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Biomedical subjects

P W Abramowitz

Publications and source records attributed to P W Abramowitz.

At least 19 recordsLinked to original sources
PubMed2001

Nurturing [correction of Nuturing] relationships: an essential ingredient of leadership.

All pharmacists must develop the skills necessary to establish caring professional relationships with patients and colleagues. An absence of such relationships makes it difficult to compete for resources, motivate staff, or provide the best care to patients. Getting to know the people you spend so much of your life with is not only logical but enriching. Good leaders promote the growth of others and find--to their surprise--that they have grown along with them. Good leaders take pride in the accomplishments of staffers and residents who distinguish themselves in pharmacy, but they also smile at the pictures of their babies. Having recently turned 50, I begin to see the professional legacy I will leave behind, and it is my turn to embrace a sense of deep personal fulfillment. As leaders, we influence not only the lives of the people closest to us, but the lives of many we may never know. It must be an awesome realization for John Webb to know that, through his leadership and compassion, he has had a profound effect on pharmacy practiced by generations of pharmacists. Mr. Webb, it is for this reason and for the endearment you inspire in so many colleagues and friends that I am honored to be named this year's John Webb Visiting Professor in Hospital Pharmacy.

Humans↗
PubMed1997

Financial management of health system pharmacy practice.

The financial management of pharmacies and health systems is a combination of the traditional management of personnel and drug and supply costs with the management of the total costs of care. It includes determining the consequences of less than optimal drug therapy, improving drug therapy, and reengineering pharmacy departments and services across all patient care settings to deliver optimal pharmacotherapy. Prevention and reduction of adverse drug events, disease state management, and other methods to improve quality of care are of major importance. Future articles in this series on the financial management of pharmacy practice in health care systems will provide examples of applications of financial management in acute care, ambulatory care, long term care, and across sites of care. They also will include the justification of the development of new types of patient care services.

Automation↗
PubMed1993

Automated compounder for adding ingredients to parenteral nutrient base solutions.

The effects of using an automated compounder for adding ingredients to parenteral nutrient (PN) base solutions was evaluated. Work-sampling methods were used to determine the amount of time spent by pharmacists and technicians in the production of PN solutions before and after the implementation of an automated device for adding ingredients to PN base solutions. Costs of materials and supplies were evaluated before and after the PN compounder was implemented. Qualitative (sterility) and quantitative (accuracy) analyses were performed by the hospital laboratory. A personnel time savings of 5.4 minutes per PN solution (1.0 full-time equivalent [FTE]) was shown. There was also an additional 0.5 FTE saved in activities not directly related to PN production. There was a 1.5% increase in pharmacist time (mean +/- S.D. preimplementation, 12.66 +/- 2.33 minutes; postimplementation, 12.85 +/- 1.96 minutes) and a significant 27.9% decrease in technician time (mean +/- S.D. preimplementation, 20.29 +/- 2.47 minutes; postimplementation, 14.62 +/- 2.24 minutes) per PN solution. The break-even point for personnel and supply costs was 33 PN solutions. Qualitative analysis resulted in one positive culture preimplementation and no positive cultures postimplementation. Quantitative analysis showed an improvement in compounding accuracy. The use of an automated compounder for adding ingredients to PN base solutions resulted in personnel time savings and improved accuracy.

Automation↗
PubMed1992

Implementation, justification, and expansion of ambulatory clinical pharmacy services.

In response to the current trends in health care utilization and provision, The UMHC Department of Pharmaceutical Services has as part of its mission the provision of comprehensive pharmaceutical services to its ambulatory patients. To achieve this, the Department began the process of identification of need and the provision of these services. Simultaneously, the Department is conducting research to document the impact that pharmacists can have on the cost and quality of care when they are actively involved in the therapeutic management of patients treated in the ambulatory setting.

Ambulatory Care↗
PubMed1992

Evolving to provide pharmaceutical care without additional resources in a university hospital.

Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug-distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC.

Centralized Hospital Services↗
PubMed1992

Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic.

