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PubMed2002

The clinical pharmacist as a preceptor in a family practice residency training program.

BACKGROUND: According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. METHODS: A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. RESULTS: Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most common therapeutic categories encompassed cardiovascular, psychiatric, infectious disease, and neurologic disorders. Seventy-six percent of questions were answered using clinical knowledge and experience, while 24% were based on published resources. CONCLUSIONS: Based on more than 2,000 precepting encounters between a faculty pharmacist and family practice residents, most encounters represented requests by residents for information on general drug management of diseases. The pharmacist answered most questions based on clinical knowledge and experience. Evaluations of the pharmacist by the residents indicated that she is an effective teacher and useful in helping take care of patients.

Data Collection↗
PubMed2003

Assessment of patient and pharmacists attitudes in Bulgaria regarding herbal medicinal products.

The study aimed at analyzing patients and pharmacists attitudes regarding herbal medicinal products (HMP) in Bulgaria and focus on two main questions: why patients or pharmacists prefer or do not prefer HMP; what are the main sources of information for patient and pharmacists. The inquire research is organized with two similar questions (for patients and for pharmacists) in 10 randomly selected country areas in 5 types of pharmacies. The results shows that HMP are preferred more in aging patients groups suffering from chronic diseases or careful to their healthy condition. In case of acute diseases patients are more disposed to buy modern medicine. The high level of positive attitudes towards HMP (60% of patients and 73% of pharmacists) could explain the growth in their market share during the last 10 years but did not correspond with the low volume of HMP kept on stock. It also did not correspond to the preference in 56% of all cases towards modern medicines. In general pharmacists also recommend HMP for chronic diseases or in case of light disorders. Availability and reliability of information for HMP is insufficient for patients and pharmacists as well. They need more independent sources of information especially for newly registered HMP with herbs from different geographic origins. Scientists and regulatory agencies should expand their efforts in providing appropriate and reliable information to the society and professionals.

Attitude↗
PubMed1992

General practitioners' views on the role of the community pharmacist.

AIM: to determine the views of general practitioners on the roles and activities of community pharmacists. METHOD: the views of 137 general practitioners in Otago and Southland were canvassed by postal questionnaire. RESULTS: one hundred and three completed questionnaires were returned. All of the general practitioners reported that their professional contact with pharmacists was useful. Seventy-five percent expressed a desire for greater cooperation. Nearly all respondents (99%) accepted that pharmacists have a role in screening prescriptions for possible problems and preparing and dispensing medicines. They also accepted that pharmacists were capable of treating and advising in the management of minor illnesses. Providing drug information to general practitioners, information about previously diagnosed conditions to patients, and advice on personal and home hygiene were less widely accepted activities. The majority indicated that they considered it inappropriate for pharmacists to undertake screening programmes (blood pressure (70.6%), cholesterol (70.6%), glucose (60.8%), haemoglobin (72.5%)). Younger general practitioners objected more often than older general practitioners to reclassification of Acetopt eye drops from prescription only to availability through pharmacies (p < 0.05). Female general practitioners were more often in favour of reclassification of Gyno-Daktarin than their male colleagues (p < 0.05). CONCLUSION: this study shows that general practitioners accept several aspects of the current role of pharmacists in providing primary health care. However, there is room for improved communication between general practitioners and pharmacists to ensure optimum patient care.

Adult↗
PubMed1992

Comparison of two systems for documenting pharmacist interventions in patient care.

Manual and computerized systems for documenting interventions by pharmacists at a large university teaching hospital are compared. The manual system allows patient data and pharmacist interventions to be quickly documented on written profiles. Completed forms are entered into a personal computer for analysis. The computerized system is a direct-entry version of the manual intervention log. Five screens allow pharmacists to enter information into a mainframe computer from any terminal. Data can be downloaded from the mainframe into a personal computer. During the first part of the study, nine pharmacists used the manual system for seven days. After a two-week pause, the same pharmacists used the computerized system for seven days. The systems were evaluated by using time-and-motion analysis and a questionnaire. Also, the number of interventions documented and the characteristics of each were compared. The mean +/- S.D. time required to document an intervention was significantly less with the computerized system (81.8 +/- 24.9 seconds) than with the manual system (100.7 +/- 37.3 seconds). Administrative time for analysis and report generation was also less with the computerized system. The pharmacists rated the computerized system more highly in terms of ease of use, accessibility, time efficiency, and acceptability. The number of interventions documented did not differ between the systems. A computerized system for documenting pharmacist interventions compared favorably with a manual system.

