Using pharmacies in Washington state to expand access to emergency contraception.
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Contraceptives, Postcoital↗
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Pharmaceutical care in Denmark: perceived importance of medicine-related problems and participation in postgraduate training.
OBJECTIVE: To investigate the readiness of Danish community pharmacists to provide pharmaceutical care. Special focus was on information provided to patients on medicine-related problems and participation in postgraduate training. METHOD: National cross-sectional survey distributed to all Danish community pharmacies (N = 288). Response rate 75.7%; non-responders were interviewed by telephone to establish their reasons for not participating. MAIN OUTCOME MEASURES: Prioritization of information to patients regarding medicine-related problems. Postgraduate courses selected by pharmacists during the past three years. RESULTS: In accordance with the profile of Danish community pharmacists, respondents were primarily female and half were below 45 years of age. The main reason given for not responding was lack of time. The prioritization of information to patients regarding medicine-related problems resulted in three clusters of answers. The overall topics of the clusters were: information related to the technical-practical use of medicines; information related to pharmacotherapeutic aspects of medicine use; and information related to the function of the medicine. The clusters accounted for 61.9% of the total variance. The most frequently attended postgraduate courses were on quality assurance and specific diseases. CONCLUSION: The patient information prioritized by Danish community pharmacists is primarily of a technical-practical nature. The postgraduate training pursued is primarily technical without much focus on the philosophy of pharmaceutical care. These factors contribute to the lack of proper readiness of pharmacists to practice pharmaceutical care.
Adult↗
A cost analysis of outpatient care for patients with Barrett's esophagus in a managed care setting.
OBJECTIVES: Although Barrett's esophagus (BE) may be associated with severe gastroesophageal reflux disease (GERD), there are currently no studies that evaluate resource utilization in Barrett's patients. The aims of this study were 1) to determine the cost and number of endoscopies and clinic visits to the GI clinic for GERD or its complications in patients with BE; 2) to determine the pattern and cost of medication use in patients with BE; and 3) to compare medication use by patients with BE to that of patients with insulin-requiring diabetes mellitus (DM). METHODS: Using the cost distribution report data and the pharmacy acquisition costs from the Durham VAMC, we calculated the monthly cost of endoscopies, clinic visits related to GERD, and medication use in 53 patients with BE between 1/1/94 and 1/1/97. We also calculated the average cost of medication use for 55 patients with insulin-requiring DM. RESULTS: All patients with BE were male. Their median age was 64.0 yr (IQR 57-68). Of them, 92% were white; 23% had low-grade dysplasia (LGD). Patients with LGD were more likely to have more than three endoscopies in 3 yr than were those with no LGD (OR 6.3, 95% CI 1.11-35.67). There was no difference in clinic visits in the patients with and without dysplasia (OR 0.335, 95% CI 0.093-1.206). A total of 139 endoscopies and 172 clinic visits were observed. Outpatient care for patients with BE costs approximately $103/month or $1241/yr. Endoscopies and clinic visits accounted for 31.1% and 5.9% of the monthly medical cost, respectively. Medications accounted for 63% of the total cost of care. Prokinetic agents accounted for 0.8% of the total cost of medications, whereas histamine receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs) accounted for 34.6% and 64.6%, respectively. Medication cost per month in patients with BE was approximately $65, similar to that of patients with insulin-requiring DM ($63). CONCLUSIONS: Our conclusions were as follows: 1) Outpatient care for patients with BE costs approximately $1241/yr or ($103/month). 2) Medication use per month accounted for more than half of the total cost; PPIs accounted for 64.6% of total medication cost, suggesting that reflux was severe. 3) Consistent with current surveillance strategies, patients with LGD had more frequent endoscopy than patients with no dysplasia. 4) Medication cost per month in patients with BE is similar to that in patients with DM, another group with a chronic disorder. 5) Those who make health policy can use these results to compare the cost of care of patients with BE to the cost for those with other chronic medical disorders.
Aged↗
Patients' perceptions of pharmaceutical services offered by an ambulatory clinic pharmacy.
