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Biomedical subjects

D K Helling

Publications and source records attributed to D K Helling.

At least 37 records · Page 2Linked to original sources
PubMed1984

Clinical pharmacy services in family practice: cost-benefit analysis. I. Physician time and quality of care.

The objectives of this study was to identify benefits and costs that a family practice clinic could expect to incur by including a clinical pharmacist in that clinic, to derive equations to estimate the magnitude of each benefit and cost, to discuss the rationale for each equation, and to demonstrate the application of these equations through the use of sample calculations. The benefits, freed physician time and improved quality of care, are discussed. The physician's time is freed since the clinical pharmacist can provide many services that were provided previously by a physician. Quantification is based on a determination of the amount of time spent by physicians in providing specific services and the proportion of those services that could be assumed by a clinical pharmacist. Literature sources document an improvement in quality of care due to clinical pharmacy services. The principle used to quantify this improvement in the quality of care involves determining a monetary value for this care before the addition of a clinical pharmacist. This baseline quality of care value is then multiplied by the projected fractional increase in the overall quality of care that would result from the inclusion of a clinical pharmacist.

Chronic Disease↗
PubMed1984

Clinical pharmacy services in family practice: cost-benefit analysis. II. Referrals, appointment compliance, and costs.

The benefits, decreased referral rate and increased kept-appointment rate, and the costs that a family practice clinic could expect to incur by including a clinical pharmacist in the clinic are discussed. By using a clinical pharmacist as a consulting partner, the physician would have a decreased need to refer patients to specialists not affiliated with the medical practice. The benefit to the practice is the revenue from office and hospital visits that would not have been received had these patients been referred elsewhere. Involvement of a clinical pharmacist in providing drug therapy management for patients with selected chronic diseases results in an increase in office appointment compliance rates. The benefit to the practice is the revenue generated by the increased number of office visits per year. Costs that would be incurred by the practice include: physician time spent due to the increased number of office visits generated by the decreased referral rate and increased appointment compliance; increased operating expenses, including the clinical pharmacist's salary and fringe benefits; and the developmental expense of establishing a reference library for the clinical pharmacist.

Appointments and Schedules↗
PubMed1984

Evaluation of family physician prescribing: influence of the clinical pharmacist.

This study was designed to determine whether prescribing patterns in family practice residency training offices were more favorable in offices with clinical pharmacists. Two family practice residency training offices with clinical pharmacists and two offices without clinical pharmacists served as study sites. At each office, 100 prescription copies were selected by stratified random sampling, and a case abstract was constructed from the medical record. An additional 38 prescriptions that resulted from clinical pharmacist consultation were studied. A blinded review panel evaluated the cases for appropriateness of drug choice and dose and anticipated benefit of the prescription. Prescriptions from offices with clinical pharmacists and consult prescriptions were rated significantly more favorably both for drug choice and drug dose (p less than 0.02). These data suggest that clinical pharmacists involved in family practice residency programs may refine and improve otherwise acceptable prescribing.

Drug Prescriptions↗
PubMed1984

Capitation payment for pharmacy services. I. Impact on drug use and pharmacist dispensing behavior.

Results of a two-county pilot study in Iowa revealed that capitation may have significant advantages over fee-for-service (FFS) reimbursement in the Medicaid drug program. Consequently, the capitation program was expanded to 32 counties on April 1, 1981 and continued through December 31, 1981. Another 32 counties were used as part of a before:after/experimental:control design. Pharmacists were paid 80% of projected drug expenditures in advance based on the types of Medicaid eligibles who chose them as their providers. The remaining 20% was withheld in an escrow account to be used for supplemental, emergency, and bonus payments. Pharmacists who participated in this experiment were guaranteed that their gross profits on Medicaid prescriptions would remain at least equal to what they would have been if they had remained under the current FFS payment system. Major differences in drug use levels and pharmacist dispensing behavior under capitation financing were observed in the pilot study. However, no such changes associated with payment type were noted in the expanded program. Relative to these findings, a discussion of pharmacist attitudes is presented.

Attitude of Health Personnel↗
PubMed1984

Multicenter study of family physician prescribing.

The objective of this study was to examine differences in prescribing characteristics among four Iowa family practice offices, each associated with family practice residency programs. This prospective study collected data over a four-month period, utilizing duplicate, carbon-copy prescriptions. The prescriptions were tabulated according to individual drug and therapeutic categories. Differences in prescribing frequency among offices were analyzed using chi-square 2 X 2 contingency tables. The number of prescriptions written at each office (designated A through D) were as follows: A, 1,034; B, 1,449; C, 2,965; and D, 2,335. The most frequently prescribed drug category was systemic antibiotics, followed by cough, cold, or allergy products, analgesic and anti-inflammatory drugs or muscle relaxants, diuretics, and topical anti-infectives. There were statistically significant differences in the frequencies of these categories among offices. The most frequently prescribed drug was amoxicillin at offices A, B, and C, and erythromycin at office D. There were statistically significant differences in the frequencies of the top ten drugs at each office. From these data the family practice faculty and clinical pharmacists can identify therapeutic areas that may require additional educational emphasis for the resident.

