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PubMed2001

Pharmacists' preferences for continuing education and certificate programs.

OBJECTIVE: To conduct an assessment of the needs and interests of West Virginia pharmacists with respect to continuing education (CE) and certificate programs (CP) versus a nontraditional PharmD program (NTP). METHODS: A cross-sectional study was conducted. The survey was mailed to 2800 West Virginia University School of Pharmacy alumni and West Virginia licensed pharmacists. The survey collected data pertaining to pharmacists' perceptions for the needs of CE, CP, and the NTP program; the optimal structuring of these programs; and the demographics of participants. RESULTS: A 24% (674) usable response rate was achieved from two mailings. Respondents were asked to address all areas of interest: approximately 75% showed interest in enrolling in CE, 45% in CP, and 40% in the NTP program. Interest levels varied across demographic and practice characteristics. Seven methods of instruction were evaluated by pharmacists, with live lectures being the most preferred for both CE and CP. Interest for specific content areas and topics for CE workshops and CP were identified. The type and amount of employer support and willingness to pay for enrollment in the two types of programs were obtained. Markets' needs for CE and CP were identified for five typical pharmacists' profiles (e.g., staff pharmacists in community practice). CONCLUSIONS: Results can be used by CE providers to develop CE and CP programs of most interest to pharmacists and target them to appropriate demographic segments in order to be cost-effective.

Adult↗
PubMed2005

Impact of the clinical pharmacist on readmission in patients with acute coronary syndrome.

BACKGROUND: Previous studies have reported a positive impact of pharmacists on care of patients with chronic illnesses. The impact of the clinical pharmacist on hospital readmission in patients with acute coronary syndromes (ACS) has yet to be evaluated, as of this writing. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on cardiac-related readmission in patients admitted to the general cardiology unit with ACS. METHODS: A prospective, nonrandomized observational study compared patients who received standard practice care with patients admitted to a service with a clinical pharmacist to provide care at the bedside. Patients admitted to and discharged from the general cardiology unit for ACS were included. The primary endpoint of the study was cardiac-related readmission at 30 days following hospital discharge. Secondary endpoints included length of stay and medication utilization. Interventions provided by the clinical pharmacist in the study group were documented. RESULTS: Cardiac readmission at 30 days was similar between the groups (p = 0.59). In the subset of patients with unstable angina, readmission in the study group was significantly lower than in the control group (1.3% vs 9.1%; p = 0.04). Patients in both groups were similarly managed using drug therapy and invasive coronary interventions. The medical staff's rate of acceptance of recommendations provided by the pharmacist was 94.4%. The most common interventions were medication education and identification of indicated therapy. CONCLUSIONS: The addition of pharmacists did not decrease readmission in patients with ACS. The finding of significant reduction in readmission in the subset of patients with unstable angina should be considered "hypothesis generating" for future randomized studies to confirm the results.

Acute Disease↗
PubMed2005

Attitudes of Australian pharmacists toward complementary and alternative medicines.

BACKGROUND: The increase in the use of complementary and alternative medicine (CAM) by the general public has led to increasing interest in how health professionals view these therapies. OBJECTIVE: To determine the knowledge and attitudes of pharmacists toward CAM. METHODS: An anonymous, self-administered questionnaire was designed and mailed to 1500 randomly selected pharmacists in New South Wales, Australia. RESULTS: Four hundred eighty-four responses were received, with 77% of respondents indicating that they had personally used CAM and 60% correctly identifying that CAM was comprised of more than just botanicals and nutritional agents. The most commonly used CAMs were herbal and vitamin supplements (74%), which was significantly above use of the next most frequent CAM, massage therapy (6%). Most pharmacists (71%) reported offering CAM products for sale; however, 27% of these practices did not have access to CAM information for pharmacy staff or patients. Pharmacists generally viewed CAM positively and believed that they enhanced the customers' image of pharmacy (57%), increased customer numbers (87%), and could increase annual sales (72%). Ninety-one percent of respondents believed that it is necessary for pharmacists to have knowledge of both CAM and conventional medicine to be able to inform patients about their treatment options. Books and journal articles were their primary information sources, with the main reasons for recommending CAM evidence of efficacy and to maintain general health. CONCLUSIONS: CAM use is prevalent among Australian pharmacists. While pharmacists are aware of their role as educators about both CAM and conventional medicines, there is a need for greater access to CAM resources and education on these therapies.

