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PubMed2000

Comparative analysis of pharmacy services based on newly developed evaluation index.

This study was conducted to evaluate pharmacy services to patients or customers with prescriptions issued by large hospitals. The primary purpose of this study is to assess patients' perceptions and expectations of pharmacy services with a view to standardizing community pharmacies for better health care. Two groups of patients or pharmacy patrons were evaluated, i.e. those who utilized pharmacies adjacent to the hospitals (Group A) and those who utilized other community pharmacies (Group B). The survey consisted of 26 evaluation functions ranging from location to services. Based on these functions, patients were requested to use a scale of 1 to 5 to rate the pharmacy they are currently using ("Pharmacy Used Today") and their perception of an "Ideal Pharmacy". These evaluation functions were analyzed and classified into seven dimensions which formed the evaluation index used in this study. These are: (1) availability of over-the-counter drugs, (2) availability of special services such as delivery of medicines, acceptance of fax order, etc., (3) facilities, (4) convenient location, (5) attitude of pharmacy/pharmacist, (6) information management, and (7) convenient hours. In comparing the results of the study, it was revealed that both groups of patients/pharmacy patrons have common expectations or perceptions as to what is an "Ideal Pharmacy". The results also revealed that of the seven dimensions mentioned above, the three most important to patients/patrons are: attitude of pharmacy/pharmacist, convenient hours, and information management. In rating the "Pharmacy Used Today", Group A patrons gave lower ratings than Group B patrons in all dimensions except facilities. The variance between the "Pharmacy Used Today" and the "Ideal Pharmacy" is greater in Group A than in Group B. The results of this investigation indicate that the Group B patients/patrons have received greater amount of benefits of the "Bungyo" than Group A ones, although the fact is that most outpatients use pharmacies located adjacent to hospitals in order to obtain their medications.

Adult↗
PubMed1990

Hospital pharmacy services in the Great Lakes region.

The results of a spring 1987 survey of hospital pharmacy services in seven states of the Great Lakes region are reported. The study group (n = 1087) comprised all hospitals in seven states that employed at least one full-time or part-time pharmacist and that had 50 or more licensed beds. The survey had a 63% response rate (681 usable responses). Seventy percent of the hospitals were small (average daily census, less than 200), 20% were medium sized (200-399), and 11% were large (greater than or equal to 400). Some 33% of the hospitals were affiliated with a college of pharmacy. Pharmacy directors who held an advanced degree (master of science or doctor of pharmacy) were more likely to work in larger hospitals and in those affiliated with educational institutions. The extent of unit dose services differed based on hospital teaching affiliation and pharmacy director's education. Provision of i.v. admixture services differed based on hospital teaching affiliation and pharmacy director's education but not hospital size. Pharmacy preparation of six specialty i.v. products differed according to pharmacy director's education and hospital teaching affiliation; however, pharmacy preparation of only three of the specialty products differed based on hospital size. Larger hospitals that were affiliated with an educational institution were more likely to employ a clinical coordinator, drug information specialist, or clinical pharmacist. Home health-care services involving pharmacists were provided by 26% of the hospitals; the most common programs were antimicrobial therapy and total parenteral nutrition therapy. Pharmacists provided services in ambulatory-care clinics in 24% of the hospitals, with the most common services being patient education, pharmacokinetics consultation, and dosage regimen adjustment. Provision of 10 of 12 inpatient clinical pharmacy services differed based on hospital size and teaching affiliation; 11 of the 12 services differed based on education of the pharmacy director. Workload and pharmacist staffing data for the inpatient clinical pharmacy services varied widely. Eleven of these services were expected to undergo a positive net growth, while one service, provision of admission medication histories, was expected to decline. An extensive survey of hospital pharmacy services in the Great Lakes region showed that the provision and scope of many services were related to hospital size, hospital teaching affiliation, and the education of the pharmacy director.

Drug Information Services↗
PubMed2004

Access to community pharmacies by the elderly in Illinois: a geographic information systems analysis.