Chicago↗
PubMed2005

[Links between profession and family in the community of Lithuanian pharmacists at the end of 19th and the beginning of 20th centuries].

Little research has been carried out in the sphere of the relations between a pharmaceutical career and family in the historiography of pharmacy history. A peculiar influence of family on the choice of the pharmaceutical way of life came into existence in the period of Lithuanian national revival at the end of the 19th century and the beginning of the 20th. This article aims to reveal the relations between a Lithuanian family and pharmaceutical career, to analyze the influence of political, social, economic factors on these relations. At the end of the 19th century and the beginning of the 20th the resistance of Lithuanian peasants against Russification, Polonification manifested in their objective to form Lithuanian intelligentsia. Priestly seminaries became the major centre for preparing new Lithuanian intelligentsia. It was prestigious to become a priest. Moreover, this profession guaranteed material wealth. Young people often left the seminary and started their work in pharmacies where they got a shelter and small 5 rubles earning of a pharmacy apprentice. Such runaways from parents settled in the university cities of czarist Russia and had a purpose to become self-dependent (i.e. to get education) without parents' support. The choice of a woman-pharmacist career, however, was greatly influenced by the profession of her husband. Some educated Lithuanian pharmacists encouraged their wives to choose the same specialty as theirs but such occasions were rare. Sometimes it happened so that pharmacists married, but there were only few Lithuanian women-pharmacists or assistants of pharmacists, and in the period of Lithuanian national revival the point of view on ethnically mixed families was negative. This article discusses about the career of women-pharmacists and the influence of family on the choice of a profession, as well as Lithuanian point of view on ethnically mixed families of pharmacists.

Career Choice↗
PubMed2005

[Fragments of information of Naoe Okamoto - the life of one of Japan's first female pharmacists.].

It has generally been believed that Naoe Okamoto of Fukui Prefecture, who was licensed to open a pharmacy in December 1885, was Japan's first female pharmacist. However, there has been no way to confirm this because the pharmacists' registry held by the Ministry of Internal Affairs was destroyed by the Great Kanto Earthquake in 1923. This paper describes a hazy picture of her life, which we traced based on fragments of information from the Tokyo University Pharmacy and Life Science (TUPLS), pharmaceutical journals of her time, and two residents of Fukui City who met her when they were children. Naoe Okamoto was born in Asuwakamicho, Fukui City, in 1870, as the eldest daughter of a druggist operating since the Edo Era. Born in a socially and economically privileged family, Naoe went to Tokyo and entered Tokyo Pharmacists School (currently TUPLS) in 1883 or 1884. After two-years' study, she passed the pharmacist certification examination held by the Tokyo Prefecture Government in the autumn of 1885 and received a license to open a pharmacy from the Minister of Internal Affairs. In 1886 or 1887, she overtook the family business and married a doctor. She got divorced shortly thereafter, but continued to manage the family business although she had a younger brother. She died in 1941 at the age of 71. Her house and all articles left by her were burned to ashes after an air raid by the US Army Air Corps in July 1945 during the Second World War. Naoe left her small native city in Fukui Prefecture to study pharmacy in the capital at the beginning of the Meiji Era, when it was extremely difficult for women to pursue a professional career. She obtained the license to operate a pharmacy and pursued her career as a pharmacist through the Meiji, Taisho and Showa Eras. Her life offers great courage and lessons to today's 139,000 female pharmacists in Japan. Naoe Okamoto should be remembered as a pioneer of female pharmacists at this turning point when the 6-year pharmacy education system is about to start.

Education, Pharmacy↗
PubMed2005

Structural equation modeling of qualification of pharmacists to improve subjected quality of life in cancer patients.

PURPOSE: To establish structural equation model (SEM) of subjected quality of life (QOL) in cancer patients taking into account qualification of pharmacists. METHOD: The SEM model was constructed from correlation matrix of the scores of answers of questions to both patients and pharmacists. Data were collected from 15 cancer patients who hospitalized and took opioid analgesics for pain control. The patients were asked 18 questions and pharmacists were asked seven questions. From the correlation matrix among scores of answers, a reasonable model was explored by SEM. RESULTS: Health-related QOL (HRQOL) in cancer patients can be modeled by latent variables consist of contributions from physical, emotional and functional domains. The fitting between data and the model was acceptable by statistical goodness-of-fit (GOF) index. The modeled HRQOL by SEM was weakly correlated with subjected QOL in patients, indicating that subjected QOL in patients would be affected not only by above latent variables but other variables. The model taking into account qualification of pharmacists to improve subjected QOL in patients was also made by SEM. The model was reasonably explained and fitting between data and the model was acceptable from some statistical index. The final model suggests that pharmacist can raise subjected QOL in patients through restraining unpleasant side effects. CONCLUSION: The qualification of pharmacists to improve subjected QOL in patients can be modeled by SEM. The final model suggests that pharmacists with qualification to assess patients' pain status contribute to raise subjected quality of life in cancer patients.