Adult↗
PubMed2006

Pharmacotherapy interventions undertaken by pharmacists in the Fleetwood phase III study: the role of process control.

BACKGROUND: The Fleetwood Model incorporates prospective review, direct communication with the prescriber, and formalized pharmacotherapy planning in patients at highest risk for medication-related problems. OBJECTIVES: To describe the intervention activities performed by consultant pharmacists and dispensing pharmacists in the context of the Fleetwood Phase III Study. METHODS: We report on a total of 4272 residents living in 12 nursing homes included in the intervention arm of the demonstration project. The intervention period was January through December 2004. Using pharmacotherapy planning software with a Web-based interface, daily interchange of information from the commercial pharmacy software, as well as laptop-based software for use in the nursing homes, pharmacists documented the reason for the intervention, the level of service, and the extent to which the recommendations were accepted. RESULTS: There were 2118 Fleetwood interventions performed on 4272 residents (intervention rate: 9.48/100 resident months), with 81% of interventions performed by consultant pharmacists. The top 5 reasons for Fleetwood interventions by dispensing pharmacists were: missing information/clarification needed (19.8%), drug-age precautions (14.4%), excessive duration alert (9.5%), suboptimal regimen (8.7%), and laboratory test needed (7.3%). The top 5 reasons for involvement of the consultant pharmacists were: laboratory test needed (13.1%), missing information/clarification needed (13%), unnecessary drug (10.3%), product selection opportunity (10.3%), and excessive duration alert (9.1%). CONCLUSIONS: Extending the federally mandated medication review process in nursing homes to incorporate elements of the Fleetwood Model is possible. The recommendation acceptance rates for pharmacist interventions are high.

Community Pharmacy Services↗
PubMed2004

[Pharmacists' knowledge of sanitary legislation and professional regulations].

OBJECTIVE: To characterize the profile of pharmacists employed as technical supervisors in drugstores and evaluate their knowledge regarding certain aspects of the legislation controlling drugstores and the profession in general. METHODS: Based on 175 drugstores in the city of Ribeirão Preto, southeastern Brazil, 100 pharmacists/technical supervisors were randomly selected. Data collection was done by means of in-person interviews, and was guided by a questionnaire evaluating knowledge and attitudes. Data were processed and analyzed using Epi Info and Stata software. Associations were sought between dependent and independent variables using Pearson's chi-squared and Fisher's exact tests. RESULTS: Most pharmacists were women (64%), aged 22-29 years (47%), graduated approximately three years prior to data collection, trained to work in the pharmaceutical industry (36%) or in clinical analysis (29%). Pharmacist's knowledge of sanitary legislation was considered as insufficient for 28% of subjects, regular for 50%, and good for 22%. Low levels of knowledge were observed regarding the legal requirement for the presence of a pharmacist during the entire drugstore opening hours, pharmacists' attributions, sale of antibiotics, and penicillin administration. It was found that most professionals have difficulties handling the concepts of 'generic' and 'similar' drugs. Low level of knowledge was not associated with any of the independent variables, indicating that this is a generalized phenomenon, i.e., one present among pharmacists of all age groups and both sexes, irrespective of the time since graduation, institution attended, and modality of graduation, among others. CONCLUSIONS: We conclude that training in the field of drug pharmaceutical care, during undergraduate studies and, especially, during traineeship in pharmacies and drugstores is deficient. It is necessary to divulge information concerning sanitary legislation so that pharmacists may fully exert their profession, without risk of legal threats or hazard to the population.

Adult↗
PubMed2001

Pharmacists' assessment of dispensing errors: risk factors, practice sites, professional functions, and satisfaction.

