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PubMed2004

A national study examining the effect of making emergency hormonal contraception available without prescription.

BACKGROUND: In January 2001, emergency hormonal contraception was made available for women over the age of 16 years directly from a pharmacist without prescription. It is of interest whether this change in the UK has led to any improvements or deterioration in the service provided for the women who need it. METHODS: Self- completed, anonymous questionnaires were distributed to women requesting emergency hormonal contraception through a single group of pharmacies located throughout England, Wales and Scotland. RESULTS: A total 419 women returned completed questionnaires. A greater proportion of women were able to take emergency contraception within 24 h when they obtained their tablets directly from a pharmacy without a prescription (64% versus 46%, P = 0.029). Women who obtained their drugs directly from the pharmacist were just as well informed, just as likely to arrange regular follow-up and generally preferred this system, although they disliked having to pay. CONCLUSION: Making emergency hormonal contraception available without prescription has improved services to women who need them, but these improvements are quantitatively minimal, preventing only five additional pregnancies per 10,000 users.

Contraceptives, Postcoital, Hormonal↗
PubMed2003

Risk adjustment using automated ambulatory pharmacy data: the RxRisk model.

OBJECTIVES: Develop and estimate the RxRisk model, a risk assessment instrument that uses automated ambulatory pharmacy data to identify chronic conditions and predict future health care cost. The RxRisk model's performance in predicting cost is compared with a demographic-only model, the Ambulatory Clinical Groups (ACG), and Hierarchical Coexisting Conditions (HCC) ICD-9-CM diagnosis-based risk assessment instruments. Each model's power to forecast health care resource use is assessed. DATA SOURCES: Health services utilization and cost data for approximately 1.5 million individuals enrolled in five mixed-model Health Maintenance Organizations (HMOs) from different regions in the United States. STUDY DESIGN: Retrospective cohort study using automated managed care data. SUBJECTS All persons enrolled during 1995 and 1996 in Group Health Cooperative of Puget Sound, HealthPartners of Minnesota and the Colorado, Ohio and Northeast Regions of Kaiser-Permanente. MEASURES RxRisk, an algorithm that classifies prescription drug fills into chronic disease classes for adults and children. RESULTS: HCCs produce the most accurate forecasts of total costs than either RxRisk or ACGs but RxRisk performs similarly to ACGs. Using the R(2) criteria HCCs explain 15.4% of the prospective variance in cost, whereas RxRisk explains 8.7% and ACGs explain 10.2%. However, for key segments of the cost distribution the differences in forecasting power among HCCs, RxRisk, and ACGs are less obvious, with all three models generating similar predictions for the middle 60% of the cost distribution. CONCLUSIONS: HCCs produce more accurate forecasts of total cost, but the pharmacy-based RxRisk is an alternative risk assessment instrument to several diagnostic based models and depending on the nature of the application may be a more appropriate option for medical risk analysis.

Adolescent↗
PubMed1994

Accuracy of technicians and pharmacists in identifying dispensing errors.

The accuracies with which pharmacists and technicians checked medications in a unit dose distribution system were compared. The study was conducted at three large hospitals in Washington State. From August through October 1991, technicians filled unit dose medication drawers and pharmacists verified the accuracy of each fill (pharmacist verification period). From November 1991 through January 1992, technicians who had undergone special training verified the accuracy with which medication drawers were filled by other technicians (technician verification period). For each study period, two error rates were estimated: the frequency with which the pharmacists or technicians identified dispensing errors and the frequency of verification errors identified by the investigators in a final independent check. A total of 143,952 unit doses were dispensed during the pharmacist verification period, of which 49,718 were randomly analyzed for accuracy. A total of 151,721 doses were dispensed during the technician intervention period, of which 55,470 were assessed. The mean +/- S.E. daily rates of dispensing-error identification by pharmacists (0.0125 +/- 0.0069%) and technicians (0.0119 +/- 0.0001) did not differ significantly. While pharmacists overlooked more errors (107) than technicians (50), the percentage of such missed errors classified as potentially serious did not differ significantly between the groups (25.2% versus 32.0%, respectively). Pharmacy technicians who underwent special training were able to verify medications in a unit dose distribution system without compromising the accuracy of dispensing.