The importance that patients place on various patronage motives and service offerings of an ambulatory pharmacy associated with a university hospital was studied. Questionnaires were distributed to 193 patients and 8 pharmacists employed at the pharmacy. The patient questionnaire contained a list of 13 patronage motives and 18 service offerings. Respondents rated the importance of each patronage motive in their decision to visit the pharmacy and their view of the importance of each pharmaceutical service offering on an anchored scale (1 = not important, 5 = very important). The pharmacist questionnaire included the 18 service offerings. Pharmacists rated their perceptions of the importance patients place on each service. The response rates were 52.8% for patients and 100% for pharmacists. Patients indicated acceptance of insurance plan, availability of prescription medication, and presence of a knowledgeable pharmacist as the most important patronage motives. Ability to call in refills by telephone and various interactions with the pharmacist were identified as the most important service offerings. The results showed congruence between the pharmacists' perceptions of important patient services and the importance patients actually place on the services. Understanding the importance of patronage motives and service offerings is necessary in the development of marketing activities to attract new patients and retain current patients.
Ambulatory Care↗
Computerized pharmacokinetics on an institutional clinical information system.
Computer-based hospital information systems (HISs) are an integral part of the current hospital environment. Traditionally, the HIS hospital information system has performed drug distribution-related activities for the pharmacy. Clinical applications have been limited to monitoring for drug interactions, duplication of therapy, drug allergies, and dosage range checking. Personal computers have been used for more clinical applications and individualized dosing. At Hamot Medical Center, the integration of the pharmacokinetics consultation service with the HIS has been accomplished. The pharmacokinetic equations were programmed into the HIS. Data needed for the equations were extracted from information in the database, thereby eliminating the need to enter the majority of the data. The program was designed to print the pharmacokinetic consultation for the chart. The integration of the pharmacokinetic consultation service with the HIS has saved time and increased efficiency.
Clinical Pharmacy Information Systems↗
[How, why, when and for how long time did the Danish veterinarians have the right to dispense drugs?].
Danish veterinarians are still allowed to prescribe and distribute drugs sold by Danish pharmacies to be used for treatment of animals under their care in agreement with the Danish rules and EU directives (4). Since the first student graduated from Danish Veterinary School in 1775, Danish veterinarians have also, in agreement with their education, had the right to dispense drugs produced in their own dispensary. However, due to the development of the methods for drug production, the introduction of registered products from medical companies, and the justified demands for documentation of drug efficacy and safety was abolished in 1988, and no exemptions were granted after January 1st 1990 (1). The controlled use of drugs with documented efficacy and safety has improved the clinical effect of animal treatment, minimized side effects in treated animals and unwanted effects on the environment and the consumers of animal products (22).
Denmark↗
[Quality control of the vaccines and cold chain during the national vaccination campaigns].
During the two vaccination campaigns against rinderpest and contagious bovine pleuropneumonia (CBPP) in 1989 and 1990, 507 vaccine samples were collected for quality control at each step of the distribution chain from the Veterinary Pharmacy of Abidjan to the vaccinator on the field. Parallel to that, the quality of the cold chain was checked. A total of 463 titrations were performed. All the titration levels were above the OIE/FAO standards, i.e. 10(2.5) DICT50/ml for rinderpest Valence and 10(7) viable germs/ml for contagious bovine pleuropneumonia Valence.
Animals↗
[A study of antibiotic use at a county hospital. Years 1998-2002].
INTRODUCTION: Adequate antibiotic use clearly influences the development of bacterial resistance, adverse events and healthcare costs. Studies of drug usage allow us to detect deviations in antibiotic use. MATERIAL AND METHODS: Antibiotic use during the period 1998-2002 was analyzed using data provided by management software applications. The prescription of restricted-use antibiotics during years 2001 and 2002 was analyzed by selecting patients according to the information available in the unit-dose drug distribution area database at the pharmacy department. RESULTS: Antibiotic use increased from 78 to 100 DDD during the period of time studied. The use of new quinolones has displaced macrolides. Two thirds of piperacillin --tazobactam prescriptions are for surgical patients. CONCLUSIONS: 1. Changes in the pattern of antibiotic use have been detected. 2. The relative weight of restricted-use antibiotics has increased. 3. This study allows a prioritization of intervention areas.
