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PubMed2006

Beliefs about medicines among Swedish pharmacy employees.

OBJECTIVE: The aim of this study was to describe the beliefs about medicines among pharmacy employees. A further aim was to analyse whether these beliefs were associated with any background characteristics, such as age, professional category or medication use. METHOD: The study subjects were pharmacy employees at 24 community pharmacies in Göteborg, Sweden. The participating pharmacies had a total of 372 employees (pharmacists, dispensing pharmacists, and pharmacy technicians). Data was collected at the weekly pharmacy information meetings with a questionnaire comprising background questions and the Beliefs about Medicines Questionnaire (BMQ). The general part of the BMQ was used. For each statement in the BMQ, respondents marked their degree of agreement on a five-point Likert scale (1=strongly disagree, 2=disagree, 3=uncertain, 4=agree and 5=strongly agree). MAIN OUTCOME MEASURE: The three subscales of BMQ General: General Harm, General Overuse and General Benefit. RESULTS: The majority of the 292 respondents were dispensing pharmacists. More than half of the respondents were aged 45 years or older and had worked in a pharmacy for 20 years or more. Compared to the other professional categories, a higher proportion of dispensing pharmacists stated that they currently used traditional medicines. The pharmacy employees had a mean score for General Benefit of 4.31 and a mean score for General Harm of 1.81. Pharmacists and dispensing pharmacists in general regarded medicines as somewhat more beneficial, whereas pharmacy technicians viewed medicines as slightly more harmful. Those who had worked in a pharmacy for 30-34 years regarded medicines as less harmful compared to those who had worked 0-4 years. Compared to non-users, current users of prescription drugs regarded medicines as more beneficial. When controlling for background characteristics, no confounders were detected for any of the three subscales (ANCOVA analyses). CONCLUSION: Results of the study of 292 Swedish pharmacy employees show that they regard medicines as beneficial rather than harmful and that there are differences in beliefs between the professional categories. However, the reasons for these differences remain unclear. Nevertheless, the positive beliefs among pharmacy employees may have an impact on the communication with clients and, eventually, clients' adherence to medicines.

Adolescent↗
PubMed2004

The Scope of pharmacy ethics-an evaluation of the international research literature, 1990-2002.

This paper attempts to provide a critical overview of international published discourse relating to ethical issues in pharmacy practice from 1990 to 2002. We found that there is little research literature specifically addressing ethics in pharmacy practice and almost none addressing fundamental philosophical issues or values for pharmacy ethics. There is no dedicated journal for pharmacy ethics. Most material relating to pharmacy ethics is articulated as codes or pronouncements from professional bodies, as opinion or reflection in textbooks and in debate such as letters and articles. However, this should not be taken to mean that pharmacy and ethics are strangers; simply that such matters are not frequently analysed in published pharmacy literature. The presumption is usually that most matters of pharmacy ethics are very familiar and require no exploration or explanation. Where the research literature does target ethical issues, the most common method is to employ "the scenario approach". This term describes the technique of using a vignette or scenario from actual pharmacy practice and then exploring a variety of possible options to identify one or more defensible solutions. The vast majority of scenarios related to the delivery of healthcare per se; rather fewer derived from delivery of healthcare in a commercial environment. One notable exception to this approach is the body of work by Latif and colleagues on moral reasoning and community pharmacy practice. Our review suggests there is a need for the knowledge base in pharmacy ethics to be systematised and integrated into the wider scheme of general healthcare ethics. The principal areas in which research is needed include, how best to teach and assess "ethical competence" before practice; how to develop and update this competence in practising pharmacists; and how the business environment, particularly where there are corporate values and reward systems in operation, affects ethical competence. In addition, general research in pharmacy practice may benefit from a greater awareness and enquiry as to the ethical issues raised by the projects being undertaken.

Ethics, Pharmacy↗
PubMed2006

Pharmacy education in Jordan, Saudi Arabia, and Kuwait.