Education, Pharmacy↗
PubMedDate not supplied

Regional variation in prescribing for chronic conditions among an elderly population using a pharmacy claims database.

BACKGROUND: Age, gender and geographical regions are recognised factors in inequalities in prescribing for chronic diseases in the elderly. AIM: To compare the health board regional distribution of chronic disease among the elderly and to examine variation in quality prescribing across age, gender and regions. METHODS: Population based study of prescribing for chronic disease using a national pharmacy claims database. All individuals aged 70 years and over (n = 271,518) were eligible. RESULTS: Over 60% of the elderly in all regions received cardiovascular related medication. The South Eastern, North Western and Western Health Boards had below average prescribing for many chronic conditions. Logistic regression identified age, gender and regional variations in prescribing of preventative therapies for CVD and diabetes. CONCLUSION: There is a high prevalence of prescribing for chronic conditions in the elderly in Ireland, and there is evidence of gender, age and residing health board inequalities in prescribing.

Age Factors↗
PubMed1988

Multidisciplinary cost-containment program promoting less frequent administration of injectable mezlocillin.

A multidisciplinary cost-containment program for promoting less frequent administration of mezlocillin injection is described. The pharmacy department and the division of infectious diseases at Hartford Hospital implemented a program through which regimens of mezlocillin 5 g every eight hours would automatically be substituted for the frequently prescribed regimen of mezlocillin 3 g every four hours. Patients with urinary-tract infections or renal insufficiency and febrile neutropenic cancer patients also received various modified regimens. Use of the modified regimens was promoted through inservice education programs and distribution of newsletters and pocket-size brochures describing the dose-dependent pharmacokinetics of mezlocillin to medical staff. The pharmacy and therapeutics committee supported the program by endorsing the use of the modified regimens and distributing periodic progress reports. Pharmacists on the nursing units were responsible for enforcing the program stipulations regarding modified dosage regimens and for reporting adverse reactions and unexpected therapeutic failures. Ten months after implementation of the program, there was better than 99% compliance with the appropriately modified mezlocillin dosage regimens. Theoretical annual cost savings based on less frequent administration of mezlocillin injection amount to more than $33,000. The multidisciplinary program described here was successful in promoting the use of modified mezlocillin dosage regimens.

Connecticut↗
PubMed1989

PharmaTrend as a management tool: experience with the program.

A hospital's experiences with two pharmacy workload measurement systems, PharmaTrend and the pharmacy productivity unit (PPU) system it replaced at the institution, are compared. In 1976 a 352-bed general acute-care hospital implemented the locally developed PPU system. Typical drug distribution-related activities were defined and were assigned standard times per work unit; miscellaneous activities were assigned constant times per month. The PPU system served the institution well but had three important limitation: (1) new pharmaceutical services were not adequately represented, (2) the data collected had to be manually manipulated in order to calculate indicators, and (3) it was not possible to compare the data with those of similar institutions. In January 1988 the hospital implemented PharmaTrend. PharmaTrend was found to be a useful management tool because of the relative ease of data collection and the system's report-generation capabilities. By combining pharmacy workload data (including non-drug-distribution-related components) with data on finance, personnel hours, and patient admissions, PharmaTrend calculated indicators that were used for determining staffing and other needs and for financial reporting. The limitations of the PPU system were eliminated, except that it was still not possible to make valid comparisons with other hospitals because of the small number of participating hospitals that consistently report data to the PharmaTrend database. PharmaTrend offers advantages over previous pharmacy workload-monitoring systems by allowing for the expanded analysis and application of data.

Colorado↗
PubMed1978

Personnel requirements for improving services in a hospital pharmacy.

