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PubMed1981

Managing computer systems.

This paper launches a 12-part series of articles on managing computer systems for the hospital pharmacy department. The series will concentrate on the evaluation, purchase, and implementation of commercial computer systems. Computer hardware and software capabilities will be reviewed, a systematic approach toward the selection of a vendor will be outlined, advice on how to justify a system wil be offered, and important considerations in implementing and managing a computer system will be discussed.

Computers↗
PubMed2005

Changes in intravenous immunoglobulin prescribing patterns during a period of severe product shortages, 1995-2000.

BACKGROUND AND OBJECTIVES: Canadian consumption of intravenous immunoglobulin (IVIG) has increased dramatically since it was first marketed in the early 1980s, and Canada is now the world's largest per capita consumer. During the late 1990s, worldwide product shortages of IVIG occurred. This study was designed to identify the disease conditions for which IVIG was being prescribed in academic hospitals during this period, and to explore the effects that IVIG shortages had on prescribing patterns. MATERIALS AND METHODS: Blood bank and pharmacy records of IVIG distribution were collected retrospectively from four Toronto teaching hospitals for the period 1995-2000. These records were then cross-referenced with patient medical records to determine the indication for IVIG administration. RESULTS: A total of 100,208 g of IVIG was prescribed to 429 patients over a 6-year period. Most of the IVIG consumption was in patients with haematological (22%) or neurological (20%) conditions, in recipients of bone marrow transplants (19%) and in patients with infectious disease-related conditions (including congenital and acquired hypogammoglobulinaemia, 18%). Dermatological conditions (7%) were the most rapidly growing indication for IVIG usage during the 6-year period of review, increasing from 0% of annual IVIG usage in 1995 to 16% in 2000. Over 80% of the diseases treated were supported by published recommendations. After 1997 there was an abrupt decline in the annual number of patients treated, primarily owing to a decline in single-use recipients. Annual consumption of IVIG, however, remained stable. CONCLUSIONS: IVIG shortages were followed by a decrease in the number of single-use recipients, who probably represented empirical use of IVIG; this had little effect on the total amount of IVIG distributed annually. Stricter adherence to currently available published recommendations may not be the optimal means of controlling IVIG use within an academic hospital setting. Rather, emphasis may be better placed on improving the evidence base upon which these recommendations are made, for example by conducting controlled prospective clinical trials.

Adult↗
PubMed1998

The availability and cost of antibiotics for treating PID in the Central Region of Ghana and implications for compliance with national treatment guidelines.

The availability and cost of antibiotics for treating pelvic inflammatory disease (PID) were assessed in 17 drug-dispensing outlets in 5 districts of the Central Region, Ghana. The outlets included the dispensaries of 2 regional and 4 district hospitals, 4 privately-owned pharmacies and 7 chemical seller shops. The most common antibiotics available, including co-trimoxazole, metronidazole, benzylpenicillin, amoxycillin, chloramphenicol and gentamicin, were also the lowest-priced drugs. Conversely, the most expensive antibiotics including ceftriaxone, ciprofloxacin, cefuroxime and spectinomycin, were also the least commonly available. Recommended anti-gonococcal antibiotics (ciprofloxacin, ceftriaxone) may not be prescribed if they are not available in the districts.

Anti-Bacterial Agents↗
PubMed2002

Patient counselling profile in a Finnish pharmacy.

The present study assessed the patient satisfaction on Finnish community pharmacy services with a special focus on patient counselling. Two different study methods were performed in one Finnish community pharmacy to clarify the patient counselling profile. In autumn 1996, 200 of local citizens were interviewed and a questionnaire has been filled by the pharmacists after counselled episodes. The patient opinion of counselling showed that counselling by pharmacists is beneficial for their medication. Furthermore, pharmacists seem to be more active with the patients receiving prescription drugs. According to our results pharmacists should adjust more counselling to every patients needs. Thus, pharmaceutical information and support of self-care were found to be important areas in patient counselling.

Adult↗
PubMedDate not supplied

Use of alternative therapies and their impact on compliance: perceptions of community pharmacists in Texas.

