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PubMed2001

Pharmacists' role in managing sexually transmitted infections: policy issues and options for Ghana.

The debate about extending the role of pharmacists in health care is growing in recognition of the ongoing difficulties experienced by many public sector services. The perceived accessibility and confidentiality of pharmacists makes them particularly attractive to patients for the management of health problems such as sexually transmitted infections (STI) that may lead to stigmatization. Despite growing interest in the subject, there are few documented analyses of the role of pharmacists in low-income countries. In Ghana, pharmacists are acknowledged by the government to be the preferred option for people seeking treatment for STI. A study was conducted to investigate the current role played by pharmacists in Greater Accra Region in the management of STI. On the basis of these findings, training schemes were developed, implemented and evaluated. This paper presents the findings of this operation-research and considers their implications for deciding to what extent and in what way pharmacists should be involved in managing STI in Ghana and other similar country settings. These findings suggest that pharmacists have a crucial role in effective management of STI, particularly in the management of urethral discharge. They may need to limit their management of genital ulcer to referring customers to laboratories and medical practitioners. They also represent a currently under-utilized opportunity for preventive activities. Regulation and quality assurance issues need to be addressed by both pharmacy and medical professions.

Anti-Infective Agents↗
PubMed1994

Impact of a clinical pharmacist in a multidisciplinary intensive care unit.

OBJECTIVES: To describe the activities of a clinical intensive care unit (ICU) pharmacist and to determine whether pharmacist-initiated consultations lead to changes in drug costs. DESIGN: Prospective, 3-month study. SETTING: A 15-bed, university-affiliated, tertiary care medical-surgical ICU. INTERVENTIONS: The following ICU pharmacist activities were recorded: providing drug information for physician inquiries; providing drug information for nurse inquiries; clarification of drug orders; drug accessibility information; pharmacokinetic consultation; detection and reporting of adverse drug reactions; and pharmacist-initiated therapeutic consultation leading to changes in drug therapy. When changes in drug therapy occurred, drug costs before and after the change were determined. MEASUREMENTS AND MAIN RESULTS: During 54 weekdays, 575 pharmacist interventions occurred (10.7 +/- 5.0 interventions/day). The most common interventions were pharmacist-initiated therapeutic consultations (44.7%, 257/575 of the total), and response to physician requests for drug information (39.0%, 224/575). The most resource-intensive activities were provision of physician drug information and therapeutic consultations (49.6 mins and 35.9 mins per day, respectively). On average, 1.70 hrs (102 mins) per day were spent on all interventions. Therapeutic consultations decreased (47.1%), did not change (42.0%), or increased (10.9%) drug costs for a net savings of $10,010.60 (Canadian) over 3 months, or a projected annual savings of $67,664.24, if clinical pharmacy services were extended to 7 days/wk. CONCLUSIONS: Dedicated ICU pharmacists are crucial healthcare team members in a multidisciplinary ICU. In addition to substantially reducing drug costs, they provide continuity in individualized pharmacotherapeutic care, and serve an important educational function.

Cost Savings↗
PubMed1981

Documenting outpatient problem intervention activities of pharmacists in an HMO.

The outpatient drug use review experiences by pharmacists at a large health maintenance organization with on-site pharmacies were investigated. Pharmacists were asked to document the nature of potential drug therapy problems encountered, drug involved, review activities undertaken, and process-outcomes. Patterns of pharmacists intervention were observed over 1 year. Results indicated that the number of problems detected increased substantially during the months immediately following the introduction of problem recording and feedback procedures. During the latter months, the number of prescriptions with problems approximated 4 per 100 dispensed prescriptions. Drug interactions of a moderate nature and drug underuse were the most frequent problem types encountered. Most were not serious and usually resulted in a cautionary or counseling message given to patients by pharmacists. The next most frequently occurring type was drug overuse problems, and, after that, problems concerning some aspect of the prescribing decision. In 9 per cent of all problem interventions and in 44 per cent of prescribing-problem interventions, the outcome of the pharmacist intervention was a change in drug, strength or directions for use. The average amount of pharmacist time per problem intervention varied from 6.0 to 7.8 minutes across problem types. This approximate a pharmacist labor cost of $0.06 per dispensed prescription, given a problem encounter rate of 4 per 100 dispensed prescriptions.

Documentation↗
PubMed1990

A survey of pharmacists recommendations for food supplements in the U.S.A. and U.K.

