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PubMed1991

Expanding staff pharmacists' responsibilities to maintain pharmacy services in a neonatal intensive-care unit.

The conversion of pharmacist responsibilities in a neonatal intensive-care unit (NICU) pharmacy satellite from drug distribution to both clinical services and drug distribution is described. When the pharmacy department could not recruit a specialty-trained clinical practitioner to fill an open NICU position, the position was converted to a fourth satellite pharmacist position, and each of the four NICU satellite pharmacists assumed clinical responsibilities for the NICU. Clinical and distributive functions had previously been separate. Staff development programs and a contract with the previous NICU clinical practitioner for consultative services helped to ease the transition. NICU pharmacists currently provide inservice education to medical residents and the nursing staff, provide drug information, monitor drug therapy, perform pharmacokinetic monitoring, are involved in research, and work to streamline satellite operations. For one of every four months, the NICU pharmacists primarily provide clinical services; the remainder of the time clinical activities are combined with drug distribution responsibilities. The staffing schedule has enabled the department to extend the hours that clinical services are available. The NICU pharmacists maintain secondary areas of staffing, and other pharmacists periodically staff the NICU satellite. Staff pharmacists in the NICU pharmacy satellite developed clinical skills that permitted integration of clinical and distributive pharmacy services.

Hospital Bed Capacity, 500 and over↗
PubMed1991

Pharmacist salaries and hiring practices in teaching hospitals.

A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1990

Clinical services provided by staff pharmacists in a community hospital.

A program for developing staff pharmacists' clinical skills and documenting pharmacists' clinical interventions in a large community teaching hospital is described. A coordinator hired in 1984 to develop clinical pharmacy services began a didactic and experiential program for baccalaureate-level staff pharmacists. Fourteen educational modules are supplemented by journal and textbook articles and small-group discussions of clinical cases, and the clinical coordinator provides individual training on the patient-care units for each pharmacist. Monitoring of clinical pharmacy services began in June 1987; each intervention provided by a pharmacist is recorded on a specially designed form. A target-drug program is used to document cost avoidance achieved through clinical services. Information collected through these monitoring activities is used to educate the pharmacy staff, shared with the pharmacy and therapeutics committee, and used to monitor prescribing patterns of individual physicians. The data are used in the hospital's productivity-monitoring system. All pharmacists who were on staff in 1984 have completed the educational modules, and all new employees are in the process. Since monitoring began, the number of clinical interventions has averaged 2098 per month. Cost avoidance has averaged $9306 per month. Over a five-year period, the development of staff pharmacists' clinical services raised the level of professional practice, produced substantial cost avoidance, and increased the number of pharmacist interventions in medication use.

Costs and Cost Analysis↗
PubMed1990

Pharmacist involvement in a thyroid clinic.

The patient-care activities of a pharmacist in a thyroid clinic are described. Since 1978 a pharmacist has been an active member of the staff of a thyroid clinic associated with a 500-bed university hospital. More than 1500 patients are referred to the clinic each year. The pharmacist initiates, maintains, or modifies the drug therapy of selected patients with physician-diagnosed thyroid disorders under the guidance of written protocols approved by the chief endocrinologist. Most patients treated by the pharmacist are receiving thyroid-suppression therapy, antithyroid drugs for Graves' disease, or thyroid hormone supplementation after surgery or after radioactive iodine therapy. The pharmacist assesses patients, prescribes medications, orders laboratory tests, charts visits and therapeutic plans, and educates patients about their conditions. Major changes in thyroid status and drug therapy are always discussed with the chief endocrinologist. The pharmacist also participates in educational programs to influence prescribing by physicians, provides drug information, serves as a preceptor to pharmacy students, and is investigating the equivalence of levothyroxine preparations in vivo and in vitro. An audit of patient outcomes showed that the pharmacist is highly effective in her role as a giver of direct patient care. A pharmacist's role in a thyroid clinic can consist of clinical practice, education, preceptorship, and research.

Hospital Bed Capacity, 500 and over↗
PubMed1987

Use and abuse of controlled substances by pharmacists and pharmacy students.