Aged↗
PubMed1978

Pharmacists' knowledge and attitudes regarding monitoring the behaviors of children with learning disabilities.

The attitudes and knowledge of pharmacists in Nebraska regarding children's learning disabilities were surveyed by questionnaire. One hundred thirty-three pharmacists responded. The results were analyzed according to type of practice (community, chain and hospital) and age (20--30 years, 31--40 years, 41--50 years, and 51 years and over). The results indicate that pharmacists are being asked about learning disabilities. Overall, 53% of the pharmacists responding had been asked about learning disabilities by parents, physicians, teachers or others. No significant interactions were found between the type of practice and age, and no significant main effect for type of practice was found in the ANOVA results for knowledge scores or attitude scores. Even though there were no differences owing to age in pharmacists' knowledge of learning disabilities, age was found to have a significant effect on attitudes toward increased pharmacist involvement in monitoring behaviors of learning-disabled children; the younger groups had a more positive attitude. The pharmacist seems to have the knowledge and attitudes required to become more actively involved in monitoring the medications and behaviors of children with learning disabilities.

Adult↗
PubMed1989

Pharmacist's role in home i.v. therapy.

The pharmacist's role in home i.v. therapy is described, and its relationship to the Medicare Catastrophic Coverage Act is discussed. Congress, in enacting the catastrophic coverage act, has recognized the need for pharmaceutical services in the provision of home i.v. therapy. Pharmacists must recognize their responsibilities in providing these services. These responsibilities include ensuring the quality of drug therapy, monitoring patient progress, advocating cost-effective therapy, and communicating with local health-care providers. Pharmacists should also educate hospital administrators about the effects of the act, suggest how the hospital can best provide home i.v. therapy, assume responsibility for overseeing the home i.v. therapy process, and help ensure compliance with the interpretive regulations of the act. Other responsibilities of pharmacists include educating potential beneficiaries about the need to pay the coinsurance and premiums for catastrophic coverage and advocating home i.v. therapy as a reasonable alternative to hospitalization. Pharmacists should become familiar with the Standards for the Accreditation of Home Care adopted by the Joint Commission on Accreditation of Healthcare Organizations because these standards may be considered when the conditions for provider participation are established by the Department of Health and Human Services. The home i.v. therapy provision of the catastrophic coverage act presents challenges for pharmacists. Appropriate pharmacist involvement should help reduce costs and ensure optimal health care.

Cost-Benefit Analysis↗
PubMed1989

Pharmacist-managed drug therapy in California hospitals.

To assess the effect of state legislation expanding the scope of pharmacy practice in health-care institutions, California hospitals were surveyed in 1982 and 1986 about pharmacists' regulation of drug therapy. Questionnaires were mailed to pharmacy directors at all hospitals in the state. The survey form explained that in pharmacist-regulated drug therapy, the pharmacist, under order or authorization of the prescriber, requests laboratory tests and initiates or adjusts drug dosage to obtain the desired therapeutic response; the questions were based on this definition. The response rates were 51.4% (292 of 568) in 1982 and 56.2% (329 of 585) in 1986. For the responding hospitals of most sizes and types, the percentage having pharmacist regulation of drug therapy increased; the largest increase was in the for-profit chain hospitals. In 1986, pharmacists were involved in regulating maintenance dosages in more than half of the responding hospitals (from 52% of hospitals with 50 or fewer beds to 86% of hospitals with 400-499 beds). The responses indicated that at least 50% of patients receiving aminoglycoside or warfarin therapy or total parenteral nutrition had their maintenance dosages regulated by pharmacists. The two surveys indicate that between 1982 and 1986 pharmacists became more involved in regulating drug therapy in California hospitals.

California↗
PubMed1988

Family practice physicians' perceptions of the usefulness of drug therapy recommendations from clinical pharmacists.

