Cost-effective clinical pharmacy services in a veterans administration drop-in clinic.

Services provided by a clinical pharmacist in a Veterans Administration outpatient clinic are described. Patients who come to the drop-in clinic for prescription refill authorization or medication-related problems are seen by a pharmacist rather than by a physician. The pharmacist interviews the patient, reviews the medical records and prescription and nonprescription drug profile, assesses appropriateness of current drug use, and records findings in the progress notes. The pharmacist may recommend presciption refill, change of medication or dosage, discontinuation, referral to a physician or nurse practitioner, follow-up appointments, or laboratory tests. The physician must countersign the pharmacist's prescriptions, referrals, and requests for laboratory tests. The clinical pharmacist's services reduced demand for physicians' time, allowed patients direct access to the health-care provider suited to deal with medication-related problems, and provided improved continuity of care. Potential benefits are cost savings from discontinuation of inappropriate drug therapy and from use of a pharmacist instead of a physician. The number of hospital admissions related to adverse drug reactions also may be reduced.