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Biomedical subjects

D M Kirking

Publications and source records attributed to D M Kirking.

At least 55 records · Page 3Linked to original sources
PubMed1987

Injectable-antineoplastic-drug practices in Michigan hospitals.

Practices related to parenteral (injectable) antineoplastic drugs (PADs) in Michigan hospitals were surveyed. All hospitals in Michigan were surveyed to assess compliance with American Society of Hospital Pharmacists (ASHP) and Occupational Safety and Health Administration (OSHA) recommendations related to PADs. Other PAD-related practice issues not covered within those guidelines were also studied. Surveys were mailed to the pharmacy directors of the state's 192 acute-care hospitals. Included were questions concerning policies and procedures for ordering, storing, preparing, handling, labeling, transporting, administering, and disposing of PADs. Questions concerning staff education, spill cleanup, and personnel issues were also included. A total of 169 questionnaires were returned, yielding a response rate of 88%. Of those respondents, 132 indicated that they prepare PAD doses for inpatients. Adherence rates were high for several of the PAD-preparation recommendations, including handwashing (97%) and gloving (98.5%). Rates for gowning (71.2%), labeling of PAD doses as biohazards (chemical hazards) (73.5%), and use of Class II biological-safety cabinets (71.2%) were less favorable. Practice areas with relatively poor adherence rates included use of plastic-backed absorbent pads under PAD preparation areas (53.8%), storing PADs separately from other drugs (48.5%), informing prospective employees of potential risks of handling PADs (36.4%), availability of spill kits (36.4%), and attaching and priming i.v. tubing before adding PADs to i.v. containers (5.4%). Many pharmacy departments in Michigan hospitals can substantially improve their adherence to ASHP and OSHA recommendations related to PADs.

Antineoplastic Agents↗
PubMed1986

Detecting and preventing adverse drug interactions: the potential contribution of computers in pharmacies.

For patients taking two or more medications concurrently, interactions among the drugs can cause undesirable effects or negate desired responses. In modern pharmacy practice, an important role of the pharmacist is to detect potentially harmful interactions and take appropriate action to prevent their occurrence. Pharmacy computer systems offer potential for improving pharmacists' effectiveness in the detection and followup of drug interactions. Based on a survey of southern Michigan pharmacists, relationships between computer use and pharmacists' attitudes and activities in drug interaction monitoring were investigated. Respondents included users of two major computer systems as well as pharmacists who do not use computers. Results suggest that general statements cannot be made about the effect of computer use on drug interaction detection. Users of one of the two computer systems detected and followed up on interactions more frequently and were more likely to report improved knowledge of drug interactions than non-users. Frequencies of drug interaction detection and other related measures reported by users of the second computer system were similar to those for pharmacists not using computers. Computer system characteristics which might lead to these differences are discussed.

Computers↗
PubMed1985

Evaluation of a medication refill reminder system for a community pharmacy.

The problem of maintaining compliance in patients taking chronic medications is well established. One recommended approach to reducing this problem is to develop a system which identifies non-compliers in order that interventions can be devised to improve that behavior. A medication refill reminder system is an example of this approach. The refill behavior was observed for 102 cardiovascular patients who were patrons of one community pharmacy in order to assess the effects of a postcard/telephone reminder system. Patients who failed to refill their prescriptions on time were sent a postcard reminding them to have them refilled. A telephone call would follow if the patient failed to visit the pharmacy after the postcard. The study results showed that the average day s late for patients who failed to refill their prescription as expected decreased from 19.15 to 6.6 days after the reminder system was used (P less than 0.005). In addition, the percent of late refills of these patients was 13% less than controls. These findings provide strong evidence that a refill reminder system can be used successfully in a community pharmacy as part of a program to identify non-compliant patients and improve their compliance with chronic medication therapy.

Cardiovascular Diseases↗
PubMed1985

Evaluation of a pharmacist-managed anticoagulation clinic.

Medical records were retrospectively analyzed to evaluate the success of a pharmacist-managed Anticoagulation Surveillance Clinic (ASC). The 78 patients in group I were followed by the ASC. The 17 patients in Group II were followed by other Veterans Administration Medical Center clinics. Demographic characteristics, warfarin indication and potentially complicating conditions were comparable between the groups. Group I patients had shorter intervals between visits to the clinic than Group II patients. Although not statistically different compared to Group II, Group I patients had better prothrombin time control. Group I patients also had fewer complications per treatment year (6.9% vs 9.0%) and received fewer potentially interacting drugs. The ASC was at least as successful as the other clinics in managing patients on warfarin, and results compared very favorably to those reported in the literature for other anticoagulation clinics.

