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PubMed1997

Reliability and validity of hospital pharmacists' clinical intervention data.

The reliability and validity of pharmacist intervention data documented at a hospital in England were studied. The study involved intervention data recorded from September 1 to December 31 in 1990 (a pilot study), 1991, and 1992 by a total of 23 pharmacists. The interventions in 1990 were coded by a single pharmacist manager and compared with coding by pharmacists of their own interventions during 1991 and 1992. To test for internal reliability of the intervention data, 25% (584) of the 2342 interventions recorded in 1991 and 1992 were randomly sampled after interventions by the 11 pharmacists no longer at the site were eliminated. In September 1993 the 12 remaining pharmacists were asked to recode the interventions they had previously entered. In March 1994 a panel of 12 pharmacists recoded 62 interventions randomly selected from the 684 recoded interventions. Each panel member also assigned financial values to interventions. Medical records corresponding to the 62 recoded interventions were inspected for evidence of the interventions. The distribution of interventions among the drug-use-process (DUP) indicators used in the coding differed significantly between 1990 (when a manager assigned all codes) and 1991 plus 1992 (when pharmacists coded their own interventions). There were similar differences between 1991 and 1992. Results from code-recode and panel testing showed the DUP indicators to be reliable. Clinical outcome indicators were unreliable, as were financial indicators. Medical records verified the occurrence of 50 (81%) of the 62 interventions selected, but in only one case was there evidence that the change in drug therapy was initiated by a pharmacist. The capacity of pharmacists at a British hospital to reliably code interventions was poor.

Chi-Square Distribution↗
PubMedDate not supplied

Bosentan.

Bosentan is the first endothelin (ET) receptor antagonist approved by the Food and Drug Administration for the management of pulmonary arterial hypertension (PAH). In patients with World Health Organization Class III and IV PAH, bosentan has demonstrated improvement in dyspnea and exercise tolerance. ET also plays an important role in the pathophysiology of different vascular diseases. Therefore, bosentan also may have the potential to alter the outcome of many other diseases, such as heart failure, hypertension, ischemic heart disease, and renal disease, as well as cerebrovascular disorders. Because of the rarity and the poor prognosis of patients with PAH, as well as the requirement of close monitoring of bosentan (due to its potential of causing liver dysfunction and its teratogenic effects), bosentan is currently available only through a special access program and is distributed by certain selected pharmacies. Patients who are receiving bosentan should be taught to recognize early signs and symptoms of liver dysfunction and possible pregnancy. In addition, bosentan is not only a substrate but also an inducer of CYP3A4 and CYP2C9. Therefore, it is anticipated that numerous drug interactions may occur. Patients should be advised to consult their physicians or pharmacists should they need to consume other prescription or nonprescription medications.

Antihypertensive Agents↗
PubMed2006

Self-management profiles and metabolic outcomes in type 2 diabetes.

AIM: This paper reports a study whose aims were (1) to examine whether it is possible to determine participants' self-management profiles using three open-ended questions about their self-perceived role in diabetes management; and (2) to analyse whether such self-management profiles have any bearing on haemoglobin A(1c) levels. BACKGROUND: The behavioural and educational aspects of self-management in type 2 diabetes have been the topic of a number of investigations. The individual's role in maintaining health and a satisfying everyday life with chronic conditions is increasingly becoming the focus of secondary prevention. METHOD: Participants (n = 259) were recruited from those attending a year-long health educational programme for people with type 2 diabetes at Swedish pharmacies. A questionnaire was distributed 24 months after baseline. The health outcome, haemoglobin A(1c) was measured on four occasions. Three open-ended questions were used to explore self-management profiles based on perceived role, goal, and need of support in treatment. Data were collected during the period 1997-2002. FINDINGS: The following profiles of participants emerged: Disease Manager, Compliant, and Disheartened, with no initial differences in metabolic control. However, during the programme Disease Managers achieved good glycaemic control and succeeded in maintaining the reduction in their blood glucose for a longer period than those in other categories: their haemoglobin A(1c) level was reduced by -0.35 at 6 months (P = 0.000), -0.30 at 12 months (P = 0.001), and -0.28 at 24 months (P = 0.001) after baseline. Compliant participants had a good everyday routine and a -0.18 reduction at 6 months (P = 0.028) but no statistically significant haemoglobin A(1c) level reduction later. A smaller group of people, the Disheartened, reported difficulties in living with diabetes and did not succeed in decreasing their haemoglobin A(1c) by statistically significant amounts. CONCLUSION: Healthcare professionals could use our three open-ended questions to assist in understanding people's views of their role in disease management so that health promotion and education can be tailored to individual needs.