Community pharmacies play an important role in maintaining population health in the United States. They are large in number, distribute widely across geographic areas, and operate for long hours. Because the elderly population tends to use more medications and have more frequent interaction with pharmacies and pharmacists, this study was carried out to understand the geographic access to community pharmacies by the elderly in Illinois and to estimate the disparity in the access between rural and urban areas. The addresses of all community pharmacies operating in 2001 were geocoded to identify their locations. The Census 2000 data on demographics at the census block group level was used to estimate the geographic distribution of the Illinois population by age group. Using the centroid of each census block group and the locations of community pharmacies, the distance to a nearest pharmacy for each census block group was calculated. The distance was then weighted to compute the aggregated distance required for the elderly to access a pharmacy. There were 1373 community pharmacies operating in Illinois in 2001. Most pharmacies (93.8%) were located in urban areas. On average, there were 1.27 and 0.38 pharmacies per 10,000 people in urban and rural areas, respectively. The average distance for an elderly person in Illinois to locate a community pharmacy was 0.9 miles in urban areas, but it was six times more (5.9 miles) in rural areas. At least 10% of the rural elderly had to travel more than 11.8 miles to find a community pharmacy, but only 0.1% had to travel more than 20 miles. The geographic access to community pharmacies appears to be appropriate in Illinois. However, a small portion of rural elderly who do not have a pharmacy in their nearby areas may warrant special attention.

Aged↗
PubMed1997

Patient satisfaction with pharmaceutical services at independent and chain pharmacies.

Patients' satisfaction with pharmaceutical services at independent community pharmacies and chain community pharmacies was studied. An interviewer administered the Pharmacy Encounter Survey (PES) face-to-face to 260 consecutive people immediately after their visits to randomly selected chain pharmacies (n = 10) or independent pharmacies (n = 16) in Philadelphia County, Pennsylvania. The 15-item PES gathers demographic data and asks respondents to rate their satisfaction with the time it took for prescriptions to be filled, the technical skills and courtesy of pharmacy personnel, the convenience of the pharmacy's location, and other aspects of the experience. An aggregate of responses across the two pharmacy types showed an excellent or very good rating given by most respondents for all items. Respondents were most satisfied with pharmacy location and least satisfied with time spent waiting for prescriptions to be filled. However, for each item rated, and for the overall visit, respondents rated independent pharmacies better than chain pharmacies. The PES was a practical, easy-to-administer tool for measuring satisfaction, an increasingly important dimension of quality in managed care organizations. People interviewed with the PES at independent and chain community pharmacies in Philadelphia County rated the pharmacies highly, with higher ratings being given to the independent pharmacies.

Community Pharmacy Services↗
PubMed2006

Community pharmacy services in Portugal.

OBJECTIVE: To describe the status and outline the trends of community pharmacy services in the Portuguese healthcare system. FINDINGS: The legal framework for Portuguese pharmacies includes geographic and demographic criteria for opening pharmacies and restricting ownership to pharmacists. Since 1975, pharmacy owners have been organized under one association, the Portuguese National Pharmacy Association, which has dealt with pharmacy development over the past 20 years. Securing the economic sustainability of pharmacies was the first milestone. Investing in information software and communication technologies and modernizing the architecture of pharmacies was the next step. Then, professional services such as point-of-care measurements, drug waste management, and needle exchange services were developed. The methadone substitution program was introduced at a later date. Finally, major comprehensive services, including disease management/pharmaceutical care programs, were implemented. DISCUSSION: All Portuguese pharmacies are independent, which means that the decision to provide different services and the extent to which they are attained vary from pharmacy to pharmacy. Recent political changes seem to reinforce the need to pursue the strategies already defined-to expand the traditional scope of pharmacy business to a wider range of health services. CONCLUSIONS: Achievements that have been accomplished and strategies that are in place reflect a high level of organization and unity among Portuguese pharmacies. From a global perspective, pharmacies are reorganizing to be able to compete against other possible agents and are preparing to expand their scope of intervention.

Community Pharmacy Services↗
PubMedDate not supplied

Prevalence and types of disease management programs in community pharmacies in California.