OBJECTIVE: To assess community pharmacists' experiences with the use of alternative therapies by their patients with chronic illnesses. DESIGN: Mail survey. SETTING: State of Texas. PARTICIPANTS: 142 community independent and chain pharmacists. MAIN OUTCOME MEASURES: Pharmacists' recollections about patients' use of alternative therapies. RESULTS: Pharmacists estimated that 17% of their patients with chronic illnesses used some form of alternative therapy. A majority (66.9%) indicated that they have patients who used some type of alternative therapy for chronic conditions and that a majority (59.7%) of these patients consulted with them regarding those therapies. However, in only 11.1% of these cases did pharmacists document alternative therapy use in patients' pharmacy records. Pharmacists reported that 25.9% of these patients who use alternative therapies for chronic conditions were not compliant with their prescribed medication regimen. One-third (33.1%) of respondents indicated they knew of no patients who used alternative therapies, and 35.9% had never asked. CONCLUSION: Pharmacists need information on patients' use of alternative therapies for chronic illnesses to make valid therapy decisions and to monitor outcomes. Future research should identify actions that pharmacists take to address drug-related problems among alternative therapy users and assess the impact of these actions on drug therapy-related outcomes.

Adult↗
PubMed1998

Motivations and practice-area preferences of pharmacists interested in pursuing a Pharm.D. degree through a nontraditional program.

Pharmacists' interest in a proposed nontraditional Pharm.D. program, motivations for wanting to pursue a Pharm.D. degree, and practice-area preferences were surveyed. Questionnaires were mailed to 12,621 pharmacists in Illinois and Arizona. Information sought included current position and practice area, number of job and career changes, preferred practice area, and interest in enrolling in a proposed nontraditional Pharm.D. program described in a cover letter. For pharmacists indicating an interest, information was sought on motivations for wanting to pursue a Pharm.D. degree expected support from employers, and preferred practice areas after obtaining a Pharm.D. degree. The response rate was 28.8%. A total of 1119 respondents (31.9%) indicated that they would or probably would enroll in the proposed Pharm.D. program. These pharmacists gave improving their clinical skills and improving the quality of their work as reasons for wanting to enroll, and half indicated that their current practice area would be their preferred area after they completed a Pharm.D. degree. Almost three quarters (72%) of hospital pharmacists; more than 60% of home health care or consultant independent, and managed care pharmacists; and 21% of pharmacists in chain pharmacies stated a preference to stay in their current practice area after obtaining a Pharm.D. degree. Eight variables were useful in predicting whether respondents would prefer to remain in their current practice area, including tuition assistance or reimbursement from employers, satisfaction with current position, and number of years in current position. Respondents who were interested in pursuing a Pharm.D. degree through the nontraditional program described to them were motivated by a desire to improve their clinical skills and the quality of their work and the opportunity to open doors to new careers.

Adult↗
PubMedDate not supplied

Pharmacists' readiness to assess consumers' over-the-counter product selections.

OBJECTIVE: To measure and explain pharmacists' readiness to adopt a proposed new standard for assessing consumers' over-the-counter product selections. DESIGN: Cross-sectional, descriptive study based on the theoretical underpinnings of the Transtheoretical Model of Change. A questionnaire was used for data collection. Sections included: (1) pharmacists' readiness to engage in a proposed standard of practice; (2) the positive and negative aspects of doing so; (3) pharmacists' agreement with current legislative status of pharmacist-only products; and (4) demographics. SETTING: Community pharmacy. PARTICIPANTS: Community pharmacists in one Canadian province. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pharmacists' readiness to adopt a proposed new standard of care. RESULTS: Response rate was 70.6%. Most respondents were staff pharmacists in independent pharmacies. The majority were not ready to adopt the proposed new behavior--57.6% were in the precontemplation stage. Age, sex, year of graduation, workload, and size of town/city had no significant effect on readiness for change. As expected, precontemplators showed less overall support for keeping pharmacist-only agents behind the counter. Positive and negative beliefs about the proposed standard varied across stages. CONCLUSION: Any initiatives to increase pharmacist involvement in assessing consumer nonprescription product selections must acknowledge that pharmacists differ in their degree of readiness for change.

Adult↗
PubMed1989

Experience with a two-tiered therapeutic interchange policy.