Family practice physicians' perceptions of the usefulness and clinical outcome of drug therapy recommendations made by clinical pharmacists in a family medicine clinic were determined. For 15 weeks, pharmacists in the clinic recorded all consultations in which they made recommendations about the drug therapy of specific patients. At the time of each consultation, the pharmacists gave the physician a questionnaire designed to gauge the physician's opinion of the usefulness of the consultation. Physicians who implemented the recommendations were sent a second questionnaire and asked to indicate the extent to which the clinical pharmacist influenced their decision to implement the recommendation, the effect the recommendation had on the patient's clinical status, and the usefulness of the recommendation to the patient in ways unrelated to clinical status (such as greater patient acceptance, safety, or lower cost). Five clinical pharmacists provided 59 consultations to 33 physicians. The physicians rated 51 (88%) of the consultations as very useful, and they implemented 78 (98%) of the 80 recommended actions. Of the 56 physicians who attributed their decision to implement the recommendation to their consultation with the clinical pharmacist, 43 believed that the recommendations had improved the clinical status of the patient, and 38 believed that the recommendations were useful to patients in ways unrelated to clinical status. Physicians in a family medicine residency training program had positive perceptions of the usefulness of drug therapy recommendations made by clinical pharmacists. A majority of the physicians believed that the recommendations had a positive effect on patients' clinical status.

Attitude of Health Personnel↗
PubMed1986

Activity analysis of decentralized pharmacists in a unit dose dispensing and drug-administration program.

The relative amount of time spent by pharmacists on specific activities related to a pharmacy-coordinated drug administration and dispensing program in a 1000-bed tertiary-care teaching hospital was determined. Discrete activities of decentralized pharmacists involved in the program were defined using information from published reports and a short pilot study. Using a work-sampling technique, two pharmacy residents who had been trained to work as decentralized pharmacists performed instantaneous observations of the activities of pharmacists on five patient-care floors over a one-month period. Neither weekend nor night-shift activities were observed. Approximately 26% of a pharmacist's time was spent coordinating drug administration activities, and another 25% was spent providing clinical consultation or drug information services or performing research. The remainder of pharmacists' time was spent in activities related to drug distribution, interprofessional communication, or miscellaneous tasks. A work-sampling method proved useful in quantifying the amount of time associated with pharmacists' activities in a pharmacy-coordinated drug administration program.

Hospital Bed Capacity, 500 and over↗
PubMed1986

Nine-year experience with a pharmacist-managed anticoagulation clinic.

A pharmacist-managed anticoagulation clinic is described, and information on patient outcome during a nine-year period is presented. Since 1974, a pharmacist has managed an anticoagulation clinic for ambulatory patients and inpatients at San Francisco General Hospital Medical Center. The pharmacist's primary responsibilities include the following: educating patients about their diseases and the importance of drug therapy, monitoring patients' vital signs, performing physical examinations, and adjusting warfarin dosage to maintain prothrombin times within the therapeutic range (1.7-2.5 times normal using control values of 1.0-1.2). These patients are also under the care of their primary physicians. The pharmacist's work is checked by the chief of the cardiac clinic at the end of each clinic session. The effectiveness of the pharmacist in managing clinic patients is reviewed periodically; from January 1975 through June 1984, the pharmacist had treated 140 patients (141 courses of therapy). Of 1792 prothrombin times taken during this time, 1060 (59.2%) were within the therapeutic range of 17-25 seconds, 510 (28.5%) were less than 17 seconds, and 222 (12.4%) were greater than 25 seconds. Only four major hemorrhagic events (0.002 hemorrhages per patient-treatment month) and 89 minor events (0.05 hemorrhages per patient-treatment month) occurred. The recurrence rate of thromboembolic events was 0.007 per patient-treatment month. Pharmacist-managed warfarin therapy in these clinic patients resulted in a level of anticoagulation control and morbidity that was acceptable to physicians.

Anticoagulants↗
PubMed1978

Pharmacist-managed patient assessment and medication refill clinic.

The effectiveness of a pharmacist in determining the appropriateness of prescription renewal for patients appearing at a hospital-based refill clinic was investigated. In part 1, data were collected on the clinic as it traditionally functioned with staff physicians evaluating the patients. In parts 2 and 3, data were collected with the pharmacist assuming the assessment function. In part 2, a physician reviewed the pharmacist's decisions before the patient left. In part 3, the pharmacist functioned without supervision and the physician reviewed patient records retrospectively. Physician agreement with the pharmacist's decisions was the primary criterion for determining effectiveness, and was found to be 99% in part 2, for a total of 105 patients. In part 3, physician agreement remained at the 99% level for a total of 106 patients. Patient waiting time was about the same in each part of the study because of clinic procedures beyond the pharmacist's control. A pharmacist can be cost-effective in this role if the task is combined with regular pharmaceutical functions.