OBJECTIVES: To (1) evaluate the prevalence and types of disease management (DM) programs provided by independent and chain community pharmacies in the state of California, (2) examine the interest among community pharmacists in establishing programs, and (3) assess perceived barriers to developing a successful DM program in community pharmacy. METHOD: An exploratory telephone survey was conducted from February 2003 to February 2004 to collect data from community (primarily independent and chainstore) pharmacies across California. The survey evaluated existence (or lack of) and types of DM programs in community pharmacies in California. Pharmacies that did not have a DM program were queried on their interest and decisionmaking authority in establishing new programs. Pharmacies that had existing DM programs were sent a follow-up survey to determine the details of the DM programs, including challenges in establishing DM programs, reimbursement issues, and program effectiveness. RESULTS: The sample comprised 1,875 pharmacies, 60 (3.2%) of which had existing DM programs. There were significantly more independent pharmacies (37) with DM programs than chain-store pharmacies (23), P<0.001. There was a statistically significant difference between independent and chain pharmacies in operating hours, number of pharmacist and nonpharmacist staff members per day, and proximity to a clinic or hospital (P<0.05). The most common type of DM program was diabetes, and the second most common type was asthma. Limited time, limited staff, and limited reimbursement were the 3 most commonly reported barriers to establishing new DM programs. About 20% of the sample that did not have a DM program reported interest in developing DM programs, and an equal percentage reported having the decision-making authority to start a program. There were no differences between independent and chain pharmacies on interest (P = 0.234); however, there were significantly more chain pharmacists that did not have the decision-making authority. Of the 18 of 60 pharmacies (30%) that had DM programs and responded to the follow-up survey, 9 respondents (50%) reported monitoring medications as part of their DM program. Fifteen of 18 (83%) perceived lack of reimbursement as a challenge to implementing DM programs. Only 2 pharmacies reported an increase in revenue as a gain from the program, and 2 reported cost savings. Improved patient satisfaction was reported by 16 of 18 respondents (89%) with DM programs, but only 8 (44%) reported that patient satisfaction was being measured. CONCLUSION: The study found that the prevalence of DM programs was very low among California community pharmacies and the interest in developing these programs moderate, attributable to several barriers such as lack of time, lack of reimbursement, and lack of trained personnel. Some of these barriers could be addressed to encourage the development and proliferation of DM programs that would improve patient outcomes and expand practice roles of pharmacists.

California↗
PubMedDate not supplied

The development of a Canadian hospital pharmacy workload measurement system.

The aim of the proposed study is to establish a national workload measurement system for hospital pharmacy in Canada. No reliable method presently exists to determine staffing requirements for hospital pharmacy. In order to establish staffing guidelines, a method of scientifically assessing and measuring hospital pharmacy workloads is needed. It is proposed to develop worlkload measurement data for hospital pharmacy according to the Canadian Workload Recording Method of Statistics Canada. The Canadian Workload Recording Method was developed to provide a scientific basis for measuring clinical laboratory workload, thus promoting effective laboratory management. This method is now being applied to other health professions. Data for hospital pharmacy will be collected from various hospital pharmacy departments across Canada based on standardized definitions of modern hospital pharmacy practice. The proposed study will be carried out over a period of two years by a research group located at the College of Pharmacy, University of Saskatchewan, Saskatoon, in cooperation with the Canadian Society of Hospital Pharmacists. Workload measurement data of pharmacy services in Canadian hospitals will serve as a valuable management tool for hospital pharmacy directors, hospital administrators and federal-provincial funding agencies in the determination of total manpower needs and resources for hospital pharmacy. Also, information obtained will be of administrative assistance in the areas of: (a) development of standardized methods of recording hospital pharmacy management information; (b) generation of valid and reliable data to allow comparative studies of hospital pharmacy departments in terms of productivity and utilization of manpower; (c) determination of the proper staffing ratio between pharmacists and supportive personnel; and (d) development of short and long-term planning goals for the hospital pharmacy department. The Canadian Workload Recording Method was designed to reflect current practice by a system of continuous monitoring and review by the user. As new pharmaceutical services develop, additional workload studies can be conducted to establish new standards demonstrating the impact of future programs on manpower requirements.

Canada↗
PubMed2000

The association between pharmacy closures and prescription drug use: a retrospective analysis of Medicaid prescription claims in Iowa.

