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PubMedDate not supplied

How pharmacists can assist physicians with controlling blood pressure.

The goals for hypertension in the publication Healthy People 2010 require a much more intensive approach in order to achieve desired blood pressure control rates. The pharmacist is uniquely positioned in the health care system to assist with improving blood pressure control by utilizing strategies to solve medication-related problems. Studies within integrated health systems have demonstrated that when pharmacists are included as members of health care teams, control rates for hypertension increase. In addition, drug interactions, nonadherence, and costs can be reduced. The authors suggest that incorporating a pharmacist or some services typically provided by traditional pharmacists into physician practices can improve blood pressure control. This review summarizes studies involving pharmacist participation in hypertension management and provides recommendations for obtaining pharmacist involvement.

Humans↗

PubMed2005

Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study).

OBJECTIVE: To evaluate the effectiveness of a community pharmacist-based home blood pressure (BP) monitoring program. DESIGN: Trial of a high-intensity (HI) versus low-intensity (LI) intervention randomized in 12 community pharmacies. The HI intervention comprised 4 face-to-face visits with a trained pharmacist. Pharmacists provided patient-specific education about hypertension. Following the first and third visits, patients were provided with a home BP monitoring device and instructed to measure their BP at least once daily for the next month. Home BP readings were used by the pharmacists to develop treatment recommendations for the patient's physician. Recommendations were discussed with the physician and, if approved, implemented by the pharmacist. In the LI intervention, pharmacists measured patients BP in the pharmacy and referred them to their physician for evaluation. PARTICIPANTS: Patients with uncontrolled BP at baseline. MEASUREMENTS: The main outcomes were the differences in systolic and diastolic BP (SBP and DBP) from baseline to follow-up between the HI and LI patients. RESULTS: The study enrolled 125 patients, 64 in the HI and 61 in the LI group. From baseline, SBP declined 13.4 mmHg in the HI group and 9.0 mmHg in the LI group. At the final visit, the difference in SBP/DBP change between the HI and LI group was -4.5/-3.2 mmHg (P=.12 for SBP and P=.03 for DBP). CONCLUSIONS: The HI intervention achieved a lower DBP and this model could be a strategy for patients with hypertension.

Aged↗

PubMed2001

Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice.

OBJECTIVE: To determine whether a pharmacist can effectively review repeat prescriptions through consultations with elderly patients in general practice. DESIGN: Randomised controlled trial of clinical medication review by a pharmacist against normal general practice review. SETTING: Four general practices. PARTICIPANTS: 1188 patients aged 65 or over who were receiving at least one repeat prescription and living in the community. INTERVENTION: Patients were invited to a consultation at which the pharmacist reviewed their medical conditions and current treatment. MAIN OUTCOME MEASURES: Number of changes to repeat prescriptions over one year, drug costs, and use of healthcare services. RESULTS: 590 (97%) patients in the intervention group were reviewed compared with 233 (44%) in the control group. Patients seen by the pharmacist were more likely to have changes made to their repeat prescriptions (mean number of changes per patient 2.2 v 1.9; difference=0.31, 95% confidence interval 0.06 to 0.57; P=0.02). Monthly drug costs rose in both groups over the year, but the rise was less in the intervention group (mean difference 4.72 pound sterling per 28 days, - 7.04 pound sterling to - 2.41 pound sterling); equivalent to 61 pound sterling per patient a year. Intervention patients had a smaller rise in the number of drugs prescribed (0.2 v 0.4; mean difference -0.2, -0.4 to -0.1). There was no evidence that review of treatment by the pharmacist affected practice consultation rates, outpatient consultations, hospital admissions, or death rate. CONCLUSIONS: A clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs. Such review results in significant changes in patients' drugs and saves more than the cost of the intervention without affecting the workload of general practitioners.

Aged↗

PubMed1993

Hospital pharmacists' participation in audit in the United Kingdom.

