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PubMed1985

Clinical training program for staff pharmacists.

This study describes the development and evaluation of a clinical training program in the areas of pharmacokinetics and infectious diseases for staff pharmacists in a decentralized unit dose drug distribution system. Five staff pharmacists were trained and three other pharmacists served as controls. The teaching sessions consisted of eight 1-hour lectures per group of two to three pharmacists. The lectures were supplemented by handouts, reading assignments, and practical assignments. There was a significant improvement in posttest scores of the trained pharmacists when compared to their pretest scores and from the scores of the control pharmacists. In the Seattle VA Medical Center pharmacy, this program was shown to be successful, and a similar program can be used to train staff pharmacists in other clinical areas of interest.

Cross Infection↗
PubMed2003

[Evaluation of the impact of a clinical pharmacist on the quality and cost of pharmacotherapy in a general surgical department, the Hillel-Yaffe Medical Center].

BACKGROUND: Clinical pharmacy could be defined as an umbrella of services aimed at maximizing the pharmacotherapeutic effect, minimizing the risk for developing adverse drug effects and reducing drug expenditures for the health care system. Clinical pharmacists, in Israel and abroad, have been practicing in different health care settings aiming to implement the principles mentioned above. Most of the articles previously published reviewed the role of the clinical pharmacist in internal medicine wards or in intensive care units. This article focuses on the role of the clinical pharmacist in a general surgery department and the influence of this service on the quality and cost of pharmacotherapy and on intravenous antibiotic therapy in particular. AIMS: Improving the quality of pharmacotherapy while optimally using economic resources in a general surgery ward. METHODS: During September 1999 to August 2000, the clinical pharmacist joined physician rounds in the surgical ward. During the rounds he advised physicians about clinical and economical aspects of drug treatment, and collected data on his activity on a specific designated form. The data was processed on a central computerized database, and analyzed to determine the influence of the clinical pharmacist on clinical and economical outcomes. RESULTS: At the end of the study period the following were found: The pharmacist made 219 interventions. These included adverse drug effects, which were identified and/or prevented. When considering the economic data, a substantial reduction of 56% in intravenous antibiotic therapy was noted (direct saving of about 140,000 NIS). Such savings were accompanied by changes in the prescribing patterns in the department, which were translated into increased rate of oral antibiotic prescribing and reduction in the use of certain i.v. antibiotics while undamaging the quality of the pharmacotherapeutic effect. CONCLUSION: The results of this study indicate that participation of a clinical pharmacist during physicians rounds improved the quality of the pharmacotherapy, assisted in changing clinicians prescribing habits, and at the same time significantly reduced the direct expenditures on medications in general and of intravenous antibiotic therapy in particular.

Costs and Cost Analysis↗
PubMed1991

Inability to justify a part-time clinical pharmacist in a community hospital intensive-care unit.

The potential for justifying the cost of a part-time clinical pharmacist position was evaluated. Patients in the medical and surgical intensive-care units of a community hospital were monitored two hours per day for 32 weekdays by a part-time staff pharmacist. The pharmacist completed an initial review of the charts of all patients newly admitted to the units and further evaluated each medical record for at least five minutes each day to determine the need for drug therapy interventions. The pharmacist contacted physicians to make any recommendations for changes in therapy. At the end of the study, the pharmacist calculated the difference in the costs of the original and recommended drug regimens for all recommendations accepted by physicians. A total of 147 patients were monitored during the 32-day period. There were 122 recommended interventions for 60 patients, and 101 (83%) of these recommendations were accepted. Estimated drug cost savings totaled $1651.35, but the cost of the pharmacist, $2599.35, resulted in a net cost to the hospital of $948. There was no significant difference in drug cost savings with respect to the day of the week when the monitoring was performed, the time of day, or the interaction of day with time. A part-time clinical pharmacist in the intensive-care unit of a community hospital reduced the costs associated with drug therapy, but the savings realized were not sufficient to offset the cost of the position.

Drug Costs↗
PubMed1991

Program for training staff pharmacists in total parenteral nutrition.