Ambulatory Care Facilities↗
PubMed1984

Relationships between computer use and pharmacists' professional behavior.

Relationships between use of pharmacy computers and performance of selected professional activities were investigated, via a survey of southern Michigan pharmacists. Respondents included users of two major computer systems as well as pharmacists who do not use computers. A net response rate of 65.7 percent (213 usable questionnaires) was achieved. In general, computer users reported encountering more drug-related problems than did nonusers and more frequent contacts with prescribers for drug-therapy problems. Little difference was found between the two groups in regard to patient counseling activities, except that computer users were more likely to use auxiliary labels. When responses from users of the two computer systems were examined separately, results suggested that one of the systems contributed positively to certain aspects of pharmacists' professional activities while the other system had little influence. These results indicate that it may not be possible to state general conclusions about the effect of computers on the professional practice of pharmacy.

Computers↗
PubMed1983

New horizons in pharmaceutical technology.

The benefits they provide have contributed toward making drugs the most commonly used treatment modality. Although drugs account for less than 10 percent of all health care expenditures, their total costs can be substantial when one considers the impact of adverse effects as well as the problems resulting from misprescribing and misuse. The 1980s will see the introduction of a large number and variety of new drugs and new ways of delivering drugs to the body. The goals of these developments include increased effectiveness, decreased seriousness and frequency of adverse effects, and less complicated dosing regimes. This new technology raises questions regarding the optimal prescribing, distribution, financing, and use of these new drugs. It is also important to consider what actions should be taken to assure that continued growth in drug technology will occur and that this growth be directed toward the development of drugs that offer significant advantages over existing therapies. Rational policy must consider not only the costs of drugs themselves but also the potential for drugs to reduce the overall cost of health care.

Cost-Benefit Analysis↗
PubMed1982

Pharmacists' perceptions of their patient counseling activities.

The counseling of patients regarding their drug therapy has been advocated as an important part of pharmacy practice. Both the need and potential for this counseling have been demonstrated. Yet, studies generally have been critical to the extent and quality of the counseling provided. This report describes counseling as it is perceived by community pharmacists who perform this activity. A mail survey, developed from interviews with pharmacists, was distributed to a random sample of Ohio community pharmacists. A net response of 76.8 percent (506 usable questionnaires) was achieved. Respondents have strong positive beliefs about counseling. When the service is provided by pharmacists, counseling sessions are usually brief, pharmacist-initiated, and one-way conversations to the patient. Although there is considerable variation as to the classes of drugs for which counseling is provided and the types of people who receive it, the components of counseling appear to be constant. Attempts to change or expand counseling activities may be compromised unless there is a common understanding among all parties involved of what counseling is. This report is one step toward achieving that understanding. It may be used by community pharmacists to measure and compare their counseling behaviors and beliefs with those of their peers and as a means of identifying possible areas for change in their own practices.

Attitude of Health Personnel↗
PubMedDate not supplied

Michigan Medicaid recipients' perceptions of medication counseling as required by OBRA '90.

OBJECTIVE: To assess pharmacist counseling under OBRA '90 from the Medicaid recipient's perspective. Specifically, the study was designed to (1) assess pharmacists' compliance with counseling requirements, (2) assess recipients' level of satisfaction with the information provided during counseling and whether the information provided increased their comfort level in taking medication correctly, and (3) determine relationships between variables associated with pharmacist counseling and recipient satisfaction and comfort level. DESIGN: Cross-sectional telephone survey of Medicaid recipients. Medicaid recipient or caregiver was the unit of measure. SETTING: Michigan. PATIENTS: 408 recipients who received new prescriptions during a one-week period in November 1995. INTERVENTIONS: Telephone survey. MAIN OUTCOME MEASURE: Recipients' perception of whether an offer to counsel was made. RESULTS: Only 104 (25.5%) recipients indicated that someone offered counseling for their new prescription, and only 62 (15.2%) recipients indicated they knew of the requirement; 163 (40.0%) indicated someone offered counseled them. Counseled recipients were satisfied with the amount, quality, and way the information was presented, and were more likely to assign a higher level of importance to pharmacist counseling. The majority of respondents indicated high levels of comfort in using their medications safely, with those who were counseled expressing a higher level of comfort. CONCLUSION: From the perspective of the Medicaid recipient, pharmacies are failing to offer counseling for most new prescriptions. The results indicate that counseling improves measures of recipient comfort in using medications safely and enhances the level of importance patients assign to pharmacist counseling.

