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PubMed2003

Predicting costs of care using a pharmacy-based measure risk adjustment in a veteran population.

BACKGROUND: Although most widely used risk adjustment systems use diagnosis data to classify patients, there is growing interest in risk adjustment based on computerized pharmacy data. The Veterans Health Administration (VHA) is an ideal environment in which to test the efficacy of a pharmacy-based approach. OBJECTIVE: To examine the ability of RxRisk-V to predict concurrent and prospective costs of care in VHA and compare the performance of RxRisk-V to a simple age/gender model, the original RxRisk, and two leading diagnosis-based risk adjustment approaches: Adjusted Clinical Groups and Diagnostic Cost Groups/Hierarchical Condition Categories. METHODS: The study population consisted of 161,202 users of VHA services in Washington, Oregon, Idaho, and Alaska during fiscal years (FY) 1996 to 1998. We examined both concurrent and predictive model fit for two sequential 12-month periods (FY 98 and FY 99) with the patient-year as the unit of analysis, using split-half validation. RESULTS: Our results show that the Diagnostic Cost Group /Hierarchical Condition Categories model performs best (R2 = 0.45) among concurrent cost models, followed by ADG (0.31), RxRisk-V (0.20), and age/sex model (0.01). However, prospective cost models other than age/sex showed comparable R2: Diagnostic Cost Group /Hierarchical Condition Categories R2 = 0.15, followed by ADG (0.12), RxRisk-V (0.12), and age/sex (0.01). CONCLUSIONS: RxRisk-V is a clinically relevant, open source risk adjustment system that is easily tailored to fit specific questions, populations, or needs. Although it does not perform better than diagnosis-based measures available on the market, it may provide a reasonable alternative to proprietary systems where accurate computerized pharmacy data are available.

Adolescent↗
PubMed1980

A new look at pharmacy services in the operating suite and recovery room.

Drug control and charging traditionally have been delegated to overburdened physicians and nursing personnel in operating rooms, anesthesiology, and immediate postoperative patient care areas. Better drug control (e.g., charging, intravenous admixture preparation, and narcotic record keeping) in these areas is needed, and a 24-hour satellite pharmacy system is proposed. Revenue production and expense incurred were projected by analyzing drug usage. Responsive drug dispensing and control were evaluated by a 10-day pilot study during which the pharmacy provided the entire drug needs of the patient while in the operating suite. Economic analyses revealed significant "lost charges" by the automatic replacement system currently in use. Revenue was maintained while providing clearly labeled drugs in a ready-to-use form. Problems with drug inventory and narcotic control were lessened for the nursing and physician staffs during the pilot study. It was concluded that drug distribution and control via a decentralized pharmacy satellite located in the operating room area is a financially viable solution resulting in better patient care.

Accounts Payable and Receivable↗
PubMed1989

A boost for family planning.

In Ghana, pharmacists and sellers of non-prescription medicines are distributing contraceptives and giving family planning advice within the framework of a demonstration programme which, it is hoped, will lead to a significant improvement in the health of rural populations.

Community Pharmacy Services↗
PubMed2006

Drug information education in doctor of pharmacy programs.

OBJECTIVE: To characterize pharmacy program standards and trends in drug information education. METHODS: A questionnaire containing 34 questions addressing general demographic characteristics, organization, and content of drug information education was distributed to 86 colleges and schools of pharmacy in the United States using a Web-based survey system. RESULTS: Sixty colleges responded (73% response rate). All colleges offered a campus-based 6-year first-professional degree PharmD program. Didactic drug information was a required course in over 70% of these schools. Only 51 of the 60 colleges offered an advanced pharmacy practice experience (APPE) in drug information, and 62% of these did so only on an elective basis. CONCLUSION: Although almost all of the PharmD programs in the US include a required course in drug information, the majority do not have a required APPE in this important area.

Curriculum↗
PubMed1991

Drug product distribution systems and departmental operations.

