Peer review as a quality assurance mechanism in three pharmacist-run medication-refill clinics.

A peer-review system for monitoring pharmacists' practice in medication-refill clinics is described. Pharmacist practitioners trained in pharmacology, therapeutics, and physical assessment provide services in three medication-refill clinics associated with a 350-bed Department of Veterans Affairs (VA) medical center. The clinics serve patients who have exhausted their prescribed drugs before their next appointment with a physician. During a clinic visit, the pharmacist assesses the patient and the drug therapy and either consults an attending physician or writes new prescriptions. The pharmacist documents his or her activities in the medical record. The peer-review mechanism involves quarterly audits in which the chart notes written by the pharmacists are reviewed by other pharmacists. Five indicators of the quality of care are used in the peer reviews. The results are presented to the ambulatory-care and quality assurance pharmacy committees for analysis and discussion. The peer-review system has resulted in better compliance by the pharmacists with the quality indicators and clinic procedures, suggesting that the quality of care has also benefited. Peer review is used successfully to evaluate and monitor the care provided by pharmacists in medication-refill clinics associated with a VA medical center.