OBJECTIVES: The objectives of this study were 2-fold: (1) to examine the association of pharmacy closures with prescription drug use by Medicaid recipients in Iowa; and (2) to evaluate how drug utilization patterns differ between patients whose pharmacies closed and patients whose pharmacies remained open. DESIGN: A 2-group pretest-posttest study of Medicaid enrollees who may have been affected by pharmacy closures. Prescription medication use during the periods preceding and after pharmacy closures was compared. A comparison group was used to account for extraneous factors. PATIENTS AND METHODS: Sixteen community pharmacies were selected from a pool of pharmacies that closed during 1994; 1092 patients were identified as the main users of these pharmacies, and a comparison group of 3491 patients whose main pharmacies had not closed also was identified. The average number of each patient's prescription claims for the 6 months preceding closing and the 6 months after closing was computed. Multiple regression analysis was conducted to determine whether any association existed between pharmacy closures and the use of prescription drugs. RESULTS: Patients whose pharmacies closed during 1994 had fewer prescription claims after the closings than before the closings. In contrast, patients whose pharmacies remained open had more prescription claims. This difference remains statistically significant after controlling for other factors, such as patient demographics and health status. CONCLUSIONS: A decrease in prescription drug use was associated with pharmacy closures. Attention should be directed to patient access to prescription medications in rural areas, as relatively more pharmacies close in rural areas.

Drug Prescriptions↗
PubMed1998

Pharmacy access to syringes among injecting drug users: follow-up findings from Hartford, Connecticut.

OBJECTIVE: To break the link between drug use and the human immunodeficiency virus (HIV), in 1992 the state of Connecticut rescinded a 14-year ban on pharmacy sales of syringes without a physician's prescription. In 1993, the Center for Disease Control and Prevention (CDC) evaluated the impact of the new legislation on access to syringes among injecting drug users (IDUs) and found an initial pattern of expanded access. However, it also found that some pharmacies, after negative experiences with IDU customers, reverted to requiring a prescription. This chapter reports findings from a four-year follow-up study of current IDU access to over-the-counter (OTC) pharmacy syringes in Hartford, Connecticut. METHODS: Through structured interviews, brief telephone interviews, and mailed surveys, data on nonprescription syringe sale practices were collected on 27 pharmacies, including 18 of the 21 pharmacies in Hartford and none from pharmacies in contiguous towns, during June and July 1997. Interview data on pharmacy syringe purchase from two sample of IDUs, a group of out-of-treatment injectors recruited through street outreach, and a sample of users of the Hartford Needle Exchange Program, also are reported. RESULTS: The study found that, while market trends as well as negative experiences have further limited pharmacy availability of nonprescription syringes, pharmacies remain an important source of sterile syringes for IDUs. However, the distribution of access in not even; in some areas of the city it is much easier to purchase nonprescription syringes than in other. All of the seven pharmacies located on the north end of Hartford reported that they had a policy of selling OTC syringes, whereas only six (54.5%) of the II pharmacies located on the south end have such a policy. Overt racial discrimination was not found to be a barrier to OTC access to syringes. CONCLUSIONS: To further decrease acquired immunodeficiency syndrome (AIDS) risk among IDUs, there is a need for public education to counter empirically unsupported stereotypes about IDUs that diminish their access to health care and AIDS prevention resources and services. In states or cities where pharmacy sale of nonprescription syringes is illegal, policy makers should examine the benefits of removing existing barriers to sterile syringe acquisition. In cases in which pharmacy sale of nonprescription syringes is legal, local health departments should implement educational programs to inform pharmacy staff and management about the critically important role low-cost (or cost-free), sterile syringe access can play in HIV prevention.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

A survey of selected Internet pharmacies in the United States.

