Interventions and documentation for drug-related problems in Dutch community pharmacies.
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Clinical Pharmacy Information Systems↗
Biomedical subjects
T F Tromp
Publications and source records attributed to T F Tromp.
Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge.
BACKGROUND: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue. OBJECTIVES: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication. METHODS: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied. RESULTS: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient. CONCLUSIONS: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.
Clinical Pharmacy Information Systems↗
Prescription data as a tool in pharmacotherapy audit (I). General considerations.
This article discusses how prescription data that are available from pharmacies can be used as a tool to support the improvement of prescribing behaviour. For the optimal use of prescription data in pharmacotherapeutic audit, the specific aim of the audit meeting must be clear. Next, appropriate measures (quality of drug choice, volume, cost) have to be selected for the presentation and discussion of prescribing. For several aims of audit meetings, suggestions for adequate measures are given. For each stage of behavioural change the article describes why and how prescription data can provide a useful contribution. Finally, recommendations are given regarding prerequisites for the optimal use of prescription data. Important factors are that the prescription data should sufficiently cover the physicians' patient population, information regarding the extent of repeat prescribing is needed, and the prescribing of drugs with multiple indications can cause difficulties with the interpretation of the graphs. With this information in mind, feedback on prescribing can be tailored to the audit groups' needs and targeted to the intervention that is pursued.
Attitude of Health Personnel↗
Prescription data as a tool in pharmacotherapy audit (II). The development of an instrument.
In many countries, prescription data are used as an instrument to provide feedback on prescribing. This article describes the development and implementation of a computer program as a tool for pharmacotherapy audit meetings and it illustrates the possibilities of such a program. The program was developed to support the optimisation of prescribing in the various stages of behavioural change. It enables pharmacists to make sophisticated overviews of prescribing by physicians in their audit group and furthermore, pharmacists can conduct drug utilisation studies or pharmaco-epidemiological studies in their own patient population. Forty percent of Dutch pharmacies have purchased the computer program since its introduction; it was distributed together with a technical handbook and a course book, which elaborated on the types of graphs available and their interpretation. An educational course was developed regarding the optimal selection and interpretation of graphs. Examples of prescription data as a tool to support various aims of audit meetings are given. The program is acknowledged as a welcome contribution to pharmacotherapy audit and to the pharmacists' advisory role in pharmacotherapy.
Attitude of Health Personnel↗
Patient education to users of oral hypoglycemic agents: the perspective of Dutch community pharmacists.
The purpose of this study was to indicate which patient education activities directed at users of oral hypoglycemic agents are desirable in Dutch community pharmacies and to explore which preconditions should be considered when implementing the desired activities. A qualitative study was conducted with a panel composed of seven pharmacists and seven technicians with considerable experience in giving advice to people with diabetes mellitus type 2. A consensus method was used, which consisted of a written questionnaire and a feedback discussion, to determine which activities were considered desirable and to identify which other health care providers should be involved. The way these activities should be implemented was explored by a focus-group discussion. The following goals of patient education activities were studied: 1) adherence to the dosage regimen, 2) adherence to lifestyle advices, 3) gaining awareness of effects and 4) self-monitoring. According to the members of the panel, patient education activities should be directed primarily at stimulating adherence to the dosage regimen, increasing awareness of side effects and improving the correct technical use of blood glucose meters. Activities directed at lifestyle advice seemed to be less desirable to the pharmacy staff. Preconditions that should be considered when implementing these activities were structural cooperation with GPs and diabetic nurses and specialization of tasks of pharmacy technicians. Our results indicate that deepening of existing tasks, such as stimulating adherence to the dosage regimen is desirable in developing patient education activities at users of oral hypoglycemic agents.
Administration, Oral↗
Quantification of communication processes, is it possible?