Adult↗
PubMedDate not supplied

Historical overview of generic medication policy.

OBJECTIVE: To provide a historical perspective on controversies surrounding the use of generic drugs. DATA SOURCES: Articles were indexed initially using terms such as generic medications, generic drugs, multisource medications, and multisource drugs. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles. STUDY SELECTION: Performed by the authors, with preference given to events from 1951 to the present. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: The history of generic drug use is a history of conflict from a variety of perspectives. The primary conflict is economic, in which manufacturers of brandname pharmaceuticals aggressively seek to protect their patents from a variety of groups (e.g., the federal government, managed care organizations, consumer groups) that want access to less expensive medications. Another conflict is professional, especially for the members of the pharmacy profession who view drug product selection as an important opportunity for pharmacists to use their professional judgment. The most confusing conflict is the scientific discussion of bioequivalence and product quality. The brand manufacturers suggest that not all products are bioequivalent and of the same quality. This position has been opposed by the pharmacy profession, generic drug manufacturers, health care institutions, and the Food and Drug Administration. CONCLUSION: Generic drug use has increased dramatically during the past 50 years and is an accepted part of health care. However, the economic consequences of generic drug use are sufficiently high for this activity to continue as a source of controversy in the future.

Drugs, Generic↗
PubMedDate not supplied

Economics and structure of the generic pharmaceutical industry.

OBJECTIVE: To review key economic trends of the generic medication market and analyze the changing structure of the generic medication industry. DATA SOURCES: Articles were indexed initially using terms such as generic medications, generic drugs, multisource medications, and multisource drugs. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles. STUDY SELECTION: Performed by the authors. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: The generic pharmaceutical market has the potential to play an important role in containing drug costs, although the amount that could be saved through the use of generic medications is not easy to measure. If estimates for the future growth in the use of generic products prove correct, the proportion of pharmaceutical sales attributable to generic products will remain in the 9% to 10% range through the first decade of the 21st century. The generic pharmaceutical industry includes several categories of companies based on business strategies. Further consolidation is expected as more resources are needed to address patent challenges stimulated by the Drug Price Competition and Patent Restoration Act. Companies are also entering into partnerships with research manufacturers to share profits from proprietary products. Future growth of the generic market will require more than increased use of generic products. Therapeutic interchange, involving switching from single-source, patent-protected products to products within the therapeutic class for which there are generic equivalents, represents a major growth opportunity for generic drug manufacturers because the savings potential is more significant than that for straightforward substitution of generic for brandname products. CONCLUSION: As it responds to challenges and opportunities, the generic pharmaceutical industry will continue to be a major force shaping the economics of medication use.

Drug Industry↗
PubMedDate not supplied

Understanding the scientific issues embedded in the generic drug approval process.

OBJECTIVE: To review the major scientific issues embedded in the generic drug approval process. DATA SOURCES: Articles indexed initially under terms such as generic medications, generic drugs, bioequivalence, and bioinequivalence. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), and Science Citation Index. Additional data sources included the Code of Federal Regulations and regulatory guidances from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research. STUDY SELECTION: Performed by the authors. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Despite the fact that regulations regarding bioequivalence have been in place for more than 20 years, controversies over bioequivalence continue to arise. Consensus on many of these issues is driving the development of new FDA guidances regarding bioequivalence. Still, despite the issuance of new guidance and consensus building among scientists, many clinicians and consumers remain uninformed regarding the scientific basis for establishing bioequivalence and the generic drug approval process in general. Although some have suggested that the generic drug approval process is flawed, overall, it appears that the process works. CONCLUSION: Understanding the generic drug approval process and the issues surrounding bioequivalence is of paramount importance to both clinicians and scientists.

Drug Approval↗