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PubMedDate not supplied

Characteristics of pharmacies and pharmacists associated with the provision of cognitive services in the community setting.

OBJECTIVE: To determine the influence of payment, pharmacy setting characteristics, pharmacist demographics, practice setting, and attitudinal characteristics on whether cognitive services (CS) were performed by pharmacists, and the volume of CS performed. DESIGN: Prospective randomized trial. Community pharmacies were randomized to a documentation-and-payment group (study group) and a documentation-only group (control). Participating pharmacies and pharmacists were surveyed by mail, and responses were linked to a documented CS database. SETTING: Community pharmacies serving ambulatory Medicaid patients in the state of Washington, excluding health maintenance organization pharmacies and pharmacies predominantly serving long-term care residents. PARTICIPANTS: 200 community pharmacies and their pharmacists (110 study, 90 control) participating in the Washington State Cognitive Activities and Reimbursement Effectiveness (CARE) Project. INTERVENTION: Payment for CS. All participants documented CS. Study group pharmacies billed Medicaid for services performed in identifying and resolving drug therapy-related problems. MAIN OUTCOME MEASURE: Documentation of CS. RESULTS: Documentation of CS was more likely if the pharmacist was an owner or manager, if documentation was not perceived as burdensome, and if the pharmacy had a low ratio of prescription to total sales. Higher documentation rates were associated with study group status, lower pharmacy prescription volume as a percentage of total sales, and a higher percentage of prescriptions billed to Medicaid. Among pharmacists, two setting variables--medical center location and rural location--were associated with higher documentation rates. CONCLUSION: Performance of CS was strongly affected by payment and other situational factors, including practice setting and volume of prescriptions dispensed. Pharmacies and pharmacists were also more likely to perform CS if the target patient population represented a relatively large percentage of that pharmacy's patient clientele.

Medicaid↗

PubMedDate not supplied

Perceptions of pharmacists about adverse effects of corticosteroid therapy: focus on osteoporosis.

OBJECTIVE: To assess the perceptions of pharmacists regarding the adverse effects of corticosteroids, in particular corticosteroid-induced osteoporosis. DESIGN: Mailed survey of a random sample of pharmacists. SETTING: Richmond, Virginia. PARTICIPANTS: 350 community and hospital pharmacists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Respondents' knowledge of adverse effects of corticosteroid therapy in men, premenopausal women, and postmenopausal women; the content of respondents' usual patient counseling for low- and high-dose therapy; and respondents' opinions of regimens for prevention of osteoporosis. RESULTS: Pharmacists associated gastritis, weight gain, and mood changes with corticosteroid use in a hypothetical 45-year-old man or 45-year-old premenopausal woman. For a hypothetical 65-year-old postmenopausal woman, pharmacists more frequently counseled about weight gain, osteoporosis, and gastritis. Patient counseling focused on these adverse effects for both low-dose (5 to 10 mg/day) and high-dose (> or = 30 mg/day) prednisone use. Osteoporosis was considered more likely in patients receiving high-dose corticosteroids on a long-term basis. CONCLUSION: Pharmacists responding to this survey frequently overlooked the association between low- and high-dose corticosteroid use and decreased bone density. Educational efforts are needed so that pharmacists can fulfill their potential for educating patients, monitoring corticosteroid therapy, and detecting drug-induced complications.

Adrenal Cortex Hormones↗

PubMed2000

Kentucky pharmacists' opinions and practices related to the sale of cigarettes and alcohol in pharmacies.

The objective of the study was to augment important findings from a 1996 statewide survey of Indiana pharmacists regarding their opinions and practices related to the sale of cigarettes and alcohol in pharmacies. More specifically, this study was designed (1) to determine opinions and practices of Kentucky pharmacists' related to the sale of cigarettes and alcohol; (2) compare these findings with results from the Indiana study; and (3) to gather information on health promotion activities by Kentucky pharmacists. A structured survey questionnaire was designed and reviewed by a jury of experts and subsequently administered to half of the 1182 pharmacies in Kentucky. Collected data were analyzed by using descriptive and inferential statistical methods. Findings reveal that 45 percent of responding pharmacists sell cigarettes in their stores even though 88 percent think that their stores should not sell cigarettes. Approximately 34 percent of the pharmacies in non-dry counties sell alcoholic beverages while more than four-fifths of the pharmacists (81%) think pharmacies should not sell alcoholic beverages. After adjusting by type of pharmacy, no statistical difference was found in retail-chain pharmacy sales of cigarettes and alcohol in either Kentucky or Indiana. However, independent pharmacies in Kentucky were less likely to sell cigarettes and alcohol compared to independent Indiana pharmacies. Study results also revealed that most pharmacists agree the use of cigarettes and alcohol are important causes of morbidity and pre-mature mortality and that pharmacists should play a role in health promotion and disease prevention through their relationship with the public. However, the majority do not ask their patients about their smoking and alcohol habits and do not participate in health education/promotion programs for the general community.

