Effectiveness of an Ambulatory Care Clinical Pharmacist: A Controlled Trial

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Abstract
OBJECTIVE: To compare two general medicine clinics to determine the effectiveness of an ambulatory care clinical pharmacist in assisting recognition of drug therapy problems for physicians and decreasing drug therapy costs. DESIGN: Controlled trial SETTING: Two general medicine ambulatory care clinics associated with a large, tertiary-care teaching hospital. PATIENTS: Those with scheduled and completed appointments in the clinics during the two-week study period. METHODS: Medication profiles of patients attending clinic A (pharmacist intervention) and clinic B (no pharmacist intervention) were reviewed by the pharmacist prior to clinic appointments. Potential drug therapy problems were identified at each clinic, but interventions were performed only at clinic A. Postappointment audits determined the number of recommendations implemented at clinic A versus the number of drug therapy problems (potential interventions) recognized and addressed by clinic B physicians independently of pharmacist intervention. Potential and actual savings were extrapolated to one year from the two-week study period. RESULTS: Implementation of interventions at clinic A was greater than at clinic B (p<0.001). Drug therapy cost savings at clinic A were annualized to yield $185 per intervention. Potential cost savings of $176 724, or four times the pharmacist salary costs, is projected. CONCLUSIONS: An ambulatory care pharmacist is effective in identifying drug therapy problems, resulting in significant cost savings to the institution.

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