Certain demographic, practice, staffing, and pharmacist satisfaction variables may contribute to dispensing errors. A survey was randomly mailed to 7298 (50%) Texas pharmacists, of which 2862 were returned (39% response rate). Responders were 2437 pharmacists who indicated that they were in practice. Of these, 535 (23%) reported no risk to patients for dispensing errors and 793 (34%) reported at least one patient/week was at risk for such an error. There was a positive relationship between number of prescription orders filled/hour and the estimated risk of dispensing errors (r(s)=0.285, p<0.001). Pharmacists practicing in mail service pharmacies (risk score = 1.85 +/- 1.32), traditional chain store pharmacies (1.66 +/- 1.18), and hospital pharmacies (1.61 +/- 1.09) reported a higher risk than other groups. Pharmacists practicing in independent community pharmacies (0.75 +/- 0.84), home health care (0.83 +/- 0.99), grocery chain store pharmacies (1.30 +/- 0.96), and mass merchandise chain store pharmacies (1.30 +/- 1.08) reported a lower risk (H=260, df=8, p<0.001). Nine job satisfaction variables were strongly associated with the risk of dispensing errors (r(s) = between -0.3 and -0.422, p<0.001), as were prescription volume, practice site, staffing, training, pharmacist functions, and professional organization membership. The results of this survey should help pharmacists and management develop specific plans for reducing the risks of dispensing errors. These data should be useful for more in-depth study of such errors.

Chi-Square Distribution↗
PubMed2003

Pneumococcal vaccination in hospitalized elderly patients: role of the pharmacist.

OBJECTIVES: To identify factors associated with receiving the pneumococcal vaccine before admission among hospitalized elderly patients and to determine patient perceptions about the role of the pharmacist in advocating its use. METHODS: One hundred sixty elderly (> or = 65 yrs) patients hospitalized during the first 4 days of each month over a 5-month period were interviewed in person to obtain data regarding their attitudes toward receiving the vaccine, knowledge about it, access to health care, health status, and interaction with a pharmacist. RESULTS: Half of the patients had received the pneumococcal vaccine before hospital admission. Patient awareness of the vaccine and physician recommendation significantly predicted vaccination; health status and access to care did not. Provider communication to patients regarding the benefit of the vaccine was a significant factor leading to awareness about the vaccine, thereby resulting in a higher likelihood of vaccination. Half of the nonvaccinated patients were willing to receive the vaccine according to the pharmacist's recommendation. Although many patients preferred to receive the vaccine at their physician's office, nearly 40% had no preference or even preferred the pharmacy. However, only half of the patients had interacted with a pharmacist in the past, and only 20% were aware that some pharmacists are certified to administer the vaccine. CONCLUSIONS: Pneumococcal vaccine coverage is low among hospitalized elderly patients despite the presence of many comorbid conditions that place them at risk and are indications for the vaccine. The pharmacist as a provider can help increase vaccination coverage by recommending and offering the vaccine. Improvements in the level of pharmacist-patient interaction and promoting patient care services to the public are needed.

Aged↗
PubMed2004

Severe acute respiratory syndrome (SARS): the pharmacist's role.

OBJECTIVES: After two outbreaks of severe acute respiratory syndrome (SARS) occurred in Toronto, Ontario, Canada, from March-June 2003, we reviewed the unexpected role and responsibilities of pharmacists during these two crises, and present strategies for better crisis preparedness. METHODS AND RESULTS: Pharmacists were actively involved in battling the SARS crises. After conducting extensive literature searches and evaluations, pharmacists prepared administration and dosing guidelines for the two investigational drugs, ribavirin and interferon alfacon-1, that were being used to treat the syndrome. They provided direct patient care under modified conditions. They revised drug distribution procedures and developed new ones to meet more stringent infection-control standards. Collaborative teamwork with key stakeholders was important in accomplishing tasks in an efficient and timely manner. Regular communication with health care staff took place internally and externally. Education and updated information for pharmacists was crucial. CONCLUSION: Pharmacists can play a vital role during crises in the areas of drug distribution, drug information, and direct patient care. Collaborative teamwork and close communication are keys to success. Pharmacists must be proactive and take a leadership role in assuming pharmacy-related responsibilities. By evaluating what worked and what didn't, pharmacists can develop procedures for future crises requiring pharmacy support.