A staff development program in total parenteral nutrition (TPN) is described. A 12-week education and training program was developed at a community hospital to enable staff pharmacists (those with B.S. degrees) to become involved in the pharmacy-based TPN service that has been in effect at the institution since 1978. Before 1987, the TPN pharmacist had always held a Pharm.D. degree. In the first four weeks of the program the trainee is allotted two hours per day for required reading. During the final eight weeks, the trainee accompanies a TPN pharmacist on daily rounds. A proficiency examination is given after week 10. Upon successful completion of the program, the pharmacist serves as a nutritional support therapy consultant to physicians who wish to have their patients evaluated, treated, and monitored by the TPN service. A quality assurance program was developed to enable the clinical coordinator in charge of the service to identify areas where further inservice education might be indicated and to satisfy requirements of the Joint Commission. Six staff pharmacists have completed the training program and are allowed to write TPN orders and conduct TPN rounds. The program has expanded the clinical roles of the staff pharmacists and has been well received by the medical staff. The quality assurance monitoring indicates that the service is excellent. A staff development program was successful in training staff pharmacists to participate in TPN therapy.

Education, Pharmacy, Continuing↗
PubMed1990

Documenting pharmacists' interventions on a hospital's mainframe computer system.

The development and implementation of a code that enables pharmacists to document their clinical interventions in the hospital's computerized patient records is described. To allow data to be entered in patient records from terminals throughout the hospital that are linked to the mainframe computer, a code was developed to summarize each pharmacist recommendation. The coded information is added to the computer entry for the specific drug requiring intervention. A computer program was developed inhouse for generating daily reports of the pharmacist interventions. During an initial 25-day study period, 300 interventions were documented; house staff physicians accepted the pharmacists' recommendations in 257 (85.7%) of these interventions. An additional 17 (6%) of the interventions resulted from physicians' requests for pharmacists' recommendations. In addition to review of all pharmacist clinical interventions, this system allows review of a specific target drug to determine compliance with institutional drug-use guidelines. Through use of the computer program developed at this hospital, information that documents pharmacists' clinical services can be entered directly into patients' records on the hospital's mainframe computer system and retrieved as useful reports.

Academic Medical Centers↗
PubMed1983

Pharmacist-managed diabetes education service.

A pharmacist-managed education service for diabetes patients is described. Clinical pharmacists in three ambulatory-care centers provide diabetes-patient education based on guidelines developed and approved by the pharmacy, therapeutics, and standing orders committee. Patients are referred by their primary health-care provider; they receive individualized information concerning the pathophysiology and therapy of diabetes mellitus and instruction in self-care methods. A questionnaire completed by the patient before the initial visit aids the pharmacist in assessing the patient's educational needs, developing an individualized teaching program, and establishing long- and short-range treatment goals. The pharmacist spends one hour with the patient for the initial visit and 15 minutes for subsequent visits; patient charges are $15 for the initial visit and $7.50 for further teaching sessions. Records maintained by the pharmacist enable primary-care providers to follow the patient's progress and anticipate problems. Patients return for periodic assessment of their progress. Patient teaching by pharmacists has been provided and reimbursed in this ambulatory-care setting for 10 years. The pharmacist-educators' responsibilities include assessment, planning, instruction, and follow-up.

Diabetes Mellitus↗
PubMed1978

Training staff pharmacists for clinical positions.

A five-phase education and training program for establishing and maintaining the clinical competency of pharmacists in a 940-bed private, nonprofit hospital is described. In Phase 1 of the program, pharmacists are given selected textbook and journal materials in 15 study sections, each requiring 20--30 hours of the pharmacist's own time to complete. Phase 2 consists of two months of instruction in the daily clinical routine with emphasis on applying knowledge by investigating clinical problems through case presentation and by answering questions of health professionals. During Phase 3, the pharmacist is assigned to a patient-care area for two months to perform the duties of a clinical pharmacist. The pharmacist is assigned to the drug information center for two months during Phase 4. Phase 5, the year-round continuing education component of the program, consists of regularly scheduled clinical rounds, meetings and conferences. Upon completion of Phases 1--4, pharmacists selected for clinical positions provide clinical services for eight to 10 months and rotate to the pharmacy distribution area during the remaining two to four months per year. The education and training program described is important to the development and expansion of clinical services in this hospital.

Curriculum↗
PubMed1980

Drug therapy assessments by pharmacists.

