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PubMedDate not supplied

Becoming 'indispensable': developing innovative community pharmacy practices.

OBJECTIVE: To describe common characteristics of successful innovative community pharmacy practices. DATA SOURCES: Four pharmacists who are successfully incorporating pharmaceutical care services into their pharmacy practices were identified for inclusion by key informants. Sites considered for inclusion were within 300 miles of the University of Minnesota College of Pharmacy. The four innovative community pharmacy practices were located in Maquoketa, Iowa, and in Bemidji, Anoka, and Minneapolis, Minn. Published articles identified through a Medline search-using the terms pharmaceutical care, Medicaid, Medicare, pharmacist, pharmacy, and collaborative practice-provided information to prepare for pharmacist interviews. STUDY SELECTION: By the authors. DATA EXTRACTION: Previsit telephone interviews with each pharmacist, combined with literature selected by the authors, were used to identify common characteristics of successful practices. Structured, on-site empirical observation was then performed to devise a tool for pharmacists to use for the development of innovative community pharmacy practices. The tool was then validated by two additional practitioners. DATA SYNTHESIS: Components of successful innovative community pharmacy practices include philosophy of practice, patient care process, management system, and clinical knowledge. A checklist tool is presented to be used in conjunction with the narrative description of the four components. CONCLUSION: Advanced pharmacy services delivered within pharmaceutical care practices can be a successful business opportunity for community pharmacists. Community pharmacists motivated to develop an innovative practice and provide pharmaceutical care services can use the checklist tool during practice implementation.

Attitude of Health Personnel↗
PubMedDate not supplied

Medication Therapy Management in community pharmacy practice: core elements of an MTM service (version 1.0).

OBJECTIVE: To develop a model framework of Medication Therapy Management (MTM) in community pharmacy designed to improve care, enhance communication among patients and providers, improve collaboration among providers, and optimize medication use that leads to improved patient outcomes. DATA SOURCES: Peer-reviewed literature, structured discussions with community pharmacy leaders and representatives from pharmacy benefit providers and health plans, and input from pharmacists and pharmacy associations. SUMMARY: Building on an MTM consensus definition adopted by 11 national pharmacy organizations in July 2004, this model describes core elements of an MTM service that can be provided by pharmacists across the spectrum of community pharmacy. The model is structured for pharmacists to use with all patients in need of MTM services, both in the private and public sector. The model describes five core elements of MTM in the community pharmacy setting: medication therapy review (MTR), a personal medication record (PMR), a medication action plan (MAP), intervention and referral, and documentation and follow-up. The MTR can be comprehensive or targeted, depending onthe needs of the patient. The PMR and MAP are patient-centered documents intended to be used by the patient to improve medication self-management. A collaborative approach to patient care involving patients, pharmacists, and physicians and other health care providers is advocated in the model. General patient eligibility considerations are also described. CONCLUSION: A model framework for consideration by community pharmacists in developing MTM services is described. The model consists of five core elements for MTM service delivery in community pharmacy practice.

Community Pharmacy Services↗
PubMed2001

Management of childhood acute respiratory infections at private pharmacies in Vietnam.

OBJECTIVE: To investigate the knowledge and practice among private pharmacy staff in Hanoi regarding case management of mild acute respiratory infection (ARI) in children. METHODS: Sixty private pharmacies in Hanoi were randomly selected. Knowledge was assessed through interviews with pharmacy staff using a questionnaire; practice was assessed through the Simulated Client Method. RESULTS: In the questionnaire, 20% of the pharmacy staff stated that they would dispense antibiotics. In practice, 83% of the pharmacies dispensed antibiotics. Only 36% of the cases were handled according to guidelines. In the questionnaire, 81% of interviewees stated that antibiotics are not effective in short therapeutic courses. In practice, 48% of the antibiotics were dispensed in courses less than five days. Traditional herbal medicines were dispensed in 41% of the encounters. In the questionnaire, 53% of the pharmacy staff stated that they would ask the patient about difficulty of breathing. In practice, questions related to difficulty of breathing were asked in less than 10% of the encounters. CONCLUSIONS: Dispensing of antibiotics for mild ARI was common practice among private pharmacies, and there was a significant difference between knowledge and practice. Interventions are needed to improve pharmacy practice in Hanoi.

