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PubMed2006

Supplementary prescribing: early experiences of pharmacists in Great Britain.

BACKGROUND: Pharmacists in Great Britain can undertake supplementary prescribing (SP) after training at a higher education institution and completing a "period of learning in practice" in accordance with the Royal Pharmaceutical Society of Great Britain (RPSGB) curriculum. OBJECTIVE: To explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course. METHODS: A questionnaire was mailed to all RPSGB prescribers (N = 518, on June 1, 2005; 30 used in pilot questionnaire). Predictors of pharmacists starting to practice SP were identified in univariate analysis, and significant variables were further tested in multivariate analysis. RESULTS: The respondents (n = 401; 82.2%) were mainly female (270; 67.3%), had more than 20 years' experience as a pharmacist (123; 30.7%), worked in hospital settings (160; 39.9%), and focused on cardiovascular conditions (143; 35.7%) during their period of learning in practice. The median course satisfaction score, on a scale of 3 to 15 (lowest to highest), was 10. Practicing SP was self-reported by 195 (48.6%) respondents, 154 (79%) of whom had written a prescription. Ninety (58.4%) of the first prescriptions were written in primary care settings. Better patient management was regarded as the major benefit by 139 (71.3%) of those engaged in SP, while funding issues were identified by 71 (36.4%) as major barriers in implementing the practice. Lack of organizational recognition of SP was the main reason given (37; 18%) for those not commencing the practice. Independent predictors of those practicing SP included a longer time since registering as prescriber (p < 0.001); confidence of pharmacists in their prescribing abilities (p < 0.001); practicing in a setting other than community pharmacy (p = 0.001); and training in cardiovascular conditions or multiple conditions during the period of learning in practice (p = 0.005). CONCLUSIONS: Pharmacists have made progress in implementing SP, which is perceived by pharmacist prescribers as beneficial for both patients and themselves. Pharmacists need more support in terms of infrastructure and integration into the healthcare team to overcome some of the barriers to implementing SP.

Adult↗
PubMed2005

Pharmacists' knowledge and perceptions of emergency contraceptive pills in Soweto and the Johannesburg Central Business District, South Africa.

CONTEXT: In South Africa, emergency contraceptive pills are available directly from pharmacies without a prescription, yet few studies have assessed pharmacists' knowledge of and attitudes toward the medication. METHODS: In-person interviews were conducted with 34 pharmacists practicing in Soweto and the Johannesburg Central Business District, from February through April 2003. The pharmacists provided data on their knowledge of emergency contraceptive pills and their attitudes toward providing the medication to women in specific situations. RESULTS: Nearly all pharmacists sold at least one of the two types of dedicated emergency contraceptive pills available in South Africa. Although most had accurate knowledge about the method's dosing schedule, side effects and mechanism(s) of action, more than half erroneously believed that repeated use posed health risks. A large majority of pharmacists believed the pills should be available to rape victims, to single or married women and to women who had never given birth, but almost half did not think the pills should be given to women younger than 18, and a fourth said they would not give them to women with a late menstrual period. About one-third to half of pharmacists supported advance provision of the medication under certain circumstances. Most were willing to display promotional materials on emergency contraceptives in their pharmacies. CONCLUSIONS: Interventions aimed at educating pharmacists about the benefits of emergency contraceptive pills, especially for adolescents, are needed. Government and medical authorities should take advantage of pharmacists' willingness to display educational materials as a way to increase women's knowledge and use of the medication in South Africa.

Adult↗
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↗
PubMed2003

Collaborative drug therapy management by pharmacists--2003.

