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PubMedDate not supplied

Hospital nurses' perceptions of pharmacist prescribing.

The final report from the Crown review team was published in March 1999. It proposed that new groups of healthcare professionals should be permitted to prescribe medicines. Most of the recent progress has centred on the extension of community nurse prescribing. However, changes have also been proposed to prescribing practices within the hospital setting to include nurses, pharmacists, and other healthcare professionals. This study is an initial piece of work examining hospital nurses' perceptions of pharmacist prescribing to identify if there are issues that warrant further investigation. Postal questionnaires, seeking responses to statements describing pharmacists writing prescriptions for drug treatment, were sent to 200 nurses at five NHS teaching hospitals in Birmingham. Completed questionnaires were received from 115 nurses (a response rate of 57.5%). Fifty-four respondents added comments to the questionnaire, giving some insight into their responses to the statements on pharmacist prescription-writing and prescribing. These comments indicated five key issues that may warrant further investigation: (1) pharmacists' knowledge of the patient (2) doctors losing the opportunity to review drug treatment (3) potential communication problems (4) pharmacists' workload, and (5) legal and professional accountability.

Attitude of Health Personnel↗
PubMedDate not supplied

Individual and structural influences shaping pharmacists' decisions to sell syringes to injection drug users in Atlanta, Georgia.

OBJECTIVE: To better understand the individual (e.g., attitudes and beliefs) and structural (e.g., laws and regulations) factors that influence and shape pharmacists' decisions about selling syringes to injection drug users (IDUs). DESIGN: Qualitative research. SETTING: Metropolitan Atlanta. PARICIPANTS: 20 practicing pharmacists who work in or near areas of high drug use in Atlanta, and nine pharmacists who are considered leaders in their profession in Georgia. INTERVENTIONS: Semistructured, in-depth interviews. MAIN OUTCOME MEASURES: Individual and structural factors that influence pharmacists' decisions about selling syringes to IDUs. RESULTS: Pharmacists reported that they use their professional discretion in making syringe sale decisions and that these decisions are influenced by individuals factors such as their personal attitudes and beliefs about the nature and causes of drug use, and by structural factors such as the Georgia Board of Pharmacy regulation stating that syringes cannot be sold if they will be used for an "unlawful purpose." CONCLUSIONS: IDUs' access to sterile syringes from pharmacies in Atlanta, would likely be increased by (1) providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterile syringes and why blood-borne infection prevention is a legitimate medical purpose for selling syringes and (2) removing or modifying the restrictive Board of Pharmacy regulation governing syringe sales.

Black or African American↗
PubMedDate not supplied

Understanding how patients form beliefs about pharmacists' trustworthiness using a model of belief processing.

OBJECTIVE: To determine what information people use in forming beliefs about pharmacists' trustworthiness and to determine whether these pieces of information can be categorized using elements of a model of belief processing. DESIGN: Participants in two focus groups were asked about the trustworthiness of pharmacists in one dispensing scenario and two pharmaceutical care scenarios. Transcripts were analyzed, and each piece of information provided was coded as an evidence statement or a claim, according to a model of belief processing. SETTING: University campus. PARTICIPANTS: University staff and students. MAIN OUTCOME MEASURES: Information used to form beliefs about pharmacists' trustworthiness and classification of the information using constructs from the model of belief processing. RESULTS: Coders identified 92 evidence statements and 19 claims. An evaluation of the data across the scenarios using predetermined criteria showed 20 evidence statements and 11 claims to be the most salient pieces of information used to form beliefs about pharmacists' trustworthiness. In considering the pharmaceutical care scenarios, participants focused more on communication and interpersonal skills when forming a trustworthiness belief. The information could be categorized as evidence statements or claims, which are parts of arguments as described by a model of belief processing. CONCLUSION: The study participants used the pharmacists' credentials, communication skills, personableness, and appearance to form trustworthiness beliefs. Overall, they wanted pharmacists to be honest, knowledgeable, and caring. Variables used to form trustworthiness beliefs represent different levels of abstraction that can be detected and coded using a model of belief processing.

Focus Groups↗
PubMedDate not supplied

An assessment of pharmacists' caring ability.

