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Biomedical subjects

D S Pathak

Publications and source records attributed to D S Pathak.

At least 55 records · Page 3Linked to original sources
PubMed1986

Medication errors in a pharmacy-coordinated drug administration program.

The medication error rate in a pharmacy-coordinated drug administration program was determined. During a five-week study period, two pharmacy interns observed pharmacy technicians administering medications to patients on five nursing units. Observations were made from 0800 to 1200 and from 1700 to 2100, Monday through Friday. The ASHP Standard Definition of a Medication Error served as the basis for the classification of medication errors. A total of 2028 usable observations were made. The predominant type of error was wrong-time error. The overall medication error rate was 4.4%; excluding wrong-time errors yielded a medication error rate of 1.6%. Comparison of this medication error rate with those of other studies must be made cautiously, with consideration given to methods, study objectives, and definitions.

Humans↗
PubMed1985

ABC analysis of the relationship between pharmacy charges and DRGs.

DRGs and pharmacy charges were analyzed using the ABC analysis for a cross section of hospitals represented in the Blue Cross of Central Ohio (BCCO) region and for Riverside Methodist Hospital (RMH). A total of 43,969 patients were discharged from the 43 BCCO hospitals and 6,121 patients from RMH in the one-year study period. They were retrospectively assigned to 465 and 371 DRG categories, respectively. The ABC analysis of pharmacy charges and DRGs showed that 10 major diagnostic categories (MDCs) accounted for 80.4% and 80.1% of all pharmacy and i.v. charges for the BCCO hospitals and RMH, respectively. Hospital charges were found to be strongly related to pharmacy charges, and length of stay was found to be moderately related to pharmacy charges. In the absence of pharmacy cost data per DRG, the ABC analysis can be used to categorize DRGs on the basis of pharmacy charges. Before using pharmacy or hospital charges data per DRG for resource monitoring, hospital pharmacy directors should investigate the causes of high pharmacy charges for the high-cost DRGs and MDCs.

Blue Cross Blue Shield Insurance Plans↗
PubMed1983

Marketing perspectives of hospital pharmacy directors.

The familiarity of hospital pharmacy directors (HPDs) with various marketing concepts for the development of pharmaceutical services was assessed. A questionnaire was designed to assess whether (1) HPDs seek input from relevant publics when evaluating or designing pharmaceutical services; (2) HPDs use marketing concepts in the development and implementation of pharmaceutical programs; and (3) marketing perspectives of HPDs differ depending on their institutional affiliations and personal characteristics. The questionnaire was sent to 320 HPDs in seven states. A total of 158 unable questionnaires were received. In response to the questions concerning input from relevant publics, HPDs agreed that they should seek input from all relevant publics with the exception of third-party agencies and patients. HPDs put more emphasis on obtaining information for evaluating existing programs and designing long-term plans from physicians, nurses, patients, and hospital administrators and less emphasis on understanding the needs of third-party agencies. HPDs seem to use marketing concepts in the development and implementation of pharmaceutical programs. HPDs indicated a clear perception of pharmacy goals, target segments among relevant publics, and a dynamic orientation toward changes in the health-care marketplace. Hospital size, level of pharmaceutical education, and years of administrative experience were found to influence the marketing perspectives of HPDs. HPDs were familiar with marketing concepts, and a favorable climate seems to exist for transferring marketing approaches to the hospital pharmacy setting.

Attitude of Health Personnel↗
PubMed1980

Influence of attitudes, normative beliefs, and situational variables on physicians' use of pharmacists as drug information consultants.

The Fishbein Behavioral Intention Model was used as a conceptual framework to explain physicians' use of pharmacists as drug information consultants (DICs) at a Midwest teaching hospital. Questionnaires based on the Fishbein model were mailed to 405 physicians practicing in a teaching hospital. The questionnaire explored the effects of situational variables and of physicians' attitudes and normative beliefs on the use of pharmacists as DICs. The response rate was 22.9%. Regression analysis showed the principal determinant of a physician's intention to use a DIC was the presence of a situation involving an adverse drug reaction. Physicians sought DIC services strictly for their functional benefits. The findings indicated that physician acceptance of DICs can be increased by documenting the benefits of DIC services, and by increasing pharmacist accessibility in the patient-care setting. Comprehensive theroretical frameworks with the Fishbein model can be used to explain and predict physician interaction with DICs and to develop strategies for altering physician behavior.