Anti-Bacterial Agents↗
Pharmacists are not just pill-counters.
Adoption of unit-dose drug distribution systems, expansion of clinical pharmacy services, and an emphasis on quality and costs were the major themes during 1979.
Costs and Cost Analysis↗
[Opportunistic infections in AIDS: the benefits of an "umbrella strategy." From an interview with Professor Willy Rozenbaum].
Availability to practitioners of a treatment for infections by atypical mycobacteria by Ansatipine should produce a reduction or delay in the frequency of opportunistic infections in AIDS, which are a heavy burden on the future of the patients and seriously after their quality of life. Today, the practice of prescribing Ansatipine increase the prophylactic strategy for opportunistic infections in AIDS, or the "Umbrella strategy". This can only improve the possible therapies for practitioners who are faced with the complexity of the disease and bring real benefit to the patients. Distribution of Ansatipine to town pharmacies is a new step in this direction.
AIDS-Related Opportunistic Infections↗
[Prevention of MAI infections in AIDS with Ansatipine: experience at a hospital. From an interview with Dr. Jean-Luc Meynard].
Nowadays, infections by the Mycobacterium avium complex (MAC) have become amongst the most frequent of the opportunistic bacterial infections in AIDS, following the introduction of prophylaxis to pneumocystosis and toxoplasmosis. MAC infections are recognised as a serious pathology that quickly causes hidden conditions then death of the patient after a short time and so there is need for an effective prophylaxis. In this context, rifabutine (Ansatipine) fills the therapeutic gap and is needed by both practitioners and patients who are affected by these serious infections. For several months, the AIDS committee of the Hôpital Saint-Antoine in Paris has advised the systematic introduction of prophylactic treatment by Ansatipine, after proper prescriptive indications, for HIV patients both in hospital and in outside consultations. Retrospective analysis after 2 1/2 months of a population sample of 32 patients, mostly non hospitalised but followed by the Service of Infectious Diseases of the hospital and receiving Ansatipine, showed no documented infection by MAC in the patients whose quality of life was very satisfactory. Furthermore, the prophylactic treatment was well-tolerated without any withdrawals. Today, distribution of Ansatipine to town pharmacies can only improve the lives of patients and encourage practitioners to profit from a treatment of indisputable benefit.
AIDS-Related Opportunistic Infections↗
The project shift: a form of participative management and staffing.
North Colorado Medical Center is a 326 bed primary and tertiary care medical center serving northeastern Colorado and southwestern Nebraska. The pharmacy department provides 24-hour-a-day clinical and distributive services to both inpatients and outpatients with a staff of 1 clinical pharmacy coordinator, 10 pharmacists (excluding pharmacy manager), and 11 technicians. Rather than rely on one assistant manager, the pharmacy manager involves all interested staff pharmacists in various administrative, clinical, and distributive projects. These project (P) shifts are scheduled 8-hour shifts with minimal or no drug distribution duties. This staffing system and form of participative management has been used since 1983 and has been successful in achieving three objectives: it provides assistance to the manager in achieving certain departmental objectives; it provides job variety and professional growth/satisfaction for staff pharmacists; and it provides flexible and readily available source of pharmacists to meet personal leave days (vacation, illness, time off) needs.
Colorado↗
Comprehensive pharmaceutical services for a state correctional facility.
A contractual model for comprehensive pharmaceutical services involving a major medical center pharmacy, a university, and a state department of corrections is described. Project goals and methods for the provision of services are described. These include areas of formulary development, inventory management, drug distribution, on-site placement of pharmacy operations, and educational development. Impact of the program was assessed over a 30-month period. Development of policies and procedures for drug use in a correctional setting enabled implementation of a strict patient population-specific drug formulary. Procedural changes resulted in an 83% decrease in on-site drug inventories and a 62% decrease in quarterly drug expenditures. A one-time saving of more than $26,500 resulted from the decrease in on-site inventory, and an annual saving of $44,000 is projected for decreased drug expenditures. All but five controlled substances were removed from the formulary, and only 13 nonprescription items remained in the formulary. An educational course on health care in correctional settings provided exposure for pharmacy students to this new area of institutional practice. The contractual model proved both cost-effective and functional for the department of corrections.
