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PubMed2003

Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units.

BACKGROUND: Previous studies found that medication errors result from lack of sufficient information during the prescribing step. Therefore, it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events (ADEs). The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process. METHODS: A single-blind, standard care-controlled study design was used to compare patients receiving care from a rounding team including a pharmacist with patients receiving standard care (no pharmacist on rounding team). Patients admitted to and discharged from the same general medicine unit were included in the study. The main outcome measure of this study was preventable ADEs. Patient records were randomly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician. Interventions made by the pharmacists in the treatment group were documented. RESULTS: The rate of preventable ADEs was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. The most common interventions were (1) dosing-related changes and (2) recommendations to add a drug to therapy. CONCLUSION: Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs.

Drug Utilization Review↗
PubMed2003

Intensive monitoring of new drugs based on first prescription signals from pharmacists: a pilot study.

BACKGROUND: Intensive monitoring can be a valuable tool in the early detection of adverse drug reactions, especially of new drugs. Aim of this pilot study was to investigate the practical possibilities of a system of intensive monitoring, using the pharmacy computer system to detect the first dispensing of a new drug. METHOD: Eight pharmacists were asked to monitor, using their computer system, when a general practitioner prescribed the target drug (rofecoxib). The pharmacists were also requested to provide the researchers at Lareb with an overview of the patient's medication history. Subsequently, the pharmacist sent the prescribing physician an envelope containing information about the project and a reporting form (all provided by Lareb), which the GP was requested to return to Lareb after the next visit of the patient. The items on the questionnaire concerned characteristics of the patient (anonymous), indication, dose and information about possible adverse drug reactions. RESULTS: During a 4-week period, the participating pharmacists signalled 44 first prescriptions of rofecoxib. For each of these signals, the pharmacist provided Lareb with the medication history of the patient involved. Of the prescribing GPs who had been sent the report form, 70.5% (n = 31) returned the form. Twenty-one of the 31 forms were returned within 4 weeks. The medication histories showed that in 43 of the 44 cases, the dispensing of the target drug was indeed the first delivery. The participating pharmacists and GPs were also sent an evaluation form. All pharmacists returned their evaluations, indicating an overall motivation to participate in the proposed system. In total, seven GPs returned their evaluation forms, three of whom had not reported adverse drug events to the national spontaneous reporting centre before. CONCLUSION: Although the number of participants in this trial was small, we conclude that pharmacists and prescribing physicians are able and willing to contribute to an intensive monitoring system for new drugs.

Adverse Drug Reaction Reporting Systems↗
PubMed1986

New clinical roles for pharmacists: a study of role expansion.

This study assessed the legitimacy of expanded roles for pharmacists with different status audiences. Pharmacy is a profession in transition and is characterized by considerable ambiguity and uncertainty concerning its status as a health care profession. Significant changes have occurred within the profession of pharmacy in the past few decades which have led to loss of function, social power and status. The response of the profession has been a movement toward a patient-oriented, clinical role for pharmacists. Hypotheses concerning level of support for expanded roles were derived from two conflict-based models of professionalization: a power model which focuses on conflict between professions and the central role of power in defining occupational territory; and a process model which focuses on conflict of interest and diversity within a profession and the development of 'segments' which struggle for control of a profession's direction. Data were collected by self-administered questionnaires sent to California pharmacists, physicians and nurses. Respondents were asked to indicate level of support for 20 role activities for pharmacists working in two practice settings (community and hospital). Pharmacy faculty were the most supportive of the clinical role activities, followed by practicing pharmacists, nurses and physicians. Physicians and nurses were more antagonistic toward clinical activities in the community than hospital practice setting, and were most antagonistic toward role activities which require independent judgement or autonomous action relevant to patient care on the part of the pharmacist. Differences were also noted in support for clinical role activities within the pharmacists' group. The effect of experience in working with a clinical pharmacist on support for clinical role activities is also discussed.

Adult↗
PubMed1995

Role orientation and community pharmacists' participation in a project to improve patient care.