Adult↗

PubMed2000

Counselling patients on psychotropic medication: physicians' opinions on the role of community pharmacists.

OBJECTIVES: To study physicians' opinions on community pharmacists' involvement in counselling patients on use of psychotropic medication. DESIGN: A postal questionnaire with open-ended questions completed by physicians. SUBJECTS: A six per cent random sample (n = 759) of the members of the Finnish Medical Association representing physicians working in hospitals, community health centres, private practices and occupational health services (response rate 64%, n = 487). MAIN MEASURES: Physicians' opinions concerning community pharmacists' involvement in counselling patients about purpose of the medication and adverse effects of benzodiazepines and neuroleptics. RESULTS: When classifying opinions into five categories, majority (72%) of the physicians regarded community pharmacists as a provider of comprehensive or at least general information about adverse effects of benzodiazepines, but only 43% about the purpose of the medication. Correspondingly, 60% of the physicians regarded community pharmacists as a provider of comprehensive or general information about adverse effects of neuroleptics, but only 35% about the purpose of the medication. There was a strong correlation between physicians' opinions concerning pharmacists' involvement in counselling patients about the purpose of the medication of benzodiazepines and neuroleptics (Spearman's coefficient 0.667), and about adverse effects of both type of medication (0.668). Male physicians had more fixed opinions, both positive and negative, than female physicians. CONCLUSIONS: Finnish physicians are still quite critical about community pharmacists involvement in counselling patients on psychotropic medication. Especially with neuroleptics, physicians feel that pharmacists should be cautious when discussing the purpose of the medication if it is excluded from the prescription.

Anti-Anxiety Agents↗

PubMed2001

The impact of the pharmacist on an elective general surgery pre-admission clinic.

OBJECTIVE: A traditional clinical pharmacy service for surgical patients involves a ward visit that identifies and responds to issues after prescribing has taken place. It was hypothesised that pharmacist involvement in a general surgery pre-admission clinic (PAC) would provide elective patients with significantly better pharmaceutical care than ward visits alone. METHOD: 100 elective general surgery patients were recruited into 2 groups as part of a non-randomised controlled trial. The groups were comparable in terms of age, surgical procedure and use of medicines. The control group received standard ward visits. The intervention group had pharmaceutical assessment in a pre-admission clinic. This assessment incorporated pharmacist-led drug history taking and prescription transcription. OUTCOME MEASURES: Number, classification and clinical significance of pharmaceutical interventions. RESULTS: A pharmacist made 76 interventions in the PAC group and 79 interventions in the ward group. No prescribing errors and omissions were made in the PAC group. The clinical significance of PAC interventions was rated more highly than ward interventions on two scales. Involvement in the PAC increased the pharmacist's workload, but saved time for surgical and nursing staff. Surgical and nursing staff identified writing discharge prescriptions as the most valuable service provided by the PAC pharmacist. CONCLUSION: By ensuring safe prescribing in the PAC group, the pharmacist was able to become more involved in clinical issues. Pharmacist involvement in PACs presents a useful opportunity for expansion of pharmacy services. However, extra resources would be needed in order to provide these services fully.

Aged↗

PubMed2001

The role of the community pharmacist in drug abuse: a comparison of service provision between Northern Ireland and England/Wales.