The use of controlled substances by samples of pharmacists and pharmacy students in one New England state was surveyed. A questionnaire was sent in November 1984 to a sample of 510 pharmacists randomly selected from the membership list of the state's pharmaceutical association and to a sample of 470 students from the state's pharmacy schools; 76% and 67% of the eligible pharmacists and students responded, respectively. The questionnaire elicited information about the respondents' use of controlled substances for self-treatment and recreation, as well as the instrumental use of stimulants to enhance performance. Almost half of the pharmacists (46%) and two thirds of the students (62%) reported using a controlled substance at some time without a prescription; 19% and 41%, respectively, used one within the past year. Whereas students used the drugs most often for recreation (57% ever, 36% currently), use by pharmacists was more equally divided among self-treatment (29% ever, 13% currently), recreation (29% ever, 9% currently), and instrumental purposes (21% ever). The drugs most often used were marijuana, stimulants (especially cocaine by students), tranquilizers, and opiates. Drug use was generally limited in amount, but 18% of the pharmacists and 35% of the students who ever used a drug either became dependent or were at risk of drug abuse. Current drug use was most strongly associated with age, non-attendance at religious services, student access, year in school, and citizenship. The findings of this study suggest the need for continued development of impaired pharmacist committees and drug abuse prevention programs for pharmacists and pharmacy students.

Adolescent↗
PubMed1986

Factors influencing the rate of job turnover among hospital pharmacists.

Factors influencing the rate of job turnover among hospital pharmacists were studied. In June 1982, pharmacists and pharmacy directors in acute-care hospitals in the Chicago area with more than 100 beds were asked both open-ended and multiple-choice questions pertaining to reasons for accepting and staying at current jobs, reasons for leaving previous and possibly current jobs, career goals, and demographic data. From the sample of 529 pharmacists, 217 (41%) usable responses were received. Pharmacy directors' responses indicated that the turnover rate for pharmacists was 14.4% and that relocation and layoffs or job termination were the most common reasons for job turnover. Overall, pharmacists' pay and benefits and opportunity for promotion or advancement were the reasons pharmacists cited most frequently both for leaving a job and for staying at a job. Men ranked pay and benefits as the most important reason for taking and staying at a position and for leaving, whereas women cited hospital location as the most important reason for taking, staying at, or leaving a job. Other factors cited as important were working hours, professional challenge, job duties, and continuation of education. Pharmacists who had been in the current job for more than two years were less likely to leave. Pregnancy of the employee or spouse was not a strong reason for leaving, and relocation was a more important reason for women than for men. Approximately half the respondents indicated they had a career goal; promotion to management and continuation of education were the goals most frequently mentioned. Regional or national studies should be conducted to gain further understanding of why pharmacists accept, remain in, and change jobs.

Chicago↗
PubMed1983

Job satisfaction among U.S. pharmacists.

A review of the literature on job satisfaction that is relevant to pharmacists is presented. Studies conducted in the United States between 1951 and 1982 were evaluated to answer two questions: (1) What is known about the level of job satisfaction among pharmacists? and (2) What factors are related to pharmacists' job satisfaction? Some study populations were selected on the basis of work setting, others on position in the job hierarchy, and others on different criteria. Job satisfaction measures were of two general types, facet-free measures, which assess overall satisfaction, and facet-specific measures, which gauge satisfaction with respect to a specific aspect of the job. Pharmacists in the studies represented a wide variety of work settings and geographic locations. Most of the studies were not comparable because they used instruments unique to a particular study. In some cases, response rates were low and sample sizes were small. Frequently, results were not analyzed statistically for significance. A few studies compared pharmacists with other job populations; the differences were not striking, although pharmacists may be slightly less satisfied with their specific jobs than the general public. Repeatedly, job position and ability utilization appeared related to pharmacists' job satisfaction. Further study of the extent, causes, and consequences of pharmacists' job satisfaction is needed. Research methods should be designed so that results can be analyzed and compared statistically.

Environment↗
PubMed1982

Analysis of information provided by clinical pharmacists.