Since publication of the initial ACCP position statement on CDTM by pharmacists in 1997, the public, government, and much of the health care community at large have come to better appreciate the growing complexity of providing effective and safe drug therapy in today's health care environment. Increased interest in the issues of cost and quality of drug use is evident in the increasing coverage of the issue in the lay press and professional literature. This represents real progress, as well as real opportunity, for pharmacists. It also heightens the potential for a better understanding of the vital role that pharmacists can play in addressing these concerns. The percentage of patients who take several drugs for chronic diseases will continue to increase. Based on current trends, the number of patients who lack adequate access to care, or who receive either suboptimal, inappropriate, or unnecessarily expensive drug therapy for their acute and chronic diseases, will increase. Even as financial and human resources are increasingly strained within the current health care system, costs will continue to rise unless changes are made. Fortunately, qualified pharmacists are prepared, capable, and willing to help address a significant portion of these challenges. The public, many health care providers, some legislators, and a few insurers now recognize that pharmacists, because of their education and training in drug therapy, are well positioned both to accept additional responsibility for patient care and to provide services that make a real difference in health care quality and outcomes. The health care programs administered by the U.S. Public Health Service, the armed forces, and the Veterans Health Administration, as well as 38 states, now support pharmacist participation in CDTM. Pharmacists, working in an interdisciplinary structure with physicians and other health care providers, have demonstrated that they can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.

Drug Therapy↗
PubMed2003

Evaluating the impact of pharmacists in mental health: a systematic review.

Efforts to improve the outcomes of patients with mental illness often have involved incorporating the skills of a variety of health care professionals into collaborative care models. For over 30 years, clinical pharmacists have contributed to these care models in capacities ranging from educator to consultant to provider. This systematic review evaluates the quantity and quality of medical literature examining the impact of pharmacists in mental health from 1972-2003. Although we identified approximately 35 publications describing the roles of clinical pharmacists in this regard, only 16 were of sufficient scientific rigor to permit evaluation and comparison. The 16 studies were divided equally between inpatient and outpatient settings and were conducted in a variety of health care organizations (e.g., Veterans Administration, health maintenance organizations, community mental health clinics, and nursing homes). Nine of the studies examined the role of pharmacists in providing treatment recommendations and patient education, five featured pharmacists as providers (with prescriptive authority), and the remaining two described the impact pharmacists have in delivering education to the psychiatric staff. Six of the 16 studies were prospective, but only three of these incorporated a randomization procedure for patients or facilities. Collectively, the results of the 16 studies were positive, demonstrating improvements in outcomes, prescribing practices, patient satisfaction, and resource use. Unfortunately, most of the investigations were small, and significant limitations in study design limited further comparison. Given the long history and anecdotal success of pharmacists in mental health care settings, additional multicenter cost-effectiveness trials are warranted to further support the role of the psychiatric pharmacist.

Humans↗
PubMed2006

Survey of care provided by ambulatory care pharmacists to patients with chronic kidney disease.

PURPOSE: A survey was conducted to determine the role of ambulatory care pharmacists in the care of patients with chronic kidney disease (CKD). METHODS: Data from a survey of ambulatory care pharmacists in the treatment and management of patients with CKD were collected. A 22-item anonymous survey was sent to 1028 potential respondents in January 2004. Only pharmacists indicating routine provision of care to patients with risk factors for the development of CKD or with stages 1-4 of CKD were included in the analysis. Additional questions surveyed the timeliness and frequency of nephrology referrals and the pharmacists' familiarity with National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. RESULTS: Of 1028 surveys, 535 were completed and returned. Only respondents who provided care in an outpatient setting to geriatric patients and patients with diabetes mellitus, hypertension, or decreased creatinine clearance were included in the analysis (n = 388). Initial assessment of CKD was performed by 85% of the surveyed pharmacists. Over one third of the pharmacists made nephrology referrals. However, even pharmacists who had a high percentage of patients with a known risk for CKD infrequently screened for kidney dysfunction, and only a small portion monitored the areas recommended by NFK-K/DOQI. The respondents' familiarity with the NFK-K/DOQI guidelines indicated that 7% were very familiar, 45% were somewhat familiar, 34% were not very familiar, 13% were not at all familiar, and 1% did not respond. CONCLUSION: The ambulatory care pharmacists surveyed were not consistently involved in the routine monitoring of common complications of CKD.