Technologies affecting institutional pharmacy practice and the operation of pharmacy departments are reviewed, future developments are outlined, and implications of these developments for pharmacy education are proposed. Computer technology, especially as applied to areas such as artificial intelligence, online information databases, electronic bulletin boards, hospital information systems, and point-of-care systems, will have a strong impact on pharmacy practice and management in the 1990s. Other areas in which growth is likely to be active include bar-code technology, robotics, and automated drug dispensing. The applications of these technologies are described, with particular attention placed on the effects of increased automation on the drug-dispensing function. Technological advances may effect marked reductions in dispensing and medication errors; questions concerning the cost-effectiveness of these new systems remain to be answered. These advances also create new opportunities for clinical involvement by pharmacists; however, a fundamental understanding of computer systems is essential. Current practitioners can benefit from attending seminars, participating in users' groups, and keeping current with the computer literature. Many students now acquire the needed skills in computer laboratories and in the classroom. Technological advances will offer the opportunity for pharmacists to expand their clinical role.

Artificial Intelligence↗
PubMed1997

Clinical training program for distributive pharmacists.

A training program to enable staff pharmacists in a state correctional system to shift their practice from distributive to clinical is described. Under a contract with the Texas Department of Criminal Justice (TDCJ), the University of Houston College of Pharmacy provides pharmaceutical services to 145,000 patients in 100 correctional facilities. An automated centralized distribution site was built in 1993 and four regional pharmacies were subsequently closed, resulting in the reallocation of eight distributive pharmacists positions to clinical services. Four of the eight pharmacists who would be displaced began a retraining program in preparation for decentralized clinical positions. The 18-month program, developed by university staff on contract to TDCJ and college faculty members, included 34 home-study modules, case studies, case presentations, seminars, and supervised practice experience. Three of the pharmacists completed the program, passed competency tests, and were certified for clinical practice privileges, including drug therapy assessment and written consultations. The three pharmacists now operate ambulatory care clinics at prison units. A clinical skills training program developed by a college of pharmacy correctional services division in cooperation with faculty members enabled staff pharmacists to convert their roles from distributive to clinical.

Education, Pharmacy, Continuing↗
PubMed1983

Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981.

The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.

Analysis of Variance↗
PubMed1999

Challenges of thalidomide distribution in a hospital setting.

The various physician, patient, and pharmacy requirements for participation in the System for Thalidomide Education and Prescribing Safety (S.T.E.P.S.) program and procedures that institutions may implement in order to comply with these requirements are described. In 1998, FDA approved the marketing of thalidomide (Thalomid, Celgene). Because of the drug's known teratogenic effects, FDA tightly controls the distribution of thalidomide in the United States. To comply with FDA requirements, Celgene developed the S.T.E.P.S. oversight program, which includes registration of thalidomide prescribers and pharmacies that dispense thalidomide, extensive patient education about the risks associated with thalidomide, and a registry of all patients receiving thalidomide. The S.T.E.P.S. program is considered part of the product label. The pharmacy requirements of the program were developed with a focus on a retail pharmacy practice model, which does not adequately reflect current hospital practice. The pharmacy department of the National Institutes of Health Clinical Center developed a model that adapts the S.T.E.P.S. program requirements to inpatient and outpatient institutional pharmacy practice. Procedures for registering patients and prescribers and dispensing thalidomide in the hospital setting were developed; the procedures were designed to meet the needs of both the inpatient and outpatient pharmacies and to comply with the requirements of the S.T.E.P.S. program.

Anti-Infective Agents↗
PubMed1984

Cost effective method of implementing decentralized unit dose pharmacy services in a Friesen setting.

A limited decentralized drug distribution system was implemented at the Graduate Hospital, a 310-bed Friesen Concept teaching hospital. This mobile system services 252 medical/surgical beds on three floors of the hospital. Operation was limited to hours of peak demand for pharmacy services and to initial doses. The system was able to reduce turnaround time from 217 minutes to 90 minutes for 80-85% of newly written orders. Further, the systems was found to increase the availability of the pharmacist as a reference source and to clarify unclear or inappropriate orders. This approach required no increase in full-time equivalents and minimal capital expenditure.

Centralized Hospital Services↗
PubMed1997

Counseling patients about prescribed medication: 12-year trends.