Drug therapy assessments made for ambulatory patients by pharmacists and those made by the patients' primary physicians were compared. Using refill assessment guidelines, pharmacists evaluated the drug therapy regimens of patients attending a general medicine clinic before they were seen by their physicians. At the end of each clinic day, the pharmacists compared their assessments with the physician evaluations. Of the 155 drug regimens reviewed, the study pharmacists would have continued 104 (67.1%) without alteration, changed 48 (31.0%), and referred three patients (1.9%) with new problems for physician evaluation. The differences between pharmacist assessment and physician agreement were not significant (p greater than 0.2), but there was a significant difference between pharmacist assessment and physician actions (p less than 0.005), because the physicians actually changed only 52% of the drugs they agreed could be changed. The study suggests that the pharmacist is able to detect drug therapy problems and to recommend appropriate actions for resolving them.

Drug Prescriptions↗
PubMed2006

Clinical pharmacists and inpatient medical care: a systematic review.

BACKGROUND: The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review was to evaluate the published literature on the effects of interventions by clinical pharmacists on processes and outcomes of care in hospitalized adults. METHODS: Peer-reviewed, English-language articles were identified from January 1, 1985, through April 30, 2005. Three independent assessors evaluated 343 citations. Inpatient pharmacist interventions were selected if they included a control group and objective patient-specific health outcomes; type of intervention, study design, and outcomes such as adverse drug events, medication appropriateness, and resource use were abstracted. RESULTS: Thirty-six studies met inclusion criteria, including 10 evaluating pharmacists' participation on rounds, 11 medication reconciliation studies, and 15 on drug-specific pharmacist services. Adverse drug events, adverse drug reactions, or medication errors were reduced in 7 of 12 trials that included these outcomes. Medication adherence, knowledge, and appropriateness improved in 7 of 11 studies, while there was shortened hospital length of stay in 9 of 17 trials. No intervention led to worse clinical outcomes and only 1 reported higher health care use. Improvements in both inpatient and outpatient outcome measurements were observed. CONCLUSIONS: The addition of clinical pharmacist services in the care of inpatients generally resulted in improved care, with no evidence of harm. Interacting with the health care team on patient rounds, interviewing patients, reconciling medications, and providing patient discharge counseling and follow-up all resulted in improved outcomes. Future studies should include multiple sites, larger sample sizes, reproducible interventions, and identification of patient-specific factors that lead to improved outcomes.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial.

CONTEXT: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. OBJECTIVE: To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. INTERVENTIONS: The pharmaceutical care program (n = 447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates [PEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n = 363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n = 303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. MAIN OUTCOME MEASURES: Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. RESULTS: At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P =.02) but not than PEFR monitoring controls (P =.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P =.03) and the PEFR monitoring group (P =.001) and were more satisfied with their health care than the usual care group at 6 months only (P =.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. CONCLUSIONS: This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.

Adult↗
PubMedDate not supplied

Contribution of pharmacists to the reporting of adverse drug reactions.

PURPOSE: The aim of the study is to get a better view about the possible contribution of pharmacists' reports to the quantity and the quality of reports and in this way to the quality of a voluntary reporting system of adverse drug reactions. METHODS: A total of 15,293 reports, sent to the Netherlands Pharmacovigilance Foundation Lareb between 1995 and 2000 were analysed for the characteristics of pharmacists' reports and the differences with reports from physicians i.e. dispersion of adverse drug reactions in relation to the different System and Organ Classes, the seriousness of the reports according to the CIOMS criteria and the documentation grade of the reports. A total of 200 reports were selected at random and their quality assessed. RESULTS: Pharmacists are responsible for 40% of the reports sent in to Lareb during this period. Their reports more frequently concern adverse effects in relation to skin and the eyes. Adverse drug reactions reported by pharmacists tend to be less severe than those reported by physicians and pharmacists' reports tend to be of a lower documentation grade than those of physicians. Also, the quality of the clinical information is higher in physicians' reports. CONCLUSIONS: The contribution of pharmacists to the voluntary reporting system in the Netherlands is of great importance, both for the number and quality of the reports.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Drug counselling in pregnancy: an opinion survey of French community pharmacists.