The PAS system (Problem-Analysis-Solution-system) is developed to quantify oral communication processes during counselling in pharmacy practice. The pharmacist translates the patient's drug-related questions into a P-code, the analysis of the question into an A-code and finally the given solution upon the question into a S-code. The PAS system has been developed for two goals. First, for the registation of drug-related questions from patients which gives the pharmacist insight in the most common issues addressed by patients. Second, it might help the pharmacist to structure the communication with the patient during the consultation. Forty-one pharmacists participated in the evaluation of the PAS system. The validation of the PAS system consisted of two phases: the external validation and the internal validation. Kappa values were calculated as a measure of agreement in the coding by the pharmacists. The kappa-value of the external validation for the P-, A- and S-codes for the total set of questions indicate a moderate to poor agreement. This means that pharmacists categorize drug-related questions from patients in a different way. Therefore we conclude that the PAS system is less reliable for research purpose. The kappa-value of the internal validation for the P-code varies from 0.42 to 0.91. For the A-code it varies from 0.07 to 0.35 and for the S-code from zero to 0.68. Internal reproducibility is good for P-code but not for the A-code and S-code. This implies that the pharmacist can use the P-codes for registration of patients' questions in his own pharmacy. Moreover, the usage of the PAS system during counselling in pharmacy practice can structure the consultation.
Communication↗
APOM-project: managing change to the customer in community pharmacy practice.
In 1994, a Ph.D.-study started regarding pharmacy, organization and management (APOM) in the Netherlands. This article describes the final phase of the study in community pharmacy practice: managerial problems in change to the customer and the difference between supported pharmacy managers and independent ones. It appeared that pharmacy managers experienced problems with the formulation and use of aims, norms, and measurements. Although many organizations operating in the pharmaceutical sector are a good source for new ideas, they lack to have the proper support for these problems. The difference between supported and independent pharmacy managers was minimal in the change to the customer. Pharmacy managers are in need of micro-instrumentalization: aims, norms, and monitor instruments for customer activities applicable at their own pharmacy. Moreover, pharmacy managers will have to learn how to deal with the tension between money and care in order to improve the 'grip' on their organization.
Community Pharmacy Services↗
Changing prescribing in the light of tolerability concerns: how is this best achieved?
Despite our knowledge regarding the efficacy, tolerability and optimal use of drugs, suboptimal prescribing still occurs. In view of all the factors that influence prescribing, this is not surprising. The focus of drug tolerability has changed from 'choosing the best alternative' when a drug is prescribed, to a balanced decision incorporating various different treatments from separate healthcare providers. This article reviews strategies that may influence prescribing behaviour and discusses practical considerations for achieving optimal prescribing in view of tolerability concerns. The patient has a major influence on prescribing and, with the current diversification of healthcare, the patient now controls prescribing behaviour more than ever before. Communication between healthcare providers consequently assumes a vital role. If messages are to be coherent and transferable, it is increasingly important that healthcare workers communicate effectively with one another regarding patients, prescribing patterns, and drug tolerability issues.
Drug Prescriptions↗
APOM-project: a survey of pharmacy organization and management.
In 1994, a Ph.D-study started regarding pharmacy, organization and management (APOM) in the Netherlands. The APOM-project deals with the structuring and steering of pharmacy organization. This article describes the summary of the empirical results of a survey in a relatively large sample (n = 169). Generalization to the population of pharmacies in the Netherlands was made. Thought results comprised a total number of seven clusters of priorities of pharmacy mixes. Most pharmacy managers were observed with product and customer activities in the first position; pharmaceutical and customer activities were perceived as the most important. Action results comprised a total number of five clusters of activities of pharmacy mixes. Most pharmacy managers were observed with product and process activities in the first position; pharmaceutical and process activities were performed most frequently. The results showed that the traditional conception of the work in the community pharmacy is still vividly present.
Data Collection↗
The ICPC coding system in pharmacy: developing a subset, ICPC-Ph.
The ICPC system is a coding system developed for general medical practice, to be able to code the GP-patient encounters and other actions. Some of the codes can be easily used by community pharmacists to code complaints and diseases in pharmaceutical care practice. We developed a subset of the ICPC codes for community pharmacists. This article describes the method used and the resulting ICPC-Ph list.
Humans↗
APOM-project: an investigation of pharmacy organization and management.
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Community Pharmacy Services↗
Pharmaceutical care in The Netherlands. History, definition and projects.
The evolving concept of Pharmaceutical Care knows different interpretations in different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical Care is tested in the TOM and OMA-projects. Patients recognise the educational, aspects of Pharmaceutical Care and in general are content about the provision thereof.
Humans↗
Auditing GPs' prescribing habits: cardiovascular prescribing frequently continues medication initiated by specialists.
