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Pharmacist-managed patient-care services and prescriptive authority in the U.S. Public Health Service
R N Herrier1, R W Boyce, D A Apgar
1US Public Health Service, Phoenix, AZ.
Hospital Formulary
|January 1, 1990
Summary
Pharmacists in the Indian Health Service (IHS) gained prescribing authority for certain drugs and therapeutic substitutions. This expansion improved patient care and demonstrated the value of clinical pharmacy services.
Area of Science:
- Health Services Research
- Pharmacy Practice
- Clinical Pharmacy
Background:
- The Indian Health Service (IHS) pioneered clinical pharmacy services for ambulatory patients starting in the 1960s.
- Early programs authorized pharmacists to dispense certain legend drugs without physician preauthorization and to make therapeutic substitutions.
Purpose of the Study:
- To describe the development and implementation of expanded clinical pharmacy services within the IHS.
- To present the results of a study on pharmacist prescribing practices in the IHS.
- To detail the IHS clinical pharmacy training program.
Main Methods:
- Review of historical development of clinical pharmacy services.
- Analysis of pharmacist prescribing protocols and patient management.
- Presentation of study findings on pharmacist prescribing.
Main Results:
- Pharmacists were authorized to prescribe specific drugs and perform therapeutic substitutions.
- Expanded roles included physical assessment, differential diagnosis, and medication-focused care management.
- The study demonstrated successful pharmacist prescribing within defined protocols.
Conclusions:
- The IHS successfully expanded the role of pharmacists, enhancing ambulatory patient care.
- Pharmacist prescribing, under defined protocols, proved effective in managing patient care.
- These programs laid the groundwork for advanced clinical pharmacy practice.