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PubMed1986

PharmD or BS: does the degree really make a difference in pharmacists' job satisfaction?

Secondary analysis of data obtained during the 1982 Socioeconomic Survey of California Pharmacists compared practice patterns and job satisfaction of BS and PharmD level practitioners. Questionnaires were mailed to 2,864 pharmacists in April 1982. Questionnaires were returned by 1,463 pharmacists yielding a response rate of 51 percent. Of those responding, 1,030 were currently practicing with either a BS or PharmD as their highest degree. Results indicate that BS level practitioners are more likely to be in hospital management or staff positions. The percent of time spent educating the public, pharmacy students and other health care professionals was the only job activity in which BS and PharmD practitioners differed to a statistically significant degree. Time spent processing the prescription and management activities had the most influence on job satisfaction. Academic degree did not have a statistically significant effect upon job satisfaction. These results suggest that when PharmD and BS pharmacists spend an equivalent amount of time doing the same job related activities, PharmD pharmacists are no more dissatisfied with their positions than are BS pharmacists.

Attitude of Health Personnel↗
PubMed1987

Use of staff pharmacists to reduce the inappropriate use of parenteral histamine-2 antagonist therapy.

This article describes the development and implementation of a target drug monitoring program using staff pharmacists as primary data collectors. This target drug program increased professional activities of staff pharmacists and showed how pharmacists could make an impact on drug therapy both financially and clinically. Parenteral histamine-2 antagonists were selected based upon amount of use and potential for inappropriate use and dosing. Criteria were developed in conjunction with the Pharmacy and Therapeutics Committee and medical staff. In phase I, pharmacists prospectively monitored all patients receiving parenteral cimetidine and ranitidine. Therapy was reviewed for justification of parenteral therapy (vs. oral), dosage adjustment in renal impairment, and monitoring of specific drug-drug interactions with cimetidine or ranitidine. During this phase, pharmacists collected data without intervening. Results from phase I and a program proposal for phase II were approved by the Pharmacy and Therapeutics Committee. Phase II consisted of the same monitoring procedures; however, when inconsistencies with the criteria were identified in one of the three categories, "chart education sheets" were placed in the chart. Results from phase I indicated a potential for cost savings. During phase II, 45% of the inappropriate parenteral therapy was changed to oral therapy, representing an annualized cost savings of $23,321 in this 540-bed hospital. The pharmacists were also successful in adjusting doses in renal impairment and monitoring potential drug interactions. The target drug program has proved to be an effective method of educating physicians and decreasing costs to the institution without the use of additional personnel.

Cost Control↗
PubMed2001

Knowledge of emergency contraception among pharmacists and doctors in Durban, South Africa.

OBJECTIVE: To determine the level of knowledge of emergency contraception among private-sector pharmacists and doctors. METHOD: This hand-delivered, confidential questionnaire survey was undertaken in North and South Central Durban, Kwazulu-Natal, South Africa. The main outcome measures were frequency of demand for emergency contraception and knowledge of its dosing schedule, side-effects and contraindications. RESULTS: Ninety-six per cent of pharmacists and 93% of doctors had received requests for emergency contraceptive pills within the past year. Thirty-two per cent of pharmacists and 28% of doctors prescribed the Yuzpe regimen correctly. Only 23 (27%) doctors and 25 (22%) pharmacists were able to identify three common side-effects associated with emergency contraceptive pills. Forty-six per cent of pharmacists and 49% of doctors correctly indicated that there are no absolute contraindications to emergency contraceptive pills other than a contraindication to contraceptive pills. Fifty-four per cent of pharmacists and 35% of doctors agreed that the multiple use of emergency contraceptive pills is risky. CONCLUSION: There is an urgent need to improve the knowledge of health-care workers regarding emergency contraception, which forms an important back-up method when existing contraception fails or is not used.

Attitude of Health Personnel↗
PubMed2001

Empirical treatment of uncomplicated urinary tract infection by community pharmacist in the Eastern province of Saudi Arabia.