Analysis of Variance↗
PubMed2005

Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit.

INTRODUCTION: The study aimed to compare the impact of computerised physician order entry (CPOE) without decision support with hand-written prescribing (HWP) on the frequency, type and outcome of medication errors (MEs) in the intensive care unit. METHODS: Details of MEs were collected before, and at several time points after, the change from HWP to CPOE. The study was conducted in a London teaching hospital's 22-bedded general ICU. The sampling periods were 28 weeks before and 2, 10, 25 and 37 weeks after introduction of CPOE. The unit pharmacist prospectively recorded details of MEs and the total number of drugs prescribed daily during the data collection periods, during the course of his normal chart review. RESULTS: The total proportion of MEs was significantly lower with CPOE (117 errors from 2429 prescriptions, 4.8%) than with HWP (69 errors from 1036 prescriptions, 6.7%) (p < 0.04). The proportion of errors reduced with time following the introduction of CPOE (p < 0.001). Two errors with CPOE led to patient harm requiring an increase in length of stay and, if administered, three prescriptions with CPOE could potentially have led to permanent harm or death. Differences in the types of error between systems were noted. There was a reduction in major/moderate patient outcomes with CPOE when non-intercepted and intercepted errors were combined (p = 0.01). The mean baseline APACHE II score did not differ significantly between the HWP and the CPOE periods (19.4 versus 20.0, respectively, p = 0.71). CONCLUSION: Introduction of CPOE was associated with a reduction in the proportion of MEs and an improvement in the overall patient outcome score (if intercepted errors were included). Moderate and major errors, however, remain a significant concern with CPOE.

Chi-Square Distribution↗
PubMed2005

Use of pharmacy data to evaluate smoking regulations' impact on sales of nicotine replacement therapies in New York City.

OBJECTIVES: Recently, New York City and New York State increased cigarette excise taxes and New York City implemented a smoke-free workplace law. To assess the impact of these policies on smoking cessation in New York City, we examined over-the-counter sales of nicotine replacement therapy (NRT) products. METHODS: Pharmacy sales data were collected in real time as part of nontraditional surveillance activities. We used Poisson generalized estimating equations to analyze the effect of smoking-related policies on pharmacy-specific weekly sales of nicotine patches and gum. We assessed effect modification by pharmacy location. RESULTS: We observed increases in NRT product sales during the weeks of the cigarette tax increases and the smoke-free workplace law. Pharmacies in low-income areas generally had larger and more persistent increases in response to tax increases than those in higher-income areas. CONCLUSIONS: Real-time monitoring of existing nontraditional surveillance data, such as pharmacy sales of NRT products, can help assess the effects of public policies on cessation attempts. Cigarette tax increases and smoke-free workplace regulations were associated with increased smoking cessation attempts in New York City, particularly in low-income areas.

Health Promotion↗
PubMed2004

Still the doctor - by a country mile! Preferences for health services in two country towns in north-west New South Wales.