Drug Prescriptions↗
PubMed1983

Association between appropriateness of prescribing and prescription documentation.

The association between the quality of physician prescribing and the degree of prescription documentation in the medical record was studied in four family-practice offices. Carbon-copy prescriptions were collected for five months at each office, and 438 were randomly selected for evaluation. For each prescription, a case abstract was prepared from the medical record. The abstract summarized the patient's previous care related to the problem for which the prescription was issued. The abstracts were blinded and randomly assigned for review by a panel of physicians and pharmacists working in family practice, resulting in a total of 1866 evaluations. Each panelist evaluated appropriateness of drug choice, potential benefit, and degree of prescription documentation. Actual prescription documentation of drug name, strength, quantity, directions, and refills was determined by comparing the carbon-copy prescription with the medical record. Multiple regression analysis revealed a significant correlation between panel evaluations for drug choice and actual documentation of drug name, strength, and directions. Likewise, the mean rating of potential benefit was significantly associated with actual documentation of drug name, strength, directions, and refills. The mean rating of appropriateness of documentation was significantly associated with all five independent documentation variables. Drug name, strength, and directions were recorded in 94%, 60%, and 75% of the medical records, respectively. These data demonstrate a positive association between the quality of prescribing and actual prescription documentation in the medical record.

Analysis of Variance↗
PubMed1982

An assessment of prescribing using drug utilization review criteria.

Drug utilization review screening criteria were applied to a sample of 30 000 prescriptions written by Iowa physicians. Characteristics of the physicians who had high percentages of prescriptions violating the explicit criteria were examined. It was found that the proportion of prescriptions failing the screening criteria did not differ significantly among physicians of differing board certification groups, medical school of graduation, year of graduation from medical school, age, or size of town where the physicians practiced. Regardless of the physicians' demographic characteristics, approximately 50 percent of their prescriptions violated the prescribing criteria. The three categories of screening criteria included irrational mixture, quantity prescribed, and daily dosage. An analysis of the relationship between physician ratings obtained for each of the categories revealed that no relationship existed between a physician's quantity prescribed rating and daily dosage rating, or between a physician's irrational mixture rating and daily dosage rating. A negative relationship was found between a physician's quantity prescribed rating and irrational mixture rating. This tends to indicate that the three categories measure different prescribing patterns and each warrants respective monitoring by pharmacists.

Drug Prescriptions↗
PubMed1982

Inadequately written prescriptions: prescriber rationales for "take as needed" and "take as directed.".

An audit of a large sample of prescriptions written by 39 physicians revealed considerable variation in the rate at which they specified adequate dosage instructions. When asked for their rationales for saying "Take as needed" or "Take as directed" on prescriptions, the physicians cited several circumstances where these instructions may be indicated. "Take as directed;; is defended 1) when the patient has a history of compliance with the regimen being prescribed; 2) when the prescription is accompanied by verbal or auxiliary written instructions; 3) when oral contraceptives are ordered; and 4) when the prescribers may need to make frequent changes in a regimen and wish to communicate these changes orally. "Take as needed" is defended when the drug is to be taken only when the patient determines that sufficient symptoms have appeared. Prescribers are cautioned to consider whether the assumed advantages of nonspecific dosage instructions are outweighed by the possible risks of patient confusion.

Drug Labeling↗
PubMed1982

Model for cost-benefit analysis of clinical pharmacy in family practice.

A cost-benefit analysis (CBA) model that can be used to estimate the economic consequences expected from the inclusion of clinical pharmacy services in a family practice clinic was developed; use of the model was demonstrated by applying it to a hypothetical solo-physician practice. The effects that clinical pharmacy services would have on the medical practice were evaluated and classified as either costs or benefits. Equations were derived to quantify all direct effects. Semi-structured, open-ended interviews of 15 family practice physicians and five family practice clinical pharmacists were conducted to generate data describing a hypothetical solo-physician practice. Responses from these interviews were averaged to provide the numerical values called for by the equations in the CBA model. The difference between total costs and total benefits was the net benefit that could be expected by the hypothetical solo-physician practice for the first year after including a clinical pharmacist in that practice. The net benefit determined by these calculations was $2744 assuming a 5% increase in overall quality of care, or $25,658 assuming a 20% increase in overall quality of care. The net-benefit figure obtained by applying the CBA model to the hypothetical case should not be generalized to other practices. Rather, by applying the CBA model, practitioners and administrators can calculate the expected net benefit specific for their particular medical practice.