PURPOSE: The aim of the present study was to determine whether community pharmacists recommend appropriate medications and give valid information to pregnant women. METHODS: A total of 163 community pharmacists randomly selected in the Midi-Pyrénées area were interviewed by means of an open questionnaire. Ten scenarios were proposed concerning back pain, headache, coughs and sore-throats, fever, constipation, nausea, dyspepsia, 'venous insufficiency', allergic rhinitis and insomnia. RESULTS: Out of the total, 130 pharmacists accepted to answer. Out of them 94.5% reported advising homeopathy, especially for coughs and allergy. They often advised medication for pain, fever, nose and oropharynx disorders, 'venous insufficiency', dyspepsia or constipation. By contrast, they referred the women to the general practitioner for nausea and vomiting or back pain. Advice without drug dispensation was given for gastrointestinal disorders or 'venous insufficiency'. Phytotherapy only concerned 0.5-2% of the answers except for anxiety and sleep disturbances (59%), 'venous disorders'(17%) and sore-throat (9%). Pharmacists' answers were sometimes inappropriate involving (1) pharmacologically illogical advice, (2) drugs for which neither clinical nor experimental data are available and (3) drugs potentially harmful in pregnancy. CONCLUSIONS: The present study shows that French community pharmacists do not always give appropriate advice to pregnant women. As primary health care providers, pharmacists have to improve counselling regarding drug use in pregnancy.

Community Pharmacy Services↗
PubMed1995

The role of pharmacists in the recruitment of a cohort for postmarketing surveillance. A case study of acitretin in The Netherlands.

In October 1990, a recall procedure was issued regarding the drug acitretin. The recommended post-therapy contraception period after acitretin therapy was extended from 2 months to 2 years. For a postmarketing surveillance study, we recruited a cohort from the source population of women aged 15-45 years who were exposed to acitretin. Recruitment occurred through dermatologists, and pharmacists plus dispensing general practitioners. We describe the speed of and the response to the recruitment procedures, and the representativeness of the recruited cohort. We also studied whether the individuals who gave informed consent would have preferred to be recruited by either dermatologists or pharmacists, and whether the information obtained from pharmacists and dispensing general practitioners was valid. This study revealed that pharmacists and dispensing general practitioners (drug dispensers) recruited their subjects rapidly, with no or little selection; they attained a 42% response. Dermatologists recruited their subjects slowly and selectively; they attained a 24% response. The majority of women (60%) recruited by dermatologists would have given their informed consent if they would have been recruited by their pharmacists. Drug dispensers are essential contributors to the recruitment of a study population. We do advise that such recruitment for a postmarketing surveillance study occurs by means of a collaboration between pharmacists and physicians.

Acitretin↗
PubMedDate not supplied

Survey of pharmacists' and physicians' perceptions of therapeutic interchange.

Therapeutic interchange has long been an integral part of drug formulary management, but physicians' and pharmacists' attitudes toward such programs are relatively unknown. This survey was undertaken to determine pharmacists' attitudes, physicians' potential response to a hypothetical interchange, and how well pharmacists predicted physicians' responses. A survey that described a drug interchange program and several potential responses to the proposed switch was provided to 300 staff physicians at a 512-bed community facility in southwest Florida; the survey was also mailed to pharmacy directors or clinical pharmacy coordinators at 42 southwest Florida hospitals. Responses were obtained from 98 physicians and 95 pharmacists. Most physicians would not cooperate with an interchange if they were not familiar with the proposed drug; 16% would continue to prescribe the original drug, knowing that the new agent would be provided; and 58% would switch to another agent with which they had clinical experience. Only 26% of physicians would follow the interchange program. In contrast, 48% of pharmacists believed that physicians would continue to order the original therapy, 32% believed that physicians would order the new agent, and only 20% believed that physicians would switch to an alternative drug (P<.005 vs physician responses). Clearly, pharmacists' expectations of physicians' response to a therapeutic interchange differ significantly from the physicians' expected behavior. This difference has potentially important implications for actual versus projected cost savings of therapeutic interchange.

Attitude of Health Personnel↗
PubMed2005

Complex pharmaceutical care intervention in pulmonary care: part A. The process and pharmacists' professional satisfaction.