A university hospital's formulary policy for therapeutic interchange is described in which pharmacists can routinely interchange some drugs but must contact the prescribers before interchanging other drugs. For drugs that are not automatically interchanged by the pharmacy, the formulary contains a "class representative," which pharmacy may change as relative prices of drug products change. When a non-formulary drug for which there is a designated class representative is prescribed, pharmacy contacts the prescriber. When a class representative for injectable histamine H2-receptor antagonists was being selected, previous positive and negative experiences with establishing therapeutic equivalence for antimicrobial agents were considered. The implementation of H2 antagonist therapeutic equivalence included the following steps: determining potential cost savings, reviewing the literature, consulting with specialty practitioners, presenting the information to the pharmacy and therapeutics committee, distributing formal bids, and educating hospital staff. Before cimetidine was designated the class representative, 84% of orders for injectable H2 antagonists were for ranitidine; one year later, 90% were for cimetidine. Orders for oral H2 antagonists also changed from predominantly ranitidine to predominantly cimetidine. The hospital's total costs for H2 antagonists decreased 8.4% in one year. The two-tiered approach to therapeutic interchange can reduce drug costs and increase the scope of agents deemed therapeutic equivalents in a manner that is acceptable to physicians and pharmacists.

Boston↗
PubMed2002

Development and evaluation of an electronic drug and therapeutics bulletin.

OBJECTIVE: To describe the development, implementation, and initial evaluation of a paperless drug and therapeutics bulletin that is distributed by electronic mail from the pharmacy department of an Australian teaching hospital. OUTCOMES: A standardized format for the bulletin was designed and approved in February 2001. The aim of the bulletin is to facilitate the timely dissemination of concise, factual information about issues of current interest in therapeutics, drug safety, and the cost-effective use of medicines. A simple and attractive graphic design was chosen, and the hospital's clinical pharmacists and drug information staff developed an initial bank of content during the period immediately preceding the launch. The bulletin is presented as a 1-page, read-only file in Word for Windows format and was initially distributed by electronic mail to all users of the hospital's computerized communication network. As the popularity of the bulletin increased, healthcare practitioners from outside of the hospital began to request permission for inclusion on the circulation list, and the content was frequently forwarded by E-mail to workers in other hospitals and community-based settings. The bulletin is now distributed to pharmacists around Australia via 2 separate moderated discussion lists, one of which provides an archive site for previous editions. Healthcare workers in Singapore, the US, Canada, and New Zealand also receive the bulletin, which is now also abstracted by a major Australian pharmacy journal. A readership survey (also electronically distributed) was used to seek feedback after the publication of the first 12 editions. Readers indicated a high level of satisfaction with the content, format, and frequency of distribution of the materials. CONCLUSIONS: Although the concept and execution of this project was relatively simple, an extensive literature review did not reveal any previously published reports describing this type of approach to the distribution of a pharmacy bulletin. The development and implementation of the electronic drug and therapeutics bulletin has provided an opportunity to use modern communication technology to promote safe and effective medication use and appears to have been well received.

Australia↗
PubMed2005

Emergency contraceptive pills: dispensing practices, knowledge and attitudes of South Dakota pharmacists.

CONTEXT: Despite a decision by the Food and Drug Administration to deny over-the-counter status to emergency contraceptive pills, pharmacists play a crucial role in a woman's access to this medication, especially in areas with large rural populations. Pharmacists' knowledge about and attitudes toward emergency contraceptive pills may affect whether pharmacies carry the medication and whether individual pharmacists dispense it. METHODS: In October 2003, all registered pharmacists living and working in South Dakota were mailed a survey to assess their dispensing practices for, knowledge about, and attitudes toward emergency contraceptive pills. Data for 501 respondents were analyzed through chi-square testing and multivariate logistic regression. RESULTS: Fifty-four percent of respondents worked in pharmacies that carried emergency contraceptive pills. Of these, 67% had dispensed the medication in 2003, and 24% were not comfortable providing customer counseling about the method. Thirty-seven percent of all pharmacists did not understand its mechanism of action; 43% and 21%, respectively, incorrectly answered questions about the medication's link to birth defects and health risks. Only 5% correctly answered all three questions. Eighty-four percent of surveyed pharmacists believed that the medication should not be made available over the counter. Multivariate analysis showed that knowledge of emergency contraception and support for over-the-counter status were relatively low among pharmacists working in small communities. CONCLUSIONS: The education of pharmacists about emergency contraceptive pills must be strengthened to ensure that women receive accurate medical information and access to all contraceptive services.

