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At least 199 records · Page 11Linked to original sources
PubMed1998

[New distribution forms for pharmaceuticals--a logistic perspective].

Pharmaceuticals are an important input in health care. As a complement to other modes of treatment and as a substitute for hospitalisation, they affect the health of individuals and populations. Enormous public financial resources are spent on pharmaceuticals, and halting the growth in expenditures is a political objective. Factors with room for improvement include drug use efficiency, cost-efficient prescription, purchasing prices and distribution. High distribution costs affect prices and, thus, the assessment of product cost vs. utility. Changes in the distribution system may be important, for three reasons: First, increased capital costs call for higher efficiency. Second, increased competition requires improved logistics. And third, information technology has opened up for new supply chain solutions. Direct sales solutions are being considered, and were discussed in a Norwegian public report on the matter, but no final conclusion has been reached. This article discusses changes in the supply of pharmaceuticals and the development of the market. Alternative supply chains are outlined, including what role the postal service may play in a deregulated pharmaceutical market.

Cost-Benefit Analysis↗
PubMed2001

Characteristics of non-responders to diabetes service use questionnaires.

Postal surveys of service use are likely to overestimate health service use and may also underestimate health needs in the population. A historical cohort study, using postal questionnaires and medical records, showed that non-respondents are registered at addresses in more-deprived wards, they are less likely to have attended a hospital diabetes clinic (38% vs 45%) and much less likely to have had a diabetes review in general practice (11% vs 26%). An analysis based on questionnaire respondents would only therefore both underestimate the level of material deprivation and overestimate the proportion receiving routine reviews in general practice in a population with a chronic condition.

Bias↗
PubMed2002

IAEA/WHO TLD postal dose audit service and high precision measurements for radiotherapy level dosimetry. International Atomic Energy Agency/World Health Organization.

Since 1969 the International Atomic Energy Agency (IAEA), together with the World Health Organization (WHO), has performed postal TLD audits to verify calibration of radiotherapy beams in developing countries. The TLD programme also monitors activities of Secondary Standard Dosimetry Laboratories (SSDLs). The programme has checked approximately 4000 clinical beams in over 1100 hospitals. and in many instances significant errors have been detected in the beam calibration. Subsequent follow-up actions help to resolve the discrepancies, thus preventing further mistreatment of patients. The audits for SSDLs check the implementation of the dosimetry protocol in order to assure proper dissemination of dosimetry standards to the end-users. The TLD audit results for SSDLs show good consistency in the basic dosimetry worldwide. New TLD procedures and equipment have recently been introduced by the IAEA that include a modified TLD calibration methodology and computerised tools for automation of dose calculation from TLD readings.

Austria↗
PubMed2004

Survey of UK hospice and specialist palliative care adult bereavement services.

METHOD: Postal survey of UK hospices and specialist palliative care services providing adult bereavement support. ANALYSIS: Descriptive statistics and content analysis of free text replies. RESULTS: Three hundred services were identified, with 248 valid responses (83%). Of these, 198 (80%) were in England and 180 (73%) were associated with inpatient units. Most had been in existence for at least 10 years. Paid staff were used by 219 services (88%) and volunteers were involved in 168 services (68%). A small minority did not provide supervision for their bereavement staff. A quarter of services had insufficient staff. The most common activities were individual support, telephone support, written information, memorialization events and group support. Ninety-five services (43%) formally assessed the need for individual support. One hundred and fourteen services (51%) had no formal mechanisms for bereaved people to provide feedback about such support. Formal audit and evaluation of bereavement services was uncommon. CONCLUSIONS: The main elements of bereavement support can be identified but their combination varies. Assessment of people for individual support varies and the small size of many services may inhibit the effective delivery of support. Audit and evaluation of bereavement support may need to be developed.

Adult↗
PubMed1969

General practitioner's view of the home nursing service.