The effects of pharmaceutical care on medication cost and quality of care in a university-based family-practice clinic were studied. Prognostic indicators were used to target patients who should receive pharmaceutical care. Those patients who received care. Those patients who received pharmaceutical care over a 14-month period during 1988-89 were included in the study. A pharmacist interviewed each targeted patient, obtained the patient's medication history, made therapeutic recommendations to the patient's physician, and counseled the patient on his or her therapy. The pharmacist's recommendations were noted, and the outcome of each recommendation was documented on subsequent patient visits. For each recommendation, drug cost avoidance was calculated and patient outcome was analyzed. For quality assessment, a panel of three health-care professionals reviewed the pharmacist's recommendations for 25% of the study patients (randomly selected) and noted their agreement or disagreement with the pharmacist's actions. Over the study period, 184 targeted patients received pharmaceutical care. Clinic physicians accepted 297 (82.5%) of 360 pharmacist recommendations. Annual extrapolated cost avoidance associated with the pharmacist's recommendations was $19,076. For 213 (80.4%) of the 265 accepted recommendations for which outcome data were available, improvement or resolution of the patient's disease state occurred. For 8 (16%) of 50 unaccepted recommendations, the patient's status declined. The peer review panel agreed with 86% of the pharmacist's recommendations. The provision of comprehensive pharmaceutical care in an ambulatory-care clinic can both reduce medication costs and improve quality of care.

Cost Control↗
PubMed1991

Measuring the ability of clinical pharmacists to effect drug therapy changes in a family practice clinic using prognostic indicators.

This study was designed to analyze physicians' acceptance of pharmacists' drug therapy recommendations in a Family Practice Clinic. It also measured the relationship between specific prognostic indicators and pharmacists' recommendations regarding drug therapy in individual patients. Once the recommendations were implemented, outcome data were collected to assess the impact on patient care. Thirty-nine patients were seen by a pharmacist during 49 clinic visits. A total of 36 recommendations were made to change therapy. Recommendations to change therapy occurred most frequently when one indicator, medication regimen changed four or more times during the past year, was present. Recommendations were accepted by physicians in 32 or 89% of cases. Patient outcome improved in 95% (18 of 19) of cases and remained unchanged in 5% (1 of 19) of cases for which outcome data were available.

Attitude of Health Personnel↗
PubMed1991

Effect of computer software on time required to prepare parenteral nutrient solutions.

Pharmacist and technician times required for the preparation of parenteral nutrient (PN) solutions were studied before and after the introduction of a software package that is used with an automated compounder. At a 580-bed teaching hospital, work sampling was used to collect data on how time was spent by personnel in the i.v. admixture pharmacy during six-week periods before and after the introduction of software that calculates the quantities of PN solution ingredients on a computer-generated work sheet and prints labels. The second data-collection period began when the software had been in use for four months. In the second study period, there was a significant decrease (28%) in total pharmacist time spent per PN solution; the mean +/- S.D. pharmacist times per PN solution per day for the two study periods were 14.03 +/- 3.24 minutes and 10.12 +/- 1.61 minutes, respectively. There were also significant decreases in pharmacist time spent performing calculations, checking calculations, and typing labels. After introduction of the software, technicians spent significantly less time typing labels and pumping base solutions. Overall, technicians spent significantly less time per PN solution in the second study period (20.15 +/- 3.50 versus 17.82 +/- 1.94 minutes). Use of the software allowed pharmacist staffing in the i.v. admixture pharmacy to be reduced, and the pharmacy resources were reallocated toward the provision of clinical services. The generation of PN labels and calculation worksheets by computer software reduced pharmacist and technician time requirements for PN solution preparation.

Data Collection↗
PubMed1990

Comparison of automated and manual methods of syringe filling.

A study to measure the time and cost associated with an automated and a manual method of syringe filling is reported. A stopwatch was used to measure the time needed by an experienced pharmacy technician to prepare batches of 200 syringes of each of seven drugs by a manual method and an automated method, the Multi-Ad Fluid Dispensing System. For each drug and method, time-and-motion data were collected during the preparation of four batches. The accuracy of each method was determined by dividing the actual by the expected number of syringes filled per batch. Material costs were calculated by summing the contract costs of the necessary equipment. The total cost of each method was determined by adding the labor and material costs. For all the drugs, the mean total time required to prepare one batch of syringes by the automated method was significantly less than that for the manual method. There was no significant difference in accuracy between methods for any of the drugs. The annual labor costs of the automated and manual methods were $4056 and $5761, respectively, and the annual material costs were $3364 and $2260, respectively. The total annual cost of the automated method was $7419, compared with $8021 for the manual method. The Multi-Ad system was significantly faster and somewhat less costly overall than a manual method for batch preparation of syringes of seven drugs.

