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Biomedical subjects

W F McGhan

Publications and source records attributed to W F McGhan.

At least 73 records · Page 4Linked to original sources
PubMed1986

The effects of DRGs and cost-containment: assessment by hospital pharmacy directors.

With the advent of prospective reimbursement, cost containment has increasingly come into focus. Arizona hospital pharmacy directors were surveyed to learn what effect DRG-based payments and other capitation programs have had on their pharmacy department and hospital. Their responses concerning effects on staffing and services are outlined. Descriptions of successful and unsuccessful cost-containing measures are provided, and pharmacists' perceptions of the effect of DRGs and the problems they see with cost containment are detailed. It is evident that P & T Committees will play an ever-increasing role as an important interface with hospital staff in resolving many cost-containment issues.

Arizona↗
PubMed1985

Theophylline serum concentrations in ambulatory patients with chronic obstructive pulmonary disease.

A two-part study was designed to investigate the application of theophylline serum concentration data at a Veterans Administration Medical Center. The investigation was unique in its use of ambulatory patients instead of hospitalized patients as study subjects for assessing the use of laboratory tests. As has been found in other studies that examined different drugs and involved hospitalized subjects, this investigation discovered significant problems in the ordering, application, and documentation of these data when judged against established criteria. There was no significant difference in the appropriate use of these drugs between physicians specializing in pulmonary versus general medicine. Of clinical importance also are the findings that confirm a positive correlation between the proper use of these tests and improvement in patient outcome, and the demonstrated relationships between clinical symptoms and subtherapeutic and toxic serum concentrations of theophylline.

Aged↗
PubMed1985

Meta-analysis: quantitative integration of independent research results.

Meta-analysis, a quantitative method of combining the results of independent research studies, is described as a method for reviewing research literature. Four steps are taken to summarize the research in an area. First, a thorough literature review is conducted to identify a group of research studies with the relevant treatment variable. Second, an effect size is calculated for each study. Third, an overall (composite) effect size is determined by a weighted combination of the obtained effect sizes. Fourth, a fail-safe N (the number of unpublished studies with opposing conclusions needed to negate the published literature) is calculated to assess the certainty of the overall effect size. Meta-analysis was applied to 33 studies of chymopapain in an illustrative example. The analysis produced a large effect size of 0.8082 and a fail-safe N of 214, indicating strong support for the effectiveness of the treatment with chymopapain. Meta-analysis can be a useful tool if it is used properly. It is particularly useful as an adjunct to other methods of review that are used in pharmacy practice.

Chymopapain↗
PubMed1985

Decision analysis applied to pharmacy practice.

The use of decision analysis is discussed as it relates to pharmacy practice. Decision analysis is a valuable approach to selecting a choice from among several uncertain alternatives. It encourages the practitioner to define his views explicitly and weigh the merits of each alternative. The decision maker lists the choices or options to be considered. These choices are incorporated into a decision tree with their probability of occurrence and the relative worth of each potential outcome (utility) to the concerned party. A limitation of the method is that utility values and probabilities are often estimated on the basis of the decision makers' biases. Examples of applying decision analysis to clinical and administrative choices in pharmacy practice are presented.

Bayes Theorem↗
PubMed1985

Leadership styles of hospital pharmacy directors.

The leadership styles of hospital pharmacy directors and the association between leadership style, participative management, and innovative pharmaceutical services were studied using a mail questionnaire. The questionnaire was sent to 570 randomly selected hospital pharmacy directors. Included were a validated instrument that measures task-oriented versus relationship-oriented leadership behavior and other questions about participation of staff members, innovative services, and respondents' personal characteristics. The response rate was 69%. The majority of respondents perceived their leadership as highly relationship-oriented as well as highly task-oriented. Respondents with the "high relationship-high task" leadership style had the highest scores for subordinate participation. There were no significant differences in scores for innovative services by leadership style. A positive correlation between scores for subordinate participation and scores for innovative services was demonstrated. Most hospital pharmacy directors used a management style in which relationships and staff participation were important.