OBJECTIVE: It is a well known phenomenon in the Kingdom of Saudi Arabia that prescription drugs are dispensed over the counter in the community pharmacies. The aim of this study is to document the attitude of community pharmacists to fulfill the concept of pharmaceutical care and to evaluate how they manage a case of acute uncomplicated lower urinary tract infection. METHODS: Eighty-eight community pharmacists in the Eastern province of Saudi Arabia were presented with a patient claiming urinary tract infection and seeking medical treatment. RESULTS: Only one attendant pharmacist refused to dispense medications without prescription. Fifteen others (17%) dispensed urinary antiseptic only and 72 (82%) gave antibacterial agents. Fluoroquinolones were the most commonly dispensed (69%) as first choice and 87% as an alternative) followed by co-trimoxazole, penicillins, cephalosporins and tetracyclines. The number of drugs dispensed ranged from a single agent at 52 (59%), 2 drugs at 31 (35%) and 3 drugs at 4 (4.5%) pharmacies. The average cost was Saudi Riyal (SR) 45.8 ($12.2) for first choice drugs and SR 31.5 ($ 8.4) for the alternatives. CONCLUSION: The heavy dispensing of fluoroquinolones over the counter could eventually lead to increased resistance of the pathogenic bacteria to these drugs. However, despite the lack of pharmacist's adherence to the pharmaceutical law, this study does not indicate that they had abused their patients. It is rather demonstrating the urgent needs for successful implementation of the pharmaceutical law taking into consideration better integration between governmental health providers and the private retail pharmacies. In addition, it supports calls to educate pharmacists to perform basic clinical assessment in the community pharmacy, as a vital tool to effectively manage their patients' health status. The Ministry of health should credit such educational activity for the renewal of pharmacist's license in the Kingdom.

Drug Prescriptions↗
PubMed2001

[Changes in pharmacists practices (1996 - 2000) related to harm reduction policy (condoms, injecting equipment, methylmorphine) and maintenance therapy delivery (buprenorphine, methadone)].

AIMS: To measure pharmacists involvement in harm reduction programs and in delivery of maintenance therapies in order to estimate their contribution to the new public health policy. METHOD: A longitudinal study was conducted among 327 pharmacies located in the southern suburban area of Paris (28 communities) using a standardized questionnaire. RESULTS: The response rate was 95% in 1996 and 92% in 2000. The number of condoms offered to intravenous drug users (IDU) decreased dramatically from 99% to 24% while delivered units decreased from 857 to 566 per day for needles and from 1200 to 760 per month per pharmacy for methylmorphine tablets (14.93 mg/tablet). Pharmacists delivered injecting equipment to some of their patients under opiate treatment: methylmorphine 19%, buprenorphine 35%, methadone 14%. Their contribution to the local healthcare network on addiction decreased from 38% to 20%. Nevertheless, the pharmacists attitude towards the IDU and public health policy was found to be improving with problems being mentioned for 62% of the cases in 1996 and for 16% in 2000. CONCLUSION: Pharmacists are rapidly and intensively changing their practices and are discovering a new comprehensive relationship with IDU. Better pharmacist involvement is associated with a shift in local healthcare network concentration, reinforcing the general practitioner-pharmacist partnership.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Pharmacists' attitudes toward advanced practice nurses' prescriptive authority.

In an era of managed care, the new healthcare paradigm emphasizes a team approach to primary care health services. A team approach requires collaboration among healthcare providers. One model that has not been adequately explored is that of the advanced practice nurse (APN) and the pharmacist. This study examines the attitudes of pharmacists in Colorado toward the prescriptive authority of APNs and explores some of the issues that may discourage a collaborative relationship between APNs and pharmacists. Although the response rate was limited (18%), a preliminary impression of pharmacists' attitudes was gathered. In general, the pharmacists were supportive of APNs' prescriptive authority, although they qualified their responses with the fact that the workload increased. Other concerns were lack of information about the legal ramifications of APNs' prescriptive authority and difficulty with third-party insurors who did not recognize APNs as primary care providers. Suggestions for developing a more cohesively collaborative relationship between APNs and pharmacists were discussed.

Adult↗
PubMed2003

Pharmacist's contribution in a heart function clinic: patient perception and medication appropriateness.