OBJECTIVE: To evaluate whether rural consumer preferences for health services have changed over time or vary across communities with different models of health service delivery. DESIGN: Questionnaire survey replicating a 1989 study, with ranking of seven different healthcare services. PARTICIPANTS AND SETTING: Adult occupants from a 20% sample of private residences, in towns and on farms, in the rural shires of Bogan and Warren in north-west New South Wales. The survey was conducted in September 2002. MAIN OUTCOME MEASURES: Rank order of preferences for different healthcare services; preference structure intervals showing relative "distance" between preferences. RESULTS: Response rates were 68% (Nyngan town), 78% (Nyngan farms) and 59% (Warren town). The doctor was the most valued health service in rural communities, followed by the hospital. These preferences occurred regardless of age, sex or place of residence, persisted over time, and were similar for residents of towns with different models of healthcare service provision. CONCLUSIONS: Rural people, both in towns and on farms, rate acute primary healthcare services provided by the doctor and hospital as the two most important services. These preferences have not changed substantially after a decade of restructuring rural health services and reorienting them towards a primary healthcare approach. The stability of rural consumer preferences may reflect a bias towards the status quo.

Adolescent↗
PubMed1991

Nonprogramming relational database primer: a case study--pharmacist intervention audits.

Using a database product has never been easier. The above example may appear to be complicated, but the Alpha Four software program guides you at every step. You have to decide what you wish to accomplish, then set up the program to handle the task. Alpha Four (or any other nonprogrammable relational database) can also be used for formulary management, investigational drug accounting, personnel management, inventory, purchase order requisitions, etc. Some drug distribution systems provide access to the patient records and clinical information. If you learn how to operate a database manager, you can create reports that may not be available from the vendor. Computers have reduced the workload required for drug distribution. The future of pharmacy practice is headed toward a highly automated setting. New roles for the pharmacist may include the provision of information from the point of admission to discharge and possibly continued follow-up. This will all be an automated process with the pharmacist as a key resource person. If you do not learn how to control the computer systems you work with, they will eventually control you. You do not have to be an expert to learn how to use a database application. If computer applications are not already part of your professional responsibilities, they soon will be.

Clinical Pharmacy Information Systems↗
PubMed1998

The effects of managed care on the retail distribution of pharmaceuticals.

The growth of managed care has resulted in substantial changes in the retail channel of distribution for pharmaceuticals. Community pharmacies' numbers and profit margins have declined, and marketshare has shifted to mail-service pharmacies as MCOs and pharmacy benefit managers have dictated reimbursement terms. Community pharmacies have consolidated to increase negotiating power and efficiency and have become more involved in direct patient care. The success of both MCOs and community pharmacies may depend on their ability to provide cooperative services that improve patients' health outcomes.

Cooperative Behavior↗
PubMed2002

Impact of a computerized alert during physician order entry on medication dosing in patients with renal impairment.

Computerized assistance to clinicians during physician order entry can provide protection against medical errors. However, computer systems that provide too much assistance may adversely affect training of medical students and residents. Trainees may rely on the computer to automatically perform complex calculations and create appropriate orders and are thereby deprived of an important educational exercise. An alternative strategy is to provide a critique at the completion of an order, requiring the trainee to enter the entire order but displaying an alert if an error is made. While this approach preserves the educational components of order-writing, the potential for errors exists if the computerized critique does not induce clinicians to correct the order. The goal of this study was to determine (a) the frequency with which errors are made by trainees in an environment in which renal dosing adjustment calculation for antimicrobials are done by the system after the user has entered an order, and (b) the frequency with which prompts to clinicians regarding these errors leads to correction of those orders.

Anti-Bacterial Agents↗
PubMed1981

Pharmacist administration of intravenous medications in a pediatric service.

The establishment and operation of a pediatric intravenous medication administration program is described. A program was developed in which a team of pharmacists rotate between assignments in a pharmacy satellite providing unit dose distribution for 87 pediatric beds and an intravenous medication administration program serving a 15-bed pediatric isolation unit. Staffing patterns, pharmacy responsibilities, and a six-week training program for pharmacists are described. The i.v. medication administration program has been well received by nurses and physicians, and pediatric pharmacy personnel view themselves as functioning, productive members of the health care team. Audits indicate the pharmacy-controlled i.v. medication administration program has favorably affected patient care.

Child↗
PubMedDate not supplied

HealthScope: a model for a low cost health education program using commercial television.