The practice of pharmacy, as well as pharmacy education, varies significantly throughout the world. In Jordan, Kuwait, and Saudi Arabia, the profession of pharmacy appears to be on the ascendance. This is demonstrated by an increase in the number of pharmacy schools and the number of pharmacy graduates from pharmacy programs. One of the reasons pharmacy is on the ascendance in these countries is government commitment to fund and support competitive, well-run pharmacy programs. In this report we describe pharmacy education in 3 Middle East countries: Jordan, Kuwait, and Saudi Arabia. All 3 countries offer bachelor of pharmacy (BPharm) degrees. In addition, 2 universities in Jordan and 1 in Saudi Arabia offer PharmD degree programs. The teaching methods in all 3 countries combine traditional didactic lecturing and problem-based learning. Faculties of pharmacy in all 3 countries are well staffed and offer competitive remuneration. All 3 countries have a policy of providing scholarships to local students for postgraduate training abroad. The majority of students in Jordan and Kuwait are female, while the ratio of male to female students in Saudi Arabia is even. Students' attitudes towards learning are generally positive in all 3 countries. In Saudi Arabia and Kuwait, most pharmacy graduates work in the public sector, while in Jordan, the majority work in the private sector.

Education, Pharmacy↗
PubMed1991

Hospital administrators' perceptions of pharmacy directors.

The results of a national survey of hospital administrators' perceptions of pharmacy directors are reported. A questionnaire was mailed to a random sample of 1000 hospital administrators nationwide. The questionnaire asked each administrator to rate the managerial skills of pharmacy directors in general and the pharmacy director at his or her institution on a 5-point scale. The value the administrator placed on clinical pharmacy services was investigated, as was the administrator's knowledge of the education of the pharmacy director and the reporting structure between administrator and pharmacy director. The net response rate was 47.8% (478 usable replies). The hospital administrators believed that pharmacy directors in general need to improve their relationship with the nursing staff, their basic managerial skills, and their communication skills. They believed that the pharmacy director at their own institution excelled at keeping up with progressive pharmacy practice, inventory management, and interacting with the pharmacy and therapeutics committee. The administrators indicated that it is very important for the pharmacy department to be involved in therapeutic drug monitoring and medication counseling and to be progressive in their offerings of services. Hospital administrators had a positive perception of the abilities of pharmacy directors but believed that there is still room for improvement.

Attitude of Health Personnel↗
PubMed1993

Pharmacy practice and education in the People's Republic of China.

OBJECTIVE: To describe the pharmacy profession and the education programs available to train pharmacists in the People's Republic of China (PRC). The practice of pharmacy in the hospital setting and the current development of clinical services are also described. BACKGROUND: There are two streams of medical practices in the PRC: traditional Chinese medicine and Western medicine. Hospital and community pharmacies are responsible for the dispensing of medicinals used for both streams of medical practices. Forty-two colleges of pharmacy offer pharmacy education, half of which provide a Western medicine approach and the other half traditional Chinese medicine. Both types of colleges offer a four-year curriculum with options for specialization. Opportunities for graduate study are also available. Most of the graduates work in hospital pharmacies. Hospital pharmacies participate in the bulk manufacture of drugs and parenteral fluids. A bulk dispensing system is used by some hospitals; individual patient doses are dispensed in others. Recently, the need to develop clinical pharmacy services in PRC was recognized and training courses were begun. Curricula with specialization in clinical pharmacy are being considered by colleges of pharmacy. CONCLUSIONS: It is anticipated that through increased awareness of the potential contribution of pharmacists in the PRC healthcare system, more opportunities for educating pharmacists will be made available to satisfy the vast need of the country. Development of clinical pharmacy services also will be expected to improve the quality of care provided.

China↗
PubMed2006

Regional influences on the dispensing of glucose test strips in Dutch community pharmacies.