Anti-Infective Agents↗
PubMed2007

Provision of pain management by a pharmacist with prescribing authority.

PURPOSE: The clinical and financial outcomes of a pain clinic managed by a pharmacist with prescribing authority are described. SUMMARY: Pharmacist clinicians in a for-profit, integrated health system recently received permission to bill for their services in certain ambulatory clinics. A pharmacist clinician, who had an individual Drug Enforcement Administration number and whose services are billable under New Mexico law, was chosen to assume the medication management responsibilities in a clinic where 90% of the patient population is treated for chronic non-cancer-related pain. No additional personnel were needed, and no additional space was required, eliminating overhead for the space and utilities needed for operating a new clinic. With the ability to bill for the pharmacist clinician's services, a new model for justification of clinical pharmacy services was developed for the ambulatory care clinics. The revenue generated was tracked by a medical billing system, and clinical outcomes were tracked using the clinic's database for patients' individual visual analogue scale (VAS) pain scores. Between June 2004 and June 2005, an average of 18 patients were seen by the pharmacist clinician each day. The clinic generated 107,550 dollars of actual revenue and saved the health plan over 450,000 dollars. There was a consistent decrease in mean VAS pain scores with continued visits. CONCLUSION: Patients with chronic non-cancer-related pain were managed effectively by a pharmacist with prescribing authority and refill authorization in a pain management clinic. The favorable clinical outcomes, revenue generated, and cost savings achieved justified the pharmacist clinician's services in this health system.

Drug Prescriptions↗
PubMed1994

Dispensing physicians and prescribing pharmacists: economic considerations for the UK.

Recent years have seen an increase in the number of dispensing physicians in the UK. There have also been suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed and that pharmacists should take a more active role in the provision of drugs. General medical practitioners and pharmacists have common ancestry in the medieval spicers, who dispensed medicines and offered medical advice. Rural practitioners have been allowed to dispense drugs since 1911. Physician dispensing can benefit patients via savings in time and the monetary cost of visiting a pharmacist, but it restricts drug choice, can compromise safety, and encourages overprescribing except for physicians with drugs budgets. The effects of physician dispensing on government costs are not yet clear. Over-the-counter (OTC) purchase can save patients the cost of a physician visit and reduce drug costs to some patients, but it can also provide an incentive to pharmacists to profit twice from a drug, at government expense. Switching drugs from prescription-only to OTC reduces the government drug bill, but provides an incentive to pharmacists to overprescribe, and may not be as safe for patients. Liberalising prescribing by doctors would discourage community pharmacies which provide an advisory service to patients. Liberalising OTC switches would reduce opportunistic assessment of patients by doctors and could compromise patient safety. Separation of physician and pharmacist functions is probably safer for patients. It is concluded that the current situation in the UK, whereby most dispensing is done by pharmacists, is the preferred option other than for those patients who do not live within easy access of a pharmacy. A reassessment of the legal status of drugs and subsequent OTC switch of drugs used to treat minor self-limiting illnesses is also favoured.

Cost-Benefit Analysis↗
PubMed1987

An equity model of staff pharmacists' job satisfaction.

Secondary analysis of data obtained during the 1982 Socioeconomic Survey of California pharmacists examined staff pharmacists' satisfaction with their job and with their employers' compensation practices. A systematic sample of licensed pharmacists residing in California was surveyed. Usable data from 208 staff pharmacists was analyzed. School of pharmacy, gender, practice setting and academic degree did not have a statistically significant effect upon pharmacists' overall job satisfaction when examined individually. When examined all together, only academic degree made a statistically significant difference in the level of job satisfaction. Pharmacists making less than the 25th wage percentile were less satisfied with their employers' compensation practices. For the entire sample of pharmacists, the factors having the greatest impact on general job satisfaction were: (1) satisfaction with compensation practices; (2) percent of time spent in patient care functions; and, (3) percent of time spent in purchasing and receiving. Academic degree did not contribute significantly to the prediction of job satisfaction.