Data were collected to characterize the interactions between clinical pharmacists and other health professionals in a university hospital with decentralized pharmaceutical services. A self-report data collection form was developed. Six faculty pharmacists participated in the study. Each pharmacist collected data by recording all clinical interactions that occurred in his normal activities for a one-month period. the pharmacists' practice sites were inpatient internal medicine, inpatient pediatrics (two pharmacists), family practice clinic, pediatric clinic, and inpatient physical medicine and rehabilitation. A computer program was written to provide correlation data among the locations, contents, and participants of the interactions. Data were collected on the time required for a literature search and on the outcomes of the interactions. Four hundred ninety-nine interactions were documented. Work rounds were the most common location for these interactions, and the housestaff physicians were the most frequent participants. Patients' dosage schedule was the most common topic discussed (17%). Pharmacokinetics accounted for only 6% of the communications; drug interactions, only 3%. Ninety-six percent of the pharmacists' recommendations were adopted within 24 hours. More than half of the interactions (56%) required no literature search by the pharmacists and nearly half (249) required less than one minute of pharmacist time.

Drug Information Services↗
PubMed1982

Physician and pharmacist attitudes toward medication use.

Pharmacist and physician attitudes toward the use of medication in various situations were compared. In May 1979, a questionnaire was sent to 300 pharmacists and 300 physicians randomly selected from practitioners licensed in Arizona. The questionnaire listed 25 statements regarding the use of medications in controversial situations; respondents were asked to rate their degree of agreement to each situation using a five-point scale. The data were factor analyzed, and a two-tailed Student's t test was used to test for significant differences between the mean physician and pharmacist response to each item (p less than or equal to 0.05). Demographic data were also collected. The response rate was 69%, representing 217 pharmacists and 198 physicians. Pharmacists had significantly more favorable attitudes toward medication use in seven situations, and physicians in six. When the data were factor analyzed, neither the pharmacist nor the physician responses showed intercorrelations that justified data reduction. The respondent's attitudes were polarized, since more than 25% of the pharmacists agreed and disagreed in 15 situations. The pattern held in 13 situations for the physician sample. Both the pharmacists and physicians reported a wide range of unpatterned attitudes regarding medication use. Further work is needed to improve the instrument used to measure attitudes in this study.

Attitude of Health Personnel↗
PubMed1982

Pharmacist activities under alternative staffing arrangements.

The proportions of time pharmacists spent in professional and nonprofessional activities is compared under alternative staffing arrangements. Daily activities were observed in three pharmacy satellites each serving approximately 100 beds of a 730-bed hospital. Ten pharmacy administrators and residents recorded more than 8000 observations over a 14-day period, 24 hours per day. In each observation, basic functions were noted; these were chosen from a list compiled to include all pharmacy activities. A specific staffing pattern was identified in each observation. The observations were then categorized as professional or nonprofessional activities as predefined by the majority of the pharmacy staff. As staffing patterns varied, significant differences occurred in the ratio of professional to nonprofessional activities. The greatest percentage of professional activity was observed when one pharmacist worked with more than one technician; where the staffing pattern contained more pharmacists than technicians, a smaller percentage of the pharmacists' time was used in professional activity. Overall, pharmacists were engaged in activities considered professional in 52% of the observations. Assuming that the most efficient use of pharmacy personnel involves a high ratio of professional to nonprofessional activity in the pharmacists' workload, the optimum staffing arrangement would include at least the same number of technicians as pharmacists. Factors other than staff mix affect efficient management of pharmacists' professional time.

Humans↗
PubMed1994

Pharmacists' perceptions of patients' needs for counseling.

Pharmacists in Wisconsin were surveyed about their assessment of patients' needs for medication counseling and factors that hinder or facilitate counseling. Pharmacists attending regional meetings for a state board of pharmacy project completed the survey. The questionnaire was pretested on pharmacists from one area and refined; the study population then included pharmacists from all areas except this one. Questions were asked about criteria for determining the amount and content of oral counseling, the importance of oral versus written counseling, and factors that impede or facilitate counseling. Responses concerning criteria, barriers, and facilitators were grouped by two judges trained in content analysis. Information was collected about years spent in practice, counselor role orientation (scored on responses to eight statements), type of practice setting and position, and use of technicians and daily prescription volume in that setting. Of 708 pharmacists asked to complete the survey 697 (98%) provided usable responses. Seventy percent of respondents were in community practice; 63% were managing pharmacists; 74% of their practice sites used technicians, and 40% averaged 76-150 prescriptions per day. Patient motivation was the most frequently cited determinant of the amount and type of counseling, followed by type of medication, patient abilities, and time available for counseling. Sixty-one percent of respondents indicated that it was important to give both oral and written counseling. Pharmacists in different practice settings and positions reported different barriers to and facilitators of counseling. Pharmacists in this survey said patient-oriented criteria and type of medication determined the amount and content of counseling given to patients. They said it was important to provide both oral and written counseling.