BACKGROUND: Pharmacy practice guidelines promote the role of community pharmacies in self-monitoring of blood glucose. However, variations between Dutch pharmacies exist in the proportion of patients to whom test strips are dispensed. OBJECTIVE: To assess whether variations between community pharmacies in dispensing of blood glucose test strips can be explained by differences in patient characteristics and the region in which the pharmacy is located. SETTING: PHARMO-Record Linkage System containing drug dispensing histories from 40 community pharmacies of about 450,000 patients in the Netherlands. METHOD: We performed a retrospective cohort study. Data on prescription of all drugs and medical aids between 1991 and 2001 were extracted for all new users of antidiabetic drugs. Patients were excluded if the dispensing history did not allow classification of the type of diabetes or if the dispensing pharmacy could not be determined. The data were analysed using a Cox proportional hazard model. MAIN OUTCOME MEASURE: Time to first test strips dispensed. RESULTS: We identified 8,233 starters of antidiabetic drugs. During a median follow-up of 2.1 years, 20% of the patients were dispensed test strips at least once. Community pharmacy was significantly associated with the dispensing of test strips after adjustment for patient characteristics. This association was less apparent when stratified for the geographical location of the pharmacy. CONCLUSION: Community pharmacy is an independent determinant of the start of use of test strips. Differences in dispensing of test strips between pharmacies are dependent on geographical region. This suggests that implementing practice guidelines for diabetes care in community pharmacy requires different approaches in different regions.

Adult↗
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

Sale of tobacco products in pharmacies: results and implications of an empirical study.

OBJECTIVE: To provide national-level data concerning the percentage of pharmacies selling tobacco products, examine relationships between selling practices and pharmacy characteristic variables, and explore perceptions of conflicts between tobacco-selling activity and professional and personal values and the potential effects of such conflicts. DESIGN, SETTING, PARTICIPANTS: Data were collected from a geographically stratified systematic random sample of 899 pharmacies. Multiple mailings were sent to the attention of the pharmacy manager. A random sample of nonrespondents was also contacted by telephone, urging participation. MAIN OUTCOME MEASURES: Whether the pharmacy currently sold cigarettes and/or smokeless tobacco products, and if so, whether these practices differed from what respondents' personal or professional values tell them to do. Scales designed to measure job satisfaction, job-induced tension, and propensity to leave were also included. RESULTS: Slightly more than half (50.5%) of the pharmacies sold cigarettes and 35.4% sold smokeless tobacco products. Independents were less likely than chain pharmacies to sell tobacco products. For those respondents working in pharmacies where tobacco products were sold, 47.6% responded that this practice differs from what their personal values tell them to do and 63.9% replied that this practice differs from what their professional values tell them to do. Even when controlling for pharmacy type, respondents working in pharmacies that sold tobacco products had significantly lower levels of global job satisfaction, higher levels of job-induced tension, and a higher propensity to leave than did respondents working in pharmacies that did not. CONCLUSION: Decision makers in pharmacies where tobacco products are still sold should take a serious look at the justification for the continued availability of tobacco products in an environment that has a goal of promoting health.

Data Collection↗
PubMed2000

"We don't carry that"--failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics.

BACKGROUND: We have observed that many black and Hispanic patients receiving palliative care at a major urban teaching hospital are unable to obtain prescribed opioids from their neighborhood pharmacies. In this study, we investigated the availability of commonly prescribed opioids in New York City pharmacies. METHODS: We surveyed a randomly selected sample of 30 percent of New York City pharmacies to obtain information about their stock of opioids. For each pharmacy, U.S. Census estimates for 1997 were used to determine the racial and ethnic composition of the neighborhood (defined as the area within a 0.4-km [0.25-mile] radius of the pharmacy) and the proportion of residents who were more than 65 years old. Data on robberies, burglaries, and arrests involving illicit drugs in 1997 were obtained for the precinct in which each pharmacy was located. We used a generalized linear model to examine the relation between the racial or ethnic composition of neighborhoods and the opioid supplies of pharmacies, while controlling for the proportion of elderly persons at the census-block level and for crime rates at the precinct level. RESULTS: Pharmacists representing 347 of 431 eligible pharmacies (81 percent) responded to the survey. A total of 176 pharmacies (51 percent) did not have sufficient supplies of opioids to treat patients with severe pain. Only 25 percent of pharmacies in predominantly nonwhite neighborhoods (those in which less than 40 percent of residents were white) had opioid supplies that were sufficient to treat patients in severe pain, as compared with 72 percent of pharmacies in predominantly white neighborhoods (those in which at least 80 percent of residents were white) (P<0.001). CONCLUSIONS: Pharmacies in predominantly nonwhite neighborhoods of New York City do not stock sufficient medications to treat patients with severe pain adequately.

