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July 1999

Pharmacy-Based Evaluation and Treatment of Minor Illnesses in a Culturally Diverse Pediatric Clinic

Author Affiliations

From the School of Pharmacy (Dr Kalister and Mss Read, Walters, and Hrachovec), Division of General Pediatrics, Department of Pediatrics, School of Medicine (Drs Newman and Graham), the International Health Program (Dr Newman), and the Social and Behavioral Science Program (Ms Hrachovec), School of Public Health and Community Medicine, University of Washington, and the Harborview Medical Center (Drs Kalister and Graham and Mss Read, Walters, and Hrachovec), Seattle.

Arch Pediatr Adolesc Med. 1999;153(7):731-735. doi:10.1001/archpedi.153.7.731

Background  Among medically underserved immigrant parents, access to nonprescription medicines for home treatment of minor childhood illnesses may be limited by scarce financial resources or language barriers.

Objectives  To design and implement a new clinical service for an urban ambulatory pediatric clinic with a large immigrant population that allows pharmacists to evaluate and to treat children and adolescents aged 6 months to 19 years with minor acute illnesses and to provide bilingual patient education materials.

Methods  We developed protocols and encounter forms for pharmacist evaluation of 5 pediatric conditions: cough/cold, fever, diaper rash, vomiting/diarrhea, and head lice. We published bilingual patient education materials for these conditions in 8 commonly spoken languages. We assessed safety by throughly reviewing the medical records of all patients who returned within 1 week of a pharmacy encounter and by asking parents in a telephone survey to compare services received through the pharmacy and the acute care clinic for treatment of the common cold.

Results  During the first year of this pilot program, 191 patients were evaluated and treated, 145 (76%) for cough/cold. Seventy percent of the patients were immigrants. No unexpected or adverse outcomes were detected, although occasional deviations from established protocols were noted. Parent satisfaction with the pharmacy service was high, and similar to that received through the standard acute care clinic. Patients evaluated by pharmacists were more likely to be attended to promptly (<15-minute wait) and were more likely to receive written information than patients evaluated by physicians for similar conditions.

Conclusions  Pharmacist evaluation and treatment of minor pediatric illnesses seems to be both safe and well accepted. Further studies are needed to evaluate the cost-effectiveness of this service in diverse settings. In states that allow pharmacists to have prescriptive authority, pharmacy-based evaluation and treatment may improve access to care for children with minor illnesses.