AIM: The aim of the present research was to establish the current extent of pharmacists' contact with illicit drug users in Northern Ireland, their willingness to provide services for this group and to compare the findings with data from a 1995 national survey of community pharmacies in England and Wales. METHOD: The questionnaire developed by the National Addiction Centre for research in England/Wales was used to collect data. It was mailed on two occasions (March and April 1999) together with a covering letter and a prepaid return envelope to all community pharmacies in Northern Ireland (n = 507). A final reminder letter was included in the local wholesalers' medical delivery for the attention of the pharmacist in May 1999. MAIN OUTCOME MEASURE: The extent to which Northern Ireland pharmacists had contact with and provided services to illicit drug users compared to pharmacists in England/Wales. RESULTS: A response rate of 67.5% was achieved. Respondents in Northern Ireland were providing fewer services to drug users than those in England/Wales. Respondents reported dispensing methadone for the treatment of addiction/misuse to only 9 patients, while only 17 pharmacists had been asked to sell injecting equipment in the previous week and no pharmacist was participating in a needle exchange scheme. However, most respondents indicated their willingness to provide such services. Barriers towards the provision of services were, however, highlighted e.g. the need for training and the establishment of support systems. CONCLUSION: Pharmacists in Northern Ireland are in a position to contribute to the policy agenda in Northern Ireland for drug misuse, prevention, treatment and harm minimisation--roles which the survey indicates they are willing to embrace. However, training programmes, support systems and adequate remuneration packages must be established before they will be in a position to participate fully.

England↗

PubMed2002

Pharmacists' perceptions of Healthy People goals in economically stressed cities.

The objectives of the study were: (a) to determine pharmacists' perceptions of the importance of Healthy People (HP) 2000 objectives for their patients and community; and (b) to analyze pharmacists' perceived perceptions about recent trends in the characteristics of patients. Three hundred one useful questionnaire were collected from pharmacists who either own or manage a pharmacy located in New Jersey's 67 cities eligible for financial assistance. Pharmacists consider health objectives which are directly linked to health care such as preventing, detecting, and controlling hypertension, heart disease, stroke, cancer, diabetes, and disabling conditions, to be very important. Pharmacists agree to some extent that their patients are now more willing to accept pharmacy counseling services with their prescriptions than before. In conclusion, pharmacists considered objectives related to preventive services to be the most important for HP 2000 objectives, and health promotion and health protection to be less important. The findings of this study will enhance the understanding of pharmacists' perceptions of community health issues and will be beneficial to attain the objectives of HP 2010.

Adult↗

PubMed2003

Development of a quality use of medicines coding system to rate clinical pharmacists' medication review recommendations.

OBJECTIVE: To develop a 'quality use of medicines' coding system for the assessment of pharmacists' medication reviews and to apply it to an appropriate cohort. METHOD: A 'quality use of medicines' coding system was developed based on findings in the literature. These codes were then applied to 216 (111 intervention, 105 control) veterans' medication profiles by an independent clinical pharmacist who was supported by a clinical pharmacologist with the aim to assess the appropriateness of pharmacy interventions. The profiles were provided for veterans participating in a randomised, controlled trial in private hospitals evaluating the effect of medication review and discharge counselling. The reliability of the coding was tested by two independent clinical pharmacists in a random sample of 23 veterans from the study population. MAIN OUTCOME MEASURE: Interrater reliability was assessed by applying Cohen's kappa score on aggregated codes. RESULTS: The coding system based on the literature consisted of 19 codes. The results from the three clinical pharmacists suggested that the original coding system had two major problems: (a) a lack of discrimination for certain recommendations e.g. adverse drug reactions, toxicity and mortality may be seen as variations in degree of a single effect and (b) certain codes e.g. essential therapy were in low prevalence. The interrater reliability for an aggregation of all codes into positive, negative and clinically non-significant codes ranged from 0.49-0.58 (good to fair). The interrater reliability increased to 0.72-0.79 (excellent) when all negative codes were excluded. Analysis of the sample of 216 profiles showed that the most prevalent recommendations from the clinical pharmacists were a positive impact in reducing adverse responses (31.9%), an improvement in good clinical pharmacy practice (25.5%) and a positive impact in reducing drug toxicity (11.1%). Most medications were assigned the clinically non-significant code (96.6%). In fact, the interventions led to a statistically significant difference in pharmacist recommendations in the categories; adverse response, toxicity and good clinical pharmacy practice measured by the quality use of medicine coding system. CONCLUSION: It was possible to use the quality use of medicine coding system to rate the quality and potential health impact of pharmacists' medication reviews, and the system did pick up differences between intervention and control patients. The interrater reliability for the summarised coding system was fair, but a larger sample of medication regimens is needed to assess the non-summarised quality use of medicines coding system.