Analgesics, Opioid↗
PubMed1996

Re-engineering a pharmacy work system and layout to facilitate patient counseling.

The development and evaluation of a new work system and facility design for a chain of community pharmacies are described. A new work system was developed to optimize utilization of pharmacist and technician time and allow the pharmacy to increase patient counseling without adding personnel. In the new system, pharmacists would review prescriptions, check technicians' work, and dispense prescriptions, counseling patients as needed; technicians would enter prescriptions into the pharmacy computer and fill them. The existing work system and design were evaluated in June and July of 1992 by observing, classifying, and recording activities of pharmacy personnel three days per week at six pharmacies in the chain. Pharmacy designs that would work with the new work system were created by a university design class after consultation with representatives of the pharmacy chain and the university's college of pharmacy. The pharmacy chain selected one design, and a detailed floor plan and specifications were created. To test how the new design and system would work at each of the six test pharmacies, a computer simulation program was developed and verified by using the data collected on the existing pharmacy operations. Computer simulation showed that, with the new design and system, increasing patient counseling would increase patient waiting time slightly but would not require additional personnel. The layout and work system in a chain of community pharmacies were redesigned to facilitate patient counseling and make the best use of employee time.

Community Pharmacy Services↗
PubMed1998

An economic analysis of needle exchange and pharmacy-based programs to increase sterile syringe availability for injection drug users.

Our objectives were to estimate the cost per syringe distributed for five syringe distribution strategies (a needle exchange program [NEP], a pharmacy-based NEP, free pharmacy distribution of pharmacy kits, sale of such pharmacy kits to injection drug users [IDUs], and sale of syringes in pharmacies); to assess the total costs of these strategies; and to conduct an economic analysis of these strategies in preventing HIV infection in IDUs. We estimated the costs for NEPs by using data from previous research; costs for the four pharmacy-based strategies were resource-based. Using estimates of the number of syringes required to provide a sterile syringe for each IDU injection, we estimated the total costs of the strategies in three representative U.S. cities. The lifetime cost of treating a person for HIV infection, discounted into current value, was used to estimate the number of syringes that could be distributed for that amount by the five strategies and thus the number of IDUs who could be ensured a sterile syringe for each injection. We then conducted a threshold analysis for calculating the annual HIV seroincidence for the program to be cost-neutral. The cost per syringe distributed in U.S. dollars was $0.97 for the NEP, $0.37 for the pharmacy-based NEP, $0.64 for pharmacy kit distribution, $0.43 for pharmacy kit sale, and $0.15 for syringe sale. The total annual cost in U.S. dollars of providing 50% of the syringes needed for a single syringe for every injection ranged from $6 to $40 million for New York City, from $1 to $6 million for San Francisco, and from $30,000 to $200,000 for Dayton, Ohio. The annual HIV seroincidence for the program to be cost-neutral compared with the cost of medical treatment for HIV injections was 2.1% for the NEP, 0.8% for the pharmacy NEP, 1.4% for pharmacy kit distribution, 0.9% for pharmacy kit sale, and 0.3% for syringe sale. All five strategies could distribute syringes at relatively low unit costs; NEPs would be the most expensive and syringe sales would be the cheapest. At annual seroincidences exceeding 2.1%, all strategies are likely to be cost-saving to society.

Costs and Cost Analysis↗
PubMed2005

Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia.

