Objective: To describe the extent of and factors associated with the provision of pharmaceutical care services (PCS) and value-added pharmaceutical services (PS) by pharmacists in North Carolina, the physical changes made in pharmacies to accommodate these services, the nature and extent of prior consent or collaborative practice arrangements between North Carolina pharmacists and prescribers, and the frequency of reimbursement for PCS.
Design: Descriptive study based on a mail survey.
Participants: Pharmacist-managers at each of the 2,048 licensed pharmacy sites in North Carolina; a list of licensed pharmacies provided by the North Carolina Board of Pharmacy was used as the sampling frame.
Main outcome measures: Pharmacists' reports of PCS and pharmacy demographics.
Results: Response rate was 40%. More than 30% of respondents provided PCS at their site, although only 20% met our more stringent definition of PCS (i.e., ensuring appropriate pharmacotherapy, ensuring patient understanding and adherence, and monitoring and reporting patient outcomes). Services were more frequently offered by university-affiliated (35%) or independent (32%) pharmacies. The median number of patients receiving PCS across all sites was 10 per week. Diabetes was the most common health problem for which PCS were offered. Three variables-weekly prescription volume (positive correlation); number of staff pharmacists with advanced training, specifically fellowship training; and medical clinic/health maintenance organization setting-were significant predictors of the numbers of patients provided PCS. Independent community pharmacies were most likely to have private counseling areas and to bill for and receive payment for PCS.
Conclusion: In North Carolina, a substantial number of pharmacists provided PCS in 1999 or planned to do so in the near future. However, the number of patients receiving PCS was relatively low. Practice setting, pharmacist education level, and prescription volume were weakly predictive of the number of patients receiving PCS. Pharmacists commonly used prior consent arrangements with physicians in their practices, but primarily to facilitate generic substitution. Relatively few pharmacists billed for PS or PCS.