Impact of computerized drug profiles and a consulting pharmacist on outpatient prescribing patterns: a clinical trial.
The effects of computerized drug profiles and clinical pharmacist consultation in the internal medicine clinics at a Veterans Administration hospital were studied. Population included patients (n = 512) and physicians (n = 35) of three internal medicine clinics during an eight-week period. The first four weeks were the preintervention period. The second four weeks were the intervention period in which a clinical pharmacist attended one clinic (A) and provided drug profiles on all patients. Two other clinics (B and C) served as controls. During the intervention, patients in clinic A experienced a significant reduction in prescribing problems as identified by the pharmacist: 49 percent of patients before the intervention versus 9.4 percent after the intervention (p less than 0.001). Patients in clinic B had no significant change in prevalence in the number of problems identified (39 versus 40 percent; NS), and patients in clinic C had a significant but less dramatic decrease (35 versus 22 percent; p less than 0.05). The proportion of patients in clinic A with net decrease in the number of prescribed medications rose from 7.1 to 34.9 percent (p less than 0.001), with a mean decrease of 0.3 medications per patient. No significant differences in number of prescribed medications were noted in clinics B or C. Accuracy of physician medication charting improved for patients in clinic A from 54 percent of charts with accurate drug lists before the intervention to 78.3 percent after the intervention (p less than 0.001). No significant improvements were noted for clinics B and C. These results suggest that computerized drug profiles together with clinical pharmacist consultation can improve prescribing practices in a hospital outpatient department.
Tamai
I Y
IY
Department of Pharmacy, Veterans Administration Medical Center (SVAMC), Sepulveda, CA 91343.
Rubenstein
L Z
LZ
Josephson
K R
KR
Yamauchi
J A
JA
D000553:Ambulatory Care; D003199:Computer Systems; D011307:Drug Prescriptions; D004363:Drug Utilization; D005069:Evaluation Studies as Topic; D006801:Humans; D010607:Pharmacy Service, Hospital