Rationale and model for integrating the pharmacist into the outpatient referral-consultation process.

Primary care providers refer patients to specialists when they need advice on the diagnosis or management of a particular condition; when a technical procedure, surgery, or specialized psychiatric intervention is required; or when additional expertise is needed for care of a complex chronic disease.1,2 In 2007, 3 million Canadians reported seeing a non–family physician specialist for a new condition in the preceding year.3 An effective referral-consultation process requires seamless transfer of complete, relevant information between providers. Inaccurate, incomplete, or delayed transfer of information might result in delayed access to care, duplicate testing, polypharmacy, inappropriate medication use, erosion of trust in the medical system, and increased costs.4,5 Referring physicians and consultants want medication lists and management plans to be included in communications between providers, yet there continues to be a gap in what is expected and what is provided.6 The potential for drug interactions, redundancies, or use of previously ineffective or not tolerated medications is substantial when there are failures in communication. Delays in initiating effective medications might occur when there is uncertainty about who is responsible for implementing and monitoring new therapies. Opportunity exists for innovative models to involve pharmacists in the referral-consultation process.