OBJECTIVE: To investigate systematically participation in audit of NHS hospital pharmacists in the United Kingdom. DESIGN: Questionnaire census survey. SETTING: All NHS hospital pharmacies in the UK providing clinical pharmacy services. SUBJECTS: 462 hospital pharmacies. MAIN MEASURES: Extent and nature of participation in medical, clinical, and pharmacy audits according to hospital management and teaching status, educational level and specialisation of pharmacists, and perceived availability of resources. RESULTS: 416 questionnaires were returned (response rate 90%). Pharmacists contributed to medical audit in 50% (204/410) of hospitals, pharmacy audit in 27% (108/404), and clinical audit in only 7% (29/404). Many pharmacies (59% (235/399)) were involved in one or more types of audit but few (4%, (15/399)) in all three. Participation increased in medical and pharmacy audits with trust status (medical audit: 57% (65/115) trust hospital v 47% (132/281) non-trust hospital; pharmacy audit: 34% (39/114) v 24% (65/276)) and teaching status (medical audit: 58% (60/104) teaching hospital v 47% (130/279) non-teaching hospital; pharmacy audit 30% (31/104) v 25% (68/273)) and similarly for highly qualified pharmacists (MPhil or PhD, MSc, diplomas) (medical audit: 54% (163/302) with these qualifications v 38% (39/103) without; pharmacy audit: 32% (95/298) v 13% (13/102)) and specialists pharmacists (medical audit: 61% (112/184) specialist v 41% (90/221) non-specialist; pharmacy audit: 37% (67/182) v 19% (41/218)). Pharmacies contributing to medical audit commonly provided financial information on drug use (86% 169/197). Pharmacy audits often concentrated on audit of clinical pharmacy services. CONCLUSION: Pharmacists are beginning to participate in the critical evaluation of health care, mainly in medical audit.

Educational Status↗

PubMed1997

Contribution of a liaison clinical pharmacist to an inpatient palliative care unit.

The impact on patient care of interventions made by a liaison clinical pharmacist visiting a busy inpatient palliative care unit were evaluated using a validated six-point scoring system. Interventions made in 13% of patients could improve patient care, save money or both, but rarely involved the drugs that are commonly used for symptom control in patients with terminal cancer. Advice to rationalize inappropriate drug regimens (53%) was the commonest intervention, followed by warnings about drug interactions (24%) and advice about therapeutic drug monitoring (8%). The interventions were evaluated by the pharmacist, a palliative medicine registrar and two independent doctors, confirming that the pharmacist was valid and accurate in assessing her own work. Although more than 60% of interventions could significantly improve patient care, compliance by medical and nursing staff with advice was only 55%, reflecting possible tensions between palliative and general hospital medicine. This survey emphasizes the role of liaison clinical pharmacists in palliative care, the need for much more critical appraisal of prescribing practices and the utility of ranking pharmacist interventions as a quality assurance and educational tool. In particular, providing palliative care for patients with advanced acquired immunodeficiency syndrome (AIDS) is enhanced when a pharmacist with a specialist knowledge of AIDS therapeutics is available.

Acquired Immunodeficiency Syndrome↗

PubMed1981

The pharmacist as prescriber of drug therapy: the USC pilot project.

Recent legislation in California allows pilot projects to investigate prescribing by pharmacists. The University of Southern California School of Pharmacy project was approved in October, 1978. To be certified as prescribers, pharmacists must successfully complete a physical assessment course and a certifying examination. From an original group of 30 interested pharmacists, 25 were certified; five different pharmacists were added later. Prescribing pharmacists must meet with their supervising physician once every two weeks, and are restricted to the project formulary. A variety of health care settings are represented in the project, with pharmacists prescribing for ambulatory patients with chronic diseases, geriatric patients in extended care facilities, psychiatric patients, and selected inpatients. Project evaluation will continue through 1982 and will focus on safety and quality of care, patient acceptance, and cost of care.

California↗

PubMed1984

Evaluation of family physician prescribing: influence of the clinical pharmacist.

This study was designed to determine whether prescribing patterns in family practice residency training offices were more favorable in offices with clinical pharmacists. Two family practice residency training offices with clinical pharmacists and two offices without clinical pharmacists served as study sites. At each office, 100 prescription copies were selected by stratified random sampling, and a case abstract was constructed from the medical record. An additional 38 prescriptions that resulted from clinical pharmacist consultation were studied. A blinded review panel evaluated the cases for appropriateness of drug choice and dose and anticipated benefit of the prescription. Prescriptions from offices with clinical pharmacists and consult prescriptions were rated significantly more favorably both for drug choice and drug dose (p less than 0.02). These data suggest that clinical pharmacists involved in family practice residency programs may refine and improve otherwise acceptable prescribing.

