Integrating clinical and distributive pharmaceutical services: implications for clinical pharmacy education

For over two decades, pharmaceutical educators and practitioners have debated whether clinical and distributive pharmaceutical services should be integrated or segregated, i.e., performed by different persons. The recently defined new federal system for reimbursing hospitals for care of Medicaid patients and other beneficiaries according to a prospective reimbursement plan impacts directly on this debate. A cross section of the profession has recently reached consensus on the definition of clinical pharmacy at a national invitational workshop. Fiscal constraints also impacted on the question in schools which are no longer able to keep expanding their clinical faculties. These factors are related questions which academic clinical pharmacy must face are discussed.