Acute Disease↗
PubMed2004

Scope of international hospital pharmacy practice.

OBJECTIVE: To review the published English literature regarding international hospital pharmacy practice. DATA SOURCES: A computer search of all English-language articles in MEDLINE (1966-June 2004) and other Internet sources and International Pharmaceutical Abstracts (1971-June 2004). STUDY SELECTION AND DATA EXTRACTION: All studies that discussed hospital pharmacy or clinical hospital pharmacy activities outside of the US were considered for inclusion. DATA SYNTHESIS: The scope of international hospital pharmacy practice is quite varied, both inter- and intra-country, and varying degrees of specialization exist. Although clinical pharmacy is well developed in some countries, it is still in infancy stages in others. In addition, there is disparity in the actual definition of clinical pharmacy throughout the world. CONCLUSIONS: Since very few data have been published regarding hospital pharmacy practice on an international scale, we suggest a survey be conducted to objectively capture this information and increase awareness of clinical pharmacy in this setting.

Formularies as Topic↗
PubMed2005

Pharmaceutical care in community pharmacies: practice and research in Canada.

OBJECTIVE: To discuss the provision of pharmaceutical care in community pharmacies in Canada including the following topics: organization and delivery of health services, health service policy, methods of payment, types of pharmacy services provided, types of cognitive pharmacy services, research in community pharmacy, and future plans for community pharmacy services. DATA SYNTHESIS: The implementation of pharmaceutical care in Canadian community pharmacies continues to become more widespread. However, barriers to the provision of pharmaceutical care still exist, including the current shortage of pharmacists and lack of reimbursement systems for cognitive services. Evidence of the value of pharmaceutical care in Canadian community pharmacies has been supported by several pharmacy practice research projects. The pharmacist's role in patient care is expected to continue to expand. CONCLUSIONS: Although Canadian pharmacists' capabilities are not yet universally recognized and applied to their full potential, there is reason to be optimistic about the future of pharmaceutical care in the community setting in Canada.

Canada↗
PubMed2005

Providing patient care in community pharmacies in Spain.

OBJECTIVE: To review the current status of Spanish community pharmacy, both in practice and research terms, and analyze its future trends. FINDINGS: Spain has a social security system where all citizens receive health care, social services, and pensions. All medical care and surgery are free for citizens; however, community pharmacies in Spain are privately owned. There are geographic and population standards for the establishment of new pharmacies, resulting in an average of 1 pharmacy per 2000 residents. Almost all pharmacies offer the same services: compounding, weight and blood pressure measurement, and cholesterol and glucose testing. There are also other, less-implemented services, such as methadone supply or directed observed treatments. Most of these services are freely provided, except compounding (fee for service), methadone, and directed observed treatments. University pharmacy practice departments do not exist in Spain, which leads to scarce research in this area. DISCUSSION: Efforts have been made to describe and measure the prevalence of negative clinical outcomes produced by pharmacotherapy and create an operational procedure to provide pharmacotherapy follow-up. CONCLUSIONS: Spain has many community pharmacies, but there is little pharmacy practice research. Some advanced cognitive services exist, but few are being remunerated.

Delivery of Health Care↗
PubMed2004

Evidence-based core clinical pharmacy services in United States hospitals in 2020: services and staffing.

We developed a model for the provision of clinical pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing clinical pharmacy services. To provide 14 specific clinical pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core clinical pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core clinical pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core clinical pharmacy services could be provided with only modest increases in clinical pharmacist staffing.

Costs and Cost Analysis↗
PubMed1998

Syndromic management of STDs in pharmacies: evaluation and randomised intervention trial.