Attitude of Health Personnel↗
PubMed2004

How to estimate the population that is covered by community pharmacies? An evaluation of two methods using drug utilisation information.

PURPOSE: Pharmacy-dispensing data are valuable sources of drug information, but the population that is covered by the pharmacies is often difficult to determine. We evaluated two methods using drug utilisation information to estimate the population size: a drug-use-based extrapolation of a known part of the population and a capture-recapture estimation without any prior knowledge of the population. METHODS: Using pharmacy-dispensing data of three towns with known populations in the Netherlands, we estimated age-and-sex specific population sizes by extrapolating the proportion of drug-using inhabitants. In addition, we applied two-source and three-source capture-recapture models with all combinations of the following drug groups as different sources: anti-asthmatics, analgesics, antibiotics and anti-histamines. RESULTS: Drug-use-based extrapolation resulted in the best estimates with the least variability. All capture-recapture models provided underestimations of the true population. Three-source capture-recapture resulted in better average estimates than two-source capture-recapture, but also had more variability. CONCLUSIONS: If a part of the population is known, and if there is reason to assume that drug utilisation patterns do not vary within the region, it is best to use drug-use-based extrapolation. In all other situations capture-recapture may be considered, with as main limitation that we found all models to underestimate the population considerably.

Age Distribution↗
PubMedDate not supplied

Results of a smoking cessation clinic in community pharmacy practice.

OBJECTIVES: To describe and assess the effectiveness of a smoking cessation clinic. DESIGN: Single group, unblinded study. SETTING: Seven chain (mass-merchandise) community pharmacies in Virginia. PARTICIPANTS: Forty-eight patients who were smokers when admitted to the study. INTERVENTIONS: Fifteen community chain pharmacists were trained using a smoking cessation training manual developed at the Virginia Commonwealth University School of Pharmacy. From April 1, 1997, through December 31, 1999, interested patients met individually with a study pharmacist during scheduled clinic times in semiprivate counseling areas. A patient chart was maintained at the site and updated after each visit. The first 30 patients completed a questionnaire after the third visit to the smoking cessation clinic to assess satisfaction with pharmacists and the overall program. MAIN OUTCOME MEASURE: Rate of long-term smoking cessation. RESULTS: Of the 48 patients, 12 (25.0%) abstained from smoking cigarettes for 12 months or more beyond their predetermined quit dates. Abstinence rates for 1, 3, and 6 months were 43.8%, 31.3%, and 25.0%, respectively. Women were nearly five times more successful in attaining long-term abstinence than were men (33.3% versus 6.7%; P= .047). No significant differences were observed in cessation rates related to age, number of cigarettes smoked per day, level of nicotine dependence, number of previous quit attempts, or method of cessation. Increased appetite and weight gain were the most frequently reported withdrawal symptoms (16.7% of patients). Patients expressed satisfaction with the pharmacists and the smoking cessation program. CONCLUSION: Compared with other types of previously reported interventions, a community pharmacist-managed smoking cessation clinic achieved greater long-term smoking cessation rates.

Adult↗
PubMed1994

A study of the effects of exposure misclassification due to the time-window design in pharmacoepidemiologic studies.

This paper considers the effects of the time-window design on the validity of risk estimates in record linkage studies. A time-window constitutes the number of exposure days assigned to each prescription, often fixed time-intervals. Prescription information was drawn from 36 Dutch pharmacies. Persons, assuming full compliance to the dosage regimen, used NSAIDs during 58% of the 30 day window time (31% with 90 day window). This proportion ranged from 51 to 81% for different NSAIDs; from 75% for elderly to 35% for younger persons. We observed with longer windows a substantive attenuation of incidence rates of peptic ulcer therapy. Simulations also showed that the assignment of equal windows to groups with different durations of drug use can bias risk comparisons, either away from the null or towards the null. We concluded that the choice of prescription time-windows can influence the estimates of exposure risks. Time-windows should cover the period with potential excess risk and be validated.

