Provision of pharmacotherapy services in a rural nurse practitioner clinic

Clinical pharmacy interventions and services provided in collaboration with a nurse practitioner in a medically underserved rural health center are described.

Data were collected via retrospective chart review of clinical pharmacy notes for all patients referred to the clinical pharmacist from July 2001 through February 2004. Data collected included demographic information, reasons for referral, duration of follow-up, insurance status, use of medication assistance programs, educational interventions, clinical interventions, and clinical outcomes. Changes in mean low-density-lipoprotein (LDL) cholesterol levels, blood pressures, and glycosylated hemoglobin (HbA(1c)) were analyzed using a paired Student's t test. Smoking cessation, the number of times the international normalized ratio (INR) was in a goal range, and attainment of goal LDL cholesterol, blood pressure, and HbA(1c) levels were also recorded.

Clinical pharmacy interventions were summarized for 101 patients who were seen in 708 patient visits. A mean of 5.6 educational interventions were provided per visit, and a mean of 1.0 clinical intervention occurred per visit. Initiation of new drug therapy or dosage adjustment accounted for 52% of the clinical interventions. A large percentage of patients attained their goals for LDL cholesterol (76%), blood pressure (86%), HbA(1c) (69%), INR (82%), and smoking cessation (43%) during the study period.

Pharmacotherapy services provided by a clinical pharmacist at a rural nurse practitioner clinic positively affected clinical outcomes and increased patients' attainment rates for LDL cholesterol, systolic and diastolic blood pressures, and HbA(1c).