Pharmacist ambulatory pharmaceutical care

Ellis, S.L. Carter, B.L. Malone, D.C. Billups, S.J. Okano, G.J. Valuck, R.J. Barnette, D.J. Sintek, C.D. Covey, D. Mason, B. Jue, S. Carmichael, J. Guthrie, K. Dombrowski, R. Geraets, D.R. Amato, M. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults The IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacotherapy 2000, 20 (12), 1508-1516. 

Pharmacists have an opportunity to extend their activities in patient care as the emphasis continues to shift from inpatient care to ambulatory care. The latter situation generally encourages a team approach to health improvement, prevention, health maintenance, risk assessment, early detection, management, curative therapy, and rehabilitation [12]. Ambulatory care offers a variety of opportunities for individualizing patient care through pharmaceutical compounding. In fact, it is the area where most compounding pharmacists practice. 

About the Author Dr. Mosavin is Chair of the Department of Pharmaceutical Sciences and Associate Professor in the Department of Pharmacotherapy and Outcomes Science at Loma Linda University s School of Pharmacy. Dr. Mosavin received a B.S. in Pharmacy from the University of Kansas, a Ph.D. in Pharmaceutical Sciences from the University of Wisconsin—Madison, and an MBA from the University of Chicago. Dr. Mosavin has experience in pharmaceutical industry, hospital pharmacy, and ambulatory care pharmacy settings. His research interests encompass economic evaluation of health care delivery systems and the role of pharmacists in these systems (especially as it relates to management of chronic diseases by pharmacists). Another key area of his research is analysis of economic gains achieved by health information technology implementation in ambulatory care pharmacy practice. 

A counterbalance to the positive roles that pharmacists play is the increase in the amount of time that we spend on reimbursement and payment issues. Pharmacists in ambulatory care play a role in adjudication of third party claims and often bring the news to patients that a drug ordered for them is not covered by their pharmacy benefit. This often places us in conflict with the patient and their physician in a system that is not our creation. The difficult financial condition of many hospifals places the pharmacist in roles of assuring reimbursemenf for pharmaceuticals for both inpatient and ambulatory care. The Ambulatory Payment Classification (APC) system is intricate and terribly complex and pharmacists must be directly involved in some aspect of fhe coding to assure paymenf. These roles do not represent the optimal use of our scarce manpower. 

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