Ambulatory Care↗
PubMed2006

Influence of pharmacists' attitudes on adverse drug reaction reporting : a case-control study in Portugal.

INTRODUCTION: Pharmacists can play a fundamental role in adverse drug reaction (ADR) reporting, although the factors that affect underreporting among these professionals are unknown. The objectives of this study were to identify (i) professional or demographic characteristics; and (ii) attitudes associated with pharmacists' ADR reporting in northern Portugal. METHODS: We conducted a case-control study on a population of pharmacists employed in hospital and community pharmacies across Portugal's Northern Regional Health Authority catchment area in 2003. Cases (n=34) comprised pharmacists who had reported at least one ADR to the northern region's drug surveillance unit, and controls (n=280) were randomly sampled from pharmacists who had never reported an ADR. All were interviewed using a mail questionnaire. Most attitudes were based on Inman's 'seven deadly sins' and were measured using a continuous visual analogue scale. Answers were recorded in a range from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to determine the ADR reporting adjusted odds ratio (OR) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS: The response rate was 86.8%. Reporting probability proved higher among hospital versus community pharmacists (adjusted OR 20.0; 95 CI 3.3, 125.0; p<0.001). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by (i) 223% (95% CI 51, 595; p < 0.05) for "Really serious ADRs are well documented by the time a drug is marketed"; (ii) 240% (95% CI 89, 508; p=0.002) for "I would only report an ADR if I were sure that it was related to the use of a particular drug"; (iii) 316% (95% CI 44, 1104; p=0.010) for "It is only necessary to report serious or unexpected ADRs"; and (iv) 171% (95% CI 13, 549; p=0.020) for "I do not have time to think about the involvement of the drug or other causes in ADRs". CONCLUSIONS: ADR under-reporting is strongly associated with certain attitudes, possibly indicating that under-reporting could be minimised through educational interventions targeted at changing such attitudes. Pharmacists' ADR education must be improved and educational programmes should be focused on altering attitudes identified by the study as being associated with under-reporting. Our data also indicate that community pharmacists must be a priority target for this intervention.

Adverse Drug Reaction Reporting Systems↗
PubMed1986

A consultant pharmacist's use of a portable microcomputer at several skilled nursing facilities.

A consultant pharmacist used a portable microcomputer and a private on-line host system in order to produce drug regimen review letters more efficiently. The portable computer was a Tandy Radio Shack Model-100, and the host system was a Sperry-PC running the MIST+ telecommunications software. The portable computer stored three letter templates used by the consultant pharmacist to prepare letters sent to physicians. After doing a drug regimen review, the consultant pharmacist edited one of the random access memory resident letter templates corresponding to the type of letter which needed to be sent to a patient's physician. The letters consisted of information concerning the drugs and diagnoses of patients at various skilled nursing facilities. The consultant pharmacist personalized the letter templates by editing the physician's name and address, patient's name, skilled care facility name, patient's room number, diagnosis, medications, and pharmacist's recommendations. After the letters were edited at the facility, the letters were then "telecomputed to" and archived on the host system. Personalized letters were then printed and sent to the consultant pharmacist, patient's physician, skilled care facility administrator, skilled nursing facility medical director, and charge nurse. The consultant pharmacist, facility administrators, physicians, and nurses have responded favorably to this computerized practice innovation for consultant pharmacists.

Computers↗
PubMed1999

Pharmacists' concerns and perceived benefits from the deregulation of hormonal emergency contraception (HEC).