Aged↗

PubMed1995

Predictors of organizational and career commitment among Illinois pharmacists.

Illinois pharmacists were surveyed to identify predictors of their work-related attitudes. A survey was mailed in April 1994 to 600 Illinois pharmacists to identify their attitudes about their career, the organization where they work, and the impact of national health care reform and the pharmaceutical care movement on the future of pharmacy. The survey also collected information on the respondents' work site and position; coworkers, family, and friends; and demographic characteristics. The survey was completed by 337 pharmacists. Pharmacists who believed that pharmaceutical care would have a more positive effect on pharmacy were more committed to their employer and to pharmacy as a career. Co-worker support had a positive effect on perceptions about pharmaceutical care, and supervisor support increased career and organizational commitment. Age did not affect career or organizational commitment, but it did negatively affect pharmacists' views of the impact that the call for pharmaceutical care would have on pharmacy. Hospital pharmacists were less committed than community pharmacists to the organizations where they worked. Practice setting, supervisor support, and perceptions about the impact of the pharmaceutical care movement were identified as possible predictors of career and organizational commitment.

Age Factors↗

PubMed1995

Pharmacists' role in a smoking-cessation program at a managed health care organization.

A smoking-cessation program at a managed health care organization and the involvement of pharmacists are described. Kaiser Permanente Northwest Region is a prepaid group-practice managed health care organization serving more than 380,000 members in Oregon and southwest Washington. A multidepartmental team at Northwest Region designed and implemented a stepped-care approach to smoking cessation in March 1992. The program progresses from advising and helping patients to quit on their own to enrolling patients in a behavioral-modification course to referring them to nicotine-replacement therapy to be given concurrently with the behavioral modification. The program was established with the help of pharmacists, and pharmacists are deeply involved in its operation. They work closely with each patient, the health educator instructing the patient, and the prescribing physician. Pharmacists attend 5 of the 10 behavioral modification/nicotine-replacement course sessions and take responsibility for enrollees throughout the program. Pharmacists prescribe and monitor nicotine-replacement therapy by protocol. They also monitor each patient for the dose-response effect, adverse drug reactions, drug interactions, concurrent medical conditions, and progress and outcome. The physician is informed about any important changes in the patient's status. In 1992, more than 80 courses were held with nearly 1000 participants, and rates of long-term abstinence achieved compare favorably with literature rates for community-based group smoking-cessation programs. Satisfaction of patients, pharmacists, and physicians with the program has been high. Pharmacists at a managed health care organization participate in a smoking-cessation program by helping with behavioral modification, educating patients about nicotine-replacement therapy, and prescribing and monitoring therapy by protocol.

Behavior Therapy↗

PubMed1996

Relationship between hospital pharmacists' job satisfaction and involvement in clinical activities.

Job satisfaction among hospital pharmacists employed by a national hospital pharmacy management company was measured by using a mail questionnaire. A previously validated survey that measured pharmacists' job satisfaction was adapted for use in this study. Additional questions determined the pharmacist's clinical pharmacy training and participation in clinical pharmacy services. Questionnaires were mailed to all full-time hospital pharmacists employed by the pharmacy management company. Of the 606 mailed, deliverable questionnaires, 354 usable responses were returned, for a response rate of 58.4%. The respondent hospital pharmacists' level of job satisfaction showed a positive association with clinical pharmacy involvement. Of the nine items in the questionnaire that measured the pharmacists' involvement in clinical pharmacy services, seven items showed a positive relationship between involvement in that clinical activity and job satisfaction. Mean job satisfaction increased as the percentage of time spent performing clinical pharmacy activities increased. Job satisfaction decreased as time spent performing distributive functions increased. The percentage of time hospital pharmacists were engaged in clinical activities was significantly associated with job satisfaction.

Adult↗

PubMed1997

Pharmacists on a primary care team at a Veterans Affairs medical center.