OBJECTIVES: To assess the level of caring ability of practicing pharmacists and to examine differences in caring ability by sex, degree earned, practice setting, years in practice, and whether the pharmacist provides clinical services. DESIGN: Descriptive survey study. PARTICIPANTS: The survey was mailed to a stratified random sample of pharmacists registered in Illinois (n = 1,200). MAIN OUTCOME MEASURES: Caring Ability Inventory (CAI) score. Information was also gathered regarding respondents' practice setting, number and types of clinical services provided, and demographic characteristics. RESULTS: Of the 1,076 deliverable surveys, 323 were returned completed and used in the analysis (response rate = 30%). Mean CAI score +/- standard deviation was 203.0 +/- 17.7. Statistical analyses revealed no significant differences in CAI score by sex, degree earned, or practice setting. A significant and positive correlation was found between years in practice and CAI score. Pharmacists who provided disease management and other clinical services scored significantly higher on the CAI than pharmacists who did not. CONCLUSION: Pharmacists exhibit relatively high levels of caring ability as assessed by the CAI. Further inquiry into the nature of caring and its implications for pharmacy practice is needed.

Data Collection↗
PubMedDate not supplied

Community pharmacists' awareness of and involvement with medications intended for use in primary and secondary schools.

OBJECTIVE: To observe the degree to which community pharmacists are aware of and involved in issues related to the use of medications in primary and secondary schools and to identify the interventions they use to deal with these issues. DESIGN: Cross-sectional survey. SETTING: Illinois. PARTICIPANTS: 569 licensed pharmacists with community pharmacy experience. INTERVENTIONS: A survey comprising questions about the experiences, attitudes, and behaviors of community pharmacists with regard to medication use in schools was mailed in June 2003. MAIN OUTCOME MEASURES: Descriptive and bivariate statistical analysis of survey items. RESULTS: Almost all respondents reported that they had dispensed medications for use in school; two thirds thought that taking medications at school creates the potential for special problems (e.g., missed dose, social stigma). Of nine interventions that could help minimize these problems, the respondents used a mean of 3.34 interventions. Providing additional labeled containers for use at school was the most common intervention reported. Respondents who thought that medication use in schools caused special problems provided significantly more interventions than those that did not share this concern. CONCLUSION: Pharmacists are aware of and involved in the issues and potential problems created by medication use in schools. While they make use of interventions that are available to all community pharmacists, they could do more to help resolve issues. Additional effort to raise pharmacist awareness about medication use in schools is warranted.

Attitude of Health Personnel↗
PubMedDate not supplied

Need for community pharmacist-provided food-allergy education and auto-injectable epinephrine training.

OBJECTIVE: To determine whether community pharmacist-provided food-allergy education and auto-injectable epinephrine training is needed. DESIGN: Cross-sectional assessment. SETTING: United States. PARTICIPANTS: 1,887 recently joined members of the Food Allergy & Anaphylaxis Network. INTERVENTION: Electronic survey. MAIN OUTCOME MEASURES: 35 items covering past education and training associated with food allergy and use of auto-injectable epinephrine, demographics, attitudes toward pharmacist-provided education about food allergy, training in the use of auto-injectable epinephrine, confidence in managing food allergies on a daily basis and in emergency situations, and the necessity for pharmacists to provide education and training about food allergy and auto-injectable epinephrine use. RESULTS: Prescriber-provided food-allergy education and auto-injectable epinephrine training is incomplete (60.7%) or absent (16.3%) at the time auto-injectable epinephrine is first prescribed. These initial prescriptions are being dispensed from community pharmacies (94%), and written information is commonly provided with the medication (73.6%); however, oral counseling is largely absent (86.6%), and training in administration of auto-injectable epinephrine occurs infrequently (13.3%). Food-allergic patients and their care-givers are receptive to the idea of pharmacist-provided education and training. The majority (63.6% or more) feel confident about managing their food allergies. They are not requesting counseling when refill prescriptions are dispensed (81.4%); however, they would like to see routine review at refill time of the signs of allergic reaction (54.5%) and use of the epinephrine auto-injector (79.3%). CONCLUSION: Community pharmacists have an opportunity to assist newly diagnosed food-allergic patients by working collaboratively with their pediatricians and allergists. Community pharmacists can provide ongoing assistance at refill time by retraining patients in the use of the epinephrine auto-injector and reviewing the signs of allergic reaction.

Community Pharmacy Services↗
PubMed1999

Survey of clinical pharmacists' knowledge of appropriateness of antimicrobial therapy for upper respiratory infections and acute bronchitis.