OBJECTIVE: To ascertain pharmacists' views, assess willingness for involvement and delineate individual perceived competence in the supply of deregulated hormonal emergency contraception (HEC). DESIGN: Cross-sectional postal questionnaire utilising closed, open and Likert-scale questions. SUBJECTS: Three thousand nine hundred and ninety-nine registered pharmacists abstracted from the mailing list of the Royal Pharmaceutical Society of Great Britain. RESULTS: In total 1543 (38.6%) questionnaires were returned and analysed. Overall 1165 (75.5%) of pharmacists stated their willingness to be involved in the deregulated supply of HEC. However, pharmacists identified the need for specific training before effective deregulation should take place. Overall, 616 (39.9%) of respondents felt individually competent to supply deregulated HEC with a positive association between perceived competence and willingness to supply deregulated HEC (p < 0.05). Pharmacists perceive the major benefits of deregulation to be a reduced unwanted pregnancy rate and a subsequent reduced abortion rate. They perceive that deregulation would allow quicker and less restricted access to HEC by clients, facilitating an increased overall supply of HEC. Pharmacists express a number of concerns, tempering their collective desire to see HEC deregulation. The majority of these concerns related to safeguarding clients and the possible adverse public health effects associated with the possible reduced use of barrier methods of contraception. CONCLUSIONS: Most pharmacists would be willing to supply HEC if it were deregulated to 'pharmacy only' from 'prescription only' medicine status. Although concerns were raised, these were mainly related to safety issues, with few pharmacists identifying moral and ethical barriers to deregulation. For effective deregulation to occur issues of professional competence need to be addressed.

Abortion, Induced↗
PubMedDate not supplied

Patients' satisfaction and their perception of the pharmacist.

OBJECTIVE: To explore the relationships between patients' satisfaction and (1) the level of pharmaceutical care services received, (2) patients' perceptions of the personal attention paid to them by the pharmacist, and (3) patients' perceptions of the pharmacist's ability to help them manage their asthma and prevent asthma-related problems. DESIGN: Exploratory study using mail or telephone survey methods. PATIENTS OR OTHER PARTICIPANTS: Asthma patients (n = 250) enrolled in one of two Florida managed care organizations. MAIN OUTCOME MEASURES: Predictor variables were level of pharmaceutical care and patients' perceptions of personal attention and their pharmacist's ability to help them control their asthma. Outcome variable was patients' overall satisfaction with the care they received from their pharmacist. RESULTS: The direct causal effects of level of care (standardized regression coefficient, beta = 0.07) and patients' perception of pharmacists' ability to help (beta = 0.01) on satisfaction were nonsignificant. Only personal attention had a significant direct path coefficient to patient satisfaction (beta = 0.63). Although the level of care was associated with patient satisfaction (r = 0.32), its direct effect was not significant because of its joint association (r = 0.27) with personal attention. Patients' satisfaction was associated with the level of pharmaceutical care and their perception of the pharmacist's ability to help them with their asthma. However, personal attention from the pharmacist was most influential. CONCLUSION: Patients may be less able to judge the technical quality of the care they receive, but they do judge their social interaction with the pharmacist. Pharmacy professionals must increase patients' awareness of the value of pharmaceutical care services and make it important to their judgment of satisfaction.

Asthma↗
PubMedDate not supplied

Effect of patient information on the quality of pharmacists' drug use review decisions.

OBJECTIVE: To evaluate the effect of incremental increases in patient information on the quality of pharmacists' clinical decisions related to legally mandated prospective drug utilization review (DUR) responsibilities. DESIGN: Unblinded comparison of two groups. PARTICIPANTS: 28 community pharmacists in Indiana (group 1) and 32 Public Health Service pharmacists employed in the Indian Health Service (IHS) (group 2). INTERVENTIONS: Clinical cases involving prescribing problems were developed from patient charts. Each case contained four levels of increasing patient information: Level 1 included only information required for a legal prescription in Indiana; Level 2 added the patient's current medication profile, age, and allergies; Level 3 added the diagnosis or reason for use of the prescribed medication; and Level 4 added the physician's progress note. Pharmacists were asked to evaluate the prescribed drug therapy at each level of each case and complete a Dispensing Appropriateness Index (DAI) report, which included all prospective DUR criteria required by the Omnibus Budget Reconciliation Act of 1990. The quality of pharmacists' DUR decisions at each level of patient information was evaluated by comparing pharmacists' responses on the DAI reports with the consensus judgment of two clinical experts. RESULTS: The quality of both community and IHS pharmacists' DUR decisions improved significantly at each incremental level of patient information. CONCLUSION: Pharmacists in this study made better decisions when they had access to more complete patient information on which to base their decisions.