A postal questionary concerned with possible developments in the home nursing service was sent to a random sample of 500 principals in general practice in Scotland in late February 1967 and was completed by 444 (89%). Only 13% of the respondents had a district nursing sister attached to their practice organization, but 70% of the remainder wanted this. The most frequently expected benefit was that she could undertake procedures at present performed by the doctor. Half the respondents thought that at present the district nursing sister did not use her professional training and skills fully. Most general practitioners agreed that a State-enrolled nurse, working under supervision, could do some of the jobs now performed by the district nursing sister.

Attitude of Health Personnel↗
PubMed2001

Sterilization and disinfection in general practice within university health services.

A postal questionnaire on 'sterilization and disinfection' was sent to all 144 nurse members of the British Association of Health Services in Higher Education (BAHSHE). Forty-nine (34%) completed valid questionnaires were returned. Despite the majority of practices performing minor surgical procedures such as cervical cytology (N= 40, 82%), ear syringing (N= 44, 90%) and wound dressing (N= 49, 100%), only 11 (22%) had access to a sterile supply department (SSD), and the definitions of sterilization and disinfection were only identified by 23 (52%) and 14 (32%) of the respondents, respectively. Forty-one (84%) respondents had a benchtop sterilizer (30 had a benchtop sterilizer, 11 a vacuum sterilizer and two had both), although there was considerable confusion on their appropriate use and maintenance. Just over half had written procedures for sterilizer use, no practice changed the sterilizer water on a daily basis as recommended by the Medical Devices Agency (MDA), few kept a sterilizer logbook and even fewer had read the MDA Device Bulletin on benchtop sterilizers. The majority of respondents voiced an interest in attending a workshop on sterilization and disinfection. We conclude that despite the location of the general practices within an academic environment, the concept of infection control is clearly not understood by university health service staff. As the implications of a failure to implement proper infection control procedures are potentially serious, the need for adequate education and training of staff is of critical importance.

Clinical Competence↗
PubMed1997

Issues for palliative care in rural Australia.

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.

Australia↗
PubMed2005

Specialty pharmacy: an emerging area of interest for medical management.

Specialty pharmaceuticals are expensive injectable and infusion therapies used to treat patients with chronic or life-threatening diseases. The high cost of these agents and their frequent usage in chronic diseases represent not only challenges, but also opportunities for medical management programs to improve the quality of care and moderate the rapid cost escalation seen in the industry. The number and variety of these agents have been increasing significantly, with hundreds of drug candidates in the development pipeline. The specialty pharmacy industry also is going through a consolidation stage, both horizontally and vertically. Industry approaches to medical management include the acquisition of specialty pharmacy companies, restrictive contracting to achieve concentrated buying power, and the development of utilization management strategies.

Chronic Disease↗
PubMed1992

Consultants' views of a district's services.

A postal questionnaire survey of consultants in the Bath Health District was conducted to establish a means for individual consultants to express their views about the provision of health services in the district, so that by working together a new relationship between the District Health Authority (DHA) as purchaser and the clinicians as providers of services could commence. A response rate of 84 per cent was achieved. The survey sought views on clinical and management issues to be used in the development of service agreements (contracts) and views on topics identified by general practitioners (GPs) as areas in need of improvement. Detail is given of results relating to out-patient services, issues of communication and the continuing role of community hospitals. Most consultants sanctioned the appropriateness of referrals by GPs to out-patient services but they identified some out-patient referrals as inappropriate. This justifies a further review of the out-patient services to be purchased by the DHA. Consultants were in agreement that there was scope for review of out-patient follow-ups. They agreed with GPs that discharge summaries could be provided within 24 hours of patient discharge to improve communication with GPs and that consultants should be available by pager to be contacted by GPs, but disagreed with GPs about the feasibility of giving patients on waiting lists a firm admission date at the time of going on the waiting lists. The majority of consultants were in favour of continuing support for community hospitals. They identified overall social value of community hospitals and greater clinical value of out-patient services than in-patient services in community hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1995

Knowledge of and attitudes about adverse drug reaction reporting among Rhode Island pharmacists.