BACKGROUND: It has been cited that the management of congestive heart failure (CHF) requires a multidisciplinary approach; however, the role of the pharmacist has not been extensively studied. The roles for pharmacists are changing to meet the long term needs of patients in the community setting, including patients with CHF. OBJECTIVES: To evaluate the effect of a pharmacist on the appropriateness of medications taken by patients in the heart function clinic using the Medication Appropriateness Index (MAI) and to measure the effect of a pharmacist on the patients' response to the pharmacist's interventions using the Purdue Directive Guidance (DG) scale. METHODS: Eighty patients attending the heart function clinic at The University Health Network, Toronto General Hospital Toronto, Ontario were randomly assigned to an intervention group that received pharmacist services or a nonintervention group that received usual care from the clinic staff. Patients were assessed at baseline and at one-month follow-up. RESULTS: The change in MAI score from baseline was 0.74 and 0.49 for the intervention and nonintervention groups, respectively (P=0.605). The change in DG survey results was 9.97 and 1.00 for the intervention and nonintervention groups, respectively (P<0.001). The intervention group improved significantly in all components of the DG survey, especially those pertaining to feedback and goal setting. CONCLUSIONS: A benefit was demonstrated for 'directive guidance' of patients, in the form of education and goal setting as shown by positive survey results.

Aged↗
PubMed2003

The effect of pharmacist intervention and patient education on lipid-lowering medication compliance and plasma cholesterol levels.

BACKGROUND: Dyslipidemias are a modifiable risk factor for coronary heart disease. The benefits of cholesterol reduction drug therapies are limited by poor patient compliance with drug regimens. OBJECTIVES: To determine the impact of a community pharmacist pilot disease-management program on patient compliance with lipid-lowering drug therapy and on serum cholesterol levels. METHODS: One hundred forty-nine patients who were nonadherent to prescribed hypolipidemic drug regimens were recruited for this six-month prospective study. Each subject served as their own control. Pharmacists educated these patients on lipid disorders, the benefit of medication compliance and lifestyle modifications that reduce the risk for coronary heart disease. Pharmacists followed up participants by telephone at two-month intervals. Drug renewal rates were monitored throughout the study and plasma lipid levels were measured at study outset and study end. RESULTS: Pharmacist intervention and patient-education programs significantly increased medication compliance, as shown by a 15.3% increase (P<0.05) in the number of compliant patients and an 11 day (P<0.001) reduction in the average number of days to prescription renewal. Concurrently, levels of total cholesterol, triglycerides and low-density lipoprotein (LDL) cholesterol, were reduced by 6%, 16.2%, and 8.5% (P<0.001, 0.01, 0.01), respectively. High density lipoprotein (HDL) cholesterol remained relatively unchanged (+0.7%) so that the LDL to HDL ratio was improved by 17.2% overall (P<0.01). Almost all of the patients (99.2%) were satisfied with the program and expressed a willingness to pay an average $34.50 per 30 min consultation for the pharmacist services offered. CONCLUSION: Pharmacists can contribute significantly to disease management of dyslipidemic individuals.

Aged↗
PubMed1992

Changing relationship between pharmacists and physicians.

The changing professional relationship between pharmacists and physicians in the United States from the beginning of the nineteenth century to the present is described. Throughout the nineteenth century, physicians intruded heavily on the pharmacist's domain, and medicine often viewed pharmacy with condescension. Toward the century's end, pharmacists gained more respect and recognition as the medical and pharmaceutical sciences grew and physicians found themselves relying on pharmacists. Hundreds of years of friction were not easily forgotten, though, and the two professions continued to hurl charges and countercharges and vie for power. With the emergence of the pharmacist as a full member of the health-care team and the crush of medical information in the twentieth century, greater cooperation is occurring, although irritations persist, especially in the areas of physician dispensing and therapeutic interchange. Improvements in the relationship between pharmacists and physicians were driven by growth in their fields and the trend toward specialization. As tensions ease, patient care should benefit.

Humans↗
PubMed1992

Pharmacist-managed drug therapy helps meet requirements for drug-use evaluation.

Pharmacist-managed drug therapy at a 205-bed nonprofit, general medical and surgical hospital is described. The pharmacy department provides a drug therapy management service in which clinical pharmacists initiate and adjust drug therapy and order laboratory tests according to criterion-based protocols. A physician requests initiation of the protocol and cosigns all orders written by pharmacists. The protocols for pharmacy-managed drug therapy are developed primarily by the clinical pharmacists and approved by the hospital's pharmacy and therapeutics and executive committees. They delineate specific indicators of the process (e.g., timely initiation of therapy) and outcome (e.g., clinical efficacy) of drug therapy management. These indicators are included in the record kept by the pharmacist for each patient treated in this program, and this documentation is reviewed daily. The same documentation is used in the drug-use evaluation (DUE) process. (Drugs for which drug therapy management protocols have been developed are among those selected for DUE.) In 1990, pharmacists managed 3616 courses of drug therapy by using approximately 100 drug protocols. The criterion-based drug therapy management service helps to fulfill the hospital's drug-use evaluation responsibilities by establishing specific process and outcome indicators, proposing drugs for DUE inclusion, and collecting data.