BACKGROUND: Public-private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries. OBJECTIVES: To evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America. METHODS: We contacted the local Pharmacists' Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before-after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists. RESULTS: The proportion of pharmacies selling TB drugs decreased (rifampicin: 23-11.5%; isoniazid: 16-3.1%; P<0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22-58%; P<0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB. CONCLUSION: The first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment.

Antitubercular Agents↗
PubMed1999

Consumer and provider evaluation of rural pharmacy services.

This paper compares consumer and provider perceptions regarding access to pharmacy services in rural Illinois, given a decrease in the number of pharmacies. Consumer data are from the Illinois Rural Life Panel in which more than 1,800 respondents answered questions about availability and use of pharmacy services and about insurance coverage and cost. A survey of all licensed retail pharmacies in 74 rural Illinois counties and in seven non-rural counties provided pharmacy background information and was the source of data on changes in profitability and payment sources. The data provided insight on factors that affect access. Descriptive statistics were used to analyze data from both groups to compare perceptions about access. The objective was to evaluate current access to pharmacy services and implications for future access from the perspective of consumers and pharmacists. Results from rural consumers show access is currently good; 77 percent have a local pharmacy, and 64 percent prefer this source. Future access is of more concern. Pharmacy survey results show 81.5 percent of rural pharmacies are experiencing declining profits from drug sales. Restricted reimbursements from third-party payers, demands of managed care and expanded competition are seen as threats to retention of local pharmacies and continued good access. An important finding, especially given survey evidence of increased managed care penetration, is the difference in views of pharmacists and consumers regarding the effects of managed care on access. Pharmacy survey data also revealed differences between rural and non-rural pharmacies.

Adult↗
PubMedDate not supplied

Establishing an on-site pharmacy in a community health center to help indigent patients access medications and to improve care.

OBJECTIVES: To describe the establishment of an on-site pharmacy in a community health center (CHC) to improve access to medications for indigent patients, the implementation of pharmaceutical care programs and clinical pharmacy services to improve patient care and therapeutic outcomes, and the development of an ambulatory care site for training pharmacy students. SETTING: Partnership Health Center (PHC), a federally funded CHC in Missoula, Mont. PRACTICE DESCRIPTION: Establishment of an on-site pharmacy and strategies for accessing medications for indigent patients, including participation in the U.S. Public Health Service pricing program, pharmaceutical manufacturers' assistance programs, and drug sampling, are described. The clinical pharmacy, disease management, and pharmaceutical care programs developed at the site to improve medication use and therapeutic outcomes are discussed. Development of an ambulatory care clerkship site at the CHC for training University of Montana pharmacy students is reviewed. PRACTICE INNOVATION: Partnership between PHC and the University of Montana School of Pharmacy and Allied Health Sciences (SPAHS) to establish an on-site pharmacy to help medically indigent patients access medications and to improve care. INTERVENTIONS: Programs to help indigent patients access, adhere, and appropriately use needed medications while decreasing clinic expenditures for medications. MAIN OUTCOME MEASURES: Number of prescriptions dispensed per month, clinic expenditures on medications per month, and number of clinical services and pharmaceutical care programs developed. RESULTS: Between November 1, 1999, and April 30, 2000, the average number of prescriptions filled for PHC clients increased from 219/month to 838/month and the average expenditure per prescription decreased from $16.55/month to $0.51/month. A pharmacist-assisted refill program was implemented. Programs in diabetes, hypertension, dyslipidemia, asthma, anticoagulation, and peptic ulcer disease were developed. CONCLUSION: Establishing an on-site pharmacy in a CHC in collaboration with a school of pharmacy significantly improved indigent patients' access to medications while decreasing clinic expenditures. Pharmaceutical care programs improved therapeutic outcomes, and clinical pharmacy services complemented the clinical activities of other health care providers in managing chronic diseases and resolving drug-related problems. The CHC provided an excellent setting for training pharmacy students in ambulatory care.

Community Health Centers↗
PubMedDate not supplied

Assessing risk for loss of rural pharmacy services in Minnesota.