The role of pharmacists on a primary care team in the VA Chicago Health Care System--Lakeside Division is described. In 1990 the Veterans Affairs Lakeside Medical Center (now called the VA Chicago Health Care System--Lakeside Division) implemented the "Firm" system to improve the quality of patient care. This system split the original primary care clinics into three identical but smaller groups, or Firms. Each Firm provides three types of care: longitudinal care (ongoing care with a primary care physician), interim care (frequent care and close patient monitoring between primary physician visits), and un-scheduled care (acute care for complaints that may require immediate attention). Each Firm has a care team composed of physicians, a pharmacist, nurses, and other health care personnel. The pharmacist assists with interim care and, in conjunction with Firm physicians, is involved in follow-up and monitoring of drug therapy and identification of new problems. Originally it was expected that pharmacists would care for 30-40% of interim care patients, but Firm pharmacists have assisted in providing care to over 50% of these patients (plus 4% of un-scheduled care patients). The pharmacists have received high ratings from the internal medicine resident staff. Pharmacists on multidisciplinary care teams provided primary care to more than half of outpatient veterans in need of health care between regularly scheduled appointments.

Chicago↗

PubMed1997

Accuracy of technicians versus pharmacists in checking syringes prepared for a dialysis program.

The accuracy of pharmacy technicians versus pharmacists in checking drug doses prepared in syringes for a dialysis program was studied. Three pharmacy technicians from the pharmacy of a regional kidney disease program in Minnesota participated in the study after completing a training program and after common preparation errors had been identified by pharmacists. From November 1995 to April 1996, the technicians used labels printed from a database of pharmacist-verified orders to prepare and label i.v. syringes. Four medications were used-epoetin alfa, calcitriol, heparin prepared from beef lung, and heparin prepared from porcine intestinal mucosa. Each syringe was checked by one of nine pharmacists for accuracy of dose and medication, and all errors were recorded. The technicians checked syringes prepared by other technicians and also recorded errors. Accuracy rates (percentages of syringes correctly evaluated) for pharmacists and technicians were compared. A total of 10,608 syringes were checked. Accuracy rates for pharmacists and pharmacy technicians were 99.86% and 99.83%, respectively. Accuracy rates in checking syringes did not differ significantly between pharmacists and technicians in this study setting.

Chi-Square Distribution↗

PubMed1998

Motivations and practice-area preferences of pharmacists interested in pursuing a Pharm.D. degree through a nontraditional program.

Pharmacists' interest in a proposed nontraditional Pharm.D. program, motivations for wanting to pursue a Pharm.D. degree, and practice-area preferences were surveyed. Questionnaires were mailed to 12,621 pharmacists in Illinois and Arizona. Information sought included current position and practice area, number of job and career changes, preferred practice area, and interest in enrolling in a proposed nontraditional Pharm.D. program described in a cover letter. For pharmacists indicating an interest, information was sought on motivations for wanting to pursue a Pharm.D. degree expected support from employers, and preferred practice areas after obtaining a Pharm.D. degree. The response rate was 28.8%. A total of 1119 respondents (31.9%) indicated that they would or probably would enroll in the proposed Pharm.D. program. These pharmacists gave improving their clinical skills and improving the quality of their work as reasons for wanting to enroll, and half indicated that their current practice area would be their preferred area after they completed a Pharm.D. degree. Almost three quarters (72%) of hospital pharmacists; more than 60% of home health care or consultant independent, and managed care pharmacists; and 21% of pharmacists in chain pharmacies stated a preference to stay in their current practice area after obtaining a Pharm.D. degree. Eight variables were useful in predicting whether respondents would prefer to remain in their current practice area, including tuition assistance or reimbursement from employers, satisfaction with current position, and number of years in current position. Respondents who were interested in pursuing a Pharm.D. degree through the nontraditional program described to them were motivated by a desire to improve their clinical skills and the quality of their work and the opportunity to open doors to new careers.

Adult↗

PubMed2001

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--2001.

The results of a 2001 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 similar surveys conducted in 1997 and 1999. Three hundred and seventy-six MCOs and integrated health systems participated in the telephone survey. The surveyelicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey respondents were asked about 24 specific ambulatory care pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary care teams, automated dispensing systems, integrated electronic medical records, very supportive medical staff, and very supportive senior management. Twenty previously measured functions decreased since 1999. Decreases were greatest in negotiating pharmaceutical contracts (-28%), administering immunizations (-27%), and immunization screening (-24%). Enabling factors supported continued expansion. Two clusters of functions, patient-related and population-related activities, were identified and supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the broadest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of functions, with an emphasis on population-focused functions. Ambulatory care functions of pharmacists have expanded to new areas and have decreased in more traditional areas, perhaps because of the current pharmacist shortage and the increase in the number of prescriptions and patients.