OBJECTIVES: The authors determined patients' report of prescription drug counseling activities after withdrawal of the pilot program to require patient package inserts in 1980 and implementation of Omnibus Budget Reconciliation Act of 1990 counseling requirements in 1993. METHODS: Four cross-sectional national telephone surveys were conducted in the fall of 1982, 1984, 1992, and 1994. Telephone households were chosen by random-digit dialing. Subjects had obtained a new prescription for themselves or for a family member at a retail pharmacy during the previous 4 weeks. Verbal counseling rates at physician offices and pharmacies for five information categories and the distribution of written information at those locations were determined. RESULTS: Spontaneous verbal counseling at the physician's office has increased slightly, with the largest increases focused on the delivery of side effect and precautionary information. Slightly larger increases in pharmacy-delivered information regarding directions for use and precautions have occurred. Patient questioning has remained at single digit levels at both sites. The percentage of patients receiving any written information has increased from 5% to 15% at the physician's office and from 16% to 59% at the pharmacy. CONCLUSIONS: The data indicate small increases in verbal counseling but larger increases in the delivery of written information provided at the pharmacy. In light of Healthy People: 2000 goals for patient counseling and legislation encouraging private-sector initiatives, these data should help to refocus attention on the continuing need for effective patient education interventions.

Adult↗
PubMed1989

Improving medical communication with facsimile (fax) transmission.

Facsimile machines (fax) used intensely in business, send copies of documents from one location to another. The medical potential for fax has not been fully explored. A general background in fax and the potential uses for fax between hospitals and within hospitals are described. Fax permits small hospitals to share the resources of larger hospitals and permits a large hospital to share resources more efficiently among its departments. The cost of a fax unit is small compared with the amount of work and time it can save. Clinics and private physicians may also find fax units cost effective. Fax boards, which provide fax capability to personal computers, are also described. The use of fax could streamline the process of patient transfer, telephone patient consultation, medical records retrieval, ECG interpretation, central information distribution, retrieval of medical literature, inpatient pharmacy orders, etc.

Copying Processes↗
PubMed2005

[Female condom or male condom: offer a choice!].

OBJECTIVES: As in the entire Ile-de-France, the Val-de-Marne is facing an increase in female contamination by HIV, a clear increase in STI and furthermore the number of legal abortions is still high. Various recent studies have emphasized the decrease in condom use since 1998. Can the possibility of proposing another condom, more specifically controlled by women, boost condom use? PATIENTS AND METHODS: The conseil général (local government authority) thus initiated a study in the general population, from January 1st 2001 to December 31st 2001, in order to study the criteria of acceptability of the female condom (FC). RESULTS: Although the women coming to consultation had no specific requests a quarter finally tested the female condom during sexual intercourse. Among them 4 out of 10 are ready to use it again. Curiosity was the primary motivation of those who accepted to test the female condom (77 %). Women who were more at ease with their sexuality were twice more likely to test the female condom. Three main advantages were put forward by the women who tested the FC: the strength of the FC, the fact that insertion was possible prior to the sexual act and the possibility of postponing removal, the latter being considered a supplementary advantage. The disadvantages most frequently cited before use were its appearance and difficult insertion process. The frequency of utilisation of the FC was multiplied by three when women practised putting the condom in place in a non-sexual context. However, even when they recognized one or several disadvantages women accepted to test it. In addition, whenever a woman finds at least one advantage before use she is twice more likely to test it. This is where counselling by professionals in charge of presenting the FC becomes a deciding factor. DISCUSSION AND CONCLUSIONS: The chance of using at least one sort of condom is increased when a choice of condoms is available. When both male and female condoms are available, the responsibility for prevention is better balanced within the couple: each partner can then be in charge of his or her own health. However the adoption of a barrier method such as the condom, means that the individual is conscious of such a need and finds that there are benefits mainly staying in good health. However the insufficient number of prevention and health promotion campaigns in France does not favour such an awareness. The availability of inexpensive female condoms in pharmacies, supermarkets as well as free distribution by certain institutions remains an unresolved question.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas.

