Training and activities of pharmacist prescribers in a California pilot project.

The training of pharmacists allowed to prescribe under protocol in California health manpower pilot projects (HMPPs) and the specific program at San Francisco General Hospital (SFGH) are described. From 1972 to 1983, several bills were passed allowing pharmacists to prescribe and administer drugs or devices in HMPPs under specified conditions. The main objective of the HMPPs was to train pharmacists to assist physicians and other providers in providing good follow-up care for chronically ill patients. Programs for pharmacists consisted of a training phase followed by an employment phase in which all primary care delivered by the pharmacists was performed under protocols and supervised by physicians. At SFGH ambulatory-care clinics beginning in early 1978, a pharmacist assisted by a licensed vocational nurse monitored patients receiving anticoagulant therapy. A cardiologist reviewed all the medical records at the end of each clinic period. Through July 1, 1983, 3,800 patients had been seen at the SFGH site; a total of 201,000 patients were seen by all HMPP pharmacists. Questionnaires answered by the supervising physicians and by patients indicated that pharmacists prescribed appropriately and were accepted in their roles as primary-care providers. Evaluations of the HMPPs at SFGH and at other sites indicate the success of and the need for these innovative programs.