Ambulatory Care↗

PubMed2003

Role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness.

The role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness was studied. Study participants were recruited from three primary care clinics. They were provided a pharmacy scenario that contained information that could be used to form causal and authoritative arguments. The participants rated the trustworthiness of the pharmacist in the scenario on a 10-point, Likert-type scale and provided the arguments used to form the trustworthiness belief. Information that contradicted the pharmacist's trustworthiness was then presented in the form of an addendum, and the participants reassessed the pharmacist's trustworthiness. Participants rated the pharmacist using a Likert-type scale. Responses were coded and analyzed. Initial trustworthiness and post-trustworthiness scores were calculated. Participants' pharmacy experience score was also determined. Reliability and principal components analyses were conducted to determine the quality of the trustworthiness and pharmacy experience scores. A total of 130 patients participated in the study. There was a positive correlation between pharmacy experience and the number of causal arguments that subjects used to form their beliefs about pharmacist trustworthiness (r = 0.223, p = 0.012). Results of t tests revealed that belief strength was similar among subjects using more causal than authoritative arguments to form beliefs and in those using fewer causal arguments (t = 1.35, p = 0.179), but belief tenacity differed significantly between the groups (t = -2.303, p = 0.023). The role of external sources in influencing the formation of beliefs about trustworthiness of a pharmacist may be limited as a patient gains pharmacy experience, as experience is based on causal associations. Moreover, causal arguments are correlated with belief tenacity.

Adolescent↗

PubMed2004

Pharmacist-facilitated enrollment in medication assistance programs in a private ambulatory care clinic.

PURPOSE: Efforts to reduce patients' out-of-pocket expenses for prescription drugs by incorporating pharmaceutical manufacturer assistance programs (PMAPs) into a private ambulatory care facility's pharmaceutical services are described. SUMMARY: From March 2001 through March 2002, the clinic's pharmacist prospectively evaluated patients for PMAP enrollment. The pharmacist completed the pharmaceutical manufacturer's application forms for patients identified as candidates for PMAP assistance and helped them obtain documentation. Some companies sent medications directly to patients, and others sent them to the clinic, where they were stored until the patients picked them up. The patients informed the pharmacist when refills were needed, which allowed the pharmacist to review patient records, verify compliance, and ensure proper follow-up. Forty-four patients were enrolled in 22 PMAPs during the year. The mean +/- S.D. annual household income for all patients was 15,631 dollars +/- 7,845 dollars. A total of 115 medication orders were processed for the patients. The mean +/- S.D. number of medications per patient obtained through PMAPs was 2.5 +/- 1.8, and the mean +/- S.D. number of refills was 1.8 +/- 1.0. The total cost of the medications was 48,143 dollars. The pharmacist needed an average of 15-20 minutes to perform the initial patient interview, 10-15 minutes to complete each initial application, and 5-15 minutes to complete a renewal application. Total pharmacist time needed to process each medication order was estimated at about one hour per year. CONCLUSION: A pharmacist in a private ambulatory care facility helped patients enroll in PMAPs and reduced the patients' expenses for prescription drugs.

Ambulatory Care↗

PubMed2003

Identification of patients attending accident and emergency who may be suitable for treatment by a pharmacist.

BACKGROUND: Several studies have demonstrated that 25-40% of Accident & Emergency department attendances are for conditions that could be managed by the patient's general practitioner. The number of these who could be appropriately managed by a community pharmacist, has not previously been established. OBJECTIVE: To establish the frequency with which patients attend an inner city A&E department with problems that could be managed by a community pharmacist. METHODS: A cross-sectional, retrospective review of A&E records for adult patients (>16 years) was conducted during the first two weeks of March 1999. Application of recognised criteria identified patients whose conditions were suitable for treatment by a pharmacist. Associated patient characteristics were investigated. RESULTS: During the study period 2636 adult patients attended the A&E department. Pharmacist management was considered appropriate in 8% of adult attendances (95% CI 6.8-8.9). The most commonly presented symptoms considered appropriate for pharmacist treatment included those of upper respiratory, gastrointestinal and pain conditions and reflect those previously identified in the literature. CONCLUSIONS: A pharmacist could manage an estimated 8% of adult attendances at this A&E department. Efforts should be made to increase the awareness of the general public of the role of a community pharmacist to reduce demand on A&E and GP services.

Emergency Service, Hospital↗