Education, Pharmacy↗
Hospital pharmacy-based service for patient-controlled analgesia.
A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.
Analgesics↗
Training pharmacy workers in recognition, management, and prevention of STDs: district-randomized controlled trial.
OBJECTIVES: To determine the effectiveness of an intervention for pharmacy workers in improving their recognition and management of sexually transmitted disease (STD) syndromes. METHODS: We randomly selected 14 districts (total population nearly 4 million) from the 24 districts of low socioeconomic status in Lima, Peru. We randomly assigned paired districts to receive training and support for management and prevention of STDs or a control intervention about management of diarrhoea. The STD intervention included interactive luncheon seminars on recognition and management of four STD syndromes (urethral discharge, vaginal discharge, genital ulcers, and pelvic inflammatory disease) and STD/HIV prevention counselling; monthly pharmacy visits by "prevention salespersons" who distributed materials that included "STD/HIV prevention packets" containing information, condoms, and cards given to patients for referral of their sex partners; and workshops for physicians on managing patients with STD syndromes referred from pharmacies. Standardized simulated patients visited pharmacies in intervention and control districts at one, three, and six months after training to assess outcomes. FINDINGS: Standardized simulated patients reported significantly better recognition and management (appropriate antimicrobial regimens provided for discharge syndromes and referral to specially trained physicians for genital ulcers or pelvic inflammatory disease) by pharmacy workers of all four STD syndromes. They also reported significantly more frequent recommendations for use of condoms and treatment of partners at pharmacies in intervention districts than in control districts (by "intention-to-train" analyses, P<0.05 for 47/48 primary outcome comparisons). CONCLUSION: Training was feasible and effectively improved pharmacy workers' practices.
Education, Pharmacy, Continuing↗
ASHP Midyear Clinical Meeting papers: 1967--1978.
Trends in the types of topics of papers presented at the American Society of Hospital Pharmacists' Midyear Clinical Meetings from 1967 to 1978 are reviewed. A total of 1,210 abstracts of papers presented at the 12 meetings were reviewed. Twenty-three subject categories were identified. Papers were subdivided into four different study types--review, case report, report, and study. Topics such as general hospital pharmacy, management and administration, and drug distribution were emphasized more during the early years of the meeting. Papers on role evaluation, adverse drug reactions and drug use review were presented more frequently in the early 1970s. Therapeutics and general clinical pharmacy were topics consistently emphasized. Case reports increased from 0% in 1967, to 2% in 1972, to 6% in 1978. Review papers decreased from 72% in 1967, to 11% in 1972, to 3% in 1978. Studies increased from 4% in 1967, to 28% in 1972, to 43% in 1978. Concentration on increasing the number of studies presented at the meeting will advance hospital pharmacy and thus improve patient care.
Congresses as Topic↗
Characteristics of hospital pharmacy practice in Indiana.
Hospital pharmacy practice in Indiana was surveyed to determine drug distribution services, additional services, staffing and salaries. Questionnaires were mailed to the directors of the 113 licensed hospital pharmacies in the state; 63% responded. Unit dose drug distribution systems were used by 19% of the hospitals for all beds; by 16% for some of their beds. Intravenous admixture services were provided by 43% of the respondents. Drug use review, patient education and inservice education were all provided by more than 10 of the respondents; in general, clinical services were not well developed. Salaries for directors were related more to hospital bed size than to years of experience as a pharmacist. Howeever, salaries for staff pharmacists were related more to years of experience than to hospital bed size. It appeared that staff pharmacists who want to earn more income must consider an administrative position.
Indiana↗
SOMARC teams with private distribution firm to implement CSM program in Ghana.
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Advertising↗