Drug Prescriptions↗

PubMed1984

Pharmacists' views on mandatory patient counseling.

A questionnaire was sent to a randomly selected sample of Florida pharmacists to obtain information on the acceptability of mandatory patient counseling. The results of the questionnaire demonstrated that most Florida pharmacists who responded to the survey do not favor a patient counseling regulation. Factors that correlated with a desire for mandatory counseling include: an institutional practice site; assistant director and staff pharmacist position; and a perceived higher income for the patients served by pharmacists. These data indicated that if the mandatory method is selected to stimulate pharmacist-patient interaction, the interrelated issues of reimbursement, facility changes, technician support, patient profiles, continuing education programs, and pharmacists' attitudes toward regulated practice will need to be addressed.

Attitude of Health Personnel↗

PubMed1985

The role of the pharmacist in home health care.

Home infusion services, a new facet of home health care (HHC) delivery, have created many new opportunities for hospital pharmacists to participate more actively in patient care. These opportunities can create new roles for the pharmacist as an educator, clinician, and administrator. Early efforts must be made to educate hospital administrators, physicians, and other allied health personnel regarding the advantages and disadvantages of providing HHC--from the perspective of both patients and institutions. The pharmacist can also collect data to assist in determining the extent to which the institution should participate in HHC delivery, and should coordinate the hospital's efforts to initiate home infusion services. Pharmacists should play an active role in screening, selecting, and training patients for HHC before discharge. The input of pharmacists in drug product selection and assistance in product compounding can ensure optimal patient outcomes and minimize costs. Clinical monitoring activities conducted by the pharmacist can include telephone interviews with patients at home and assessment of clinical progress during scheduled return visits to the clinic.

Drug Compounding↗

PubMed1986

Pharmacist involvement in Norwegian clinical drug trials: a questionnaire study.

In order to survey the involvement of pharmacists in clinical drug trials (CDTs) in Norway, a questionnaire was submitted to all community pharmacies (288), pharmacy departments in hospitals (98), and pharmaceutical companies (52). The response rate was 81, 73, and 64 percent, respectively. Community pharmacies had minimal involvement, while 34 percent of the pharmacy departments had taken part in one or more CDTs annually 1980-1982. During the same three-year period, 393 trials had been started by the responding companies. Within the pharmaceutical industry 41 percent of the CDT staff were pharmacists. Pharmacists in 48 percent of community pharmacies and 96 percent of pharmacy departments in hospitals considered CDTs a pharmaceutical task. However, none of the community pharmacists and less than half of the hospital pharmacists said they had knowledge of CDT methodology. We recommend that pharmacists should be more extensively engaged in CDTs. Their participation should not be limited to traditional pharmaceutical work, but should include CDT planning and monitoring. This in turn requires education in CDT methodology, which should be included in the compulsary pharmaceutical curriculum.

Attitude of Health Personnel↗

PubMed1986

Review of systemic fluoride supplementation and consideration of the pharmacist's role.

Interprofessional contact and consultation among dentists, physicians, and pharmacists can help to optimize patient care. Because pharmacists are readily accessible to the public, their influence is essential for the appropriate prescribing and continued use of systemic fluoride supplements. Pharmacists should be familiar with various aspects of fluoride therapy, such as mechanisms of caries inhibition, dosages associated with acute and chronic toxicity, and recommended daily dosage levels. The impact of breastfeeding, multiple sources of water intake, and changing age of the patient must be considered in determining proper systemic fluoride dosage. Pharmacists should consult with both physicians and dentists to coordinate water fluoride assay and prescribing responsibilities. They also can help to educate both prescribers and patients. Because of frequent patient contact and access to medication records, pharmacists can encourage and monitor patient compliance. Fluoride prescriptions and results of water fluoride assays should be documented on the patients' computerized or card profiles. In addition, pharmacists can counsel patients about the fluoride ion content of various home-use products and make recommendations to ensure that an optimal level of fluoride ingestion is maintained.

Dental Caries↗

PubMed1987

Protocols for the treatment of essential hypertension and type II diabetes mellitus by pharmacists in ambulatory care clinics.