Drug Therapy↗
PubMed2005

Pharmacist misconduct: the pitfalls of practice.

This article identifies the changing role of pharmacists in the provision of health care and analyses 78 complaints against pharmacists over a recent 12-year period in New South Wales, finding that the majority of complaints were in relation to the oversupply of particular medications, from which some pharmacists made significant financial gains. A number of other areas of complaint were identified, including issues in relation to the recording and labelling of medications and the roles and responsibilities of pharmacists, dispensing errors, fraud, and sexual misconduct. As the roles of pharmacists continue to expand, with the growth of "compounding chemists", and the suggestion that pharmacists are now performing basic medical tasks which were once the domain of a general practitioner, it is increasingly important that pharmacy take its place in any debates about the provision and regulation of health services.

Community Participation↗
PubMed2006

[The role in cancer chemotherapy of "a pharmacist specialized in cancer"].

A pharmacist system specialized in cancer has been established to authorize a clinical pharmacist to provide safe and sure support for cancer chemotherapy. A pharmacist specialized in cancer supports a protocol that has became complicated or involves management of anticancer agent side effects from a professional standpoint. The examination certifying a pharmacist specialized in cancer is very difficult, sophisticated (certification by pharmacists society) and requiring first-hand clinical experience of cancer chemotherapy to be eligible necessary for the examination. 41 pharmacists specialized in cancer were qualified in March of 2006.

Education, Pharmacy↗
PubMed1991

Multidimensional work sampling to study the activities of decentralized clinical pharmacists.

Self-reported multidimensional work sampling (MDWS) was used to study the activities of decentralized clinical pharmacists at six hospitals in Portland, Oregon, and Seattle-Tacoma, Washington, in March through June 1989. A community hospital, a university hospital, and a hospital associated with a health maintenance association were selected in each city, and pharmacists at each site who provided clinical services were recruited. Each pharmacist wore a random reminder device and recorded the activity during which the device sounded by writing on a card numbers assigned to describe work activity, contact, location, and function. Of 6609 classifiable observations, 34.5% (2280) were of clinical activities and 35.8% distributive activities. Pharmacists spent 28.6% of their clinical time reviewing and assessing patients' charts, 17.1% on clinical rounds, 15.9% on activities related to therapeutic drug monitoring, 10.2% providing drug information, 11.6% attending or giving formal education, 6.1% doing research, and 2.6% attending meetings. The average pharmacist spent less than 10 minutes each day with patients but spent a substantial portion of time providing clinical services to other health professionals. Self-reported, multidimensional work sampling appears to be a valuable method for describing and monitoring decentralized pharmacists' work activities at multiple sites and work settings.

Hospitals, Community↗
PubMed1991

Attitudes of Ohio hospital pharmacists toward pharmacy technicians.

A survey was conducted to determine the attitudes of Ohio pharmacists toward pharmacy technicians. A questionnaire was developed with questions about the current and future scope of technician responsibilities; training, certification and licensure; and possible displacement of pharmacist positions. The questionnaire was mailed in January 1990 to a random sample of 357 hospital pharmacists registered with the Ohio State Board of Pharmacy. There were 182 usable questionnaires returned, for a response rate of 51%. Nearly all the respondents (98.4%) employed pharmacy technicians. Of 32 functions listed in the questionnaire, 16 were performed by technicians at more than half of the responding hospitals. The functions performed by technicians varied depending on the size and location of the hospital; and the education, experience, and current position of respondents influenced their opinions on the appropriateness of having technicians perform several functions now and in the future. Most respondents agreed that all technicians should receive standardized training and education, and more than a third believed that technicians should be certified. The respondents did not believe that increased use of technicians would eliminate present pharmacist positions in their department but were neutral toward a statement that technicians would eliminate pharmacist positions in general. Ohio pharmacists' attitudes toward the expanding role of pharmacy technicians seemed in concert with the recommendations that have emerged in the profession.

Attitude of Health Personnel↗
PubMed1991

Pharmacist career ladder with clinical privilege categories.