OBJECTIVE: To determine whether differences in the provision of pharmacy services exist among different types of Internet pharmacies. DESIGN: Survey of selected pharmacies with a presence on the Internet. Data were abstracted onto a data collection form for further analysis. Data collection was limited to 3 weeks. SETTING: U.S.-based Internet pharmacies that allow patients to purchase prescription medications online. Pharmacies were identified using a metasearch engine with the search terms "Internet pharmacy" and "Internet pharmacist." INTERVENTION: Survey. MAIN OUTCOME MEASURES: Comparisons of availability of 10 commonly used products representing a variety of product categories, prescription verification methods, and privacy issues; and determinations of site navigability, drug information and provider access, and payment methods. Sites were categorized as "chain pharmacy extensions," "mail order pharmacies," "independent pharmacy extensions," and "online pharmacies." RESULTS: Thirty-three sites were reviewed. There was significant variation among the four types of pharmacies selling prescriptions over the Internet. Most pharmacies provided all of the drugs in the survey. Patients were required to provide their own prescription at 88% of the sites, and 75% of sites used mail or fax to verify prescription integrity. More than 50% of sites had privacy policies posted, and 64% used cookies. Chain pharmacy extensions required completion of an average of 10.2 pages to order drugs versus 2.4 to 4 pages for all other site types. Drug information was written at an eighth-grade reading level at 36% of the sites. More than two-thirds of the sites provided a toll-free telephone for a health care professional. Nearly 80% of the sites accepted health insurance, and 95% accepted credit cards; however, only 40% used a secure transmission mechanism for patient or payment information. CONCLUSION: Internet pharmacies provide varying levels of service. Policies regarding the use of the Internet for obtaining medications should focus on improving the privacy of consumer information and ensuring the secure transmission of financial information.

Analysis of Variance↗
PubMed1996

Influence of location and staff knowledge on quality of retail pharmacy prescribing for childhood diarrhea in Kenya.

BACKGROUND: Retail pharmacies are important sources of advice on pharmaceuticals in developing countries, where many purchasing decisions are unmediated by medical professionals. For childhood diarrhea, choice of drug sales in pharmacies has been found to be consistently poor, whether with or without prescription, as evidenced by a low use of effective oral rehydration salts (ORS) and high use of marginally effective or ineffective products such as antimotility agents, adsorbents, and antimicrobials. Little information is available about factors influencing prescribing by pharmacy personnel in these settings. This paper reports results of an analysis which examined the influence of rural versus urban location, neighborhood socio-economic status (SES), and clinical knowledge of pharmacy assistants on quality of prescribing in retail pharmacies in Kenya. METHODS: Using WHO treatment guidelines, we measured quality of prescribing in childhood diarrhea as: (1) the proportion of client encounters in which ORS is prescribed (indicating higher quality practice); and (2) the proportion of visits in which an antidiarrheal product is prescribed (lower quality practice). We obtained data on prescribing in a simple case of childhood diarrhea using surrogate patient visits to 91 pharmacies located in the major urban area of Kenya (Nairobi) and four rural towns. Multivariate logistic regression was used to examine the association between pharmacy predictor variables and the quality of prescribing. RESULTS: No consistent relationship was found between the clinical knowledge of pharmacy assistants and quality of prescribing. Controlling for number of products prescribed, gender of the assessor, and level of knowledge, multivariate analyses indicated that in comparison to rural pharmacies, the odds of prescribing ORS were significantly higher in pharmacies located in high SES (OR = 4.7; 95% CI = 1.4,16.1) or middle SES (OR = 4.5; CI = 1.9,10.6) urban neighborhoods; the odds in low SES urban pharmacies were similar to those in rural areas (OR = 2.0; CI = 0.6,6.2). The odds of prescribing antidiarrheal products did not differ significantly in any geographic area. CONCLUSIONS: Location of a retail pharmacy in a rural area or in a low-income urban neighborhood was associated with suboptimal quality of prescribing as evidenced by lower use of ORS. No relationship between clinical knowledge and quality of practice was detected. Future research is needed to examine such factors as the influence of intra-pharmacy authority structure, perceived efficacy of pharmaceuticals, local patterns of physician practice, and economic incentives on the quality of prescribing.

Adult↗
PubMedDate not supplied

Changes in number and distribution of community and ambulatory pharmacies in Virginia from 1994 to 1999.

OBJECTIVE: To determine whether market changes have resulted in a decrease in the number or geographic distribution of pharmacies available to ambulatory patients in Virginia. DESIGN: Retrospective review of Virginia Board of Pharmacy records of pharmacy registrations in 1994 and 1999. SETTING: The Commonwealth of Virginia. PARTICIPANTS: All pharmacies classified as outpatient pharmacies (including community and other types of ambulatory pharmacies) and operating in Virginia in 1994 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Changes in the total number, geographic distribution, and metropolitan/nonmetropolitan distribution of outpatient pharmacies between 1994 and 1999. RESULTS: The total number of outpatient pharmacies increased from 1,290 to 1,337 between 1994 and 1999. Chain pharmacies, mass merchandiser, and grocery pharmacies increased in number while independent pharmacies declined. There was little change in the geographic or metropolitan/nonmetropolitan distribution of pharmacies. CONCLUSION: Changes in the number and distribution of community and other ambulatory pharmacies in Virginia have not diminished their availability to consumers.