Community pharmacists are being assigned increased responsibility in assuring the appropriateness and effectiveness of drug therapy. This increased responsibility is reflected in recently passed legislation (OBRA '90) in the United States that requires pharmacists to counsel patients about prescriptions received and to engage in prospective drug use review for Medicaid recipients. The potential impact of this legislation is unclear due to a dearth of research evaluating the effects of community pharmacists' activities on medication use. In addition, there is little research on pharmacists' willingness to assume increased responsibility. Research that would demonstrate the effectiveness of community pharmacists in improving therapeutic outcomes is hampered by problems inherent in conducting experimentally designed research in field settings. This paper examines two issues of concern in such studies--namely, the extent to which those who agree to participate in a demonstration project differ from those who decline to participate and the extent to which differential dropout from treatment and control conditions compromise the comparability of the two groups. Specifically, this report examines pharmacist characteristics related to participation in a demonstration project to improve the care of elderly patients. Community pharmacists in Florida who had earlier been asked to participate in a demonstration project (N = 418) were sent mail questionnaires to assess their attitudinal, demographic and employment characteristics. In particular, researchers were interested in the role orientation of pharmacists in regard to patient counseling and physician consultation, satisfaction with current jobs and career choices, employment settings and treatment vs control group assignment as predictors of participation in the research project. Demographic characteristics were also examined as possible predictors of participation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Pharmacist-patient relationships: authoritarian, participatory, or default?

The purpose of this study was to investigate the nature of pharmacist-patient relationships in New Mexico community pharmacies. A total of 344 pharmacy personnel-patient interactions were observed. Pharmacists interacted with only 57% of patients who were picking up their prescriptions. Pharmacists used an extensive participatory style with only 13% of the patients who they interacted with. Pharmacists were significantly more likely to use a participatory style with older patients and with patients who were picking up refill prescriptions. The average length of pharmacist-patient encounters was just less than 2 min (114s). Pharmacist-patient interactions were significantly longer if: (1) pharmacists used more of a participatory approach with patients and (2) pharmacists gave more drug information to patients.

Adolescent↗
PubMed2005

Patients' willingness to pay for pharmacist-provided menopause and hormone replacement therapy consultations.

OBJECTIVE: To determine what women would be willing to pay for pharmacist-provided menopause and hormone replacement therapy consultations and the relationship between willingness to pay (WTP) and patients' perceptions of importance of resolving menopausal symptoms, their satisfaction with physician services, their perceptions of pharmacists' abilities, and income. METHODOLOGY: A convenience sample of 203 adult women using medications to treat menopause was recruited by their pharmacists. A self-administered survey was used to address the study objectives. The contingent valuation method was used to assess WTP in 4 scenarios (ie, 50% and 100% improvement in symptoms after a half-hour initial and a half-hour follow-up visit, respectively). Logistic regression analyses were used to assess the relationship between WTP and the independent variables. RESULTS: Two hundred and three surveys were returned resulting in a response rate of 41%. Across all 4 scenarios, at least 85% of women surveyed were willing to pay a minimum of 20 US dollars for pharmacist-provided menopause and hormone replacement therapy services. Respondents were willing to pay a median of 40 US dollars (for both 50% and 100% improvement) per half-hour for initial consultations, and 20 US dollars and 40 US dollars (50% and 100% improvement, respectively) per half-hour for follow-up consultations. Regression analyses revealed that across all 4 scenarios, patients' perceptions of pharmacists' abilities and income were significantly and positively (P < .05) related to WTP for menopause and hormone replacement therapy counseling. CONCLUSION: This study showed that most women surveyed were willing to pay for pharmacist-provided hormone replacement therapy and menopause counseling services and that the WTP amounts increased as patients' perceptions of pharmacists' abilities and income increased. If pharmacists can effectively educate the public about their capabilities and expertise, they may discover that they have a new niche opportunity.

Female↗
PubMed2005

The role of hospital and community pharmacists in pharmacovigilance.

In this paper, we give an overview of the role pharmacists actually have and could have in collecting reports of adverse drug reactions (ADRs) and more widely in pharmacovigilance. In the literature, several ways are mentioned in which the pharmacist, both the community pharmacist and the hospital pharmacist, can contribute to the safe use of drugs. In addition to their responsibilities regarding drug dispensing and compliance, they can have a substantial role in ADR reporting. Especially, hospital pharmacists can play a significant role in ADR reporting because the most serious adverse drug events occur in hospitals, and ADRs account for a substantial proportion of hospital admissions. Community pharmacists, however, can also play an important role in ADR reporting. This is, for example, the case in the Netherlands where community pharmacists contribute substantially, both in numbers and in quality of ADR reports. The contribution of the pharmacist to pharmacovigilance should, however, not be limited to ADR reporting. The various pharmaceutical disciplines could also greatly enhance our understanding of the nature of ADRs. If those involved in pharmaceutical disciplines can rise to this challenge, they will significantly help deepen our insights into ADRs.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Characterizing the professional relationships of community pharmacists.

