Other sources of stability research.
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Drug Incompatibility↗
Biomedical subjects
P N Catania
Publications and source records attributed to P N Catania.
Sterility of intravenous therapy in home care settings.
Providing sterile parenteral therapy for patients in home care settings has been an option for clinicians for two decades. Initially, home intravenous therapy was prepared only by pharmacists in carefully controlled environments or by nurses in the patient's home using strict aseptic techniques. Today, patients or their caregivers may be responsible for preparing parenteral products for home administration.
Female↗
Strategies to improve patient understanding.
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Chronic Disease↗
Home chemotherapy: basic concepts.
The diagnosis of cancer imposes a devastating sense of loss of control over a patient's life. Home chemotherapy allows patients to become active participants in administering their own therapy, providing an opportunity to regain some of that control. The purpose of this article is to provide an overview of some basic concepts of chemotherapy that relate to home therapy regardless of the specific therapeutic agent prescribed.
Antineoplastic Agents↗
Viagra for home care patients.
In March 1998 a totally new type of therapeutic agent, sildenafil citrate (Viagra), was approved by the Food and Drug Administration for marketing in the United States as an oral tablet for erectile dysfunction in men. Extensive media coverage may have overshadowed the actual value and potential limitations of this therapeutic agent. Because sildenafil is a prescription-only medication that may be used in ambulatory and home care patients, home caregivers need to understand its intended use, mechanism and dose, and potential problems that may occur in patients who receive it.
Community Health Nursing↗
Risk factors for drug-related problems in elderly ambulatory patients.
Medication use among elderly patients in ambulatory care, home health care, and long-term care settings has become increasingly complicated during the past decade. Home intravenous therapy, multiple drug regimens to treat multiple chronic diseases, increased acuity of nonhospitalized patients, and increased longevity have placed elderly patients at increased risk for drug-related problems.
Activities of Daily Living↗
Drug-induced hypoglycemia in home care patients with diabetes.
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Community Health Nursing↗
Problems with herbal remedies in anticoagulated home care patients.
The increasing popularity of alternative therapies, including herbal remedies, poses new challenges for home health care providers. The cost of herbal remedy use now exceeds $1 billion annually in the United States and is expected to increase. The use of traditional medicine in combination with alternative therapy may lead to complications for patients and their caregivers as evidenced by the adverse effects of certain herbal products in patients who receive traditional anticoagulant or antiplatelet medication.
Anticoagulants↗
Medication use in home care patients with COPD.
Chronic obstructive pulmonary disease (COPD) is the fourth-leading cause of death in the United States. Although many other diseases have seen a gradual decline in their associated mortality, COPD rates have increased nearly 33% from 1979 to 1991. The disease is defined as a slowly progressive obstruction of airflow that is predominantly irreversible. COPD usually begins in the fifth decade of life as an increased cough. Dyspnea on exertion is frequently observed in the sixth or seventh decade.
Adrenergic beta-Agonists↗
Storing parenteral medication at home.
The storage requirements for parenteral products vary with the characteristics of the medication in the product. Temperature, light, moisture, pH, composition of the container, type of infusion fluid, and exposure to other chemical substances are the major determinants of the stability of parenteral medication stored in the patient's home.
Drug Storage↗
What is the role of the pharmacist in home care?
Pharmacists provide a wide range of medications, along with health and convalescent aids, for patients at home. Traditionally community pharmacists have been viewed as providers of prescription and nonprescription medications administered orally. Today pharmacists in community and hospital pharmacies across the country have expanded their services for the homebound patient and provide a variety of sophisticated products and services in the patient's home.
Community Pharmacy Services↗
The next step in clinical intervention programs.
