Pharmacist-managed drug therapy in California hospitals

To assess the effect of state legislation expanding the scope of pharmacy practice in health-care institutions, California hospitals were surveyed in 1982 and 1986 about pharmacists' regulation of drug therapy. Questionnaires were mailed to pharmacy directors at all hospitals in the state. The survey form explained that in pharmacist-regulated drug therapy, the pharmacist, under order or authorization of the prescriber, requests laboratory tests and initiates or adjusts drug dosage to obtain the desired therapeutic response; the questions were based on this definition. The response rates were 51.4% (292 of 568) in 1982 and 56.2% (329 of 585) in 1986. For the responding hospitals of most sizes and types, the percentage having pharmacist regulation of drug therapy increased; the largest increase was in the for-profit chain hospitals. In 1986, pharmacists were involved in regulating maintenance dosages in more than half of the responding hospitals (from 52% of hospitals with 50 or fewer beds to 86% of hospitals with 400-499 beds). The responses indicated that at least 50% of patients receiving aminoglycoside or warfarin therapy or total parenteral nutrition had their maintenance dosages regulated by pharmacists. The two surveys indicate that between 1982 and 1986 pharmacists became more involved in regulating drug therapy in California hospitals.