Leadership↗
PubMed1984

Clinical pharmacists prescribing drug therapy in a geriatric setting: outcome of a trial.

Clinical pharmacists, under the supervision of a family practitioner physician, assumed responsibility for drug management of geriatric patients in a Los Angeles skilled nursing facility. In a quasi-experimental, pretest-post-test control group design, outcome criteria were measured. Compared with the control group which received traditional patient care, the prescribing clinical pharmacists' group had a significantly lower number of deaths (P = 0.05), a significantly higher number of patients being discharged to lower levels of care (P = 0.03), and a significantly lower average number of drugs per patient (P = 0.04). The lower number of patients hospitalized approached significance (P = 0.06) in the prescribing clinical pharmacists' group. The practice of having clinical pharmacists prescribe drug therapy and render general care, under the supervision of a physician, has the potential for saving the health care system approximately $70,000 per year per 100 skilled nursing facility beds.

Aged↗
PubMed1984

Diffusion of innovation: computer technology in hospital pharmacy.

The diffusion of computer technology in hospital pharmacy departments was studied by surveying pharmacy directors in a randomly selected sample of 501 hospitals in the United States with at least 100 beds. Pharmacy directors were asked to indicate for which of 17 tasks a computer or memory typewriter was used in the pharmacy department. The time of first adopting computers in the department was compared with the predicted S adoption curve; adoption time was also correlated with characteristics of the hospital, pharmacy, and pharmacy director. Of the 417 respondents, 308 reported use of a memory typewriter or computer in the pharmacy. Fifty-one directors reported only memory-typewriter use, and 94 reported both computer and memory-typewriter use. Maintenance of patient census lists and patient billing were the most frequent uses of computers. The primary uses of memory typewriters were preparation of letters and labels. There was no significant difference in the actual and predicted S curves for time of adoption of computers. The number of months since first adopting computers was positively correlated with hospital bed size and the pharmacy director's number of years as a pharmacist, years in current position and with current employer, and number of subordinates; it was also positively correlated with number of pharmaceutical services and number of computer uses in the department. Computer technology is becoming more universally accepted in hospital pharmacy, and research on the diffusion of innovations suggests that acceptance will continue to increase.

Computers↗
PubMed1983

A comparison of pharmacists and physicians on the quality of prescribing for ambulatory hypertensive patients.

This article discusses a quasi-experimental study of the quality of pharmacists' and physicians' drug prescribing for ambulatory hypertensive patients in a health maintenance organization. The null hypothesis was that there is no difference between pharmacists and physicians as to the quality of drug prescribing for hypertensive patients. Analysis revealed no difference in prescribing between the physician group and the pharmacist group on the scoring for the presence of drug interactions, appropriateness of quantities, dose, and patient directions. The pharmacist prescriber group did significantly better than the physician group, however, on choosing the appropriate drug, prescribing for a "positive effect on the patient's health," and overall appropriateness from combining all the above scales (p less than 0.05). The diastolic pressures of the patients assigned to the pharmacists' group were not significantly different from the physicians' group on pretest, but on posttest the diastolic pressures were slightly lower in the pharmacists' group (p less than 0.10).

California↗
PubMed1983

A randomized trial comparing pharmacists and technicians as dispensers of prescriptions for ambulatory patients.

This article describes a study on the impact of utilizing technicians in the dispensing of prescriptions for ambulatory patients. The two hypotheses were 1) there is no difference in error rate for prescriptions dispensed by pharmacists versus technicians, and 2) there is no change in the amount of time pharmacists spend counseling patients after technicians begin dispensing prescriptions. Power analysis indicated that a sample size of 900 prescriptions would need to be randomized into each group to adequately compare error rates. Results showed that there was no significant difference in error rate between pharmacists (5.17 per cent) versus technicians (4.17 per cent), supporting the first null hypothesis. Pharmacists did spend significantly more time counseling patients (p less than 0.001), leading to a rejection of the second null hypothesis. Since the number of staff did not change during the study, it is calculated that, based on annual salary plus fringe benefits, +20,080 in additional pharmacists' time was freed up for patient counseling when technicians were dispensing the prescriptions.