Adult↗
PubMed2005

Direct-to-consumer advertising and the patient-physician relationship.

BACKGROUND: Differences in attitudes of patients and physicians toward direct-to-consumer advertising (DTCA) of prescription medications may influence the patient-physician relationship, which may in turn influence health care outcomes. OBJECTIVE: The objective of this study was to provide empirical evidence to show how the patient-physician relationship may be influenced by DTCA. METHODS: The study used a cross-sectional research design. Pharmacists at 71 pharmacies were asked to distribute self-report survey instruments to patients who used either a proton-pump inhibitor or a nonsedating antihistamine by prescription. Data were collected between March and June 2003. Hierarchical multiple regression was used to assess the research propositions. RESULTS: A usable response rate of 7.3% (n=326) was obtained. About 95% of the sample had seen an advertisement for either a proton-pump inhibitor or a nonsedating antihistamine. Response to DTCA was significantly related to the patient's satisfaction with the physician and the patient's evaluation of communication, even after controlling for demographic variables and length of the patient-physician relationship. Other outcome variables (trust, relationship commitment, and average visit time) were not significantly related to DTCA response. Post hoc analyses revealed that DTCA responders, who asked their doctor to prescribe a specific product after seeing its advertisement, rated satisfaction and communication lower than the DTCA nonresponders. Additional follow-up analyses showed that these findings were largely attributed to patients in the proton-pump inhibitor group. CONCLUSION: The findings suggest that response to DTCA may be significantly related to patients' evaluation of communication quality and their satisfaction with the physician. However, these findings may not generalize to all medical conditions or types of patient. Furthermore, DTCA response does not appear to be related to other patient-physician relationship outcome variables. Given these findings, key variables to explore in future DTCA research with respect to its effect on the patient-physician relationship include patient expectations and disease/condition type.

Adult↗
PubMed2001

A comparative analysis of domiciliary oxygen therapy in five European countries.

This comparative study analyses the domestic market of domiciliary oxygen therapy in five European countries (Denmark, France, Germany, Italy, and the UK) according to a common checklist of subjects. Domestic legislation, prescription procedures, delivery, and the market situation concerning oxygen therapy were considered. The analysis involved (i) reviewing the literature on oxygen therapy in national and international journals, and (ii) interviewing a selected expert panel of market operators in each country (composed of at least one civil servant, one physician, one distributor, and one oxygen manufacturer). The analysis did not find any specific relationship between the health care system framework and the oxygen therapy market, except for a greater inclination towards home care in national health services. In all these countries oxygen therapy is reimbursed, but the type of supply and its diffusion differ widely. The spread of domiciliary care has undermined the traditional role of pharmacies in the oxygen distribution chain in all countries except Italy. The study did not help identify any specific country that can be considered a benchmark for oxygen therapy, each one dealing with oxygen therapy in a different way. An economic evaluation of the different supply modalities could help improve decision making by public authorities.

Cross-Cultural Comparison↗
PubMed1998

Rationale and design of the International Verapamil SR/Trandolapril Study (INVEST): an Internet-based randomized trial in coronary artery disease patients with hypertension.