We conducted a survey to assess clinical pharmacists' recommendation of antibiotics for upper respiratory infections (URIs) and acute bronchitis. A random sample of 752 members of the American College of Clinical Pharmacy were mailed a multiple-choice survey that presented four examples consistent with clinical symptoms of the two disorders. Respondents were asked what treatment they would recommend for each example. The response rate was 59%. Pharmacists recommended antibiotics for the treatment of both URIs and acute bronchitis significantly more if patients' symptoms included discolored discharge or sputum as opposed to clear discharge. Those who were board certified were less likely than nonboard-certified pharmacists to recommend antibiotics for URIs with discolored discharge. Pharmacists who specialized in either ambulatory care or infectious disease were less likely than those in other specialties to recommend antibiotics for acute bronchitis with discolored sputum. Clinical pharmacists are similar to patients and physicians in their belief that antibiotics are appropriate for URIs and acute bronchitis with discolored discharge. Considering the role that pharmacists play as clinical consultants to physicians, greater efforts should be made to educate them regarding appropriate prescription of antibiotics.

Acute Disease↗
PubMed2006

Outcomes of recommendations by hospice pharmacists.

PURPOSE: The value of pharmaceutical care recommendations made by consultant pharmacists and the outcomes of these recommendations were studied. METHODS: The study was conducted at three hospice programs, and the investigators were consultant pharmacists who shared the responsibility of providing drug therapy recommendations to the three programs. A literature search was conducted to determine if any tools had been developed to evaluate recommendations made by pharmacists in clinical practice settings. One tool was identified and adapted for use in a hospice clinical setting. Drug-related problems (DRPs) (n = 98), clinical interventions (n = 87), and outcomes data were collected by two hospice consultant pharmacists and evaluated by a panel of experts using the assessment tool. RESULTS: Ninety-eight interventions were collected and evaluated. Eighty-seven of the 98 interventions were classified as clinical interventions with specific therapeutic goals established. Of these 87 interventions, 73 (84%) were accepted by the prescriber and 56 (77%) out of the 73 helped achieve the therapeutic goals. An additional 6 (8%) interventions partially achieved the therapeutic goals. Over 75% of all of the pharmacists' recommendations achieved their intended therapeutic effect, which resulted in better management of the patients' physical symptoms. None of the accepted recommendations resulted in the patient coming to harm or having an adverse effect. Overall agreement between raters for severity and value was moderately high, 60-70% and 63-80%, respectively. Kappa scores were low. CONCLUSION: Hospice-based clinical pharmacists influenced patient outcomes positively by identifying DRPs and recommending appropriate drug therapy.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist.

Polypharmacy in the elderly complicates therapy, increases cost, and is a challenge for healthcare agencies. In the context of the evolving role of the pharmacist, this systematic review examines the effectiveness of interventions led by pharmacists in reducing polypharmacy. A computerised search was conducted using Medline, Embase geriatrics and gerontology (2001 edition), the Cochrane Library and International Pharmaceutical Abstracts (IPA) databases. A manual search of articles on polypharmacy and the role of pharmacists in the therapy of the elderly and of the reference sections of all retrieved articles was also carried out. Search terms used were 'polypharmacy', 'elderly', 'aged', 'intervention' and 'pharmacist(s)'. Articles that fulfilled the following criteria were included: only elderly people were included in the study, or all ages were included but the study gave separate results for the elderly; the outcome was expressed as a reduction in the number of medications; a pharmacist participated in the study; and the study was a controlled or a randomised controlled study. We initially identified 106 articles, but only 14 studies met our four inclusion criteria. Reduction in the number of medications was not the major purpose of most selected studies but often a secondary outcome. Objectives differed, the general aim being to enhance the quality of prescribing in elderly patients. These controlled studies argued in favour of the effectiveness of pharmacists' interventions, even though the number of medications eliminated was small. Most studies were not designed to demonstrate the impact of reducing the number of drugs on the clinical consequences of polypharmacy (nonadherence, adverse drug reactions, drug-drug interactions, increased risk of hospitalisation, and medication errors). The most frequently reported outcome related to cost savings. It was therefore difficult to assess whether the interventions benefited the patient. The methodological quality of many identified studies was poor. In particular, the study objectives were often very broad and ill-defined. Polypharmacy itself has been defined in different ways and the appropriate definition may differ according to the patient population and the study setting. Further studies are needed to find the most effective way to reduce polypharmacy, especially in the frail elderly population, and to quantify the real advantages of simplifying their drug regimens in terms of improved quality of life.

Age Factors↗
PubMed2004

Pharmacist computer skills and needs assessment survey.