California↗
PubMed2006

Job satisfaction and stress among pharmacists in the long-term care sector.

OBJECTIVE: To provide normative information regarding levels of job satisfaction and stress between consulting and dispensing pharmacists in the long-term care arena. DESIGN: Cross-sectional. SETTING: United States. PARTICIPANTS: All current members of the American Society of Consultant Pharmacists as of March 2005. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Health Professional Stress Inventory. RESULTS: More than 90% of consultant pharmacists were satisfied with their jobs. The most frequently reported source of stress among the pharmacists was short staffing, affecting their ability to perform their duties. More than one-third of dispensing pharmacists were often stressed, frequently because of the need to keep up with developments to maintain professional competence. CONCLUSION: Pharmacists serving the long-term care sector are very satisfied. Methods to assist dispensing pharmacists to keep up with practice developments must be explored. Whether or not new models of long-term care pharmacy improve job satisfaction must be explored.

Consultants↗
PubMed1998

Attitudes to and use of a modified prescription form by general practitioners and pharmacists.

OBJECTIVE: To evaluate the rate of use and acceptance of a new prescription form designed to provide more information to pharmacists and patients. DESIGN: Prospective descriptive study. SETTING: A semi-rural community outside Melbourne, Victoria, in November 1994. PARTICIPANTS: GPs and pharmacists working three or more sessions per week in the locality, and 21 consumers who formed two consumer focus groups. INTERVENTION: An education session for GPs and pharmacists, followed by a one-month trial of new prescription forms which included notations to facilitate interprofessional communication. MAIN OUTCOME MEASURES: Rate of use and acceptability of the new prescription notations. RESULTS: Eighteen GPs and 10 pharmacists participated; 3600 forms were issued and 2521 prescriptions, including 3464 prescription items, were analysed. GPs and pharmacists used at least one of the new prescription notations in 45% (1559) of prescription items; 35% of prescription items (1222) were notated with the general purpose of the medication. Qualitative findings suggested that GPs, pharmacists and consumers considered the new prescription form to be beneficial and useful. CONCLUSIONS: A modified prescription form to increase communication between GPs and pharmacists is acceptable in clinical practice.

Abbreviations as Topic↗
PubMedDate not supplied

The pharmacist's role in the medicinal management of depression.

AIM: To elicit pharmacists' perceptions of medication management for people who have been prescribed medication for depression. METHOD: A questionnaire survey of 103 mainly community pharmacists was used. RESULTS: People frequently approached pharmacists for information about a range of issues concerning antidepressant medication. Although pharmacists were knowledgeable about all aspects of pharmacological interventions, many felt their location in the commercial sector inhibited the amount of assistance they could provide. Barriers to providing information were identified, and the paucity of pharmacists' links with primary care teams exposed. CONCLUSION: The survey supports other studies that have suggested pharmacists could provide considerable assistance in helping people to understand their medication and its benefits. There is also discussion of the ways in which the future role of pharmacists could be developed so that they collaborate more closely with other healthcare professionals.

Antidepressive Agents↗
PubMed1999

[The clinical pharmacist in internal medicine--impact on the quality of therapeutic care].

Several studies have documented the impact of clinical pharmacy services on patient care and drug costs in hospital wards. However most hospitals in Israel do not provide such services and until recently their benefits in local health care have not been demonstrated. We therefore determined whether the activity of a pharmacist in the medical department of a medical center leads to improved quality of drug utilization and reduced costs. During the first 3 months of the clinical pharmacist's work all interventions and consultation were documented. The effect of these interventions on drug costs was calculated by the change in drug acquisition costs during the study period compared with those of preceding months, as well as in the other 5 medical departments of the hospital without clinical pharmacy services. During the study period the pharmacist joined 44 clinical rounds in which he documented 40 consultations in response to physicians' requests for drug information and 42 interventions on his own initiative. The pharmacist's recommendations were accepted in 38 of the 42 cases (90%). In 10 cases the pharmacist's initiative in improving the quality of drug therapy led to an increase in drug acquisition costs. However, the overall drug costs during the study period decreased 12.6%. During the same period drug costs in the other medical departments decreased only 2.2%. The results of this study conform with those of many other studies that show a beneficial impact of the clinical pharmacist on the quality of drug therapy and on drug costs. They indicate that the clinical pharmacist can play a crucial role in the medical department.

