New York City pharmacists and OBRA '90: one year later.

New York state regulations to implement patient counseling mandated by the Omnibus Budget Reconciliation Act of 1990 took effect in December 1992, yet one year later, little was known about how successfully the counseling mandate was being implemented. To begin assessing the impact, an anonymous questionnaire was distributed to 300 New York City pharmacists and pharmacy interns in the fall of 1993; a 65% (194) response rate was achieved. The opinions of interns and pharmacists differed on whether the counseling requirement had been implemented correctly (p < 0.01). Time, personnel, and expense constraints were most frequently cited as barriers to implementation. Half of the respondents mentioned that patients had to wait for counseling. More often than not, the offer to counsel originated with the pharmacist (51%). Interns (19.5%), technicians (12%), and clerks (17%) offered counseling less frequently. Approximately 35% of patients chose not to supply counseling information. Reasons for not accepting counseling as well as methods for documentation were described and analyzed. A list of items discussed each time a prescription is dispensed revealed little agreement on what constitutes counseling.