BACKGROUND: The use of the term "patient" to describe individuals served by pharmacists may affect expectations, roles, and responsibilities. Whereas this term has been widely accepted and embraced within the profession, there is little empirical evidence to justify its use in the pharmacy practice context. OBJECTIVES: To describe and characterize the type of relationships that form between community pharmacists and the individuals they serve. METHODS: A qualitative study was undertaken with pharmacist-volunteers. Participants were asked to maintain a written diary over a 10-day period, in which their workplace experiences were documented. Responses to cued questions as well as free-form notes were analyzed to form a typology. Through successive iterations using confirmatory focus groups consisting of study participants, a final typology was developed. RESULTS: A total of 45 pharmacists participated in this study. The final typology describes 5 distinct idealized types of relationships formed by pharmacists: analytic-authoritative, emotive-interactive, opportunistic-expedient, reliant-paternalistic, and autonomous-informative. CONCLUSIONS: The complexity of practice suggests that the "patient-pharmacist" paradigm for understanding relationships in pharmacy does not adequately capture the variety of day-to-day interactions that pharmacists encounter. Pharmacists engage in a variety of adaptive and responsive strategies to meet expressed and implicit needs of the individuals they serve.

Adult↗
PubMed2004

A pharmacist model of perceived responsibility for drug therapy outcomes.

Pharmacists in community and ambulatory care settings are in a unique position to reduce drug-related morbidity and to optimize patient outcomes by identifying, resolving, and preventing drug therapy problems. This particular approach to pharmacy practice expands traditional pharmacist responsibilities of dispensing pharmaceuticals and providing drug information to optimizing patients' drug therapy outcomes. However, pharmacists in general, and community pharmacists in particular, have yet to incorporate this expanded professional role into daily practice. The objective of this study was to examine the validity of a pharmacist model of perceived responsibility for drug therapy outcomes based on the triangle model of responsibility. A survey instrument was tested among community and ambulatory care pharmacists in Florida, USA. The survey instrument contained the following pharmacist-related constructs from the model: clarity of standards, personal control, professional duty, and perceived responsibility for drug therapy outcomes. The model was examined by testing hypothesized relationships between the model constructs and pharmacists' reports of providing pharmaceutical care. The survey response rate was 40.9% (525/1283). All of the study measures exhibited Cronbach alpha values greater than .70. A measurement model was tested using confirmatory factor analysis. The chi2/df ratio (3.02), CFI (.95), and residual (.051) indicated a good fit of the item data to the constructs. According to path analysis, clarity of standards, personal control, and professional duty were significantly related to perceived responsibility for drug therapy outcomes, which in turn, was significantly related to pharmaceutical care provision. Perceived responsibility for drug therapy outcomes acted as a mediator of the effects of clarity of standards, personal control, and professional duty on pharmaceutical care provision. These findings have implications for pharmacy practice and research.

Adult↗
PubMed2003

Pharmacists' knowledge and the difficulty of obtaining emergency contraception.

This cross-sectional study was performed to examine knowledge and attitudes among pharmacists about emergency contraception (EC) and determine the factors associated with their provision of EC. A random systematic sampling method was used to obtain a sample (N = 320) of pharmacies in Pennsylvania. A "mystery shopper" telephone survey method was utilized. Only 35% of pharmacists stated that they would be able to fill a prescription for EC that day. Also, many community pharmacists do not have sufficient or accurate information about EC. In a logistic regression model, pharmacists' lack of information relates to the low proportion of pharmacists able to dispense it. In conclusion, access to EC from community pharmacists in Pennsylvania is severely limited. Interventions to improve timely access to EC involve increased education for pharmacists, as well as increased community request for these products as an incentive for pharmacists to stock them.

Clinical Competence↗
PubMed1995

Pharmacist counseling and outcomes of smoking cessation.

The Pharmacists Educating Patients Program (PEPP) was designed (1) to provide pharmacists with smoking cessation consultation guidelines for patients on nicotine transdermal therapy and (2) to test the effectiveness of these pharmacists' consultation services. More than 6,500 pharmacies and 40,220 patients participated in this program. One year after treatment began, a survey of 2,001 patients on nicotine transdermal therapy found that those who had not joined a comprehensive smoking cessation program (86.5%) but were counseled by a pharmacist had a self-reported smoking cessation rate of 37% at the end of treatment, and 33% at an average of 10 months after treatment. The average length of treatment was five weeks. Patients who participated in a comprehensive behavioral smoking cessation program, such as SmokEnders, and who also received counseling from their pharmacists (13.5% of surveyed patients) had a quit rate of 62% at the end of treatment and 45% after 10 months. Among surveyed patients, those who stopped smoking reported that their pharmacists' counseling had been more intense and more helpful than the counseling reported by those who did not stop smoking. In addition, those who stopped smoking had more pharmacist counseling interventions and more weeks on nicotine patch treatment than did those who failed to stop smoking. Results of this study show that pharmacists who counsel patients on nicotine transdermal therapy about smoking cessation can improve outcomes.