Pharmacies↗
PubMed2002

Which sorts of pharmacies provide more patient counselling?

OBJECTIVE: This paper investigates the characteristics of pharmacies that are associated with the degree of counselling provided to customers purchasing medicines. METHODS: Twelve 'mystery shoppers' (research assistants posing as normal customers) purchased restricted medicines at 180 pharmacies around New Zealand. One drug (diclofenac) and one class of drugs (vaginal antifungals) were purchased. The amount of counselling provided was recorded, and linked to profile data on the pharmacies, obtained through a questionnaire, from Census data, and from direct observations of pharmacies. RESULTS: Location within a city, a large town, or strip shopping did not affect the level of counselling pharmacies provided. Pharmacies adjacent to medical centres gave significantly less counselling to diclofenac purchasers than other pharmacies. No consistent relationship was found between pharmacy size and the level of counselling provided. There were large differences between areas of the country. A strong negative relationship was found between the amount of counselling given about thrush, and the proportion of Pacific Island people in the population around the pharmacy. Although only some results reached statistical significance, there seems to have been a similar trend for pharmacies to provide less counselling in areas with more Maori people and with higher levels of social deprivation. CONCLUSIONS: Regional variation in the provision of pharmacy services, and in particular the tendency for pharmacies to provide less counselling in areas that are likely to have higher health care needs, must be addressed if pharmacies are to fulfil their potential as health care providers.

Chi-Square Distribution↗
PubMedDate not supplied

Medication therapy management services in North Carolina community pharmacies: current practice patterns and projected demand.

OBJECTIVE: To evaluate the types of cognitive services offered and the number of patients being served in community pharmacies, determine the number of pharmacies that plan to offer medication therapy management (MTM) services under the Medicare Part D prescription drug benefit, and assess whether current and expected practices will meet the potential needs of enrollees. DESIGN: Cross-sectional study. SETTING: North Carolina in January 2005. PARTICIPANTS: 1,593 community pharmacy managers. INTERVENTIONS: Survey using a Web-based tool. MAIN OUTCOME MEASURES: Provision of cognitive services and number of patients for whom services are provided. RESULTS: A total of 262 (16%) pharmacy managers provided usable responses. Approximately 42% of respondents (n = 110) indicated that they provide some type of cognitive service. Comprehensive MTM services, or services consistent with the professionwide consensus definition, were provided by 31% of respondents (n = 81). Independent pharmacies were more likely to offer some type of service compared with chain pharmacies (58% versus 31%, respectively; P < .001). Pharmacy managers with a doctor of pharmacy degree were less likely than pharmacy managers with a bachelor's degree to offer services in their pharmacies (P = .02), and pharmacies with pharmacists on staff who had received certificate training were more likely to offer cognitive services (P = .03). Of all respondents, 28% (n = 73) indicated that they planned to offer MTM services under the Medicare Part D prescription drug benefit. CONCLUSION: Comparing these results with those of a 1999 survey of North Carolina pharmacists that used some of the same items, the percentage of community pharmacies that provide cognitive services has increased in the intervening years but remains low. Among the services being offered in 2005, most were focused on patient education and training, coordinating and integrating care, and medication regimen reviews. Implementation of MTM services under the Medicare Part D prescription drug benefit should hasten the development and offering of these services in community pharmacies.

Ambulatory Care↗
PubMedDate not supplied

Comparison of costs of community and mail service pharmacy.