Pharmacists should incorporate and modify existing clinical intervention programs to document pharmacists' effects on patient care and quality drug-therapy management. We have already demonstrated the pharmacist's role in drug cost savings through the intervention programs, and now QIP can assist us in taking the next step in providing quality patient care. If we endorse the principles of pharmaceutical care, we must assume the responsibility for documenting our value as pharmacists in managing drug therapy in patients. The clinical intervention programs will deemphasize the value of drug cost analysis and emphasize effects on patient-care outcome. We believe that facilitating positive patient outcomes will decrease overall health care costs. As managers, we must assist our pharmacists in endorsing this concept by developing our programs to show the maximum benefit of their efforts in the patient-care arena.
California↗
Outcome of cholesterol screening in a community pharmacy.
The purpose of our study was to determine if a community pharmacist could affect total blood cholesterol (TBC) of ambulatory patients by a program of education, consultation, and cholesterol screening. Of 241 initially screened individuals, 57 patients with TBC greater than 5.17 mmol/L (greater than 200 mg/dL) met the inclusion criteria of this six-month study. Of these, 51 completed the study. Outcome was determined by changes in TBC measured during the initial screening and after two follow-up visits. Pharmacist intervention included obtaining TBC concentrations and reporting the results to patients, teaching patients about the role of cholesterol in illness and health, explaining risk factors associated with cardiovascular disease, and providing follow-up communication with patients. Data were analyzed using ANOVA, Mann-Whitney, and chi-square. The mean TBC was 5.84 mmol/L (225.7 mg/dL) for the study group and 4.23 mmol/L (163.8 mg/dL) for participants with TBC less than 5.17 mmol/L (less than 200 mg/dL (p less than 0.0001). There was a significant difference (p = 0.0124) in mean age for the study group (36.4 years) versus other participants (30.0 years) but no difference in distribution by gender (p = 0.18). ANOVA showed significant differences in TBC during the three visits (p less than 0.0001). There was a significant decrease in mean TBC concentrations between visits 1 and 2 and between visits 1 and 3 (p less than 0.0001), but no difference between visits 2 and 3 (p = 0.48). Compared with mean baseline values, 81.4 and 72.6 percent of the patients had a decline in TBC at visits 2 and 3, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Four years' experience with a clinical intervention program: cost avoidance and impact of a clinical coordinator.
Four years of data are reported on the drug cost avoidance and the net cost savings associated with a clinical pharmacy intervention program. In 1986 the pharmacy department at a 324-bed nonprofit community medical center began a clinical intervention program by adding one full-time equivalent for providing clinical services. A new clinical pharmacist position was created in 1988. A reorganization in 1989 resulted in further increases in staffing, including the creation of a clinical coordinator position to oversee the intervention program, and in administrative time. Staff pharmacists self-report a broad range of interventions on a clinical documentation form. During the period 1986-1989, monthly data on the number of types of interventions recommended, the percentage of recommendations accepted by the medical staff, and drug cost avoidance were tabulated. Cost avoidance was calculated by subtracting the cost of therapy ordered by the physician from the cost of therapy initiated as a result of the intervention. Net drug cost savings were calculated by subtracting from cost avoidance the cost of pharmacist time required for performing the interventions. The average number of interventions per month ranged from 170 in 1986 to 292 in 1990. During an 18-month period before the clinical coordinator was added, average monthly cost avoidance and net savings were $4932 and $3739, respectively. Average monthly cost avoidance increased to $6244 and savings to $4644 in a 12-month period after the clinical coordinator was added. A four-year study of a clinical intervention program showed that the dollar value and impact outlasted the initial success expected for such programs.
Administrative Personnel↗
Therapeutic outcome of elderly and nonelderly patients receiving home intravenous antimicrobial therapy.