The development of a career ladder program for staff pharmacists at a Department of Veterans Affairs (VA) medical center is recounted. Center policy required the establishment of clinical privileges for all pharmacists with direct patient contact and specified three VA privilege categories with increasing degrees of autonomy. The pharmacy department supported the need for all pharmacists to incorporate clinical activities into their daily practice but faced several problems, including inadequate instruction, insufficient incentives, fragmentation of clinical services, and subjectivity of measures of competence. In response, a pharmacy credentialing committee created a career ladder with three levels based on the established system of clinical privileges. Level A integrated basic clinical pharmacy knowledge with dispensing activities. Level B increased the number of clinical skills required and allowed the pharmacist to act as a therapeutic consultant. Level C incorporated the skills necessary for specialty practice. Instructors were designated for each clinical service area, readings and sample problems were assigned, and staff development presentations were improved. Objective tests of skills were designed. Combining the three levels on the career ladder with the three categories of clinical privileges formed a matrix of nine options for advancement. Pharmacists applying for advancement must master all requisite skills and submit relevant documentation. Each level carries a pay increase of 2%. A total of 53% of the staff pharmacists have participated in the program, which has had a favorable impact on staff retention. By combining nationally established categories of clinical privileges with an institution-specific career ladder, a pharmacy department helped ensure the consistency of services and promote the development of clinical practitioners.

Career Mobility↗
PubMed1991

Attitudes among Department of Veterans Affairs pharmacists toward postgraduate education and training.

The results of a survey of the attitudes of Department of Veterans Affairs (VA) pharmacists toward postgraduate education and training are reported. In January 1990 an anonymous questionnaire was mailed to 800 randomly selected VA pharmacists. The mailing occurred one month after the announcement of new policies for recruiting and retaining VA pharmacists that allow salaries to be determined on the basis of education, job responsibilities, publishing, and other professional activities and accomplishments. Recipients were asked to provide educational and demographic data, information on their work settings and job responsibilities, and their perceptions of the benefits of and barriers to additional education and training. Of the 800 questionnaires mailed, 310 (38.8%) usable responses were received. The majority (77%) of the pharmacists held B.S. degrees only. One-day to one-week training programs had been attended by 74.5% of the respondents; at least 61.6% desired to attend such programs, and many indicated the desire to attend longer training programs. Some 48.3% of the B.S.-level pharmacists had expressed an interest in earning another pharmacy-related degree. More than 40% of the respondents saw time, money, and the location of programs as barriers. Perceived benefits included personal development, enhanced job satisfaction, and improved patient care; only 1.9% perceived no benefit. Seventy-seven percent believed that salary should reflect the level of professional training. VA pharmacists desire additional education and training and believe that such programs may enhance patient care and reduce staff turnover.

Attitude of Health Personnel↗
PubMedDate not supplied

Effectiveness of a specially trained pharmacist in a rural community mental health center.

Pharmacists having training in psychopharmacology and psychiatry are being specially trained to function in community mental health centers as a resource in psychopharmacology and to provide direct care to patients. Management information data over a 3-year period from eight rural mental health clinics indicate that these pharmacists can successfully maintain large numbers of stabilized psychiatric patients within their communities. The cost of a pharmacist's services is, conservatively, one-half that of a psychiatrist's services. A followup study of the stabilized and active aftercare outpatients in the 10-county rural area in which the 8 clinics are located revealed that those patients who received all their direct care from the pharmacist were functioning at a slightly healthier level than the other aftercare patients. The pharmacist's patients indicated that they were at least as satisfied with their care as were the aftercare patients who received care from other mental health professionals. If the results of this study can be generalized to other community mental health centers in rural areas, a pharmacist can provide services effectively when psychiatrists are inaccessible or unavailable or when funds for mental health professionals are limited.

Aftercare↗
PubMed1990

Professional relationships between general practitioners and pharmacists in health centres.

The inclusion of pharmacies in health centres has created opportunities for general practitioners to become better acquainted with the potential contribution of pharmacists to health care. A qualitative study has been made to explore the extent to which this potential has been realized. Ten health centres with an integral pharmacy were selected, one from each of the regional health authorities in England which had at least one such health centre. Interviews were conducted with 13 general practitioners and 10 pharmacists working in the health centres. Nine general practitioners working in health centres without pharmacies and 10 community pharmacists were also interviewed. General practitioners' attitudes towards health centre pharmacists appeared to differ markedly from the attitudes of colleagues working in relative isolation from pharmacists. It appears that general practitioners working closely with the pharmacist develop a collaborative approach to health care.

Ambulatory Care Facilities↗