The increased prevalence, morbidity, mortality, and health costs associated with asthma among children suggest the need for accessible asthma education. This study examined the effect of telepharmacy counseling, using interactive compressed video, on metered-dose inhaler (MDI) technique and patient satisfaction among adolescents with asthma in rural Arkansas. The telepharmacy counseling provided accessible education regarding MDI technique for adolescents in this study. Twenty percent of the adolescents who participated had never been shown the appropriate use of an MDI. The study used an experimental design with random assignment of participants to a telepharmacy counseling group (n = 15) or a control group (n = 21). Both groups participated in pre-test, post-test, and 2- to 4-week follow-up assessments for MDI technique and patients satisfaction (follow-up assessment only) via interactive compressed video. Results indicated that from pre-test to follow-up the telepharmacy counseling group showed more improvement in MDI technique than participants in the control group (p < 0.001). There was no significant difference between the telepharmacy counseling group and control group in satisfaction with the instructional sessions (p = 0.132). Both groups had high levels of satisfaction with the telepharmacy sessions. The study findings demonstrated that patient education provided by pharmacists via interactive compressed video was superior to education provided via written instructions on an inhaler package insert. Interactive compressed video is an effective medium for teaching and improving MDI technique in this rural, adolescent, predominantly African-American population.

Administration, Inhalation↗
PubMedDate not supplied

Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit.

Polymicrobial bacteremia developed in 5 of 20 infants in a neonatal intensive care unit during a 48-hour period; 2 infants died. Klebsiella pneumoniae serotypes 21 and 24 and Enterobacter cloacae were isolated from four infants, and K. pneumoniae serotype 24 and E. cloacae were isolated from the other infant. Case-control studies revealed an association between receipt of lipid emulsion on one day and the subsequent development of bacteremia (P = 0.0005). Epidemiologic evidence suggested that extrinsic contamination of the lipid emulsion bottles had occurred when the hands of a nurse became transiently colonized with these organisms while she was caring for an infant colonized with K. pneumoniae and E. cloacae. Repeated entry of the lipid emulsion bottle, which was used as a multidose medication, probably resulted in contamination. No further cases occurred after lipid emulsion administration practices were changed. We recommend that, except in a pharmacy where conditions for unit dose distribution exist, lipid emulsion should not be used as a multiple dose medication because repeated entry of the bottles increases the risk of contamination. Furthermore lipid emulsion from one container should be administered to only one infant.

Cross Infection↗
PubMed1994

Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility.

OBJECTIVE: To examine the relationship between pharmacists' willingness to assume further professional responsibilities, as measured by attitudes to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requirements, and their attitudes toward voluntarism as their responsibility to society and their level of interest in their jobs. DESIGN: A survey was distributed to a convenience sample of 443 pharmacists who were asked to indicate their responses on a number of items. SETTING: Surveys were distributed to participants in an annual pharmacy continuing education program. PARTICIPANTS: The response rate was 65 percent with completed surveys from 290 Florida pharmacists who were typically male (73 percent) and practicing in the community setting (39 percent) for over 25 years (33 percent). MAIN OUTCOMES: Questions were aimed at gathering the following information: (1) demographics; (2) attitudes concerning the benefits of the three OBRA '90 requirements: patient counseling, prospective drug-use review (DUR), and information recording; (3) attitudes toward voluntarism; and (4) job interest. RESULTS: Pharmacists tended to agree that all three of the OBRA '90 mandates will be beneficial. Fifty-six percent favored the prospective DUR requirements, while 68 percent favored the patient counseling requirements and 66 percent favored the information-recording requirements. Logistic regression analysis showed that unit increases in scaled responses, indicating more favorable attitudes toward believing that voluntarism was one's responsibility, increased the odds of favoring counseling by 38.7 percent and information recording by 32.4 percent. A similar directional relationship was found for the DUR requirement. Job interest did not add to the predictive ability of the variables already in the models. CONCLUSIONS: This study suggests a possible association between pharmacists' attitudes toward social responsibility and their acceptance of expanded professional responsibility.

Attitude of Health Personnel↗
PubMedDate not supplied

Abuse of prescription medicines in southwestern France.

BACKGROUND: Few quantitative data are available concerning abuse of medicine in the general population, although dependence on prescription medicines involves a significant proportion of the population. Falsified prescription forms can be used as an indicator of abuse. METHODS: Community pharmacists in a representative network were asked to report any falsified prescription form presented over a 1-year period. Sales data were used to express results as abuse rate and abuse rate ratio. RESULTS: Two-thirds of the 130 pharmacies in the network reported at least 1 falsified prescription. The reported incidence of falsified prescriptions was 2.3 per 10 000 inhabitants. A total of 392 falsified prescription forms was collected. The abuse rate ratios were 171 (95% CI 140 to 210) for dextroamphetamine-phenobarbital in combination, 168 (95% CI 131 to 216) for fenozolone, 67 (95% CI 53 to 84) for buprenorphine, and 40.5 (95% CI 33 to 50) for clobenzorex. CONCLUSIONS: These results show the efficiency of a method for detecting falsified prescriptions forms using community pharmacists. The abuse of medicines already known for their addictive potential can be estimated and alerts can also be detected.