Attitude of Health Personnel↗
PubMedDate not supplied

Evaluation of community pharmacists' experiences with cholesterol screening programs.

OBJECTIVE: To assess the cholesterol screening experiences of Nebraska community pharmacists. DESIGN: A mail survey was used to assess pharmacists' experiences with and involvement in cholesterol screening and patient follow-up based on National Cholesterol Education Program guidelines. SETTING: A college of pharmacy in an academic health center. PATIENTS OR OTHER PARTICIPANTS: Pharmacists-in-charge of all Nebraska community pharmacies. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Participants' responses to survey items. RESULTS: Of 308 respondents, 83 indicated that cholesterol screenings had been held in their pharmacies. Whereas 95% felt that the screenings had been conducted appropriately, only 61% had actually monitored the screening process. Pharmacists were somewhat aware of the types of information being provided to patients being screened, although few were aware of the specific procedures used to identify high-risk patients. Eight of 80 pharmacists indicated that they obtained a list of patients who were told to contact their physicians based on their cholesterol screening results. Only 3 of 30 pharmacists responding to a question asking whether they contacted such patients to remind them to contact their physician reported actually doing so. CONCLUSION: Pharmacists were relatively uninvolved in both the screening process and the provision of information to the patients who were screened. Few pharmacists initiated-up contact with patients who were referred for physician evaluation.

Community Pharmacy Services↗
PubMed1999

[Pharmacist's attitudes towards opioid prescription].

UNLABELLED: The prescription of strong opioids underlies a special legislation. The attitude of the pharmacists towards the long-term treatment with these analgesics and their opinion about the legislation is unknown in Germany and other European countries. METHODS: A questionnaire was included in the Journal "Mitteilungsblatt der Apothekerkammer Westfalen-Lippe" and send to all 2300 pharmacists of the region Westfalen-Lippe in December 1997. RESULTS: 797 (35%) questionnaires were returned. In 82.4% of the pharmacies strong opioids are kept in stock. However, 140 pharmacists do not have opioids in stock due to too many different preparations or low prescription rate. 54% of the pharmacists warn their patients about endangering by the medication. The fear of psychological addiction (48.1%) is the main argument, also in patients with regular intake of the opioids (20.1%) and related to long acting opioids (10.8%). Nevertheless, 73% of the pharmacists advocate for a liberalization and 10.7% for an abolishment of the actual prescription laws. DISCUSSION: The importance of the therapy with strong opioids is well accepted by the pharmacists. An ease of the prescription is demanded to improve the situation of the patients with chronic pain. However, the majority of the pharmacists warns the patients about this medication. Contact between prescribing doctors and pharmacists and an intensified education concerning the therapy with opioids are needed in addition to the education of the medical staff and the liberalization of the prescription laws.

English Abstract↗
PubMed2005

Nurses' evaluation of pharmacists' services--a hospital survey.