OBJECTIVE: To survey pharmacists' knowledge of the adverse drug reaction (ADR) reporting process, as well as the nature and seriousness of ADRs observed by pharmacists, and to determine how pharmacists perceive their role in monitoring and reporting suspected reactions. DESIGN: A survey was mailed to 793 Rhode Island pharmacists with a 40% (318) response rate. RESULTS: Two hundred and thirty-five surveys were reviewed for final analysis. Pharmacists in retail settings were more likely than hospital pharmacists to be aware of ADRs relating to therapeutic inequivalence and over-the-counter products, and more likely to ask the patient about ADRs (40% vs 16%). Hospital pharmacists were more likely to receive ADR information from physicians (40% vs 15%). Almost all pharmacists (97%) believed that action should be taken when a serious ADR is suspected. Younger pharmacists (< 45 y) were more willing to contact the physician and refer the patient to medical attention. CONCLUSIONS: Our results show that fewer than half of the respondents (41%) claimed to have observed a serious ADR (potentially life-threatening or requiring hospitalization), although almost all (97%) believed that pharmacists should take some action when a serious ADR is suspected. The influence of the practice setting, the number of years in practice, and the number of hours worked per week influenced the reporting practices and attitudes.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Generic dispensing and substitution in mail and retail pharmacies.

Mail-order pharmacies have lower aggregate generic-dispensing rates than their retail counterparts. This fact has been used as evidence of self-dealing that could arise when a pharmacy benefit manager (PBM) is both a plan administrator and a pharmacy owner. Using the aggregate generic-dispensing rate, however, is problematic because it confounds variation in performance with differences in demand. Controlling for therapeutic mix alone explains 87 percent of the apparent difference in aggregate dispensing rates. An alternative measure--one that fully controls for differences in price and indications across molecules within a category--eliminates the discrepancy in dispensing rates.

Administrative Personnel↗
PubMed2005

Assessment of patient satisfaction with telephone and mail interventions provided by a clinical pharmacy cardiac risk reduction service.

OBJECTIVE: Kaiser Permanente of Colorado developed a population-based program, the Clinical Pharmacy Cardiac Risk Service (CPCRS), to help close the treatment gap for patients with coronary artery disease. CPCRS provides much of its care via telephone. The purpose of this study was to determine the level of satisfaction among patients in this unique service. METHODS: This was a cross-sectional survey of patients enrolled in CPCRS for at least 6 months. A sample of patients who met the inclusion criteria were chosen at random to receive the satisfaction survey via mail. Questions pertained to overall satisfaction and satisfaction with individual components of CPCRS. A Likert-type, 5-point scale was used for the majority of the questions. Analyses of the results were primarily descriptive. RESULTS: Of 1,000 surveys mailed, 491 (49.1%) were returned. The majority of respondents were male (68.5%). The average age of respondents was 71.7 (SD) 9 years. Of those surveyed, 94.6% (95% confidence interval [CI], 92.6%- 96.6%) reported being satisfied (agree or strongly agree) with the care they received for cholesterol management from their CPCRS clinical pharmacy specialist. Respondents reported that their CPCRS clinical pharmacy specialist was easy to contact (83.7%, 95% CI, 80.3%-87.1%), provided timely service (94.8%; 95% CI, 92.8%-96.8%), and addressed all questions or concerns in a way that was easy to understand (85.8%; 95% CI, 82.6%-89.0%). The majority of respondents reported that they were content receiving care over the telephone (86.7%; 95% CI, 83.5%-89.9%) and by mail (90.0%; 95% CI, 87.1%-92.9%). CONCLUSION: Overall, survey respondents indicated a high level of satisfaction with the services provided by CPCRS. Based upon patient satisfaction, the results of this survey suggest that the use of telephone and mail systems to provide patient care can allow clinical pharmacy specialists to manage a large number of patients successfully. Health care systems may wish to explore similar methods to address the needs of patients with coronary artery disease.

Aged↗