Pharmacist-managed allergy desensitization program

A pharmacist-managed immunotherapy program for ambulatory atopic patients is described. Pharmacists in a network of three health centers recommended that they assume management of the allergy desensitization program when they recognized problems with the existing program. Guidelines for the immunotherapy service were developed and approved by the pharmacy, therapeutics, and standing orders committee. Patients, already tested by an allergist, are referred to the pharmacists for the administration of their immunotherapy. Under the guidelines for the program, pharmacists collect and record the patients' history, assess the patients' knowledge of allergy desensitization, administer the allergens, examine the injection site, question the patients about symptoms, and initiate treatment of local and systemic reactions. A physician is available for consultation and for treatment of life-threatened adverse reactions. Following any reaction, the pharmacist adjusts the next antigen dose accordingly. Typical charges for these services are $10-15 for the first visit, and $3.50 for subsequent visits. The pharmacists spend about 30 minutes of their time for the initial visits, and 10 minutes for subsequent visits. The time spent by physicians is negligible, and there is no charge for their consultations. Patients under the care of the pharmacists rarely wait more than 15 minutes for an appointment. This service has been well accepted by patients, physicians, and mid-level practitioners. Pharmacists are using their knowledge and skills to provide a direct patient-care service, and they are being reimbursed for a nondispensing activity.