Editor's Note: Pharmacy's Focus on Quality

Mr. McAllister is a health-systemsconsultant based in Chapel Hill, NC.

Pharmacists who practice inhospitals have warmly embracedquality improvement initiatives,especially those promulgatedby accreditation standards or by hospitalleadership. Whereas virtually allhospital pharmacy departments arefocused on medication safety in thehospital, some practice pioneers havebecome strong advocates for expandingthe quality-focus well beyondpatient safety to include many systemsand quality-improvementstrategies for processesboth internal and externalto the pharmacy department.Despite these efforts,as well as selected hospitalsand health systemsbecoming nationally recognizedas leaders in qualityimprovement, health carequality is not as high as ourpatients deserve, especiallyin the ambulatory care environment.

In the October 11, 2007, issue of theNew England Journal of Medicine,researchers describe their findings inassessing the quality of ambulatorycare delivered to children in the UnitedStates. Medical records for childrenfrom 12 metropolitan areas were examinedfor receiving indicated care.The complex analysis shows that, overall,only 45.6% of these children receivedthe indicated care. While thesepatients received 67.6% of indicatedcare in acute problems, chronic careand preventive care followed with53.4% and 40.7%, respectively.These data suggestthat, collectively, the healthcare delivery system fallsconsiderably short of optimalhealth outcomes. Previousstudies reveal similardata for adult populations.

As I read the details of thefindings, I was struck by theopportunities pharmacistshave to improve health carequality, especially in theambulatory care environment.Some of the indicatorswhich fell well short ofgood care are taught as basicsof care topharmacy studentsand areroutinely followed with inpatients.Pharmacists have apositive track record foridentifying opportunities andinitiating processes thatimprove care. The traditionalfocus of hospital pharmacistson acute care, however,has limited our effectivenessin clinic environments. Inaddition, dedicated staff whopractice in outpatient environmentsare woefully inadequate andpoorly reimbursed for their activities.

The authors of a companion editorialin the same issue state, ?Effectingchange will require leadership acrossall levels and systems involving children?shealth care and a wholeheartedcommitment by those who delivercare, pay for care, and receive care.?

We are about to elect new politicalleaders, and undoubtedly some type ofreform will be promoted. Organizedpharmacy needs to consider trainingstudents and residents for new roles,strongly encouraging integrated (evenif informal) care networks with our colleaguesin community pharmacy,becoming proactive advocates forexpanding pharmacists? roles and toutingour collective impact, and educatingleaders in the public and privatesectors about the considerable potentialwe offer to improve health careoutcomes.

Are we poised for these potentialchanges? Will our national associationscollaborate at this time of opportunity?Will our schools support the necessaryeducation and training to help us leadreform? Can we develop strategies inour departments to be positive championsfor change with hospital andmedical staff leaders? What do youthink?