A survey was sent to 1,000 pharmacists in metropolitan Detroit U.S.A. (19.7% responded) and 750 pharmacists in the U.K. (57.9% responded) to assess the frequency of recommendations for health food stores, minerals, multivitamins, natural vitamins, protein supplements, Stresstabs, and weight-reduction products. Pharmacists were also asked about their five most common reasons for recommending vitamins and minerals from a list of 16 items, which included alcoholism, anaemia, arthritis, athletically active, children, colds, dieting, fatigue, feeling nervous, headaches, old age, pain, pregnancy, prophylaxis, skin problems, stress or other. About 40% of the U.S.A. community pharmacists recommended multivitamins more than five times a week compared to 28.6% of U.K. community pharmacists. Anaemia (48.6%), dieting (44.8%), alcoholism (42.3%), pregnancy (40.0%), and fatigue (36.8%) were the five most common reasons for pharmacists to recommend vitamins and minerals, this was consistent, for the most part, with the American Medical Association's Council on Scientific Affairs report, however, a large number of pharmacists placed the non-specific symptoms of fatigue and stress in the five most common reasons for which they recommend vitamins or minerals.

Food, Formulated↗
PubMed2006

Patient outcomes following an intervention involving community pharmacists in the management of depression.

OBJECTIVE: Documentation and evaluation of patient outcomes in a pilot study into the role of rural community pharmacists in the management of depression. DESIGN: Parallel groups design with a control and intervention group. SETTING: Thirty-two community pharmacies in rural and remote New South Wales, Australia. PARTICIPANTS: One hundred and six patient participants, mean age of 46 years, predominantly female, not currently employed, recruited by participating pharmacists. INTERVENTIONS: Intervention pharmacists were given video-conference training on the nature and management of depression by a psychiatrist, psychologist and general practitioner and asked to dispense medication with extra advice and support. Control pharmacists were asked to provide usual care. MAIN OUTCOME MEASURES: Adherence by self-report, K10, Drug Attitude Index. RESULTS: The results indicated that adherence to medications was high in both groups (95% versus 96%) and that both groups had improved significantly in wellbeing (a reduction K10 score of 4 (control) versus 4.7 (intervention)). No significant change was found in attitude to drug treatment once baseline scores were controlled for. CONCLUSIONS: Because both groups improved in wellbeing it is not possible to claim that the training provided to the intervention pharmacists was responsible for the success. However, the improvements gained in such a short time (two months) suggest that the involvement of pharmacists has had a beneficial rather than negative effect. Further research into the most appropriate ways in which to integrate the skills of pharmacists into a model of mental health care delivery in rural communities is recommended.

Antidepressive Agents↗
PubMedDate not supplied

Pharmacists and travel advice for tropics in Lisbon (Portugal).

BACKGROUND: In Portugal, little is known about the quality of advice given to international travelers by pharmacists. The aim of this study was to determine pharmacists' training, experience, and interest in travel medicine and to assess the technical quality of the information given. METHODS: We sent a postal questionnaire to all pharmacies in the Lisbon area. The technical director or another graduate pharmacist was asked to complete the questionnaire. RESULTS: A total of 251 pharmacists participated in the study. Most of them (93.2%) did not have any training in travel medicine, and most of them expressed a wish to be informed and/or updated on this subject. The number of advised travelers was low. The use of repellent, protective clothes, and mosquito bed nets was the most frequent advice on protection against mosquito bites. From a subgroup of 170 pharmacists, 43.5% indicated mefloquine and 44.1% indicated chloroquine as malaria chemoprophylaxis to African countries. A significant association existed between the variables "to indicate mefloquine" and "seeks to be informed/updated on travel medicine." Those who indicated chloroquine tended to like travel medicine less. Concerning diarrhea prevention and treatment, the consumption of bottled and/or treated water and the administration of antibiotics during the episode were the most reported advice. Concerning vaccination against yellow fever, only 8 of 91 pharmacists correctly indicated all Portuguese-speaking countries with and without the risk of this disease. CONCLUSIONS: Studied pharmacists need training in travel medicine. Travel advice was incomplete and/or incorrect and must be improved.

Adult↗
PubMed1983

The relationship between patient variables and frequency of pharmacist counseling.

Over the past 20 years, much research has focused on evaluating pharmacists' performance as drug consultants to patients and on identifying factors that affect pharmacists' performance in this role. Little has been done, however, to assess the impact of patient characteristics, such as age, income, education, and drug expenditures, on pharmacists' performance as drug consultants. The purpose of this study was to examine this impact. Data were gathered via a mail survey of 300 households in Raleigh, NC. Multiple regression analysis was used to analyze the data. Results indicated that pharmacists generally are available to answer patients' drug-related questions, that pharmacists usually do not provide counseling to patients voluntarily, and that pharmacists are significantly more likely to counsel patients who have lower educational attainment and higher drug expenditures. These results appear to suggest that pharmacists have adopted the role of drug consultant to patients, but only to a limited extent.