OBJECTIVE: To quantify rural communities' risks for losing access to local pharmacy services using a newly developed risk-assessment tool. DESIGN: Cross-sectional study. SETTING: Minnesota in June through August 2003. PARTICIPANTS: Pharmacy owners and managers in rural communities with populations less than 5,000 residents and only one community pharmacy. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Each answer was given a score based on the related factor's ability to affect risk of pharmacy closure. Scores were summed to give a comparative risk score with a positive score indicating higher risk; these scores could range from -13.5 to +30.75, depending on responses. RESULTS: From 126 communities outside of the Minneapolis-St. Paul metropolitan area with populations of fewer than 5,000 residents and only one community pharmacy, 81 (64.3%) usable responses were received. The calculated risk scores ranged from -7 to +12.3, with mean (+/- SD) scores of 1.55 +/- 4.17. Factors that contributed most to rural pharmacies' risk index were dramatic decreases in community populations within 5 years, poor community support for the pharmacy, owner's intent to sell pharmacy within 2 years, less than dollar 750,000 in annual prescription revenue, perceived erosion of total market share of prescriptions, difficulties in recruiting full-time pharmacist-employees, lack of access to local primary care, and perceived likelihood that local primary care clinics would not be active in 5 years. Approximately 26% of pharmacy owners responding expressed interest in selling their pharmacy within 3 years, and 62% were interested in selling within 10 years. CONCLUSION: The tool developed for this study allows prospective assessment of risk, which can facilitate a greater awareness by local and regional officials and consumers of the possibility of loss of rural pharmacies, assist in targeting resources to areas most in need, and serve as a bridge to collaborative relationships aimed at ensuring local access to both pharmacy services and the knowledge of a pharmacist.

Community Pharmacy Services↗
PubMed2005

Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies.

BACKGROUND: Nearly one-half of adult Americans have limited functional literacy skills. Low patient literacy is associated with poor medication adherence and health outcomes. However, little is known about how pharmacies address literacy-related needs among patrons. OBJECTIVE: To determine the frequency with which pharmacies identify and provide appropriate assistance to patients with limited literacy skills and provide specific recommendations to help improve pharmacists' recognition of low health literacy, as well as strategies to improve adherence in this population. METHODS: Through a telephone-based survey of Atlanta-area pharmacies, we obtained information on (1) whether the pharmacy attempted to identify patients with limited literacy skills, (2) what measures were taken by the pharmacy to optimize the health care of low-literacy patients, especially with regard to medication adherence, and (3) what services the pharmacy offered to improve adherence in general. RESULTS: The response rate among eligible pharmacies was 96.8% (N = 30). Only 2 (7%) pharmacies reported attempting to identify literacy-related needs among their patrons. One of these facilities provided additional verbal counseling to assist low-literacy patients, and the other pharmacy involved family members, provided verbal counseling, and had patients repeat instructions to confirm comprehension. Most pharmacies reported availability of adherence aids that could help low-literacy patients if such patients were identified and targeted to receive additional assistance. These included verbal and written counseling (offered at 73% of pharmacies), packaging or organizing aids (27%), refill services (17%), and graphic or multimedia aids (13%). CONCLUSIONS: Pharmacies infrequently attempt to identify and assist patients with limited literacy skills.

Adult↗
PubMed2005

Collaborative services among community pharmacies for patients with diabetes.