Automation↗
PubMed1989

Indicators for the selection of ambulatory patients who warrant pharmacist monitoring.

The development of indicators to identify ambulatory patients who might benefit from pharmacist monitoring is described. With the assistance of an eight-member panel of ambulatory-care pharmacists, six prognostic indicators were identified: (1) five or more medications in present drug regimen, (2) 12 or more medication doses per day, (3) medication regimen changed four or more times during the past 12 months, (4) more than three concurrent disease states present, (5) history of noncompliance, and (6) presence of drugs that require therapeutic drug monitoring. The charts of patients who had visited the internal medicine, general surgery, pediatric, and obstetric/gynecology clinics during five randomly selected weeks in 1985 and 1986 were reviewed to determine the presence or absence of the six prognostic indicators and their adverse outcomes. Evidence of drug-therapy-related adverse outcomes was present in 79 (33.1%) of 239 charts. Charts of patients with a documented history of noncompliance were most likely to show evidence of an adverse outcome. The likelihood that a patient chart would show evidence of an adverse outcome increased as the number of prognostic indicators present increased. The presence of individual or multiple prognostic indicators in the charts of ambulatory-care patients should enable pharmacists to identify patients at greatest risk of experiencing drug-therapy-related adverse outcomes.

Ambulatory Care↗
PubMed1988

Formulary management at a tertiary-care facility: P&T committee interview.

Managing a formulary at a large tertiary-care center like the University of Minnesota Hospital and Clinic, demands a controlled, yet flexible system, Russell Lucas, MD, chairman of the P & T Committee, and Paul Abramowitz, PharmD, secretary of the P & T Committee tell Hospital Formulary in an exclusive interview. Because of their responsibility and commitment in educating the house officers who prescribe within their hospital, establishing P & T Committee guidelines and programs that are educational and nonconfrontational is critical. Discussed in this interview are the evolution of various subcommittees and adhoc groups (when greater expertise than that available on the P & T Committee was needed), the continuous development of educational programs, and the institution's policies on nonformulary drug requests and drug restrictions. Drs. Lucas and Abramowitz also comment on how HMOs, which account for nearly 50% of the health care provided in the area, may affect drug therapy practices within the University.

Drug Utilization↗
PubMed1987

Changing use patterns of plasma volume expanders through educational intervention.

Use patterns of the plasma volume expanders albumin and hetastarch were evaluated before and after an educational program promoting the preferential use of hetastarch was implemented in a 700-bed teaching hospital. The high acquisition cost and periodic shortages of 5% albumin injection prompted the implementation in March 1985 of a target drug program that would encourage the use of 6% hetastarch injection in place of albumin whenever possible. Purchases of albumin and hetastarch were monitored from August 1984 to March 1985 and again from April to November 1985 to determine how much and where these agents were being used. Criteria and guidelines for the use of plasma volume expanders were developed by the pharmacy with physician input. Senior attending physicians who had been identified as primary decision makers in the clinical use of albumin were asked to abide by the guidelines; also, pharmacists conducted inservice educational programs on the use of hetastarch. Patterns of albumin and hetastarch use changed significantly (p less than 0.05) after the educational program was implemented. From August 1984 to March 1985, the mean number of units of albumin and hetastarch purchased monthly were 325.5 and 0.4, respectively. These numbers changed to 195.3 and 163.1 units, respectively, from April to November 1985. The monthly cost avoidance associated with this change was $5127, which extrapolates to $61,526 annually. An educational program can be effective in controlling hospital expenditures for plasma volume expanders. However, clinicians should be aware of the potential adverse effects of hetastarch and should avoid using it in excessive amounts or in patients with underlying coagulopathies.

Albumins↗