BACKGROUND: One of the tools to evaluate quality of service is to measure satisfaction from services provided. This survey evaluates the quality of pharmacy services based on the satisfaction of nurses who require pharmacy services on the wards. When a nurse evaluates pharmacist services, an appropriate concept of their evaluation should be selected. Three different types of evaluation have been identified that could be applied to these services: performance evaluation (how convenient, reliable, and accessible is a service), disconfirmation of expectations (service experience that involves comparison between the service experience and expectation), and self- efficacy evaluation (extent to which a pharmacist service leads to nurse self-efficacy). OBJECTIVE: To measure nurses' evaluations of pharmacists' services in a general hospital in Israel, using those three types of evaluations. METHOD: Nurses were asked to evaluate, by a questionnaire the service in terms of performance, disconfirmation of expectations by rating statements for each subject on a 5-point scale, where 5 was the highest rating. Self-efficacy was evaluated by one choice positive or negative answer. RESULTS: A total of 252 (95.1) questionnaires were filled out and returned for evaluation. Nurses rated pharmacists' performance as 4.2 (+/-0.5) (P=0.01). Disconfirmation of expectations was rated as 3.6 (+/-0.8) and self-evaluation as 3.7 (+/-0.2). Linear regression models were estimated for general satisfaction of pharmacists' services and performance was significant when correlated with the period of nurses' professional service. CONCLUSIONS: Analysis of the three tools of evaluation for pharmacy services by nurses showed that the performance evaluation was most favored, followed by disconfirmation of expectations and self-efficacy evaluation. Conceptualization of satisfaction, with tools as performance evaluation and disconfirmation of expectations is useful for those services that nurses have experience with and can relate to. For services with ambiguous or unfamiliar nature (e.g., professional self-evaluation due to pharmacist services), most nurses do not have the expertise to assess pharmacist performance. This survey provides for a better conceptual understanding of how nurses evaluate pharmacist services and how these evaluations should be measured.

Attitude of Health Personnel↗
PubMed1990

The pharmacy supervisor and the employee pharmacist's job satisfaction.

It seems obvious that satisfaction with one's immediate supervisor would have a significant impact on one's general job satisfaction. However, this relationship has received little attention in the pharmacy literature. This study was designed to determine 1) whether there are differences in job-related satisfaction between pharmacists whose immediate supervisors are pharmacists and those whose supervisors are not pharmacists, and 2) whether the occurrence of conflict between a pharmacist and his or her immediate supervisor is related to the employee pharmacist's job and career satisfaction. The most pronounced finding was the importance of supervisors being pharmacists: satisfaction on five of six satisfaction subscales was related to whether one's supervisor was a pharmacist. Moreover, pharmacists who had the fewest conflicts and disagreements with their supervisors were more satisfied with their choice of pharmacy as a career, their employers, their supervisors, and their jobs.

Job Satisfaction↗
PubMedDate not supplied

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

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

Adult↗
PubMed2001

More than just a shopkeeper: involving the community pharmacist in undergraduate medical education.

The 1996 Medical Undergraduate course at Liverpool University provides the opportunity for second-year medical students to explore the importance of the roles of the personnel in the extended primary healthcare team. The community pharmacist is one such member that the students may not meet during a standard general practice attachment but who could have an important role in student understanding of the community. Community pharmacists appear to be an underused resource in undergraduate teaching. This paper describes a pilot study in which the students explored the role and potential of the community pharmacist. Students attending one Community Teaching Centre arranged to visit the local pharmacy with predefined and discussed learning objectives. They then returned after the visit to discuss their findings in a group environment. Evaluation demonstrated that this experience changed the students' perceptions and understanding of the role of the pharmacist. They felt encouraged to make more appropriate use of the pharmacist in the future, whilst becoming aware of the undervalued feelings of the pharmacists. The pharmacists were greatly encouraged by the initiative, believing it to be a worthwhile experience for the students, and encouraging better use of pharmacists in the future.

Journal Article↗
PubMed1999

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--1999.

The results of a 1999 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of a similar survey conducted in 1997. Four hundred MCOs and integrated health systems participated in the telephone survey. The survey elicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey recipients were asked about 24 specific ambulatory pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary teams, automated dispensing systems, integrated electronic medical records, and "very supportive" medical staff and senior management. Thirteen functions were reported to be routine activities for more than 50% of the respondents, compared with nine functions in 1997. The top four functions-using pharmacoeconomic data to make formulary decisions, conducting medication management programs, tracking adverse drug reactions, and providing written information with each new prescription-were performed in 75% or more of organizations. Some 15-18% of respondents indicated they would add specialized pharmacy-managed clinics, services to determine patient use of herbal products and dietary supplements, and Internet prescription services within 12 months, suggesting this expansion is likely to continue. Enabling factors supported expansion. Two clusters of functions were identified that related to either population-focused or patient-focused activities, and these were supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the greatest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of pharmacist functions, with an emphasis on population-focused functions, suggesting that a second model of ambulatory care pharmacist activity may be emerging. Ambulatory care functions of pharmacists in integrated health-system settings have expanded broadly since 1997.

Ambulatory Care↗