Quality assurance and clinical pharmacy: lessons from medicine

A quarter-century of empirical work in measuring the quality of medical care has both documented serious inadequacies in care and advanced the state of the art of quality assessment. Experience with quality assurance programs at institutional, local, and national levels emphasizes that early, careful attention must be given to: specifying the purposes of a study or program, choosing the dimensions of care to be evaluated, understanding the reliability and validity of data sources and methods, and compiling appropriate evaluative criteria before projects are implemented. Superimposed on these concern are cost/benefit and cost/quality tradeoff issues. To the degree that the pharmacy profession has dealt with such conceptual and methodologic problems, it has much to offer the medical profession. To the degree that clinical pharmacy has not yet encountered them, lessons drawn from the medical experience may be helpful in implementing evaluation efforts in the future.