospital-Based Outpatient Clinics The Outpatient Prospective Payment System (OPPS) is the method for compensation for hospital-based outpatient facilities (DHHS, 2000a). With this system, there is a professional component (e.g., for physician providers) and a technical component (e.g., for nonphysician health care professionals) to billing that describes the various contributions of the health care team during the specific patient encounter. Ambulatory Payment Classification (APC) codes are used within this system to describe the type and complexity of the patient visit to the insurance company. When pharmacists provide services within a hospital-based clinic, the compensation for the service goes to the hospital facility instead of directly to the provider. The revenue generated should be able to be tracked internally as to which department or health care professional was involved in the care of the patient (Snella and Sachdev,... 

In various settings such as the VA outpatient clinics, Kaiser Permanente outpatient services, hospital-based outpatient clinics, physician offices, and community pharmacies, pharmacists have been successfully managing patients warfarin therapy. " Research demonstrates the positive outcomes associated with and the cost-effectiveness of pharmacist-run warfarin clin-iCs.50/51... 

In the acute ward setting, the top three causes of anemia in the elderly have been identified as chronic disease (35%), unexplained cause (17%), andiron deficiency (15%), whereas in community-based outpatient clinics the most prevalent causes are unexplained (36%), infection (23%), and chronic disease (17%). Risk factors for the development of anemia in the elderly include race and ethnicity with the highest prevalence in elderly blacks, those with serum albumin and serum creatinine abnormalities, and recent hospitalization or placement in an instimtion. " ... 

Assessments are both initial and ongoing. An initial assessment is made based on objective and subjective data collected when the patient is first seen in a hospital, outpatient clinic, health care provider s office, or other type of health care facility. The initial assessment usually is more thorough and provides a database (sometimes called baseline) from which later data can be compared and decisions made The initial assessment provides information that is analyzed to identify... 

To compare the epidemiological, clinical, and economic impacts of the HIV epidemic in Italy prior to and after the introduction of HAART, Tramarin et al. (2004) conducted a prospective and observational study with a multi-center design. They used data collected on an AIDS cohort from 1994 and updated data from a comparable cohort in 1998. Mortality and medical costs of 251 patients were measured in 1994 and in 1998, respectively. A considerable difference was observed in mortality (33.9% in 1994 vs. 3.9% in 1998). The cost per patient per year was US 15,515 in 1994 and US 10,312 in 1998. Based on the comparison of the two cohorts between both years, the authors concluded that after the introduction of HAART, hospital-based provision shifted from an inpatient-based to an outpatient-based service, with major focus on pharmaceutical care. 

In this section, results obtained in a case study (Itoh and Andersen 2008, 2010) will be reviewed to illustrate the contribution of safety culture to safety outcome. In a case study, a questioimaire-based survey concerning staff reactions after the adverse event introduced in the last section, was conducted in addition to the safety culture survey. At the same time, incident reports for three years (2004-06) submitted by nurses were obtained from one of the hospitals (Hospital M) that participated in the safety culture survey. Hospital M was a private, acute-type general hospital, located in Tokyo. This hospital covered almost all clinical specialties and, at the time of the survey in 2006, it had about 500 inpatient beds, 160 full-time doctors and 360 full-time nurses. Nurses belonged to any one of 18 clinical work units 14 inpatient wards, an outpatient clinic, operating room, kidney centre, and medical examination unit. 

Much less attention has been paid to chronic PCP use per se, i.e., the substance use disorder itself. Such issues as the effects of chronic PCP use, and the diagnosis, clinical characterization, and treatment of chronic PCP abusers are rarely discussed in the published literature, even in detailed review articles (Davis 1982 Pearlson 1981 Pradhan 1984). This paper reviews the literature on inpatient and outpatient treatment of PCP abuse, outlines our own experience with PCP users and abusers in one large, public, urban hospital, and makes suggestions for future research based on this information and animal research findings (Balster, this volume). 

The prototypes of modem psychopharmaceuticals were discovered between 1952 and 1958. Since that time the effective treatment of schizophrenic psychoses, depressions, anxiety syndromes and other mental disorders has become possible and a new, multidisciplinary science biological psychiatry has developed. Clinical psychiatry has changed dramatically in the past 50 years fewer patients are hospitalized long term, psychiatric care and treatment have largely shifted to outpatient departments and private practices, and new models of combined pharmacological and non-drug-based prophylactic and therapeutic interventions have been developed. 

These authors wanted to describe the overall disease impact for patients with chronic epilepsy, using a retrospective cross-sectional design in a managed care organization. Multiple data sources were required, as no single data base served as a repository for the various types of data required, and included administrative databases, medical charts, pharmacy databases, outpatient databases, hospitals, laboratories, outside services, memberships and so on. They found that all the identified sociodemographic variables were available in at least one automated database, as were two of the clinical variables, and 26 of the economic variables. None of the humanistic variables were available in any database. 

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