Attitude of Health Personnel↗
PubMed1980

Drug regimen review in skilled nursing facilities by consulting clinical pharmacists.

The organization and operational methods of clinical pharmacists providing contractual pharmaceutical services in skilled nursing facilities (SNFs) are described, and the use of a model toidentify drug therapy problems is analysed. A group of clinical pharmacists incorporated as Clinical Pharmacy Consultants (CPC) provided consultative services through contractual agreements with pharmacy vendors or SNF administrators. Using a drug regimen review model designed by CPC, the consulting pharmacists reviewed 13,081 medical charts at 10 SNFs. Of the reviews, 928 (7.1%) indicated potential or real drug therapy problems; on an annual basis this corresponds to approximately eight drug therapy problems per 10 beds per year in an SNF. About 60% of the problems could be attributed either to prescribing of medication with no documented indication (23.9%) or to lack of objective data for monitoring drug therapy effectiveness (34.6%). Because these problems are related to disease state management, it was concluded that consulting clinical pharmacists could help to improve patient care in SNFs, primarily through drug therapy review and staff consultation.

Consultants↗
PubMed1980

Research design: sampling techniques.

Conditions affecting the decision of whether to take a census or a sample; the major types of sampling procedures, both probability and nonprobability;; and the statistical approaches to sample size determination for simple random samples are discussed. An overview of selected terms and symbols used in sampling literature and a checklist of basic questions to guide a researcher interested in using sampling for a study are provided. While the researcher can control sampling error by increasing the sample size, the concern should be the magnitude of the total error for the study (both sampling and nonsampling errors).

Pharmacy Service, Hospital↗
PubMed1979

Cost-effectiveness of clinical pharmaceutical services: a follow-up report.

The cost-effectiveness of pharmacist-conducted training programs for patients self-administering at home antihemophilic factor, calcitonin, cytarabine, injectable analgesics and parenteral nutrients was studied. Records of 35 patients participating in the training programs from September 1976 through August 1978 were reviewed. The benefits of the patient training programs were measured by approximating the days of hospitalization or outpatient visits saved (and their related costs) per patient. For every dollar charged by the pharmacy service for the patient training programs, 1.25 days of hospitalization and $321.90 in hospital charges were saved. The cost-effectiveness ratios demonstrated the benefits of the patient training programs. Third-party reimbursement can be improved by designing comprehensive measures of cost-effectiveness.

Cost-Benefit Analysis↗
PubMed1979

Developing reimbursable clinical pharmacy programs: a goal-oriented approach.

Using a goal-oriented approach, a model for achieving third-party reimbursement for clinical pharmaceutical services is proposed. Within the framework of this model, the discussion includes: (1) determination of the hospital pharmacy mission, goals and objectives; (2) classification of clinical services into eight categories to establish the reimbursement potential for each service; (3) development of a clinical service protocol, techniques to establish charges and stages involved in communicating with the parties affected by the clinical services; and (4) methodologies for evaluating program outcome.

Evaluation Studies as Topic↗
PubMed1977

Third-party reimbursement for clinical pharmacy services: philosophy and practice.

A step-by-step approach is outlined for obtaining third-party reimbursement for clinical pharmacy services separate from dispensing fees. The program is based on a patient-care philosophy rather than a cost-conscious philosophy. The steps in implementation of the program were: (1) a total commitment to the patient's health, (2) identification of patient needs that require clinical pharmacy expertise, (3) development of a patient training program, (4) presentation of a written proposal to the hospital administration, (5) presentation of the proposal to third-party agencies, (6) initiation of charges for the services, and (7) preparation of reports on the progress of the program. Third-party reimbursement covers pharmacist instruction of home therapy patients receiving antihemophilic factor, cytarabine, parenteral nutrition, calcitonin-salmon and injectable analgesics. Financial data based on one year's experience with the program show that savings far outweight the charges.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Two approaches to comparing hospital charges between cadaveric renal transplant patients who received orthoclone OKT 3 sterile solution or Atgam sterile solution for induction therapy.

