Pharmacists on a primary care team at a Veterans Affairs medical center

The role of pharmacists on a primary care team in the VA Chicago Health Care System--Lakeside Division is described. In 1990 the Veterans Affairs Lakeside Medical Center (now called the VA Chicago Health Care System--Lakeside Division) implemented the "Firm" system to improve the quality of patient care. This system split the original primary care clinics into three identical but smaller groups, or Firms. Each Firm provides three types of care: longitudinal care (ongoing care with a primary care physician), interim care (frequent care and close patient monitoring between primary physician visits), and un-scheduled care (acute care for complaints that may require immediate attention). Each Firm has a care team composed of physicians, a pharmacist, nurses, and other health care personnel. The pharmacist assists with interim care and, in conjunction with Firm physicians, is involved in follow-up and monitoring of drug therapy and identification of new problems. Originally it was expected that pharmacists would care for 30-40% of interim care patients, but Firm pharmacists have assisted in providing care to over 50% of these patients (plus 4% of un-scheduled care patients). The pharmacists have received high ratings from the internal medicine resident staff. Pharmacists on multidisciplinary care teams provided primary care to more than half of outpatient veterans in need of health care between regularly scheduled appointments.