Administration, Cutaneous↗
PubMed1992

Pharmacists' compensation and work patterns, 1990-91.

Several major trends were observed in these findings from the 1990-91 National Pharmacists' Compensation Survey (for details see the final report). Only 72.6% of licensed pharmacists were working full-time in pharmacy; another 14.4% were working part-time in pharmacy, and nearly 13.0% were either not working in pharmacy or not working at all. Although 90.0% of active men pharmacists were working full-time, only 70.7% of active women pharmacists were working full-time. Men were more likely to be working in independent and chain pharmacies as a manager or owner. Women were more likely to be working in hospital or chain pharmacies as a staff pharmacist. Pharmacists' base salary in 1990 was substantially higher for men than for women with averages of $46,661 versus $42,668. Total pharmacy compensation showed a similar pattern but an even greater spread between men and women with averages of $51,032 versus $44,751. However, after adjusting for years in practice and number of hours worked per week, the base HWE for employee pharmacists shows that men and women pharmacists do get "equal pay for equal work" in the first 20 years of practice. The difference that develops between men and women with more years in practice is probably due to the higher proportion of men in management positions and to differences in practice setting preferences.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗
PubMed1989

Cancer detection and the community pharmacist.

A questionnaire was prepared to asses community pharmacists' perceptions of their abilities to recognize the common signs and symptoms of cancer and their preferred methods for obtaining further education. Of 5,539 questionnaires mailed, 1,187 were returned and analyzed. Seventy percent of the pharmacists reported that at least one patient per month sought advice about possible cancer signs and symptoms. Almost half estimated that between 1% and 25% of the patients who had sought advice for these cancer signs and symptoms had attempted to purchase a medication to treat these symptoms. The vast majority of the pharmacists perceived that they could recognize common signs and symptoms of skin, breast, and colorectal cancers. However, the majority felt they could not identify the symptomatology for six other common cancers. Essentially all pharmacists rated education in cancer symptomatology to be important. There was no consensus as to the type of provider, format, or times for this continuing education. These data suggest that pharmacists can play an important role in the early detection and prevention of cancer. The rate of interaction by pharmacists in this study translates to more than 60,000 patients counseled about cancer symptoms per 1,000 pharmacists per year. Further education of the pharmacist in cancer detection is warranted, and appraisal of the outcome of such educational interventions on patient-referral patterns and cancer-related diagnoses is imperative.

California↗
PubMed1999

Between intention and behavior: an application of community pharmacists' assessment of pharmaceutical care.

A new practice philosophy for pharmacists, pharmaceutical care, encourages pharmacists to ensure that medication-related health outcomes are optimized. However, its adoption by community pharmacists has been slow due to numerous barriers including the economic structure of retail pharmacy, interprofessional conflicts, information limitations, gaps in pharmacy training and uneven patient demand. The specific study objectives were to (1) describe self-efficacy, beliefs, evaluations and perceived behavioral control in the provision of pharmaceutical care, (2) quantify intention and behavior to provide pharmaceutical care in a period of two weeks and (3) examine the relationships between intention and behavior. A 20% sample of Alberta community pharmacists received an attitude survey followed in two weeks by a behavior survey. Both surveys were developed for this study. Of the 320 pharmacists receiving the attitude survey, 230 completed surveys were obtained (71.9%). The behavior survey was received from 182 of those completing the attitude survey (79.1%). A causal model was constructed predicting pharmaceutical care behavior/s from pharmacists' self-efficacy, beliefs, evaluations and behavioral control. Behavioral control exerted its effect upon behavior via three pathways and its direct effect on belief was strongest. The only direct predictor of behavior was self-efficacy. The chi2 measure indicated that the model was not a perfect fit (chi2 = 99.24, df = 67, p<0.006), but the goodness of fit index (0.931), adjusted goodness of fit index (0.876), and root mean squared error (0.067) fall within acceptable ranges. Thus, it appears that pharmaceutical care implementation programs which address individual factors singly in providing pharmaceutical care will not be successful. The control pharmacists' perceive over their patient care behaviors in their practice environment is critical. Programs which help pharmacists assess their work environment and determine strategies to impact or reconstruct their environments are required.

Adult↗
PubMed1996

Chain pharmacists' attitudes on and awareness of domestic abuse.