Consultants↗
PubMed1979

Pharmacist as team leader for total parenteral nutrition therapy.

A total parenteral nutrition program in a 635-bed private nonteaching institution which uses the pharmacist as team leader is described. To initiate TPN therapy, the attending physician writes a request for a consulation with the pharmacist. Prior to initiation of TPN therapy, the pharmacist reviews the chart, conducts a physical and nutritional assessment of the patient, orders any laboratory tests needed for further assessment of the patient and uses these results to classify the patient's nutritional status. The pharmacist then writes all TPN-related orders, including orders for laboratory tests and nursing care. Communications between the pharmacist and the attending physician concerning the progress of the patient and TPN changes are conducted orally on rounds and via chart notes. The number of patients receiving TPN therapy has increased each year--from six patients during 1976, to 19 patients during 1977 and 54 in 1978. Of the two preventable complications that developed in these 79 patients, both were quickly resolved by the pharmacist. Physicians who, in the past, opted not to place patients on TPN because of lack knowledge or lack of a TPN consultant, now rely on the pharmacist for this service.

Florida↗
PubMed2000

[How do pharmacists evaluate the newly introduced system of substituting prescriptions?].

In 1997 a new prescription system was introduced in the Danish health care system. The pharmacist must now substitute a prescription with a cheaper version of the drug (either generic or original) unless the prescribing doctor indicates that substitution is not allowed in the specific case. The purpose of this study was to evaluate problems of the system and obtain the pharmacists' views on the system. The study was based on questionnaires to a representative sample of 75 pharmacists (a quarter of Denmark's pharmacists). The response rate was 72%. Half of the pharmacists were dissatisfied with the system, which primarily was due to the excessive workload imposed. In spite of this, about half the pharmacists wanted the system to be continued, because the overall purpose of finding the cheapest drug for the patient is good. Nearly all pharmacists thought that analogue substitution (substitution between drugs with the same overall effects but obtained by different means) should not be introduced.

Adult↗
PubMed2001

Attitudes and practices of pharmacists towards emergency contraception in Durban, South Africa.

Emergency contraception, which is used to prevent pregnancy following unprotected intercourse, could prove invaluable to a country like South Africa which has high fertility and pregnancy rates. However, the success of emergency contraception is dependent on the awareness, knowledge, attitudes and practices amongst health-care providers and the public towards it. The aim of this study was to assess the attitudes and practices of community pharmacists towards emergency contraception. The study was conducted in North and South Central Durban, South Africa. This questionnaire-based study sought from pharmacists the frequency of demand and supply of emergency contraception, as well as their attitudes and practices towards it. The sample included all 182 pharmacies located in the study area. A total of 96% of pharmacists had received requests for emergency contraception within the last year. On average, each pharmacist received 177 requests for emergency contraception. Sixty-nine per cent of pharmacists were in favor of making emergency contraceptive pills available without a prescription, 62% were already supplying emergency contraceptive pills without a prescription and 67% felt that it was important to increase public awareness regarding emergency contraception. Ninety-one per cent of pharmacists did not have any literature regarding emergency contraception to hand to clients, 68% had a private area in their pharmacy to counsel patients and 86% of pharmacists indicated that they discussed long-term contraception with clients. This study is the first in South Africa aimed at determining the utilization of emergency contraception. However, further studies are required in order to ascertain information that will assist in changing current health policies to improve those in reproductive health care.

Attitude of Health Personnel↗