The therapeutic outcomes of elderly patients receiving home i.v. antimicrobial therapy were compared with those of younger patients receiving the same therapy. Using predetermined inclusion and exclusion criteria, 150 consecutively referred patients were accepted into the study. These patients were receiving home i.v. antimicrobial therapy from three home-health-care pharmacies (HHCPs). Referred patients were classified as elderly (greater than or equal to 62 years old) or nonelderly. Data for these patients were compiled retrospectively using interviews and chart reviews. Outcome of the i.v. antimicrobial therapy was rated as either adequate or inadequate based on predetermined criteria. Outcomes were analyzed for each HHCP and for the pooled data. The mean age of the pooled nonelderly group was 38 +/- 14 years, and the mean age of the pooled elderly group was 71 +/- 6 years. Adequate outcomes were noted in 70% of the pooled samples of elderly patients and 76% of the pooled samples of nonelderly patients. The difference between the outcomes of patients in the two age groups was not significant. In this carefully selected population, elderly and nonelderly patients receiving home i.v. antimicrobial therapy had similar therapeutic outcomes.
Adult↗
Using clinical interventions to cost-justify additional pharmacy staff.
This paper reports on the use of clinical interventions in cost justifying an additional pharmacist in a 316 bed hospital. Data were collected during a 5 month period in 1986 related to clinical interventions by satellite pharmacists. To justify to the hospital administration the permanent hiring of an additional pharmacist, a 10% return on the hospital's investment in salary and fringe benefits was required. The effect of clinical interventions on the cost of drug use was viewed as the only way to demonstrate the administration's mandated return on investment. Actual drug cost savings were $30,657, which resulted in a total estimated annual savings of $73,572 or a 54% return on the hospital's investment in the salary of the additional full time equivalent pharmacist. The 855 interventions resulted in an average savings of $35.88 per intervention. The study successfully demonstrated the use of clinical interventions to cost-justify additional pharmacy staff.
California↗
Using a hand-held spirometer as a monitoring tool in chronic theophylline therapy.
This study evaluates the use of a hand-held spirometer (pocket spirometer, Buhl type) in monitoring pulmonary function as a part of a homebased pharmacokinetic service for patients with respiratory disease. To calibrate the spirometer and determine its accuracy, six healthy volunteers were trained in its use by the pharmacist. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined for each volunteer once a month for six months. The T test for the presence of outliers showed no statistical difference at p less than 0.05. Seven patients on chronic therapy with theophylline derivatives for respiratory problems were randomly referred by their physicians to the pharmacokinetic service. The pharmacist counseled each patient and measured FVC and FEV1 once a month for six months. The ratio, (FEV1:FVC) X 100, was calculated for each patient before and after steady-state serum level determination and dosage adjustment. The mean value for this ratio was 45.1 before pharmacokinetic intervention and 57.5 after intervention. Using the Student's t-test, these results were significant (p less than 0.05). The correlation coefficient was calculated to determine if a correlation existed between the increase in the ratio and the increase in serum theophylline levels. Serum levels were ordered before and after intervention for five of the seven patients receiving pharmacokinetic intervention. The change in serum levels vs. change in the ratio was associated with a correlation coefficient of 0.718. Monitoring pulmonary function may be a useful adjunct for the pharmacist who provides pharmacokinetic counseling to patients with respiratory disease, but expanded studies are needed to judge the value of routine spirometric measurements on homebased patients.
Adult↗
Evaluation of three manual drug information retrieval systems for investigational antineoplastic drugs.
The manual drug information retrieval systems, de Haen's Drugs in Use, Iowa Drug Information Service (IDIS), and International Pharmaceutical Abstracts (IPA), were evaluated to determine their usefulness as sources of drug information for investigational antineoplastic drugs during the years 1980-81. During both years, de Haen's provided the greatest number of antineoplastic drug citations, IPA the least. Concerning qualitative analysis, (the ability of the information systems to provide citations in seven subject areas for the five drugs), IDIS was found to have the greatest overall utility and was statistically different from IPA in many subject areas. IPA provided few citations in the seven subject areas for the five drugs. On pairwise analysis, no differences emerged between IDIS and de Haen's. Commonly available manual drug information retrieval systems such as IDIS and de Haen's appear to be useful sources of information for investigational antineoplastic drugs.
Antineoplastic Agents↗