Search PubMedSearch

Biomedical subjects

D A Knapp

Publications and source records attributed to D A Knapp.

13 recordsLinked to original sources

Pharmacy practice in 2040.

Pharmacy practice 50 years in the future is discussed. The practice of pharmacy in 2040 will be influenced by many trends and issues, such as increasing cultural diversity, the aging population, evolving drug and information technology, rising drug costs, and increasing third-party coverage. Pharmacy may take one of two paths. In the first scenario, institutional and community practice would drift further apart, with community pharmacy becoming more involved with retailing than with health care. In the second scenario, all pharmacists would become a vital component of an integrated, patient-centered system of health care; pharmacists, like physicians, would be salaried professionals, paid for by health-care programs financed through health insurance. The difference between the two scenarios is the degree to which pharmacists actively participate in their creation: The first will happen if pharmacists do not take action; the second will require a considerable amount of work. If pharmacists wish to see an active system of patient-centered pharmaceutical care in 2040, they must begin to create it now, regardless of their practice setting. Pharmacists must work to create a future in which they are an integral part of the health-care system.

Age Factors

Strategy for increasing the demand for clinical pharmacists.

A strategy for increasing the demand for clinical pharmaceutical services in hospitals is described. The strategy consists of three steps: (1) Show that the overall quality of drug prescribing affects patient outcomes not only in a negative way but also in a positive manner; i.e., appropriate prescribing speeds recovery and minimizes the need for more expensive types of care; (2) show that the pharmacist can detect poor quality prescribing; and (3) show that after detecting poor quality prescribing, the clinical pharmacist can effectively intervene in the prescribing process to reduce inappropriate prescribing and improve patient outcomes.

Drug Prescriptions

Low cost, manual drug use review of Medicaid recipients to screen prescriber and pharmacist performance.

A manual drug use review (DUR) methodology to screen outpatient prescribing which would meet the needs of large third-party programs that cannot afford elaborate computerized DUR was developed and pilot tested. A Medicaid drugs data base was used for the pilot test. A probability sample of 100 recipients over a three-month period was selected for the DUR. The drugs for each recipient, listed by their generic composition and amount, were recorded. Then a priori, explicit, screening criteria were developed for these generics. These criteria delineated drugs of choice, daily dose and refill patterns and, as appropriate, therapy length, drug holidays, and disease-drug and drug-drug interactions. Only 11% of recipients had prescribing patterns which passed all the screens. The most frequent screening failure was due to the prescribing of a drug which was not a drug of choice. In nearly all of the cases which failed the other screens, an alert pharmacist with patient records should have noticed these problems. An analysis showed that the initial start-up cost for the manual DUR was estimated at $1053 (not including personnel fringe benefits); for subsequent quarterly review, the cost was estimated to be about $530. The project showed that manual DUR can effectively and efficiently screen prescribing in a large third-party program.

Costs and Cost Analysis

Can pharmacists influence drug prescribing? A look at eight of the top 25 drug products for 1976.

The most frequently prescribed drug products were reviewed for insights into prescribing and dispensing patterns for ambulatory patients. The indications for eight of the "top" drug products were considered to be pharmacologically or therapeutically questionable. The drug products were: tetracycline, systemic; Dimetapp; Empirin Compound with Codeine; Actified; Darvon Compound 65; Darvocet-N; Donnatal; and Keflex. Drug prescribing review and prescriber education are crucially needed, as well as formulary controls when feasible.

Drug Utilization

Detecting prescribing problems through drug usage review: a case study.

A retrospective drug usage review was performed on 1,033 randomly sampled prescription orders from the outpatient pharmacy of a hospital and clinic system. Prescription orders were screened in accordance with criteria based on daily dosage, length of therapy or quantity dispenced, diagnosis, and labeling. The results of the study point to a number of potential prescribing problems. In addition, the study demonstrates the feasibility of collecting and analyzing drug usage data on a retrospective basis.

Diagnosis

Drug usage screening criteria.

Screening criteria for adult use of 40 drugs and pediatric use of 10 drugs are presented. The reasons for presenting the criteria are to (1) document the specific screening criteria applied in a number of drug usage review studies, (2) provide a starting point for other groups wishing to develop criteria for drug usage review and (3) seek comments to be used in improving the criteria.

Drug Labeling

Economics of institutional pharmacy services under national health insurance in Australia.

The development and effect of the National Health Scheme on institutional Health Scheme on institutional pharmaceutical services in Australia are discussed. Government control over drug costs and the provision of pharmacy services, with its effect on both community and institutional practice, is assessed. Methods of improving the present system of health insurance under the Pharmaceutical Benefits Scheme in Australia are suggested, including their relevance to health care in the United States.

Australia

Containing costs.

Explore the source record for details and available documents.

Cost Control