Cost-Benefit Analysis↗
PubMed1982

Antibiotic use review in ambulatory care using computer-assisted medical record audit.

The use of a computer-assisted medical record audit (CAMRA) for reviewing antibiotic use in ambulatory patients was evaluated. A random sample of 40 medical records documenting treatment of streptococcal pharyngitis, otitis media, or acute, uncomplicated urinary tract infections at two family practice clinics was used to evaluate the accuracy and efficiency of computerized prescription screening and CAMRA relative to medical record audit (MRA) alone. Accuracy was the ability to correctly classify antibiotic therapy as appropriate or inappropriate. The initial computerized prescription screening criteria were modified to reduce the proportion of false positives and negatives and a second random sample of 40 medical records was audited. The computerized prescription screening was the most efficient method, requiring less than one hour of professional time to audit 80 medical records. MRA and CAMRA took 17.4 and 3.0 hours, respectively. By definition, MRA was 100% accurate. Computerized prescription screening and CAMRA correctly classified 73% and 78% of the medical records, respectively. The results of this study are similar to a previous study reviewing antihypertensive therapy, but this study showed CAMRA less favorably. This is primarily because of the many diagnoses for which a particular antibiotic can be prescribed and the wide dosage ranges for antibiotics based on body weight. CAMRA could be more useful for evaluating antibiotic therapy if diagnostic information were available before doing the computerized prescription screening and if the computerized prescription screening criteria included patient diagnosis and body weight.

Ambulatory Care↗
PubMed1982

Patient care telephone calls received in family practice offices.

The majority of patients care calls referred to practitioners at each of two family practice office study sites were related to medications. However, there were significant differences in the proportion of patient care calls managed by staff physicians, family practice residents, and clinical pharmacists which involved discussion of medication. There were also significant differences in the callers and types of medication related calls managed by each practitioner group. Calls initiated by patients and those classified as refill requests accounted for the largest proportion of calls managed by staff physicians, residents, and clinical pharmacists. The majority of calls received by each practitioner group were managed without consultation. A follow-up office visit was recommended in approximately one half of all medication related calls. The findings of this study may be useful in determining the personnel required to manage medication related telephone calls and in identifying potential areas for education and training of personnel in family practice.

Delivery of Health Care↗
PubMed1982

Comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices.

A comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices is described. A peer review panel, composed of two family practice physicians and two clinical pharmacists not involved in the study, evaluated the appropriateness of management in 102 medication-related telephone calls. The effects of the following variables on the management ratings were determined by analysis of variance: (1) provider group (staff physicians, family practice residents, clinical pharmacists); (2) caller (patient, community pharmacist, third party, e.g., family member or friend); (3) type of medication-related telephone call (refill, new medication, drug information, or other); (4) consultation with another provider; and (5) recommendation for follow-up. Among the provider groups, a larger proportion of the calls to clinical pharmacists (72.6%) received the highest management rating of "appropriate, best alternative available" compared with staff physicians (39.7%) and residents (34.6%). Analysis of variance indicated that the management by clinical pharmacists was rated significantly more favorably than management by staff physicians or residents (p less than 0.05).] Statistical analyses also indicated that the differences in the management ratings among the provider groups were not explained by differences in the callers, type of medication-related call, consultation with another provider, or recommendation for a follow-up. These data suggest that clinical pharmacists may contribute substantially to improved patient-care through the management of medication-related telephone calls.

Community Pharmacy Services↗
PubMed1981

Comparative trial of two sulfisoxazole regimens in acute urinary tract infection.

Many clinicians are utilizing a 2-g loading dose of sulfisoxazole in the treatment of uncomplicated urinary tract infection. Although some of these clinicians understand the theoretical reasons for not utilizing such a treatment plan, they may be reluctant to depart from the official recommendations for sulfisoxazole because of the lack of supporting clinical data. The findings of this study provide support for the theoretical considerations outlined previously. Also, considering the potential disadvantages of the loading dose employment, for example, source of patient misunderstanding and complicated patient instructions data supporting the omission of a sulfisoxazole loading dose should be most welcome. In conclusion, the study results suggest that the inclusion of a 2-g loading dose of sulfisoxazole in the treatment of this sample of acute, uncomplicated urinary tract infections did not offer any therapeutic benefit.

Acute Disease↗