Enhancing pharmacists' recommendation process in an internal medicine resident clinic

To determine the number and type of recommendations made by pharmacists in an internal medicine residency clinic, the percentage of recommendations that were addressed and acted upon by the residents, whether changes needed to be made to the recommendation process, and areas in which pharmacy services could be improved.

Outpatient, urban, internal medicine clinic.

The clinic operates Monday through Thursday afternoons. Each of these afternoons, six to eight medical residents evaluate patients. Pharmacists provide services on Monday and Thursdays. The pharmacists spend the mornings before patients' visits reviewing charts and making recommendations for more appropriate medication use. Originally, pharmacists' recommendations were listed on a form that was attached to the front of each patient's chart but did not become a part of the medical record. At times, pharmacists made recommendations while a medical resident presented the patient's case to the attending physician.

Data for calendar year 2002 were analyzed retrospectively to identify a recommendation acceptance rate, areas of potential improvement, and actions that might enhance pharmacists' effectiveness.

Number of recommendations made, number of each type of recommendation made, percentage of overall recommendations addressed and acted upon by the residents, and percentage of each type of recommendation addressed and acted upon by the resident physician.

For 61 patients, 135 recommendations were made by pharmacists during 2002. Of these, 72 (53.3%) were therapeutic interventions and 63 (46.7%) were recommendations for laboratory monitoring. Overall, 66 (49.0%) recommendations were addressed and acted upon by the residents, while 69 (51.1%) were not addressed by the residents. Because of deficiencies identified in the communication process, a new form was developed that includes spaces for pharmacists' recommendations and residents' responses. Other potential future enhancements include providing more education for residents and implementing a pharmacist-run disease clinic.

This retrospective analysis showed that pharmacists were able to identify many therapeutic and laboratory interventions, thus serving a useful role in patient care and physician education in an internal medicine residency clinic.