BACKGROUND: Patients performing self-monitoring of blood glucose (SMBG) may benefit from community pharmacy services. However, wide-scale implementation of these services is limited. Many pharmacy characteristics (eg, physical layout of the pharmacy, knowledge and competence of the pharmacy team) are reported to be relevant when implementing these services. Still, the importance of local agreements on the division of roles with, for example, local general practitioners or diabetes nurses, is less clear. OBJECTIVE: To study the association between local collaboration and the level of services provided by community pharmacies to patients performing SMBG. METHODS: In 2004, we performed a cross-sectional survey among all 1692 Dutch community pharmacies. Data were gathered on provision of services for SMBG, local agreements, and pharmacy characteristics. Data were analyzed using logistic regression. Associations were adjusted for pharmacy characteristics. RESULTS: About 44% (724) of the community pharmacies returned the questionnaire. Pharmacies that were not involved in local collaborative services on patient counseling reported to provide fewer services compared with those that were involved in such agreements (OR 0.26, 95% CI 0.13 to 0.53). Similar findings were observed for agreements on calibration of SMBG equipment (0.17, 0.04 to 0.71). The associations remained after adjusting for pharmacy characteristics. CONCLUSIONS: Local collaboration on the division of roles in diabetes care between healthcare professionals is independently associated with the number of pharmacy services provided to patients performing SMBG.

Blood Glucose Self-Monitoring↗
PubMedDate not supplied

Impact of a clinical pharmacy consult service on guideline adherence and management of gabapentin for neuropathic pain.

OBJECTIVE: Our objectives were to (1) determine whether a computerized clinical pharmacy approval and follow-up consult process for ordering new prescriptions for gabapentin for the treatment of neuropathic pain decreased the number of patients without documented treatment benefit while increasing follow-up and documentation of effectiveness, and (2) describe gabapentin use patterns at a Veterans Affairs (VA) Medical Center, including the use of first-line therapies prior to gabapentin therapy for neuropathic pain. METHODS: The clinical pharmacy intervention included review of (1) the indication for gabapentin; (2) the required use and failure or contraindication of 3 first-line therapies: nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants (TCAs), and capsaicin cream; (3) the initial pain assessment; and (4) patient follow-up in 4 to 6 weeks, with repeat pain assessment. A retrospective chart review was performed for all patients who received a new prescription for gabapentin from October 2002 to April 2003 at the Portland VA Medical Center (PVAMC). The outcomes of interest for the provider group versus the clinical pharmacy managed group included follow-up at 6 weeks or less versus follow-up at more than 6 weeks, documentation of treatment benefit, how many of the 3 first-line therapies were tried before gabapentin, and whether the gabapentin therapy was discontinued. RESULTS: There were 237 patients who received a new prescription for gabapentin between October 2002 and April 2003. Of these gabapentin prescriptions, 61% (n=144) were prescribed for neuropathic pain. Of the new gabapentin prescriptions for neuropathic pain, 61% (n=88) were made from approved clinical pharmacy consults, 38% (n=54) were ordered without a clinical pharmacy consult, and 1% (n=2) were not included because the patient received the drug despite denial by the clinical pharmacy consult. The rate of follow-up to assess documentation of benefit of therapy with gabapentin was 87% (n=62) in the clinical pharmacy consult group compared with 51% (n=27) in the provider-managed group (chi2=18.07, P<0.001). Of the patients who were assessed by follow-up, 89% (n=55) of the clinical pharmacy consult group received follow-up within 6 weeks versus 52% (n=14) of the provider-managed group (chi2=12.63, P <0.001). Compared with the patients managed by clinical pharmacists, 43% (n=23) of the gabapentin patients in the provider-managed group had no evidence of prior use of any of the 3 agents required by the gabapentin neuropathic pain guideline, 55% (n=29) had evidence of prior use of 1 or 2 first-line agents, and only 2% (n=1) had evidence of prior use of all 3 required first-line agents, versus 100% (n=71) of the patients managed by clinical pharmacy consult. There was no difference in the rate of continuation of gabapentin therapy in the group of patients who received clinical pharmacy consults (65%) compared with the provider-managed group (68%, chi2=0.11, P=0.718). Of the 148 pharmacy consults for new gabapentin prescriptions that were completed during the 7-month period from October 2002 through April 2003, 60 (40%) were denied, which resulted in the lack of gabapentin use in these 60 patients. CONCLUSIONS: A clinical pharmacy intervention as part of the management of a treatment guideline for appropriate gabapentin use promotes documentation of drug therapy effectiveness in neuropathic pain and prevention of gabapentin use prior to a trial with alternative first-line therapies.

Amines↗