Adolescent↗
PubMed1986

How pharmacists are rated as a source of drug information by physician assistants.

A study to examine physician assistants' (PAs) views of drug information sources was undertaken in a sample of practicing PAs in Georgia. Analysis of Kendall's coefficient of concordance statistic indicated Pharm.D.s were ranked highest as being good sources of drug information of the six categories listed. Next in descending order of classification as good sources of drug information were the categories of journal articles, physicians, non-Pharm.D. pharmacists, detail persons, and physician assistants. A significant correlation was found between PA contact with pharmacists and the classification of pharmacists as good sources of drug information. The difference in rating between Pharm.D.s and journal articles and physicians was not significantly different, but the rating differences between these categories and each of the other sources were statistically significant. Pharm.D. pharmacists were rated higher as a source of drug information than were non-Pharm.D. pharmacists. Results indicate pharmacists are viewed positively as sources of drug information for PAs, and that view increases with contact with pharmacists.

Age Factors↗
PubMed1992

Professional self-image among Israeli pharmacists: sectoral differences.

OBJECTIVE: To examine sectoral differences in the professional activities and self-images of Israeli pharmacists. DESIGN, SETTING, AND PARTICIPANTS: Pharmacists from private, community, and hospital sectors (n = 145) completed a survey that assessed the rewards accrued from their professional activities as pharmacists and evaluated their professional and sectoral self-image. RESULTS: Few intersectoral differences were found among Israeli pharmacists. Most agreed that the main rewards in the public sector are secure employment, intellectual challenge, and responsibility. In the private sector, the rewards are high income, responsibility, and opportunity to counsel. The majority of pharmacists in all sectors are satisfied with their profession, and 90.7 percent would choose it again. Nevertheless, they ranked pharmacy eighth among nine professions chosen for comparison, which shows quite a low professional image. The private and hospital pharmacists attributed a higher social status to their own sectors than to the community sector. CONCLUSIONS: The inferior professional self-image held by pharmacists, despite the rewards of the profession, should be examined in greater detail.

Adult↗
PubMed1993

Effectiveness of an ambulatory care clinical pharmacist: a controlled trial.

OBJECTIVE: To compare two general medicine clinics to determine the effectiveness of an ambulatory care clinical pharmacist in assisting recognition of drug therapy problems for physicians and decreasing drug therapy costs. DESIGN: Controlled trial. SETTING: Two general medicine ambulatory care clinics associated with a large, tertiary-care teaching hospital. PATIENTS: Those with scheduled and completed appointments in the clinics during the two-week study period. METHODS: Medication profiles of patients attending clinic A (pharmacist intervention) and clinic B (no pharmacist intervention) were reviewed by the pharmacist prior to clinic appointments. Potential drug therapy problems were identified at each clinic, but interventions were performed only at clinic A. Postappointment audits determined the number of recommendations implemented at clinic A versus the number of drug therapy problems (potential interventions) recognized and addressed by clinic B physicians independently of pharmacist intervention. Potential and actual savings were extrapolated to one year from the two-week study period. RESULTS: Implementation of interventions at clinic A was greater than at clinic B (p < 0.001). Drug therapy cost savings at clinic A were annualized to yield $185 per intervention. Potential cost savings of $176,724, or four times the pharmacist salary costs, is projected. CONCLUSIONS: An ambulatory care pharmacist is effective in identifying drug therapy problems, resulting in significant cost savings to the institution.

Adult↗
PubMed1996

Identification and clarification of drug therapy problems by Indian health service pharmacists.

OBJECTIVE: To describe drug therapy problem intervention activities of Indian Health Service (IHS) pharmacists and to characterize the types of drug therapy problems encountered. DESIGN: Longitudinal descriptive study of documented potential drug therapy problems detected by pharmacists during the conduct of routine dispensing activities during a 6-month period. SETTING: All 18 IHS hospitals and ambulatory care facilities in one geographic area. MAIN OUTCOME MEASURES: Potential drug therapy problem detection rates by pharmacists and problem detection rates per 100 dispensed prescriptions are reported. Problems are characterized as to type, nature of intervention activities undertaken, and results of interventions. Changes in problem detection rate across clinics and over time are reported. RESULTS: Pharmacists detected and reported problems at a rate of slightly less than one per 100 prescriptions dispensed; however, drug therapy changes occurred 78% of the time as a result of the interventions. The types of drug therapy problems occurring most frequently were incorrect information (40.7%), prescription clarification (39.6%), clinical problems (10.4%), and inappropriate drug (9.3%). Physician acceptance of pharmacist interventions varied by type of drug therapy problem. Drug therapy changes occurred 77.7% of the time as a result of the interventions. Pharmacists at several sites used records of the drug therapy problems to make changes in policy or procedures as a part of continuous quality improvement activities. As a result, the problem detection rate declined over time in several settings. CONCLUSIONS: In comparison with other settings where cognitive services have been reported, IHS pharmacists detected fewer problems, but their interventions resulted in a higher percentage of drug therapy changes.