OBJECTIVE: To compare the costs of prescriptions dispensed through mail service and community pharmacies to quantify the comparative costs of the two types of pharmacies. DESIGN: Modeling study based on 1-year of claims data from a cohort of patients. SETTING: A health plan in the northeastern United States. PATIENTS: Approximately 100,000 members of the health plan. INTERVENTION: The plan used a small pharmacy benefits manager (PBM) and a mail service pharmacy that was not owned by a major PBM, a three-tier benefit design, and specified that patients could get a 90-day supply through mail service for the equivalent of two 30-day community pharmacy copayments. MAIN OUTCOME MEASURES: Actual total, ingredient, plan, and patient costs of prescriptions dispensed through a mail service pharmacy and the estimated costs of those same prescriptions at community pharmacies. RESULTS: Total costs for the 44,847 prescriptions dispensed through mail service were dollar 6,401,624. Had these prescriptions been dispensed at community pharmacies, costs would have been dollar 6,902,252. Ingredient costs were dollar 6,401,624 through mail versus dollar 6,633,170 at community pharmacies. Total costs to the health plan were dollar 4,726,637 through mail versus dollar 4,417,733 at community pharmacies. Member costs were dollar 1,674,987 through mail versus dollar 2,484,519 at community pharmacies. CONCLUSION: Compared with community pharmacies, the mail service pharmacy was less expensive overall, less expensive for patients, but more expensive to the health plan. From the health plan's perspective, the loss of copayments in the mail service benefit was greater than the savings on ingredient costs and dispensing fees.

Adolescent↗
PubMed1984

Analyzing pharmacy charges using DRGs.

Pharmacy charges at a 316-bed community hospital were analyzed using diagnosis-related groups (DRGs). All patients admitted to the hospital between January 1, 1983, and August 31, 1983, were retrospectively categorized by DRG. For the 20 most expensive DRGs for the pharmacy department in terms of pharmacy charges, the following data were compiled: number of patients, total pharmacy charges, mean hospital and pharmacy charges per patient, mean length of stay, pharmacy charges as a percentage of hospital charges, and DRG distribution and total pharmacy charges by major diagnostic category ( MDC ). A total of 10,550 patients were assigned to 390 DRGs. For the 20 most expensive DRGs, the mean total pharmacy charges and number of patients per DRG were $83,457 and 140, respectively. DRG 107 (coronary bypass) and MDC 5 (diseases and disorders of the circulatory system) had the highest pharmacy charges in the respective DRG and MDC categories. Pharmacy charges as a percentage of hospital charges ranged from 4.1% to 32% for the 20 most expensive DRGs. While there appeared to be a direct relationship between high hospital charges and length of stay for the most expensive DRGs, there did not appear to be a direct relationship between these two measures and high pharmacy charges. Until hospitals have data on actual cost per case and on cost per DRG for each department, analysis of pharmacy charge data by DRG for establishing pharmacy priorities may be a reasonable approach.

California↗
PubMed2006

Pharmaceutical care in community pharmacies: practice and research in Germany.

OBJECTIVE: To discuss the provision of pharmaceutical care in community pharmacies in Germany including community pharmacy, organization and delivery of health services, pharmacy education, community pharmacy services, research in community pharmacy, and future plans for community pharmacy services. FINDINGS: In Germany, cognitive pharmaceutical services have been developed for more than 12 years. Several studies and programs have shown that pharmaceutical care and other pharmaceutical services are feasible in community pharmacy practice and that patients benefit from these services. In 2003, a nationwide contract was established between representatives of the community pharmacy owners and the largest German health insurance fund. In this so-called family pharmacy contract, remuneration of pharmacists for provision of pharmaceutical care services was successfully negotiated for the first time. In 2004, a trilateral integrated care contract was signed that additionally included general practitioners, combining the family pharmacy with the family physician. Within a few months, the vast majority (>17 000) of community pharmacies have registered to participate in this program. CONCLUSIONS: German community pharmacies are moving from the image of mainly supplying drugs toward the provision of cognitive pharmaceutical services.

Community Pharmacy Services↗
PubMedDate not supplied

Pharmaceutical care in community pharmacies: practice and research in the US.

OBJECTIVE: To describe the state of community pharmacy, including patient care services, in the US. FINDINGS: Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees. DISCUSSION: The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations. CONCLUSIONS: Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research has been conducted, but there is no national research agenda or infrastructure. Reimbursement for cognitive services remains an infrequent, but growing, activity.

Community Pharmacy Services↗