OBJECTIVE: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. METHOD: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs. Next, questionnaires were sent to the prescribing GPs to find out whether the prescriptions were in fact repeat prescriptions. If they were, the GPs were asked whether or not they had originally been prescribed by a specialist. SETTING: Six pharmacies in the northeastern part of the Netherlands. SUBJECTS: Fourty-four GPs, 39 of whom responded. RESULTS: Of 1648 questionnaires, 1342 (81%) were returned. Of drugs for cardiovascular therapy that the GPs prescribed, 66% had originally been prescribed by specialists. CONCLUSIONS: For many cardiovascular drugs, GPs' prescriptions predominantly originated from specialists' prescribing. For more reliable attribution of prescription data or prescribing behaviour to either specialists or to GPs, similar studies should be made for other drug groups. Since the extent of repeat prescribing is high, qualitative studies should be made of the appropriateness of chronic medication, initiated by specialists and continued in repeat prescribing by GPs.
Cardiology↗
Information about drugs in family magazines.
Family magazines can play an important role in the diffusion of medical information and information regarding drugs to a 'lay audience'. We describe what kind of drugs are discussed in the family magazines and which information regarding these drugs is given. Furthermore, we look into the information sources for journalists; special attention is paid to the role of the pharmacist: is (s)he recognized by journalists as one of the experts on drugs? Two approaches were used in order to answer the above described research questions: a content analysis of family magazines and in-depth interviews of journalists. Gynaecological products as well as drugs for the central nervous system receive much attention in family magazines. The kind of information given about drugs is limited. Only part of the publications pays attention to side-effects. Patients asking questions about drugs in response to publications in family magazines know the name of a drug but are rarely informed about other aspects of the therapy, such as side-effects. In the provision of information physicians and medical specialists play an important role as sources of information for journalists. There is, however, until now no role for the pharmacist as a source of information on drugs in family magazines.
Drug Therapy↗
Setting the agenda: does the medical literature set the agenda for articles about medicines in the newspapers?
The source of ideas and information on medicines most important to journalists in the Netherlands, and most commonly consulted by them, is known to be the scientific medical literature. In this study we therefore, explored the relation between the kind of medicines discussed in the scientific medical literature and those discussed in newspapers. A content analysis of scientific medical journals was combined with a content analysis of Dutch daily newspapers. The results show an agreement in the main groups of medicines discussed in the scientific medical literature and newspapers. In both the newspapers and the professional journals anti-infective medication and drugs for the central nervous system are the groups of medicines most frequently discussed. Although it has been suggested that 'bad news' is more newsworthy then 'good news', the negative consequences of the use of medicines received proportionally more attention in the professional literature than in the newspapers.
Drug Therapy↗
Interactive individualization: patient counselling and drug information supported by knowledge systems.
A model for computer-supported patient counselling and drug information in community pharmacies is described. Two types of informational need are distinguished: the subjective informational need, i.e. the informational need perceived by the patient himself, and the normative informational need, i.e. the patient's informational need according to the professional. Accordingly, individualization is defined as the fine-tuning of information to the informational needs of the participants in the process of communication. A computer-supported process of communication based on this model is defined as 'interactive individualization'. The task of this knowledge system is to support the interactive encounter of the professional and the patient. The process of providing information consists of two subtasks: determining the items of information, e.g. pregnancy, dosage, etc., and subsequently determining the content of information or the advice itself. Based on these subtasks several functionalities of the proposed knowledge system can be derived.
Artificial Intelligence↗
Journalists and their sources of ideas and information on medicines.
In this article we describe from which sources science writers who write about medicines in daily newspapers get their ideas and information. This study was undertaken because mass media, and therefore newspapers, can play an important role in the diffusion of information about medicines. Two approaches, interviews and a content analysis, were used to answer the research questions. Both methods show the importance of professional medical journals and information from universities and their hospitals as sources of ideas and information. Although the pharmaceutical industry did not seem to play a role as source of ideas and information according to the journalists, it is the third most frequently cited source of information in the newspaper articles. To gain a better insight in the role of the pharmaceutical industry as source of ideas and information for newspaper journalists further research is necessary.
Drug Industry↗
A simple and rapid computer-assisted technique for the identification of some selected Bacillus species using biochemical tests.
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Bacillus↗