Little has been written to specifically educate pharmacists on the subject of spousal or partner abuse. This project was undertaken to determine whether pharmacists have received training in domestic abuse and to ascertain their attitudes toward participating in abuse intervention. Two hundred twenty-four pharmacists from two chain pharmacies in Arizona received a questionnaire, and 121 (54%) responded. Most (97.5%) had received no training on domestic abuse intervention techniques and did not feel adequately prepared to intervene in a potential situation. Respondents were divided on the extent to which pharmacists should be involved in intervention. Pharmacists who graduated before 1980 were less likely to agree that intervention was an important activity for pharmacists (p < 0.05). More women than men would feel comfortable helping abused patients if they knew more about intervention. More women than men agreed that pharmacists should keep information about domestic abuse on hand (p < 0.025), but most respondents believed that information should be available in pharmacies to give to patients. Opportunities exist for pharmacists to provide educational materials to patients on domestic abuse and abuse intervention.

Adult↗
PubMedDate not supplied

Response forms reflect pharmacists' participation in retrospective DUR.

This study examined pharmacists' responses to two different Medicaid retrospective therapeutic interventions (excessive use of beta 2-agonist inhalers and long-term use of sedatives) in New Mexico. It also examined the types of actions pharmacists reported taking, and the differences between actions taken by physicians and pharmacists in terms of response rate, tone of responses, and time spent responding to the intervention. The most frequent pharmacist action was to call the physician. Response rates for the drug use review (DUR) program were higher for physicians than for pharmacists; pharmacists also took twice as long as physicians to respond to both interventions. The study results indicate a need for better methods to document clinical services performed by pharmacists under the Medicaid DUR program to obtain reimbursement and justify therapeutic decisions. Pharmacists also need documentation methods that are relatively easy to use so that they can respond more quickly to interventions.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Comparison of targeting a DUR letter intervention at pharmacists separate from and in addition to physicians.

OBJECTIVE: To examine the impact on dipyridamole prescribing of a letter mailed to pharmacists and/or physicians. DESIGN: Interrupted time series with control series. SETTING: State of Wisconsin. PARTICIPANTS: Physicians and pharmacists caring for patients who were prescribed dipyridamole. INTERVENTIONS: The state of Wisconsin was divided into four sections, three of which were designated as experimental regions (letter to physician only, letter to pharmacist only, and letter to both physician and pharmacist) and one of which served as a control region. MAIN OUTCOME MEASURES: Cost of drug per patient per month in ambulatory and long-term care populations. RESULTS: For 763 long-term care and 586 ambulatory Medicaid patients, letters sent to both physicians and pharmacists resulted in significant reductions in dipyridamole expenditures relative to the control group. For long-term care patients, interventions directed at both physicians and pharmacists produced significant reductions in dipyridamole prescribing relative to interventions directed at physicians alone or pharmacists alone. CONCLUSION: Future DUR letter interventions designed to change prescribing habits would be more effective if they targeted both physicians and pharmacists, particularly in the long-term care setting.

Aged↗
PubMedDate not supplied

Onset of illegal use of mind-altering or potentially addictive prescription drugs among pharmacists.

OBJECTIVES: To determine the temporal and descriptive aspects of pharmacists' decision-making processes regarding illegal use of mind-altering or potentially addictive prescription drugs (PAPDs) and to measure the effects of social factors associated with being and becoming a pharmacist on pharmacists' decisions to use PAPDs illegally. DESIGN: One-time, written, mailed survey. SETTING: United States. PARTICIPANTS: Random sample of licensed practicing pharmacists who were members of the American Pharmaceutical Association in fall 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responses to items on the survey. RESULTS: Nearly 40% of respondents indicated that they had used a form of PAPD without first obtaining a physician's authorizing prescription. A significant portion of the sample showed signs of repeated use-20% of the respondents reported 5 or more lifetime PAPD-use episodes, and 6% reported more than 10 such episodes. Almost 6% of the respondents identified themselves as being drug abusers at some point during their pharmacy careers. Moreover, a full 88% of these pharmacists began such illegal PAPD use after entering college, 51% used more than one type or class of PAPD, and 69% directly violated their professional code of ethics and state and/or federal laws by either stealing PAPDs from their place of employment (61%) or forging prescriptions (8%) to obtain them. CONCLUSION: A considerable percentage (40%) of the pharmacists surveyed had, on at least one occasion, used some form of PAPD without first obtaining a physician's authorizing prescription, and about one-fifth of respondents reported repeated use. The onset of such illegal PAPD use by pharmacists almost always occurred after the individuals had entered college. Interpersonal factors, such as positive reinforcement of self-medication practices from peers and increased levels of one's own approval for self-medication, appear to increase the likelihood that a pharmacist will engage in such illegal PAPD use.

Adult↗