California↗
PubMed1983

Comparison of physician and pharmacist management of anticoagulant therapy of inpatients.

The management of anticoagulant therapy for hospitalized patients by seven certified pharmacist prescribers and one physician was compared. Eighty-one consecutive patients referred to the anticoagulation service were randomly assigned to two groups. For patients in the pharmacist-prescriber group, the physician independently monitored laboratory results and simulated heparin and warfarin doses. The roles of pharmacist and physician were reversed for patients in the physician-prescriber group. According to an established protocol, adjustments in heparin sodium infusion rate were based on activated partial thromboplastin time (PTT); warfarin sodium dosage was adjusted using a proconvertin and prothrombin (P&P) method. Heparin doses, warfarin doses, and clotting-test results were compared for patients in the two prescriber groups; simulated and actual doses also were compared. Patients were observed for complications of anticoagulant therapy. There were no significant differences in the mean heparin and warfarin doses administered to patients in the two prescribed groups. Similarly, PTT and number of days to reach therapeutic P&P were not significantly different. Within each group, the mean prescribed and simulated heparin doses were not significantly different. There were no episodes of major bleeding, but four patients in the pharmacist-prescriber group had minor bleeding. While the results are not applicable to all pharmacists or all settings, the certified pharmacist prescribers in this study adjusted anticoagulant therapy as well as an experienced physician.

Anticoagulants↗
PubMed1982

Pharmacists as drug prescribers: validation of certification exams and evaluation instruments.

The purpose of this article is to discuss the validity and reliability of certification tests and evaluation instruments for pharmacists as drug prescribers. Under California Law AB 717, the University of Southern California is operating one of two pilot programs to train and evaluate prescribing pharmacists. Various instruments have been created and administered, and validity results are presented. The presentation is organized into two areas dealing with the development of the examination instrument and then the assessment of the prescriptions written by pharmacists. The reliability of the three sections of the certification examination as measured by internal consistency was as follows: clinical therapeutics (KR 20=.84), physical assessment (KR 20=.88), and law (KR 20=.84). The exam was given to a group of physicians (N=14) to establish a cutting score. Thirty pharmacists who took the exam did slightly better than the physicians on clinical therapeutics, but the physicians performed better than pharmacists on physical assessment (p less than .01). A prescription evaluation form was constructed to evaluate the performance of the pharmacists as prescribers. The reliability of the form as measured by coefficient alpha was .84. Concurrent validity was explored by assessing the relationship between performance on the certification exam and judges' appropriateness scored on prescriptions for ambulatory hypertensive patients. These results indicate that the pharmacists, who passed the exam, can prescribe as appropriately as physicians.

California↗
PubMed1982

Application of cost-benefit and cost-effectiveness analysis to clinical practice.

This article is intended to introduce the reader to the concepts of CEA/CBA for purposes of evaluating innovative pharmacy services. Furthermore, sensitization to the issues surrounding CEA/CBA studies should allow the reader to be more discriminating in reviewing such reports in the literature. Rising costs for health care and the existence of limited resources are forcing policy makers to allocate resources in ways that maximize return-on-investment. It is felt by some that in the 1980s, researchers will be expected to answer the questions, "How much better is the innovation?" and "How do the expected benefits of an innovation compare with the benefits that could be obtained if the resources were used in some alternative way?" Part of the solution will require changes in the training and practice of health professionals. Future physicians, pharmacists, and others will need to acquire skills from the behavioral, social, and decision sciences (e.g., epidemiology, statistics, economics, decision analysis). The notion of cost-effective clinical decision making needs to be taught at all levels. Health practitioners involved with decision making at the level of the patient need to become more knowledgeable of the overall impact (regarding costs and benefits) of their decisions. Finally, evaluation of innovative pharmacy services is but one element of a management program for clinical services. Our attempt is not to deemphasize the need for studies documenting the value of clinical services, but rather to put evaluation in perspective with an equally important need, the need for development of an overall pharmacy program that is not only cost effective but efficient as well. The means to this end is a total management program integrating all pharmacy services.