Cost-Benefit Analysis↗
PubMed1982

Comparison of pharmacist and physician prescribing for psychiatric inpatients.

Drug prescribing for inpatients by three certified pharmacist prescribers and two psychiatrists at a 40-bed mental health facility in California was evaluated. The pharmacist prescribers were assigned diagnosed patients whose treatment plan was primarily pharmacologic. For each prescriber, 60 prescriptions were randomly selected to include 20 neuroleptic drugs, 20 anticholinergic drugs used to alleviate the parkinsonism-like syndrome induced by neuroleptic drugs, and 20 antidepressants. A panel of four clinical judges independently evaluated the appropriateness of each prescription using explicit screening criteria; the judges' mean scores were reported. The patients treated by pharmacists and physicians were similar in age, sex ratio, number of drugs prescribed, and number of medical diagnoses. There was no significant difference in the appropriateness of prescribing between pharmacists and physicians for anticholinergic drugs, while mean scores for pharmacists were significantly better than physicians for neuroleptic and antidepressant drugs. The mean scores for all prescribers in most areas were in the appropriate range. While the results are not applicable to all pharmacists, the certified pharmacist prescribers in this study prescribed drugs for psychiatric inpatients as safely and appropriately as the physicians.

Antidepressive Agents↗
PubMed1978

Pharmacist's impact on chronic psychiatric outpatients in community mental health.

The impact of a specially trained pharmacist upon the treatment of chronic psychiatric outpatients being maintained within their communities was studied. The quantity and costs of the services provided were assessed as well as patient satisfaction and well-being. Three years of management information data from eight mental health centers were used to compare the medication monitoring services provided by pharmacists and psychiatrists. In a separate study of chronic psychiatric outpatients, patients treated exclusively by the pharmacist were compared with patients treated by other mental health professionals on measures of community adjustment and satisfaction with treatment. The pharmacist monitored the medications of about 200 chronic psychiatric patients each month. The cost of a pharmacist providing medication monitoring services was 40% of the cost of providing that service by a psychiatrist. The pharmacist's patients were found to be functioning in the community as well as or better than other patients and their reported satisfaction with treatment was at least that of other chronic psychiatric patients sampled. The psychiatric pharmacist in this study successfully monitored stabilized psychiatric patients within their communities.

Ambulatory Care↗
PubMed1982

Comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices.

A comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices is described. A peer review panel, composed of two family practice physicians and two clinical pharmacists not involved in the study, evaluated the appropriateness of management in 102 medication-related telephone calls. The effects of the following variables on the management ratings were determined by analysis of variance: (1) provider group (staff physicians, family practice residents, clinical pharmacists); (2) caller (patient, community pharmacist, third party, e.g., family member or friend); (3) type of medication-related telephone call (refill, new medication, drug information, or other); (4) consultation with another provider; and (5) recommendation for follow-up. Among the provider groups, a larger proportion of the calls to clinical pharmacists (72.6%) received the highest management rating of "appropriate, best alternative available" compared with staff physicians (39.7%) and residents (34.6%). Analysis of variance indicated that the management by clinical pharmacists was rated significantly more favorably than management by staff physicians or residents (p less than 0.05).] Statistical analyses also indicated that the differences in the management ratings among the provider groups were not explained by differences in the callers, type of medication-related call, consultation with another provider, or recommendation for a follow-up. These data suggest that clinical pharmacists may contribute substantially to improved patient-care through the management of medication-related telephone calls.

Community Pharmacy Services↗
PubMed1980

Printed drug information sources used by pharmacists in southeastern Michigan.

A survey to determine the type and number of printed resources used by community and hospital pharmacists in southeastern Michigan was made between June and September 1978. A self-administered questionnaire was mailed to 445 pharmacists from 77 hospitals and 296 community pharmacies. A total of 259 pharmacists (58.1%) representing 215 pharmacies (58.0%) responded. The results indicate that hospital pharmacists are likely to have more drug information resources to them than do community pharmacists. All pharmacists surveyed tended to use a narrow group of textbooks despite the variety of books available to them. The textbook most commonly used by both groups of pharmacists was Facts and Comparisons.

Drug Information Services↗