Adult↗
PubMedDate not supplied

HIV/AIDS knowledge and attitudes amongst pharmacists in Zimbabwe.

OBJECTIVE: To examine the knowledge of HIV/AIDS amongst pharmacists in Zimbabwe. DESIGN: Cross sectional survey. SETTING: National survey of pharmacists in major urban areas and final year pharmacy students at the University of Zimbabwe. SUBJECTS: 250 pharmacists and 47 pharmacy students with 126 completed questionnaires returned (42.4%). INTERVENTIONS: The questionnaire asked for demographic details of the respondent, sources of knowledge about HIV/AIDS and measured knowledge (KW), fear of contagion (FC), negative emotions (NE) and professional resistance (PR) using a Likert scale of 1 to 5. MAIN OUTCOME MEASURES: Computed scores of KW, FC, NE and PR and reported sources of knowledge on HIV/AIDS. RESULTS: All pharmacists scored highly on KW (mean [SEM] = 4.0 [0.0] with academics scoring the highest (4.2 [0.5]; n = 7) and private hospital pharmacists the lowest (3.7 [0.2]; n = 5). Medical books/journals and professional colleagues were the most important sources of information. Scores for FC (2.7 [0.1]), PR (2.4 [0.1]) and NE (2.1 [0.1]) were low. Government hospital pharmacists tended to have a higher KW score than those in private hospitals (4.1 [0.3] vs 3.7 [0.2] respectively). Most of the respondents believed that HIV/AIDS had increased their workload. However, they saw a role for pharmacists in the prevention and management of HIV/AIDS but felt there were important time constraints. CONCLUSION: Pharmacists can play an important part in the strategy to manage the national HIV/AIDS epidemic, but negative attitudes towards HIV/AIDS sufferers may adversely affect their efficiency.

Adult↗
PubMed2003

Electronic transfer of prescription-related information: comparing views of patients, general practitioners, and pharmacists.

BACKGROUND: The National Health Service (NHS) intends to introduce a system of electronic transfer of prescription-related information between general practitioners (GPs) and community pharmacies. The NHS Plan describes how this will be achieved. AIM: To gather opinions of patients, GPs, and community pharmacists on the development of a system of electronic transfer of prescription-related information between GPs and community pharmacies. DESIGN OF STUDY: Survey combining interviews, focus groups, and postal questionnaires. SETTING: General practitioners, opinion leaders, computing experts, pharmacists, and patients. Eight hundred members of the public, 200 GPs, and 200 community pharmacists, all living in Scotland. METHOD: Content-setting interviews and focus groups were conducted with purposive samples of relevant groups. Postal questionnaires were developed and sent to random samples of members of the public selected from the electoral roll, GPs, and community pharmacists. RESULTS: The corrected postal response rates were: 69% (patients); 74% (GPs); and 74% (community pharmacists). All three groups were generally supportive of electronic transfer of prescription-related information. Different aspects appealed to each group: patients anticipated improved convenience; GPs, better repeat prescribing; and pharmacists, an enhanced professional role. Security of patient-identifiable information was the main concern. All groups acknowledged potential benefits of a full primary care information system, but GPs and patients had reservations about allowing community pharmacists to access parts of the medical record that did not concern medication. CONCLUSION: Electronic transfer of prescription-related information is likely to be acceptable to all users, but concerns about patient confidentiality and an extended role for pharmacists in prescription management need to be addressed.

