Biomedical subjects

K L Rascati

Publications and source records attributed to K L Rascati.

22 records · Page 2Linked to original sources

PubMed1987

Multidimensional work sampling to evaluate the effects of computerization in an outpatient pharmacy.

The effectiveness of multidimensional work sampling versus direct observation in evaluating the effects of computerization in an outpatient pharmacy was studied. A direct-entry, self-reporting method of multidimensional work sampling was used to measure and compare the relative times spent on various tasks before and after computerization in the outpatient pharmacy of a 475-bed teaching hospital. Analysis of variance was used to evaluate differences in the types of functions performed, differences in functions among the five employees (two pharmacists, one pharmacy intern, and two technicians), and differences in functions on a week-to-week basis. Data obtained by multidimensional work sampling were compared with data obtained by direct observation to determine the level of agreement between the two methods. Also, a time clock method was used to measure and compare the time required for prescription processing before and after computerization. After computerization, the percentage of time spent on some clerical tasks decreased by 26.7%, but this decrease was offset by a significant increase of 27.7% in the percentage of time spent entering information into the computer. Time spent on clinical tasks did not change significantly. A significant difference among employees was found in the percentage of time spent on clinical functions. The differences in time spent on clinical or clerical functions from week to week were not significant. The time to process a set of prescriptions increased after computerization, primarily because of the time needed to enter information into the computer. However, computerization enabled the generation of patient profiles. Multidimensional work sampling is an accurate method of work measurement that may be more useful than direct observation in capturing clinical functions.

Drug Prescriptions↗

PubMed1986

Work measurement in pharmacy research.

The applicability of various methods of work measurement to pharmacy research is discussed, and studies that have used these methods are reviewed. Methods of work measurement include subjective evaluation, direct time study, work sampling, statistical data, and pre-determined data. Subjective evaluation lacks precision in its estimates but may be useful in formulating hypotheses. Direct time study is most appropriate for readily observable, highly repetitive tasks that can be divided into short segments, although it has been used for longer and more variable activities. Work sampling is the most frequent method of work measurement used in pharmacy research, but few studies reported doing any check of measurement reliability or validity. Multidimensional work sampling and other forms of direct-entry, self-reporting work sampling may be useful in measuring the more complex and unobservable tasks of pharmacists such as clinical activities. By developing an understanding of the purposes and applications of measurement techniques, hospital pharmacists can choose the most appropriate method for their research setting and purpose.

Methods↗

PubMedDate not supplied

Effects of Medicaid drug utilization review intervention letters.

The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians and six pharmacists, meets quarterly to determine criteria for implementing retrospective DUR. The board agreed to send intervention letters to physicians concurrently prescribing: (1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters, approximately half of these physicians were randomly chosen to receive a letter while the others served as a control group and did not receive letters. This project focused on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective one was to examine feedback from the physicians who received the letters, and objective two was to review and compare patient profiles 6 months after the letters were sent. Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117 identified patient profiles) were selected to receive an intervention letter with their patient's profile or profiles, a response form, and a stamped envelope addressed to the Texas Department of Human Services. A 67.5% response rate was obtained. Of these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter. The remaining indicated responses such as "not my patient," they were no longer seeing the patient, or that they did not prescribe the medication in question. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker.

The US Department of Defense recently assembled electronic records of outpatient prescriptions dispensed through the Uniformed Services Prescription Database Project (USPDP) going back to 1990. The objectives of this portion of a larger study were: (1) to examine longitudinally the patterns of antihypertensive drug use during the first year of therapy in patients whose initial therapy was with an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker (CCB); (2) to determine continuous and noncontinuous users of antihypertensive drugs; and (3) to estimate the direct medication costs for each pattern of medication use. Filtering criteria for patient and prescription identification were developed, because the USPDP contains no records of confirmatory diagnoses of hypertension. Once data filters were implemented, information for 771 patients was analyzed. An ACE inhibitor was the initial therapy for 328 patients, accounting for 1935 antihypertensive medication prescription fills, and a CCB was the initial therapy for 443 patients, accounting for 2459 fills (including refills). Slightly more than half of the patients (n = 401, 52.0%) were classified as continuous users (> or = 80% medication-possession ratio [supply of medication in days divided by the number of days in the 12-month study period]). In the first year, 177 of these continuous users (44.1%) had no change in therapy in the first year, 49 (12.2%) had an increase in dose, 8 (2.0%) had a decrease in dose, 15 (3.7%) had a change to a different therapeutic class of antihypertensive medication, 14 (3.5%) were changed to a different medication in the same therapeutic class, 20 (5.0%) had a new medication added to the regimen, and 118 (29.4%) had complex regimens involving more than one change. For continuous users, the mean medication supply in days was 354.6, and the average time before a medication change was 152.1 days for those continuous users who had one change in therapy. The overall average wholesale price (AWP) and average manufacturer price (AMP) for continuous users during 1 year of therapy were $471.31 and $378.51, respectively. For those patients whose therapy was changed to an ACE inhibitor/CCB combination and who were continuous users, the average AWP was $598.47 per year ($492.05 AMP). Once the change from monotherapy to an ACE inhibitor/CCB combination occurred in continuous users, AWP costs per member per month increased by approximately $22.00 ($18.00 AMP). Over half of the patients whose initial therapy was an ACE inhibitor or CCB had at least one change in their first year of therapy. Research into the reasons for these changes and their outcomes is needed.

Angiotensin-Converting Enzyme Inhibitors↗