Drug Prescriptions↗
PubMed2006

An evaluation of pharmacist contribution to an oncology ward in a Swedish hospital.

AIM: The aim of this project was to establish the importance of a pharmacist in the health-care team in improving drug use in an oncology ward in the Department of Oncology, Karolinska University Hospital, Stockholm, Sweden. METHODS AND PATIENTS: The pharmacist participated in the medical round in the mornings and worked as a member of the health-care team. Drug-related problems (DRPs) were identified by drug chart reviews based on data from medical files, laboratory tests and interviews with patients and/or relatives. A questionnaire to physicians and nurses was used to evaluate their experiences of the pharmacist's contribution to the oncology ward. RESULTS: In total, 114 DRPs were identified in 58 patients. For each DRP, the pharmacist gave proposals for solutions. Sixty-eight suggestions out of 114 (59.6%) were implemented by the physician. Two suggestions (1.8%) were partly followed. For 32 suggestions (28.0%) it was unclear if they had caused any change in medication. Twelve suggestions (10.5%) were not followed. Most of the physicians and nurses acknowledged the pharmacist's contribution to improved drug use in the ward. CONCLUSION: A pharmacist can improve drug use in an oncology ward as a member of the health-care team. The pharmacist contributes with a systematic focus on the patient from a drug perspective.

Adult↗
PubMed2005

Physician-assisted death: attitudes and practices of community pharmacists in East Flanders, Belgium.

This study investigates attitudes and practices of community pharmacists with respect to physician-assisted death. Between 15 February and 15 April 2002, we sent anonymous mail questionnaires to 660 community pharmacists in the eastern province of Flanders, Belgium. The response rate was 54% (n = 359). Most of the pharmacists who responded felt that patients have the right to end their own life (73%), and that under certain conditions physicians may assist the patient in dying (euthanasia: 84%; physician-assisted suicide: 61%). Under the prevailing restrictive legislation, a quarter of the pharmacists were willing to dispense lethal drugs for euthanasia versus 86% if it were legalized, but only after being well informed by the physician. The respondents-favour guidelines for pharmacists drafted by their own professional organizations (95%), and enforced by legislation (90%) to ensure careful end-of-life practice. Over the last two years, 7.3% of the responding pharmacists have received a medical prescription for lethal drugs and 6.4% have actually dispensed them. So we can conclude that community pharmacists in East Flanders were not adverse to physician-assisted death, but their cooperation in dispensing lethal drugs was conditional on clinical information about the specific case and on protection by laws and professional guidelines.

Adult↗
PubMed2005

Using interpersonal perception to characterize pharmacists' and patients' perceptions of the benefits of pharmaceutical care.

Pharmacists and patients seem to have divergent beliefs about potential pharmacy services. Patients have reported desiring more from pharmacists, yet pharmacists have cited lack of patient demand as a reason for not providing pharmaceutical care. Pharmacists (N = 147) and patients (N = 151) completed a questionnaire from multiple perspectives using an interpersonal perception approach assessing their perceptions of the benefits of pharmaceutical care. Findings revealed that pharmacists and patients disagreed on the benefits of those services. Further, they misunderstood each other's perceptions of those services. Few significant differences were found between patients who reported receiving additional services from their pharmacist and those who did not. By directly addressing these differences, pharmacists can attempt to improve patients' perceptions of pharmacy services while providing valuable new services.

Adult↗
PubMedDate not supplied

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.

Adult↗
PubMedDate not supplied

Preceptors' perspectives on benefits of precepting student pharmacists to students, preceptors, and the profession.