During the last several years, the pharmacist has acted as a primary-care provider for patients with selected chronic illnesses at an urban county health department. The pharmacist's responsibilities include examining patients, ordering laboratory tests and X-rays, and adjusting or prescribing medication. In order to comply with health department regulations requiring the use of protocols by non-physician practitioners, and to better define the pharmacist's role, pharmacy protocols for the treatment of essential hypertension and type II diabetes mellitus have been developed. The protocols provide specific guidelines for the pharmacist involved in primary patient care. In addition, they describe a procedure for the selection and referral of patients. These protocols can serve as a sound foundation by which other pharmacists involved with primary patient care treat essential hypertension and type II diabetes mellitus. They can easily be modified to suit a pharmacist's particular needs and situation.

Ambulatory Care Facilities↗

PubMed1989

Communication of verbal information by community pharmacists.

Communication of verbal information on prescribed drugs is recognized as an important function of the pharmacist. This article describes and analyzes the communication behavior adopted by community pharmacists in the province of Quebec. Data were collected by means of two questionnaires mailed to a random sample of 634 community pharmacists. Percentage of prescriptions for new medications on which the pharmacists indicated they provide verbal information averaged 68.9 (SD 24.2). A majority of respondents indicated that they include information on the indication and mode of administration in more than 75 percent of their counseling episodes. However, on average, rare but serious adverse effects were less frequently discussed. The frequency of verbal communication was analyzed according to the pharmacist's gender, number of years since licensure, employment status, work setting, and perceptions of both professional and commercial dimensions of the pharmacist's role. Regression showed that perception of the professional dimension of the role, gender, workload, and floor surface of the pharmacy were related to provision of verbal information on new prescribed medications.

Communication↗

PubMed1994

Pharmacists' attitudes toward adverse drug reaction reporting in Hong Kong.

OBJECTIVE: To study the attitudes and knowledge of pharmacists in Hong Kong toward the reporting of adverse drug reactions (ADRs). METHODS: In December 1993, all pharmacists who were working in retail shops (n = 230), hospitals (n = 44), or outpatient clinics (n = 12) in Hong Kong were sent a questionnaire as well as a letter explaining the purpose of the survey. RESULTS: One hundred and twenty-nine pharmacists (retail pharmacies 40.4 percent, hospitals 68.2 percent, outpatient clinics 50 percent) responded. Although 93 percent of the pharmacists in this survey agreed that it is necessary to report ADRs, a much smaller proportion (14.7 percent) had actually done so in the previous 12 months. Most pharmacists (87.4 percent) were not aware of any ADR reporting system in Hong Kong. There did not appear to be a relationship between ADR reporting and the length or place of practice, workload, or patient contact time. Severe or unusual ADRs and ADRs to new products were perceived to be significant enough to report. CONCLUSIONS: The great majority of pharmacists in Hong Kong agreed on the necessity of reporting ADRs. The lack of knowledge of an ADR reporting program might have led to nonreporting in the past. It is important that there be continuing efforts to promote ADR reporting programs.

Adverse Drug Reaction Reporting Systems↗

PubMed1996

Quantifying the clinical significance of drug-drug interactions: scaling pharmacists' perceptions of a common interaction classification scheme.

OBJECTIVE: To develop a precise, interval level scale of the clinical significance of drug-drug interactions that reflects the professional judgments of practicing pharmacists. PARTICIPANTS: A convenience sample of 63 practicing pharmacists representing hospital (clinical and staff) and retail (chain and independent) practice settings. METHOD: Pharmacists judged the similarity among 15 interaction categories that have been commonly used to classify drug-drug interactions. A multidimensional scaling technique produced a spatial representation (i.e., a psychological map) of the structure inherent in those similarity judgments. Pharmacists' ratings of clinical significance were projected onto that same spatial representation using a multiple regression procedure, and the resulting information was used to develop a scale of clinical significance. RESULTS: The clinical significance scale developed from pharmacists' judgments was substantially different from a comparison scale published in a popular reference. The new scale was more precise than the comparison scale, and it also approximated an interval level of measurement. The judgments used to produce the new clinical significance scale were not reliably influenced by pertinent demographic characteristics of the sample. CONCLUSIONS: Inconsistencies between published clinical significance scales and the professional judgments of practitioners could affect patient care to the degree that a summary measure of clinical significance affects a practitioner's response to a potential drug-drug interaction. The clinical significance scale developed in this study has good measurement characteristics and reflects the professional judgments of practicing pharmacists. Use of the new scale is recommended on these grounds, although further assessment of its generality is warranted.