The objectives of this study were: (1) to compare total hospital charges for a sample of cadaveric renal transplant patients categorized according to the type of induction therapy used (Orthoclone OKT3 Sterile Solution or Atgam Sterile Solution); (2) to compare specific charge categories between the two groups; and (3) to examine the relationship between charges and a set of independent variables. A retrospective review was conducted of hospital charges associated with a sample of renal transplant patients. The overall sample for this study comprised 510 patient discharges from 22 hospitals in the United States. Comparisons between the OKT3 and Atgam groups were made for total and specific charge categories using two different approaches to help control variations in charges that were not related to the type of induction therapy used. The first approach consisted of t test or chi-square comparisons between the groups for subsets of observations that had been identified in a stepwise fashion. These judgment samples were defined to remove sources of variation in charges other than those resulting from the type of induction therapy selected. The second approach used multiple linear regression analysis to help statistically control variation in charges from other sources. The results showed that higher drug charges in the Atgam group were offset by lower charges in other categories (P < 0.05). These findings suggest that hospital formulary committees should consider all relevant costs, not just drug acquisition costs, when selecting products. However, further investigation is warranted to explore differences in charges due to: (1) between-hospital variation; (2) patients' severity of illness before receiving induction therapy; and (3) differences in side-effect profiles for the two induction therapies.

Antilymphocyte Serum↗
PubMedDate not supplied

Cost-effectiveness analyses of the conversion of patients with non-insulin-dependent diabetes mellitus from glipizide to glyburide and of the accompanying pharmacy follow-up clinic.

At the Department of Veteran's Affairs Outpatient Clinic in Columbus, Ohio, patients with non-insulin-dependent diabetes mellitus who were receiving glipizide therapy were converted to glyburide therapy over a 6-month period starting in mid-1993. A pharmacy follow-up clinic was instituted to help patients with problems associated with the transition. The conversion was intended to reduce costs by converting from a more expensive to a less expensive drug (in terms of acquisition cost) within the same therapeutic class. An initial analysis of the conversion indicated a savings of $65,000.00 to the Department of Veterans' Affairs (VA) based on the drug acquisition cost differential alone. The purpose of our study was to retrospectively evaluate the cost-effectiveness of the conversion and pharmacy follow-up clinic from the perspective of the VA pharmacy department. Relevant costs and effectiveness (percentage of patients who achieved good glycemic control) were examined for three groups: group I--patients who were treated with glipizide, group II--patients who were treated with glipizide; group II--patients who were switched from glipizide to glyburide, accompanied by a pharmacy follow-up clinic; and group III--patients who were switched from glipizide to glyburide, with no follow-up clinic. Overall, group II had the lowest costs, and group II had to be the most effective. Cost-II effectiveness analysis indicated that, in general, the conversion from glipizide to glyburide was cost-effective. Incremental analysis performed for the follow-up group over the no follow-up group showed that for every 1% of patients who achieved good glycemic control, the VA would spend $1.01 more for the follow-up groups. This was considered to be cost-effective for the VA.

Adult↗
PubMedDate not supplied

Postcard and telephone reminders for unclaimed prescriptions: a comparative evaluation using survival analysis.

OBJECTIVE: This study investigated unclaimed prescription reminders with the goal of developing practical and useful recommendations for pharmacies interested in reminding patients to pick up unclaimed prescriptions. Based on the recipient and mode of the reminder notification, this study measured differences in unclaimed prescription pickup time. DESIGN: This study was conducted using a convenience sample of three independent pharmacies in a large Midwestern city. A total of 120 subjects with prescriptions remaining unclaimed after 3 or 4 working days were included in the study. Once identified as unclaimed, these prescriptions were randomly assigned into a control group or one of the following four intervention groups: (1) a telephone reminder to the patient, (2) telephone notification to the prescribing physician, (3) a postcard reminder to the patient, and (4) postcard notification to the prescribing physician. RESULTS: The results suggest that different methods of pharmacist-initiated reminder systems may affect time to prescription pickup in community pharmacy practice. Marginally significant differences were found among the five study groups and the time to prescription pickup (P = .09). Compared with the control group, neither telephone nor postcard reminders--to patients or physicians--significantly decreased the mean number of days to pickup of potentially abandoned prescriptions. CONCLUSION: The actual value of an unclaimed prescription reminder program may reside in improved relationships with customers and with the medical community. The effort and expense of implementing and maintaining an unclaimed prescription reminder system should be balanced against the opportunity to establish and improve pharmacist-patient and pharmacist-physician relationships. Further research in different pharmacy settings should investigate the effectiveness of (1) postcard versus telephone reminders, (2) physician versus patient notification, and (3) the effects of reminders on patient outcomes.

Community Pharmacy Services↗