Cost-Benefit Analysis↗
PubMed1982

Comparison of pharmacist and physician prescribing for psychiatric inpatients.

Drug prescribing for inpatients by three certified pharmacist prescribers and two psychiatrists at a 40-bed mental health facility in California was evaluated. The pharmacist prescribers were assigned diagnosed patients whose treatment plan was primarily pharmacologic. For each prescriber, 60 prescriptions were randomly selected to include 20 neuroleptic drugs, 20 anticholinergic drugs used to alleviate the parkinsonism-like syndrome induced by neuroleptic drugs, and 20 antidepressants. A panel of four clinical judges independently evaluated the appropriateness of each prescription using explicit screening criteria; the judges' mean scores were reported. The patients treated by pharmacists and physicians were similar in age, sex ratio, number of drugs prescribed, and number of medical diagnoses. There was no significant difference in the appropriateness of prescribing between pharmacists and physicians for anticholinergic drugs, while mean scores for pharmacists were significantly better than physicians for neuroleptic and antidepressant drugs. The mean scores for all prescribers in most areas were in the appropriate range. While the results are not applicable to all pharmacists, the certified pharmacist prescribers in this study prescribed drugs for psychiatric inpatients as safely and appropriately as the physicians.

Antidepressive Agents↗
PubMed1981

The pharmacist as prescriber of drug therapy: the USC pilot project.

Recent legislation in California allows pilot projects to investigate prescribing by pharmacists. The University of Southern California School of Pharmacy project was approved in October, 1978. To be certified as prescribers, pharmacists must successfully complete a physical assessment course and a certifying examination. From an original group of 30 interested pharmacists, 25 were certified; five different pharmacists were added later. Prescribing pharmacists must meet with their supervising physician once every two weeks, and are restricted to the project formulary. A variety of health care settings are represented in the project, with pharmacists prescribing for ambulatory patients with chronic diseases, geriatric patients in extended care facilities, psychiatric patients, and selected inpatients. Project evaluation will continue through 1982 and will focus on safety and quality of care, patient acceptance, and cost of care.

California↗
PubMed1981

Dilemmas in evaluating health care and clinical programs.

This article discusses some of the dilemmas in evaluation research that are commonly encountered in evaluating pharmacy and health care programs. Emphasis is on the difference between decision-oriented evaluation and hypothesis-testing research. Deficiencies, abuses, and pitfalls are discussed along with rationalizations often generated by negative findings. Disclosure of the problems that arise should make the path to quality evaluations less perilous.

Evaluation Studies as Topic↗
PubMed1980

Pharmacy competencies: their relative importance to consumers, practitioners, educators, and students.

The pharmacy profession increasingly is involved in developing and maintaining competency standards as objective criteria in evaluating the educational process and in judging practitioners' continuing competence. This study compared the rankings of various pharmacy competencies among diverse populations, specifically, consumers, practicing pharmacists, pharmacy educators, and pharmacy students. The competencies were assessed through a questionnaire which required the respondents to rank 17 competency labels in order of importance. The questionnaire was completed by 104 metropolitan residents and additional samples included 450 practitioners, 39 pharmacy educators, and 217 pharmacy students. Interesting differences appear between the rankings of the competencies among the consumers, practitioners, faculty, and students. Results indicate that consumers highly ranked the traditional roles of the pharmacist as a drug distributor. Faculty tend to rank highly the clinical roles of the pharmacist. The highest rank correlations on pairs occurred between students and faculty (0.89) and between pharmacists and consumers (0.89). The lowest rank correlation occurred between faculty and consumers (0.64).

Attitude of Health Personnel↗