Pharmacists in Ambulatory Clinics—Déjà Vu

The term déjà vu describes anexperience of feeling that onehas previously witnessed orexperienced a new situation. I got thatfeeling recently after a colleague and Imet with a physician leader about expandingpharmacy services to ourFamily Medicine Clinic patients.

At University of North Carolina (UNC)Hospitals and Clinics, we have beenslowly expanding pharmacist presencein the ambulatory care environment.For the most part, we have accomplishedthis with partial financial supportfrom the School of Pharmacy, theDepartment of Medicine, and others.As the leader of our department, I havebeen less committed to the evolutionof pharmacy services in the clinic environmentthan to competing inpatientinitiatives. I have based this philosophyon the challenges for creating newor supplementing existing revenuestreams to "justify" the assignment ofstaff in ambulatory care.

A handful of clinical specialists practicein our Internal Medicine, FamilyMedicine, Heart Failure, and Oncologyclinics. I have followed the evolution oftheir practices, and I know they contributeto the improvement of thehealth of their patients. The success ofthese UNC practice pioneers has resultedin requests by multiple members ofthe medical staff to assign a pharmacistto many more clinics. It is a good problemto have!

As I reflected on the meetingwith the chairman ofFamily Medicine, I experienceddéjà vu. During theearly stages of my career,we were enabling pharmaciststo practice "clinically,"and we did so creatively.These early practice pioneersworked long and hardto maximize their contributionsand develop rapportwith patients and physicians.I remembered the physiciansupport we had andtheir demands for additionalstaff to collaborate on drugtherapymanagement onpatient-care units as theybecame familiar with thecontributions of clinicians on the pilotservices. Even though the pharmacycould not charge inpatients for theirnondistributive services, we foundways to enable the expansion of clinicalpharmacy services by selling the conceptof "clinical pharmacy" and itsvalue to hospital administration.

Health-system pharmacy leadersneed to realize that the time is here tomake ambulatory-care pharmacy servicesa much higher priority. We needto set aside the reimbursement challengesfor investing human resourcesin managing pharmacotherapy for outpatientsas we did in the days of thebirth of inpatient clinical practice. It willtake creativity, entrepreneurship, andvision to make this happen, but I amconvinced it can be done.

Health-system pharmacists havebeen shy about embracing wellness,health promotion, and disease preventionand managing our outpatients. Weneed to review the American Society ofHealth-System Pharmacists'2015 Initiatives,since 2 of the 6 primary goalsrelate to outpatients. We need to beleaders in our health systems to maximizepay-for-performance related tonational goals and standards.

Finally, we need to assume responsibilityfor medication reconciliation collaborativelywith any pharmacist whocares for outpatients, regardless of thepractice setting. If we make these commitments,we will again be contributorsto the evolution of the practice ofpharmacy.

Mr. McAllister is director of pharmacyat University of North Carolina (UNC)Hospitals and Clinics and associatedean for clinical affairs at UNCSchool of Pharmacy, Chapel Hill.