Crime↗
PubMed2003

Importance of nondrug costs of intravenous antibiotic therapy.

INTRODUCTION: Costs are one of the factors determining physicians' choice of medication to treat patients in specific situations. However, usually only the drug acquisition costs are taken into account, whereas other factors such as the use of disposable materials, the drug preparation time and the staff workload are insufficiently taken into consideration. We therefore decided to assess true overall costs of intravenous (IV) antibiotic administration by performing an activity-based costing approach. METHODS: A prospective survey on costs and workload by means of a time and motion analysis and activity-based costing was performed in a 605-bed secondary referral centre with 20 intensive care unit beds. The subjects were 50 consecutive patients admitted to our hospital with community-acquired pneumonia or intra-abdominal infections requiring treatment with IV antibiotics. A time and motion analysis of 103 routine acts of preparing and administering IV antibiotics was performed in the intensive care unit and in the Department of Internal Medicine. To measure the entire process an inventory and work flowchart were made using detailed questionnaires completed by members of the nursing staff, the medical staff and the pharmacy staff. In addition, questionnaires were distributed to management and secretarial staff to determine additional overhead costs. The average costs for different methods of IV antibiotic administration were then compared by timing all steps in the process. Four different methods of drug administration were used: administration by volumetric pump, administration by syringe pump, administration by 'unaided' infusion bag, and administration by direct IV injection. RESULTS: The average times required for each of these procedures, including preparation and administration of the drug, were 4:49 +/- 2:37, 4:56 +/- 2:03, 5:51 +/- 3:33 and 9:21 +/- 2:16 min (mean minutes:seconds +/- standard deviation), respectively. When the costs for expended staff time and materials (not including drug costs) were calculated this resulted in average costs of 5.65, 7.28, 5.36 and 3.83, respectively, for administration of each dose of antibiotics. These costs represent between 11% and 53% of the total daily costs of antibiotic therapy. Compared with the acquisition costs, these indirect costs ranged from 13% to 113%. Not included in this comparison is the time required for insertion of an IV catheter, which was found to be 10:15 +/- 6:31 min with an average calculated cost of 9.17. CONCLUSIONS: Total costs of IV antibiotic administration are formed not only by the costs of the drugs themselves, but also, to a substantial degree, by the time expended by medical and nursing staff, costs of disposable materials and overhead costs. Physicians making decisions regarding the use of specific medications in intensive care unit patients should take these factors into account. Use of IV antibiotics is associated with considerable workload and additional costs that can exceed the acquisition costs of the medications themselves.

Adult↗
PubMed2005

Pharmaceutical terms reflecting the change in practice in Japan.

The implementation of Iyaku Bungyo, the changed regulations for drug distribution and the proposed change of pharmacy education from a four-year program to a six-year program are rapidly changing the practice of pharmacy. However, pharmacists' activities still remain at the level of simple dispensing and selling of drugs. Also, the terms that describe the essence of pharmacists' activities, such as services in patient care areas are still unclear. In order to solve and improve the problem of terminology for pharmacists' activities the use of terms related to pharmacists' services were examined in historical context. It was found that the terms "Rinsho yakugaku" and "Iryo yakugaku" have been used as having a similar meaning. Further, the term "Iryo yakugaku" was used to denote the comprehensive scope of pharmacists' services including "Rinsho yakugaku". It was verified that "Rinsho yakugaku" is a valid translation for "clinical pharmacy". "Iryo yakugaku" has a more comprehensive translation than "pharmaceutical care", therefore, it appears that "Iryo yakugaku" is a suitable translation for "pharmaceutical services". Hence, we proposed "Iryo yakugaku" as the English translation for "pharmaceutical services" and "Chiryo yakugaku" as the Japanese translation for "pharmaceutical care". There is a need, however for further clarification and definition of pharmacists' activities.

Education, Pharmacy↗