Search PubMed⌕ Search

Biomedical subjects

J D Grabenstein

Publications and source records attributed to J D Grabenstein.

At least 19 recordsLinked to original sources
PubMed1999

Health-system pharmacists' role in immunizing adults against pneumococcal disease and influenza.

The role of pharmacists in immunizing adults against pneumococcal disease and influenza is discussed. Pneumococcal disease and influenza each cause up to 40,000 deaths annually in the United States. Vaccination against these diseases is encouraged for all people 65 years of age or older and for those with certain chronic diseases or immunosuppression. Influenza virus vaccine should also be given to residents of long-term-care facilities, many pregnant women, and health care workers. Pneumococcal vaccine is usually given once in a lifetime; influenza virus vaccine is given annually in the fall. Advocacy of immunization is consistent with the precepts of pharmaceutical care, and pharmacists can promote immunization by assuming the roles of educator, facilitator, and immunizer. Despite lack of specific mention of it in accreditation standards, health-system personnel have a duty to vaccinate adults, just as they do pediatric patients. Pharmacists should review immunization records with patients periodically and at the time of immunization. As with other drug products, formulary decisions and the distribution, storage, and handling of vaccines are important pharmacist responsibilities. Pharmacoeconomic studies have demonstrated the value of pneumococcal and influenza virus vaccines. Medicare covers these vaccines under Part B. Pharmacists have an important role to play in promoting adult immunizations against pneumococcal disease and influenza.

Adult↗
PubMed1998

Pharmacists as vaccine advocates: roles in community pharmacies, nursing homes, and hospitals.

Pharmacists increasingly take on immunization roles for their communities: advocates, facilitators and immunizers. Between 50 and 94% of people who receive a pharmacist's recommendation to be immunized accept that recommendation. Over 5 million doses of influenza vaccine per year are administered in pharmacies. In 25 states, pharmacists are authorized to administer immunizations. More than 1000 pharmacists were trained to immunize in 1997. Consultant pharmacists can recommend vaccines in nursing facilities in the course of monthly drug regimen reviews. People have exceptional access to pharmacist at a wide variety of hours. Pharmacy-based immunization training incorporates safeguards that mimic or exceed quality standards in public-health clinics.

Health Knowledge, Attitudes, Practice↗
PubMed1998

Should vaccines require a prescription?

OBJECTIVE: To review the rationale for requiring prescriptions to control vaccine access, in contrast to other medications. DATA SOURCES: Literature on immunization delivery and health-service barriers was reviewed via MEDLINE search and relevant textbooks. Additional literature was obtained from reference lists of pertinent articles. DATA SYNTHESIS: Society controls access to medications to protect consumers. Many medications have changed from prescription-only to over-the-counter (OTC) status. No parenteral drug has been switched, although insulin has long had OTC status. Limiting access to vaccines has advantages in record-keeping, storage, injection quality, and response to anaphylactic reactions. These advantages are outweighed by 600000 people who will die over the next decade for lack of pneumococcal and influenza immunizations. Physicians see most of those who die of these diseases, but many neglect to vaccinate them. Three options are offered to expand access to these vaccines. The most feasible one involves expanding prescribing authority for pneumococcal and influenza vaccines to all licensed healthcare professionals and paraprofessionals with physiologic and pharmacologic expertise to responsibly vaccinate. Community pharmacies offer advantages as immunization delivery sites, in terms of proximity, hours of operation, and knowledge of people at highest risk. Expanded professional training can ensure high levels of public safeguards while expanding immunization delivery. CONCLUSIONS: Society decides the controls needed to protect the health of the people. If society restricts vaccine access too severely, people die needlessly. Increasing prescribing authority for pneumococcal and influenza vaccines to more health professionals will save many lives.

Humans↗
PubMed1997

Status and future of vaccines for adults.

The current status and future prospects of vaccines for adults are discussed. For every child in America who dies of a vaccine-preventable disease, about 400 adults die of such a disease. Evidence of the merit of influenza vaccination continues to accumulate, yet < 30% of high-risk people younger than 65 have been vaccinated. Use of pneumococcal vaccine lags behind that of influenza vaccine. Serious discrepancies in immunization levels exist among different segments of U.S. adult society. A vaccination status assessment is now recommended for everyone reaching the age of 50. New vaccines are available to prevent varicella, hepatitis A, and typhoid fever. There are now two formulations of hepatitis A virus vaccine; adult users of these vaccines include travelers, people relocating to areas with poor sanitation, military personnel, laboratory workers, and hemophiliacs. New rabies vaccines may be the next vaccines to be used primarily in adults. Vaccines against pertussis, Lyme disease, cholera, herpes simplex, malaria, other infectious diseases, and cancer are in various stages of development. For health care personnel in areas where there is a strong likelihood of Mycobacterium tuberculosis transmission and infection, BCG vaccination is recommended. The risk of immunization to a person infected with the human immunodeficiency virus is likely outweighed by the protection offered against other health threats. Health systems should select tetanus-diphtheria toxoids adsorbed for their formularies for immunizing adults, not monovalent tetanus toxoid. Vaccines are available to prevent a growing list of infectious diseases but are underused in adults.