OBJECTIVE: In the IPMP study (Interventions on the principle of Pulmonary Medication Profiles), tailored pharmaceutical care interventions were provided to pulmonary patients selected because of drug use that deviates from Dutch guidelines. The aims were to solve drug-related problems and to improve patients' drug use. This article describes the pharmaceutical care process tailored to the individual problems of patients in the intervention arm of a randomized controlled trial and defines the package of care. METHODS: After a preliminary selection of the patients with the help of the algorithmic IPMP computer instrument, instructed Dutch community pharmacists had structured consultations with patients (aged 13-70 years) in the intervention arm to identify behaviour and specific problems with their medication. Based on this identification process, a tailored intervention was constructed that could comprise one or more of six pharmaceutical care modules. Modules were clustered in sets describing the complete programme of care provided to one patient. If necessary, pharmacists consulted the patients' physicians to improve the prescribed therapy. After the interventions, medication changes were evaluated with the patients. The prescribed medication and the refill rate were monitored in the pharmacy computer during 1 year. All activities and results were extensively monitored and documented. MAIN OUTCOME MEASURE: Process description, i.e. number of provided pharmaceutical care modules and medication changes. Pharmacists' satisfaction. RESULTS: Tailored interventions were provided to 199 patients at risk of sub-optimal drug therapy. In all 813 pharmaceutical care modules were performed and documented, and clustered in four different programmes. In addition to education and motivation to adhere to prescribed medication for all 199 patients, a medication change was suggested in 124 cases. Patients and physicians agreed upon a change in 94 cases. Device change was agreed upon in 58 of 64 cases, often simultaneously with medication change. Pharmacists consulted physicians concerning 100 patients. Pharmacists reported satisfaction with the pharmaceutical care approach. CONCLUSION: Because of the extensive documentation, interventions could be described completely. Pharmacists observed a better drug use after educating patients or by solving their drug-related problems. In collaboration with physicians drug treatment could be improved.

Adolescent↗
PubMed2006

Risks and concerns about supplementary prescribing: survey of primary and secondary care pharmacists.

UNLABELLED: OBJECTIVE (OF THE STUDY): To provide data on the views of chief pharmacists (CPs) and primary care trust pharmacists (PCTPs) on the risks and concerns surrounding supplementary prescribing. SETTING: Secondary and primary care within England. METHOD: Postal questionnaire surveys of chief pharmacists and primary care trust pharmacists. MAIN OUTCOME MEASURE: Significance of the association between the extracted factors. RESULTS: The response rate was 68% for both the primary care (183/271) and secondary care surveys (97/143). The survey tool was subjected to factor analysis and reliability testing. For both sectors, the three factors that were extracted described concerns over the training model for supplementary prescribing, concerns about the professional competency/responsibility of the supplementary prescribers once trained, and positivity about the implementation of supplementary prescribing. For both sectors, as trusts have more experience of supplementary prescribing by nurses, the respondents had less concerns about the supplementary prescribing training model. For secondary care, as the total number of pharmacists employed within the trust increases, the respondents had less concerns over the limitations of the supplementary prescribing training model. CONCLUSION: Although both sectors have concerns over the training model for supplementary prescribing and also professional competence and responsibility once trainees qualify, there is overall a positive attitude towards supplementary prescribing and there is a belief that pharmacists wish to take this role on.

Attitude of Health Personnel↗
PubMed2007

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists.

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.

Adult↗
PubMed1996

Face and politeness in pharmacist-physician interaction.

This study used Brown and Levinson's theory of politeness to gain a better understanding of the factors that influence pharmacists' messages to physicians. Specifically, perceived differences in power and social distance between pharmacist and physician were expected to influence the amount of politeness observed in pharmacists' messages. The effects of age, sex and practice context were also examined. Written messages were gathered from 210 community pharmacists and 112 hospital pharmacists in response to a hypothetical drug allergy scenario. Messages were segmented into independent clauses, and independent clauses were classified according to the politeness strategy used to make allergy reports and alternative drug recommendations respectively. Content analysis of the messages in relation to demographic variables revealed that age and practice context were significantly associated with the overall level of politeness of alternative drug recommendations, but not with overall politeness of allergy reports. Demographic factors were significantly related to perceptions of power and social distance, but, contrary to Brown and Levinson's prediction, these perceptions were not associated with variation in politeness. Regardless of other factors, recommendations were made more politely than reports. Implications for pharmacists' professional roles and identities are discussed.

Adult↗