BACKGROUND: To use technology effectively for the advancement of patient care, pharmacists must possess a variety of computer skills. We recently introduced a novel applied informatics program in this Canadian hospital clinical service unit to enhance the informatics skills of our members. OBJECTIVE: This study was conducted to gain a better understanding of the baseline computer skills and needs of our hospital pharmacists immediately prior to the implementation of an applied informatics program. METHODS: In May 2001, an 84-question written survey was distributed by mail to 106 practicing hospital pharmacists in our multi-site, 1500-bed, acute-adult-tertiary care Canadian teaching hospital in Vancouver, British Columbia. RESULTS: Fifty-eight surveys (55% of total) were returned within the two-week study period. The survey responses reflected the opinions of licensed BSc and PharmD hospital pharmacists with a broad range of pharmacy practice experience. Most respondents had home access to personal computers, and regularly used computers in the work environment for drug distribution, information management, and communication purposes. Few respondents reported experience with handheld computers. Software use experience varied according to application. Although patient-care information software and e-mail were commonly used, experience with spreadsheet, statistical, and presentation software was negligible. The respondents were familiar with Internet search engines, and these were reported to be the most common method of seeking clinical information online. Although many respondents rated themselves as being generally computer literate and not particularly anxious about using computers, the majority believed they required more training to reach their desired level of computer literacy. Lack of familiarity with computer-related terms was prevalent. Self-reported basic computer skill was typically at a moderate level, and varied depending on the task. Specifically, respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. CONCLUSIONS: Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness.

Adult↗
PubMed1991

Impact of a pharmacist on the educational value of pharmaceutical industry film showings.

A controlled trial was performed to assess the impact of drug information provided by a pharmacist on the educational value to physicians of pharmaceutical manufacturers' film showings. The trial consisted of two teams of physicians who attended pharmaceutical manufacturers' films and who afterward answered multiple choice questions on the drug being promoted. In one group, the liaison pharmacist, who had no knowledge of the content of the questionnaire, presented information on the drug being featured prior to the film showing while the control group did not have a pharmacist presentation. Out of a perfect score of five, there was a higher test score in the group of physicians who attended the pharmacist presentation/film showing (n = 75) than in the group which only attended the film (n = 65) (3.3 +/- 1.1 versus 2.8 +/- 1.2, respectively (p = 0.017)). While there was no difference in the scores obtained by the clerks, interns and residents (3.2 +/- 1.1, 3.3 +/- 0.9, 3.4 +/- 1.2 respectively) when a pharmacist was present, in his or her absence the scores for clerks, interns and residents were 2.5 +/- 1.3, 2.8 +/- 1.0, 3.6 +/- 1.2 respectively with residents scoring higher than clerks (p = 0.047). A pharmacist can enhance the educational value of a pharmaceutical manufacturer's film showing.

Attitude of Health Personnel↗
PubMed1993

Hospital mainframe computer documentation of pharmacist interventions.

The hospital mainframe computer pharmacist intervention documentation system described has successfully facilitated the recording, communication, analysis, and reporting of interventions at our hospital. It has proven to be time efficient, accessible, and user-friendly from the standpoint of both the pharmacist and administrator. The advantages of this system greatly outweigh manual documentation and justify the initial time investment in its design and development. In the future, it is hoped that the system can have even broader impact. Intervention/recommendations documented can be made accessible to medical and nursing staff, and as such further increase interdepartmental communication. As pharmacists embrace the pharmaceutical care mandate, documenting interventions in patient care will continue to grow in importance. Complete documentation is essential if pharmacists are to assume responsibility for patient outcomes. With time being an ever-increasing premium, and with economic and human resources dwindling, an efficient and effective means of recording and tracking pharmacist interventions will become imperative for survival in the fiscally challenged health care arena. Documentation of pharmacist intervention using a hospital mainframe computer at UIH has proven both efficient and effective.

Chicago↗
PubMed1994

Impact of a clinical pharmacist on cost saving and cost avoidance in drug therapy in an intensive care unit.

The authors performed a study to document the impact of a clinical pharmacist on cost saving and cost avoidance in an intensive care unit, and to evaluate the cost saving and avoidance to justify additional clinical pharmacist positions. Over 13 consecutive 5-day weeks, a clinical pharmacist with 50% teaching responsibility documented time spent and all interventions that impacted the cost of drug therapy. Both cost avoidance and cost saving were documented on change in route, change in dosage, change to another drug, discontinuation of therapy, discontinuation of therapeutic duplication, discontinuation of inappropriate therapy, notification of pharmacy of discrepancy, and improper drug-level monitoring avoidance. Cost analysis was calculated based on acquisition costs. The final cost saving was derived from adding cost avoided and cost saved minus pharmacist salary for the time spent in conducting the study. A total of 310 interventions were documented during the 13 weeks (65 days) of the study. The final cost saving was $79,723, which would extrapolate to an annual savings of $318,891. Although 31.3% of interventions involved change of dosage, interventions involving change to another drug (13.9%) had the largest economic impact ($62,527). The majority (85.4%) of the savings involved costs of medications saved (actual dollars saved rather than avoided). The authors concluded that the clinical pharmacist had a significant impact on the cost of drug therapy in the intensive care unit and that the cost of additional clinical pharmacist positions should be justified.

