Michael T. Rupp

Prescribing problems and pharmacist interventions in community practice.

Interventions performed by 89 community pharmacists in 5 states to correct the prescribing problems they identified on new prescription orders were documented by trained observers. Pharmacists intervened to resolve a prescribingrelated problem in 623 (1.9%) of 33,011 new prescription orders that were screened and dispensed during the study period. A panel of three expert evaluators concluded that 28.3% of the prescribing problems identified during the study could have caused patient harm if the pharmacist had not intervened to correct the problem. The rate at which pharmacists identified prescribing problems was negatively related to the number of prescriptions they dispensed per hour, suggesting that in pursuing distributive efficiency, some pharmacists may be exceeding their safe dispensing threshold. The authors recommend that the interprofessional system of oversight and verification (i.e., “checks and balances”) in the delivery of pharmaceutical care in the community setting should be maintained and strengthened.

Developing and marketing a community pharmacy-based asthma management program.

OBJECTIVE To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. SETTING Community-based ambulatory care. PRACTICE DESCRIPTION Independent community pharmacy. PRACTICE INNOVATION Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. MAIN OUTCOME MEASUREMENTS Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. RESULTS A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. CONCLUSION The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.