Therapeutic outcomes monitoring: application of pharmaceutical care guidelines to community pharmacy.
OBJECTIVE
To design a pharmaceutical care model, and develop and field test a set of community pharmacy guidelines and practice support materials--Therapeutic Outcomes Monitoring (TOM) modules.


METHODS
Concept interviews with pharmacists, physicians, and patients; development and field testing of practice guidelines.


METHODS
Community pharmacies.


METHODS
Five independent, five chain, and two clinic site pharmacies.


METHODS
A prototype TOM module for asthma was developed through a seven-step process. Concept interviews were held with pharmacists, physicians, and patients to determine the desirability and feasibility of the TOM concept, prototype, and materials. Two field tests were completed and modifications made. Results were gathered through further concept interviews at the completion of the second field tests.


METHODS
Participants' opinions and experiences.


RESULTS
Pharmacists, physicians, and patients expressed favorable attitudes about community pharmacists' participation in this pharmaceutical care model. Of the 12 participating pharmacists, 7 successfully implemented TOM in their practice sites and participated in the project throughout the testing; 49 patients were recruited into the study; and 22 patients remained in the program at the end of the second field test. In providing TOM services to these patients, the two most problematic areas for the pharmacists were in documenting care and reporting to physicians. A final phase of the TOM project has not been conducted in the United States because of insufficient numbers of patients for evaluating patient outcomes.


CONCLUSIONS
The TOM project was successful from a technical but not a marketing perspective. Useful practice guidelines can be written and taught to pharmacists. Enrollment of patients was difficult, and the concept is not likely to spread spontaneously within the existing market for pharmaceutical services.
Grainger-Rousseau
T J
TJ
Faculty of Pharmaceutical Sciences, University of British Columbia.
Miralles
M A
MA
Hepler
C D
CD
Segal
R
R
Doty
R E
RE
Ben-Joseph
R
R
D001249:Asthma / Q000188:drug therapy; D003157:Community Pharmacy Services / Q000592:standards*; D016903:Drug Monitoring; D004358:Drug Therapy / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D016730:Program Development