Adult↗
PubMed1995

Prescribed medication use among troops deploying to Somalia: pharmacoepidemiologic analysis.

To describe the frequency of chronic ambulatory prescriptions dispensed to troops, pharmacists analyzed records of soldiers deploying to Somalia for Operation Restore Hope. Prescriptions recorded in the Fort Drum pharmacy data base for soldiers deploying between November 24, 1992, and January 12, 1993, were compared to the roster of troops deployed. Among 3,701 deploying soldiers, 273 patients (7.4%) received 425 prescriptions. For each 1,000 troops, 114.8 prescriptions were dispensed. Of 333 presumptive diagnoses, the most common diagnostic groups were contraceptive, musculoskeletal, dermatologic, respiratory, and cardiovascular. Of 425 prescriptions, the most common therapeutic classes of medication dispensed were oral contraceptives, anti-inflammatory drugs, acne treatments, and beta-adrenergic agonists. Generically, the common prescribed substances were contraceptives, ibuprofen, pirbuterol, temazepam, piroxicam, and beclomethasone. Although women represented 6.8% of troops, women represented 31.5% of prescription recipients and received 29.4% of prescriptions. Women were 6.5 times as likely to receive a prescription as men (p < 0.0001); this relative risk was 3.4 if contraceptives were omitted from analysis (p < 0.0001). Two hospitalizations in Somalia may have been related to medication use.

Adult↗
PubMed1995

Review of the 1995 Food and Drug Administration/National Institutes of Health Public Forum on informed consent in clinical research conducted in emergency circumstances.

We describe some of the deliberations and questions raised by the recent Food and Drug Administration/National Institutes of Health Forum on Informed Consent in Clinical Research Conducted in Emergency Circumstances. Consent will have to be waived in emergency medical research if such research is to be conducted, because it is virtually impossible to obtain meaningful informed consent in emergency circumstances. There is clearly a conflict between research subject autonomy and society's perceived need for answers about emergency medical care. Who will resolve this dilemma and how it will be resolved are important questions for modern medicine.

Emergencies↗
PubMed1992

Community pharmacists as immunization advocates. Cost-effectiveness of a cue to influenza vaccination.

To assess the cost-effectiveness of a cue to influenza vaccination provided by community pharmacists, a decision tree was constructed of the consequences of implementing a pharmacy-based vaccine-advocacy program, based on experience gained in an experiment involving three community pharmacies in Durham County, North Carolina. The model used morbidity and mortality assumptions derived from the infectious-disease literature and cost assumptions based on 1990-91 Medicare Part A and Part B reimbursement costs. This analysis suggests that if Medicare reimbursed pharmacists for advising 100,000 patients at risk to accept influenza vaccine through vaccine-advocacy messages, for an apparent expenditure of $110,000, the increased rate of influenza vaccinations would avert 139 hospitalizations and 63 deaths, and actually yield Medicare a net savings of $280,588. These calculations probably underestimate the benefit to society of a pharmacy-based vaccine-advocacy program, because only direct costs to the single government agency were computed and no cost was attributed to death or lost earnings.

Aged↗
PubMed1992

Pharmacoepidemiology and military medical automation: opportunity for excellence.

Fielding of the Composite Health Care System (CHCS) brings an unparalleled opportunity for medical research. This sophisticated automated medical record system promises pharmacoepidemiologic research of a quality and quantity never before possible. Pharmacoepidemiology provides answers about the validity of beneficial and adverse drug events and aids in individualizing drug therapy. When CHCS eventually encompasses an estimated 9.1 million patients at 166 military hospitals and 588 clinics around the world, it will provide a database capable of supporting sophisticated automated research. In addition to the unprecedented size of this resource, advantages of pharmacoepidemiology performed with the CHCS database include integration of inpatient and outpatient care records, the completeness of prescription and medical records, and the wide socioeconomic spectrum covered in a defined population. Limitations and potential biases of such a database include separate drug formularies at each medical treatment facility, only limited information about nonprescription drug use and single-dose drug orders in clinics, and the mobility of military service members and their families. Pharmacoepidemiology is a tool that will benefit individual members of the military family, as well as advancing the sciences of pharmacy and medicine. Using the CHCS database for this form of research is in the best tradition of military medical research.

Attitude to Health↗