Attitude of Health Personnel↗
PubMed1992

Peer review as a quality assurance mechanism in three pharmacist-run medication-refill clinics.

A peer-review system for monitoring pharmacists' practice in medication-refill clinics is described. Pharmacist practitioners trained in pharmacology, therapeutics, and physical assessment provide services in three medication-refill clinics associated with a 350-bed Department of Veterans Affairs (VA) medical center. The clinics serve patients who have exhausted their prescribed drugs before their next appointment with a physician. During a clinic visit, the pharmacist assesses the patient and the drug therapy and either consults an attending physician or writes new prescriptions. The pharmacist documents his or her activities in the medical record. The peer-review mechanism involves quarterly audits in which the chart notes written by the pharmacists are reviewed by other pharmacists. Five indicators of the quality of care are used in the peer reviews. The results are presented to the ambulatory-care and quality assurance pharmacy committees for analysis and discussion. The peer-review system has resulted in better compliance by the pharmacists with the quality indicators and clinic procedures, suggesting that the quality of care has also benefited. Peer review is used successfully to evaluate and monitor the care provided by pharmacists in medication-refill clinics associated with a VA medical center.

California↗
PubMed2003

[Active involvement of pharmacists in initial treatments for acute poisoning and overdosed patients in the intensive care unit].

We have developed guidelines of pharmaceutical activity which describes how pharmacists are actively involved in supporting the initial treatment of poisoning and overdosed patients in the Intensive Care Unit (ICU). These guidelines are derived from the original procedural manual that consisted of protocol charts. The charts provide the pharmacist including ICU staff members with directions for the collection of clinical information and the forms to use for documentation. We focused on appropriate collection and proper preservation of collected samples in order to perform diagnostic analysis when needed. The original Information Record Form, completed by the participating pharmacist, documents all information regarding the patient's care. This record provides for integration of the diverse and complicated clinical information of the patient so that the physician can gain a comprehensive picture of the patient. The guidelines, manual book, materials for sample collection and the Information Record Form are stored in a container called the "Poisoning Aid Set", which will be available in the ICU. The guidelines are activated once an emergency call from paramedics is received regarding a suspected poisoning patient. According to the guidelines, the emergency room (ER) physician immediately contacts the pharmacist who will provide his professional services as a member of the treatment team. We have applied these guidelines to 29 poisoning patients and have critically evaluated for effectiveness. Early participation by pharmacists, by reviewing timely, accurate and competent clinical information enabled the pharmacist to identify the suspected drug from the biological samples obtained. From our experiences, we conclude that this active involvement of pharmacist in the initial treatment of poisoning and overdosed patients in the ICU was both supportive and beneficial to the patient. In addition, the participation of pharmacist as a member of a treatment team provided an excellent opportunity to collaborate with the entire ICU staff members.

Acute Disease↗
PubMed2004

Drug related problems identified by European community pharmacists in patients discharged from hospital.