HealthScope is a health education based on the Health Belief Model that uses television and print materials. It was designed for a number of agendas--(a) a desire by health educators to provide health information to a broad audience at a reasonable cost (b) a desire by the local medical association to promote its role in prevention and primary care, and (c) a desire by commercial television to expand its coverage of local health issues in a cost-effective way. In its summer series, HealthScope included 10 weekly television programs that focused on various aspects of disease prevention and health promotion and answered viewers' questions on the air. Each program was followed by a bank of physicians answering questions on the telephone for 90 minutes. Corresponding fact sheets were distributed through a local pharmacy chain. A "healthy weekend" sweepstakes contest also was held. Intermediate outcome measures indicated that HealthScope had a broad reach and stimulated viewers to seek additional information about health. At the same time, the program generated revenue for the commercial television station.

Adolescent↗
PubMed1997

Screening for colorectal cancer. A comparison of 3 fecal occult blood tests.

BACKGROUND: Colorectal cancer is the second leading cause of cancer deaths in the United States. Fecal occult blood testing has become a standard screening test for large-bowel cancers in the average asymptomatic population. Performance characteristics of the test and physician and participant compliance are the 2 major elements that impact the success of screening and early detection. OBJECTIVES: To evaluate the nonhydrated Hemoccult, rehydrated Hemoccult, and Hemoccult SENSA tests (SmithKline Diagnostics Inc, Palo Alto, Calif) and to assess participant and physician compliance. METHODS: A mass community-based screening study in an urban setting. Kits were distributed by a local pharmacy and at community sites. Diagnostic tests were completed through physicians' offices and clinics. Participants were asymptomatic and aged 50 years or older. Those who tested positive were advised to follow up with a physician. RESULTS: An overall positivity rate of 16% was reported for the 8293 kits that were processed. Rehydrated Hemoccult had a positivity rate of 15%; Hemoccult SENSA, 7%; and nonhydrated Hemoccult, 5%. The positive predictive value of nonhydrated Hemoccult was 14%; rehydrated Hemoccult, 7%; and Hemoccult SENSA, 11%. Of those who tested positive, 59% had a colonoscopy or flexible sigmoidoscopy and double-contrast barium enema examination on follow-up. Recommended follow-up was more frequent for those who consulted a gastroenterologist. CONCLUSIONS: Rehydrated Hemoccult yielded a higher positivity rate and lower positive predictive value than either Hemoccult SENSA or nonhydrated Hemoccult. Hemoccult SENSA approached the positive predictive value of nonhydrated Hemoccult. Adequacy of follow-up of patients testing positive for fecal occult blood needs improvement.

Aged↗
PubMed1997

["Lingue di seripi", "serpents' tongues" and "glossopetrae". Highlights from the history of popular "cult" medicine in early modern times].

In the 16th, 17th and 18th century "Glossopetrae", popularly known as "Lingue di Serpi", found on the Mediterranean island of Malta, were extensively used for medical purposes as antidotes. These fossil teeth, including specimens of the "Carcharodon Megalodon" (an extinct variant of the great white shark), were ground to powder or used as amulet pendants and "credence" and exported to pharmacies and shops in various cities of Europe. In antiquity, authors like Plinius or Solinus, excluding any religious connotations, had regarded "Glossopetrae" as objects "fallen from heaven on dark moonless nights". However, from the beginning of the 16th century the miraculous antidotic power of the specimens found at Malta was very strongly connected with the Pauline cult there. This cult owed ist origin to the excerpt of the shipwreck of the Apostle of the Gentiles on this island, as recorded in the New Testament. As in so many cases found in medieval and early modern medicine and pharmacy, the renown, collection, distribution and use of the antidote "Glossopetrae" or "Lingue di Serpi" was never limited to its real chemical and pharmaceutical properties. In the period of enlightenment and secular thinking mythic medicine as "Glossopetrae" had lost ist "magical" power. Consequently, with beginning of the late 18th century also the Maltese "Glossopetrae" featured in literature merely as exotic objects of curiosity or symbols of an age bound to medical superstition.

Animals↗
PubMed1991

Paraguayan pharmacies and the sale of pseudo-abortifacients.

This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.

Abortifacient Agents↗