OBJECTIVES: The primary objective of the International Verapamil SR/Trandolapril Study (INVEST) is to compare the risk for adverse outcomes (all-cause mortality, nonfatal myocardial infarction [MI] or nonfatal stroke) in hypertensive patients with coronary artery disease (CAD) treated with either a calcium antagonist-based or a noncalcium antagonist-based strategy. BACKGROUND: Treatment recommendations for hypertension include initial therapy with a diuretic or beta-adrenergic blocking agent, for which reductions in morbidity and mortality are documented from randomized trials but are less than expected from epidemiologic data. For this reason, recent attention has focused on calcium antagonists or angiotensin-converting enzyme inhibitors. While these agents reduce blood pressure, outcome data from large randomized trials are lacking, but some case-control data, dominated by short-acting dihydropyridines, suggest an increased risk of cardiovascular events. These studies had methodologic limitations and did not differentiate among calcium antagonist types and formulations. Several studies differentiating among calcium antagonist types and an overview of published randomized trials show no increased risk with verapamil and suggestion for benefit in CAD patients. METHODS: A total of 27,000 CAD patients with hypertension will be randomized at 1,500 primary care sites to receive either a calcium antagonist-based (verapamil) or beta-blocker/diuretic-based (atenolol/hydrochlorothiazide) antihypertensive care strategy. The study uses a novel, electronic "paper-less" system for direct on-screen data entry, randomization and drug distribution from a mail pharmacy linked to the coordination center via the Internet. RESULTS: Contract negotiations with the United States and international sites are ongoing. Patients being enrolled are predominantly elderly (72% aged 60 years or older) men (54%), with either an abnormal coronary angiogram or prior MI (71%). In addition to hypertension, CAD and elderly age, most patients (89%) have one or more associated conditions (diabetes, dyslipidemia, smoking, cerebral or peripheral vascular disease, etc.) contributing to increased risk for adverse outcome. While 26% have diabetes, most of these are noninsulin dependent. Using the protocol strategies, target blood pressures (according to JNC VI) have been reached in 58% at the fourth visit, and as expected most (89%) are requiring multiple antihypertensive drugs. CONCLUSION: The design and baseline characteristics of the initial patients recruited for a prospective, randomized, international, multicenter study comparing two therapeutic strategies to control hypertension in CAD patients are described.

Aged↗
PubMed2003

Effects of coaching by community pharmacists on psychological symptoms of antidepressant users; a randomised controlled trial.

BACKGROUND: Community pharmacists strive to deliver pharmaceutical care to patients. At the moment, coaching of depressive primary care patients on taking their antidepressants (ADs) is not yet part of their standard care package. AIMS: To investigate the effects of coaching by community pharmacists on psychological symptoms. METHOD: A randomised controlled trial with a 6-month follow-up. OUTCOMES: psychological symptoms with the Hopkins Symptom Checklist (SCL). Intention-to-treat (ITT) was performed with (1) last observation carried forward and (2) with group mean imputation (GMI). RESULTS: Analyses with LOCF and GMI resulted in different findings. The LOCF method revealed that at the 6-month follow-up, the intervention patients were less depressed and less anxious than the controls. The intervention was particularly effective in patients with lower levels of education who received pharmacist's coaching. However, ITT with the GMI method showed no differences in psychological symptoms. Differences between LOCF and GMI were explained by the selective attrition in the intervention arm (attrition intervention patients had lower initial SCL-item scores on depression and anxiety than the completers) and by the higher attrition rate in controls. CONCLUSIONS: Our study indicates that the interpretation of the effects of an intervention on psychological symptoms can differ substantially by the way missing values are imputed. If both LOCF and GMI produce significant differences, efficacy can be concluded. If not, the effects based on ITT analyses with LOCF are based on artefacts. We recommend that positive intervention effects should only be reported when findings with LOCF and GMI are in accordance.

Adult↗
PubMed1996

Task analysis of home care pharmacy.

The demographics of home care pharmacists and the frequency and perceived importance of home care pharmacy tasks were studied. Two questionnaires were mailed in August 1994 to each of 1420 sites that provide home care pharmacy services. Home care pharmacists were asked to provide information on themselves and their companies and to rate 47 home care pharmacy tasks (administrative, clinical, distributive, and miscellaneous) on how often they are performed as part of the job and how essential they are for successful job performance. Of the 2840 surveys mailed to the 1420 sites, questionnaires for 87 sites were not deliverable, leaving an adjusted gross sample of 1333 sites. A total of 393 usable questionnaires were received from 326 sites (net site response rate 24.5%). Respondents tended to be male, have a B.S. degree only, and have more than six years' home care experience. The most commonly identified type of employer was an independent company. Some 34% of respondents said their company had only 1 site; another 33% stated more than 50 sites. Forty-three percent of locations had 2 pharmacist full-time equivalents. Distributive tasks had the highest frequency scores; clinical tasks were performed second most frequently. Distributive and clinical tasks also received high importance scores. The data suggests that, despite other demands on their time, home care pharmacists give considerable attention to tasks consistent with pharmaceutical care. A survey of home care pharmacists provided baseline information on demographics and the frequency and perceived importance of specific tasks.

Female↗