OBJECTIVES: To educate pharmacists on the shortage of quality preceptors and the benefits received from precepting; present insights from successful preceptors and offer guidance to current and prospective preceptors; and encourage pharmacists to become preceptors and mentor aspiring pharmacy professionals. SETTING: Advanced experiential settings for Nova Southeastern, Ohio Northern, and Creighton Universities. PRACTICE DESCRIPTIONS: Hospital, community, and outpatient clinic settings. PRACTICE INNOVATION: Successful incorporation of student pharmacists and the experiential process into pharmacy practice. MAIN OUTCOME MEASURE: Not applicable. RESULTS: A variety of factors has produced an increased demand for qualified pharmacist preceptors, including workload issues, an increasing number of pharmacy schools, and an increased experiential load in the pharmacy school curricula. Characteristics of quality preceptors include demonstrating enthusiasm in their teaching, being open to questions, and providing constructive feedback. Sites and preceptors can benefit from teaching student pharmacists by receiving assistance in developing and maintaining clinical services, sensing the satisfaction of giving back to the profession, and material rewards provided by schools of pharmacy. In this article, three successful preceptors share their perspectives and insights about precepting, and a professional organization perspective is included to highlight the support for precepting student pharmacists. CONCLUSION: Additional introductory and advanced quality pharmacy experiential practice sites are needed, and pharmacists are encouraged to contact nearby pharmacy schools to become preceptors.

Attitude of Health Personnel↗
PubMedDate not supplied

Patient counseling provided in community pharmacies: effects of state regulation, pharmacist age, and busyness.

OBJECTIVE: To describe the nature and extent of patient counseling in community pharmacies and determine whether current counseling practices are influenced by pharmacist and pharmacy characteristics and variations in state regulation of patient counseling. DESIGN: Observational, cross-sectional study. SETTING: 306 community pharmacies in eight states. PARTICIPANTS: Trained shoppers (acting as patients). INTERVENTIONS: Three new prescriptions were presented in each pharmacy, and regression techniques were used to analyze the effects of pharmacist age, pharmacy type, and busyness; whether written information was provided; and "intensity" of a state's patient counseling regulation as measured by its scope, stringency, and duration. MAIN OUTCOME MEASURES: Whether any or all of these events occurred: pharmacist talked with shopper, oral drug information was given, oral risk information was given, and/or questions were asked to assess shopper understanding; number of informational items mentioned (range 0-7) was also recorded. RESULTS: About 63% of the shoppers were given oral drug information (mean = 2.3 items). Shoppers with a younger responsible pharmacist were more likely than other shoppers to receive risk information, a higher number of informational items, and assessment of understanding. While pharmacy type was unrelated to counseling, busyness reduced the odds of any pharmacist talk, oral information-giving, and assessment of understanding. Counseling practices varied significantly according to the intensity of a state's counseling regulation, with frequency of any information provision climbing from 40% to 94% as states' counseling regulations increased in intensity. More intensive regulations also increased the likelihood of any pharmacist talk, any provision of risk information, any assessment of shopper understanding, and amount of oral information given. CONCLUSION: Counseling varied significantly according to intensity of state regulation, pharmacy busyness, and age of responsible pharmacist. These results present important challenges to state boards of pharmacy, pharmacy associations, managers, and individual practitioners who are in a position to improve this important element of patient care.

Age Factors↗
PubMedDate not supplied

Effects of empowerment on pharmacists' organizational behaviors.

OBJECTIVE: To investigate the effects of power factors, need for achievement, and empowerment on commitment, loyalty, identification, and job turnover intention among pharmacists. DESIGN: Cross-sectional study. SETTING: United States. PARTICIPANTS: 447 licensed pharmacists nationwide. INTERVENTION: Self-administered questionnaire. MAIN OUTCOME MEASURES: Structural equation modeling was used to assess the fit of the theoretical model and examine the effects of empowerment on pharmacists' behaviors within their organizations using pharmacists' self-reports. RESULTS: An overall response rate of 42.2% was obtained. The test of the hypothesized model using structural equation modeling resulted in a satisfactory fit. The effects of power factors and need for achievement on psychological empowerment (gamma11 = .75, gamma12 = .27) and structural empowerment (gamma21 = .81, gamma22 = .20) were examined. Also, the effects of psychological empowerment and structural empowerment on loyalty (beta31 = .05, beta32 = .69), commitment (beta41 = - .09, beta42 = .92), and identification (beta51 = .05, beta52 = .78) were analyzed. Finally, the effects of loyalty (beta63 = -.24), commitment (beta64 = -.74), and identification (beta65 = .35) on job turnover intention were assessed. CONCLUSION: Kanter's theory, which maintains that structures within organizations have an impact on organizational behaviors, was supported by our findings. Pharmacists' organizational behaviors such as commitment, loyalty, identification, and job turnover intention are influenced by structural empowerment. Given the pharmacist supply-and-demand imbalances of the past few years, organizations should make every effort to retain the pharmacists currently in their employ.

Cross-Sectional Studies↗