Cost Savings↗
PubMed1982

The clinical pharmacist as a member of the burn team.

Pharmacists are becoming involved increasingly in a patient care. At the University of California, San Diego Medical Center, a pharmacist has become a member of the multidisciplinary burn team. Through participation in work rounds and team conferences, the pharmacist has had a considerable beneficial impact on drug therapy, drug dosing, monitoring adverse drug reactions, and total parenteral nutrition. Specific benefits to patient care that the pharmacist provides are discussed and also the benefits derived in using a burn unit as a clinical teaching rotation for pharmacy students. The pharmacist has found his association with the burn unit to be professionally rewarding and the attending surgeons and surgical house staff have found his input to be valuable. The authors encourage other burn units to enlist a pharmacist as part of their burn team.

Burn Units↗
PubMed1982

Role effectiveness of a pharmacist in the maintenance of patients with hypertension and congestive heart failure.

This study was designed to measure the role effectiveness of pharmacists in the management of patients with hypertension and congestive heart failure. Based on therapy protocols established by physicians and pharmacists prior to the study, the pharmacist was measured against the standard for providing primary care--i.e., the physician. The study showed that the pharmacist competently elected drug therapy and identified adverse drug reactions. As a group, the 20 study patients, whose therapy was determined by the pharmacist, were better managed than the 20 control patients (p less than 0.05). It is suggested that the pharmacist is effective in the role of managing patients with hypertension and congestive heart failure.

Clinical Competence↗
PubMed1982

PPIs: community pharmacists' perceptions.

In order to measure pharmacists' perceptions about the PPis for estrogen and oral contraceptives, questionnaires were distributed to a random sample of 105 community pharmacists in a large midwestern city. Seventy completed questionnaires were returned, producing a response rate of 67 percent. A slight majority of the responding pharmacists indicated that pharmacists should be responsible for distribution of these PPIs but that physicians should be responsible for determining whether a patient should receive a PPI. The pharmacists indicated that patient information should be verbally communicated and accompanied by a written summary sheet and that patients neither read nor understand these PPIs. Although limited in size and geographic area, this study suggests that retail pharmacists have doubts about the current PPI program mandated by the Food and Drug administration.

Attitude of Health Personnel↗
PubMed1982

Pharmacists' perceptions of their patient counseling activities.

The counseling of patients regarding their drug therapy has been advocated as an important part of pharmacy practice. Both the need and potential for this counseling have been demonstrated. Yet, studies generally have been critical to the extent and quality of the counseling provided. This report describes counseling as it is perceived by community pharmacists who perform this activity. A mail survey, developed from interviews with pharmacists, was distributed to a random sample of Ohio community pharmacists. A net response of 76.8 percent (506 usable questionnaires) was achieved. Respondents have strong positive beliefs about counseling. When the service is provided by pharmacists, counseling sessions are usually brief, pharmacist-initiated, and one-way conversations to the patient. Although there is considerable variation as to the classes of drugs for which counseling is provided and the types of people who receive it, the components of counseling appear to be constant. Attempts to change or expand counseling activities may be compromised unless there is a common understanding among all parties involved of what counseling is. This report is one step toward achieving that understanding. It may be used by community pharmacists to measure and compare their counseling behaviors and beliefs with those of their peers and as a means of identifying possible areas for change in their own practices.

Attitude of Health Personnel↗
PubMed1984

An introduction to the clinical laboratory for pharmacists.

The intent of this article is to provide pharmacists with an introduction to the clinical laboratory. As clinical pharmacy services expand, interactions between pharmacists and the laboratory will increase. Laboratory results are an essential tool for pharmacists involved in monitoring drug therapy and adjusting dosing regimens. Laboratory medicine, however, is a complex and rapidly changing field with new analytical techniques and instruments continually being developed. Thus, methodologies vary greatly from one laboratory to another and even within the same laboratory from time to time. Quality control procedures are necessary to ensure accurate and reliable results. The medical technologists who staff clinical laboratories are highly trained professionals. Pharmacists should utilize the medical technologist as a consultant on the interpretation and limitations of laboratory tests. Likewise, there are many areas, such as therapeutic drug monitoring, in which the pharmacist can serve as a consultant to the laboratory. Pharmacists involved in patient care will benefit from a greater understanding of the clinical laboratory, and may also find new opportunities for clinical pharmacy practice and interaction with other health care professionals.

Humans↗