Drug Interactions↗

PubMed2001

A national survey of U.S. pharmacists in 2000: assessing nonresponse bias of a survey methodology.

The first objective of this study was to assess the existence of nonresponse bias to a national survey of licensed pharmacists conducted in 2000. Three methods were used to assess nonresponse bias. The second objective of the study was to examine reasons why sampled licensed pharmacists did not respond to the national survey of licensed pharmacists. We used data from 2204 respondents to a national survey of pharmacists and from 521 respondents to a survey of nonrespondents to the national survey. We made comparisons between respondents for 5 variables: employment status, gender, age, highest academic degree, and year of initial licensure. Chi-square tests were used to examine differences in the 5 variables between respondents to the first mailing and second mailing of the survey, early and late respondents to the survey, and respondents to the survey and respondents to the nonrespondent survey. There were no significant differences between first mailing and second mailing respondents, but there were differences in each variable except year of licensure between early and late respondents. These differences likely were due to regional bias possibly related to differences in mailing times. There were differences between respondents and nonrespondents in terms of employment status and year of licensure. The main reasons for not responding to the survey were that it was too long or that it was too intrusive. Overall, the survey methodology resulted in a valid sample of licensed pharmacists. Nonresponse bias should be assessed by surveying nonrespondents. Future surveys of pharmacists should consider the length of the survey and the address where it is sent.

Adult↗

PubMed2004

[The role of pharmacists for promotion of cancer chemotherapy in outpatients].

To promote cancer chemotherapy among outpatients, a special room for cancer chemotherapy (outpatient drip infusion room) was established in Yamaguchi University Hospital in April 2002. Since then, pharmacists have played a central role in all aspects, including decisions on the flow rate for prescriptions/injections, protocol checking, preparation of injections, aseptic preparation of anticancer agents, provision of information to patients, and financial impact analysis. In this study, we analyzed the current status of these activities and conducted a questionnaire survey regarding the involvement of pharmacists in chemotherapy at the outpatient clinic among patients and physicians. Pharmacists contributed to the administration of anticancer agents, including protocol checking and aseptic preparation, and no malpractice incident has occurred since the outpatient drip infusion room was established. According to responses from patients, 28 of 29 patients reported that they underwent treatment without anxiety. According to responses from physicians, 15 of 18 physicians considered the involvement of pharmacists beneficial. In addition, the amount claimed for health insurance as of March 2003 was 500000 yen, which was about 5-fold that before the establishment of the outpatient drip infusion room. These results suggest that pharmacists contribute to the promotion of cancer chemotherapy in outpatients with respect to the safety of medical practice, patient services, and hospital management. Therefore participation in cancer chemotherapy at the outpatient clinic may become a primary activity of pharmacists.

Antineoplastic Agents↗

PubMed2000

Pharmacist's perceptions of nurse prescribing of emergency contraception.

Proposed strategies to reduce the rate of unplanned pregnancy in the UK include widening access to hormonal emergency contraception (HEC) through nurse prescribing and over-the-counter sales by pharmacists. This article reports on the perceptions of pharmacists regarding the appropriateness of nurse prescribing of HEC drawn from a survey of pharmacists' attitudes towards HEC deregulation. A 10% sample (n = 3999) of all members of the Royal Pharmaceutical Society of Great Britain was surveyed and a response rate of 38.6% (1543 respondents) achieved. Pharmacists were asked whether or not nurses should prescribe HEC and in what capacity. In respect of the statement that: 'Nurses should not be allowed to prescribe post-coital contraception', 42% of respondents agreed while 31.6% disagreed. This indicates that pharmacists do not have a consensus view regarding nurse prescribing of HEC. Arrangements for pharmacists prescribing under protocol received the support of 60.2% of respondents, whereas 41% expressed support for nurse prescribing under protocol. There was also relatively little support for 'specifically trained' nurses prescribing HEC. The findings are considered in relation to the development of a coherent and accessible provision of HEC and the wider implications for interprofessional relationships concerning prescribing.

Attitude of Health Personnel↗