Pharmacy services at Boston Hospital for Women were made to meet 1976 JCAH pharmacy standards. Changes made in the pharmacy program are described, comparing the average amount of staff hours per week devoted to various pharmacy activities in 1974 and 1976. Activities are broken down into four major areas: administration, distribution of drugs, preparation of drugs and clinical programs. The clinical role of the pharmacist and updating of programs and operating procedures has been a major consideration in making changes.

Boston↗
PubMed2003

Factors associated with carriage of penicillin-resistant Streptococcus pneumoniae among Vietnamese children: a rural-urban divide.

This study examined the relationship between antimicrobial resistance in Streptococcus pneumoniae and patterns of antimicrobial usage and over-the-counter dispensing by pharmacies in urban and rural districts of Vietnam. The antimicrobial susceptibility of S. pneumoniae carried by healthy urban and rural school children was determined. Questionnaires were distributed to parents to describe their healthcare-seeking behaviour. Mock parents presented standardized cases of mild respiratory infection and acute watery diarrhoea to pharmacies in the district surrounding each school. Penicillin resistance was significantly more common in S. pneumoniae carried by urban children compared to rural children as was recent antibiotic usage. Both urban and rural pharmacies showed high rates of dispensing inadequate antimicrobial regimens. The high level of antimicrobial resistance in S. pneumoniae may be related to greater antimicrobial usage. This may result from the much easier access to healthcare providers in urban areas and may suggest that relying solely on education without limiting access to outlets may have only limited impact. The results suggest a greater understanding of the subtleties of healthcare-seeking behaviour, and access to healthcare is needed to help refine and guide rationale suggestions to reduce the continued spread of drug resistance.

Child↗
PubMed1988

Direction through accreditation--CCHA (Canadian Council on Hospital Accreditation) recommendations to Ontario hospital pharmacies.

A questionnaire was circulated in December 1986 to 157 Ontario hospital pharmacy directors that asked about the recent recommendations made by CCHA surveyors. Sixty-four directors responded and assigned their received recommendations to four categories of pharmacy service. Similar recommendations were tabulated by category of service and by number of hospital beds (less than 200 and greater than 200 beds). The results show that drug distribution was the most emphasized area of service cited for improvement. Frequent recommendations concerned patient medication profiles, night supply services, hospital formulary, Pharmacy and Therapeutics Committee policy review, adverse drug reaction programs, quality assurance, and regular medication room checks. Responses indicated that 27 of the 62 eligible hospital pharmacies (44%) that received recommendations have acquired administrative support to implement changes, and 33 of 62 (53%) have had specific action as a result of an accreditation survey.

Accreditation↗
PubMed2000

Distribution of pharmaceuticals--a Norwegian logistic perspective.

There is a general concern about rising costs of pharmaceutical expenses. One political measure is a more efficient distribution system, which can take the form of new channels for retailing. In Norway mail-order pharmacy (MOP) has been brought to the agenda due to the recently proposed law regulating pharmacies ("Apoteklov"), market developments abroad, demand for self-medication, the increase in OTC-products and advances in information technology. Mail-order pharmacy involves direct delivery of medications through postal mail to patients or those responsible for dispensing medication. With reference to the USA, mail-order pharmacy has filled a niche in the market and several other countries are following. We are convinced that it is possible to maintain a high level of service quality in the sense of safety, counselling and compliance, and that there is a potential to develop a model for this distribution form in Norway. We believe that the actors in the Norwegian pharmaceutical market are better served in taking a more active role in this area and where possible initiating pilot projects in mail-order distribution. The pharmacists will continue to play an important role as a retail outlet and should, with their influence over patients, their knowledge and experience, contribute towards developing MOP to be a safe and complementary sales outlet. Developing such a solution demands the right balance between performance and quality on the one hand and efficiency on the other; two criteria, which we believe, do not contradict each other.

Humans↗