INTRODUCTION: Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Community pharmacists' interventions to detect, prevent and solve DRPs in this population are scarcely studied. OBJECTIVE: To examine the nature and frequency of DRPs in community pharmacies among patients discharged from hospitals in several countries, and to examine several variables related to these drug related problems. METHOD: The study was performed in 112 community pharmacies in Europe: Austria, Denmark, Germany, The Netherlands, Portugal and Spain. Community pharmacists asked patients with a prescription after discharge from hospital between February and April 2001 to participate in the study. A patient questionnaire was used to identify drug related problems. Pharmacists documented drug related problems, pharmacy interventions, type of prescriber and patient and pharmacy variables. RESULTS: 435 patients were included in the study. Drug related problems were identified in 277 patients (63.7%). Uncertainty or lack of knowledge about the aim or function of the drug (133; 29.5%) and side effects (105; 23.3%) were the most common DRPs. Practical problems were reported 56 times (12.4%) by patients. Pharmacists revealed 108 problems (24.0%) concerning dosage, drug duplication, drug interactions and prescribing errors. Patients with more changes in their drug regimens (drugs being stopped, new drugs started or dosage modifications) and using more drugs were more likely to develop DRPs. Community pharmacists recorded 305 interventions in 205 patients with DRPs. Pharmacists intervened mostly by patient medication counselling (39.0%) and practical instruction to the patient (17.7%). In 26.2% the intervention was directed towards the prescriber. In 28 cases (9.2%) the pharmacists' intervention led to a change of the drug regimen. CONCLUSION: This study shows that a systematic intervention by community pharmacists in discharged patients, or their proxies, is able to reveal a high number of DRPs that might be relevant for patient health outcomes. There should be more initiatives to insure continuity of care, since DRPs after discharge from hospital seem to be very common.

Aged↗
PubMedDate not supplied

Increasing access to emergency contraceptive pills through state law enabled dependent pharmacist prescribers.

Emergency contraceptive pills ("ECPs"), a form of contraception which has a 75% chance of preventing pregnancy when taken within 72 hours after unprotected intercourse, are currently available only by prescription. Increasing access to ECPs will help to reduce unintended pregnancies and abortions and will help to provide women with an extra level of control over their reproductive futures. Private access initiatives, while helpful, are insufficient to address the access problem; federal level solutions are unlikely to be implemented soon. Thus, this Article proposes that all states adopt the Washington model for dependent pharmacist prescribers, whereby state law enables physicians to create collaborative agreements with pharmacists, pursuant to which the physician can effectively delegate to a pharmacist in a retail setting the power to prescribe ECPs. Dependent pharmacist prescribing of ECPs increases access to contraception, increases patient satisfaction and decreasing cost, while preserving patient safety through screening mechanisms and the good safety profile of ECPs. A state-by-state analysis of pharmacy law reveals that while there is a national trend expanding the scope of pharmacy practice, states vary widely in the amount of prescribing power allowed to pharmacists. However, dependent pharmacist prescribing of ECPs is currently feasible in a few states and close in a number of others, and implementation of dependent pharmacist prescribing in some states may lead to greater nationwide acceptance of both dependent pharmacist prescribing and of ECPs.

Contraceptives, Postcoital↗
PubMed1991

Effect of pharmacist participation on a medical team on costs, charges, and length of stay.

The financial impact of pharmacist participation on a medical team in a tertiary-care teaching hospital was studied prospectively. Two medical teams, one with and one without a pharmacist, operated simultaneously for 11 months. Physicians and a pharmacist on the teams rotated monthly during the first five months of the study. Subsequently, the hospital administrator, who was unaware that the controlled study was under way, permanently assigned an attending physician to the team that did ot have a pharmacist. After patients' discharge, pharmacy costs, pharmacy charges, hospital charges, and length of stay (LOS) were compared for the two teams. Data analysis was separated into four phases: phase 1, during which attending physicians rotated monthly; phase 2, with a permanent attending physician; phase 3, which encompassed the entire 11 months; and phase 4, which encompassed the 11-month period but omitted patients whose LOS exceeded 30 days. Data were analyzed for a total of 619 patients on the two teams. In phase 1, the team with a pharmacist had significantly lower per-patient pharmacy costs, pharmacy charges, hospital charges, and LOS. In phase 2, no significant differences were found between the teams. In phase 3, the only significant difference was that the team with a pharmacist had lower pharmacy costs and pharmacy charges. In phase 4, the team that included a pharmacist had significantly lower pharmacy costs ($105 difference), pharmacy charges ($368 difference), hospital charges ($2065 difference), and LOS (1.3-day difference). Participation of pharmacists on the medical team can significantly reduce pharmacy costs and charges, hospital charges, and LOS.

Costs and Cost Analysis↗