BACKGROUND: Improved clinic based syndromic management of sexually transmitted diseases (STDs) in Tanzania reduced HIV transmission. However, in many developing countries, people seek STD treatment in pharmacies. This study used standardised simulated patients (SSP) to assess STD syndromic management in pharmacies and evaluate the impact of an educational intervention. METHODS: SSP presented syndromes of urethral discharge, genital ulcer, vaginal discharge, and pelvic inflammatory disease (PID) at 180 randomly selected pharmacies in Lima, Peru. These pharmacies were then randomised to receive or not receive education on STD recognition, management, and prevention counselling, and were again visited by SSP. RESULTS: At 360 pharmacy visits before the intervention, syndromes most often recognised as STD related were genital ulcer (81%) and urethral discharge (73%) in men, followed by vaginal discharge (43%) and PID (6%) in women. Treatments offered to 82.5% of SSP rarely conformed to international or national guidelines (for urethral discharge, 1.5%; genital ulcer, 1%; vaginal discharge, 4%; and PID, none). Only 20.5% of SSP were referred to a physician and 30% received any counselling. The intervention reached 55% of pharmacies, and produced a small but significant increase in counselling; by "intent to intervene" analysis, intervention pharmacies provided post-counselling more often than did controls (40% v 27%, p = 0.01). CONCLUSION: Pharmacies usually failed to recognise STD syndromes in women, and usually provided treatment, most often with ineffective regimens. Educational interventions improved counselling. More effective interventions are needed to improve STD recognition, treatment, and referral practices.

Adolescent↗
PubMed1983

Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981.

The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.

Analysis of Variance↗
PubMed1987

Development of a model for predicting pharmacy personnel requirements.

The purpose of this study was to adjust current staffing based on productivity measurement and analysis of the unit dose and sterile products area of the pharmacy, and to develop a model for predicting pharmacy personnel requirements based on Pharmacy Staffing Units (PHASUs). Time measurements of the specific pharmacy procedures were performed to define baseline procedure data. A PHASU equivalency system was developed to allow comparison of all pharmacy procedures. This system was based on the time required to complete a specific procedure divided by the time required to complete the procedure most reflective of workload, a single medication order. Pharmacy personnel requirements were forecasted using the number of unit dose orders and the number of miscellaneous sterile preparations in the sterile products area. A software package used by management engineering to predict patient days and number of admissions was used to forecast workload. The PHASU system provides a means for forecasting workload and addressing personnel requirements for the next fiscal year. Pharmacy administrative personnel must adopt a contemporary business approach to meet the challenge that pharmacy will encounter in the new health care environment.

Forecasting↗
PubMed1996

The role of policy in community pharmacies' response to injection-drug use: results of a nationwide Canadian survey.

The response rate to this survey reflects the salience of the topic and the professional concern about and interest in issues presented by HIV. The HIV/AIDS epidemic has presented pharmacists with one of the greatest challenges to their professional training, ethics, and practice. It further expedites a current re-examination that is occurring among community pharmacies concerning their roles in community health practices. In response to HIV there have been dramatic and unprecedented changes in pharmacy policy and practices. Clearly, some community pharmacies have led the way and influenced policy and practices. In view of the recent introduction of many of these policies and practices, it is likely that change will continue. Survey respondents were, in general, very comfortable with an expanded role involving counseling, health promotion, and disease prevention, consistent with a broader role for community pharmacies in general that has been recently advocated. Community pharmacies serve all areas of the country, in communities large and small; many are open seven days a week, and some provide extended hours of service. Community pharmacies may provide an important complement to community outreach programs as a source of clean needles and syringes for IDUs in most communities, and as an alternative service in some communities where more elaborate programs are not feasible. Safer needle use, as part of a health-promotion approach, is divergent from conventional practice. While major changes have occurred, it appears that there has been some polarization of attitudes and response. The explanation for this is not simple, and further analysis is required to determine the full impact from several ethical perspectives that include professional, business, and public health viewpoints. We have highlighted the role that policy has in moving toward preventive and harm-reduction approaches. From a policy perspective, we have found that support from the federal government, regulatory bodies, and professional associations may be an important catalyst to pharmacists' participation in programs. Further, it does not appear to be possible to implement such policies without professional development and continuing education, and collaboration with the community. Based on data on knowledge and educational need, we believe that our study population's lowest levels of information were in such areas as the role of methadone in HIV prevention and the availability of needle-exchange programs. As with other health-promotion campaigns, additional skills training may be important. Movement forward with expanded preventive and harm-reduction strategies by pharmacies will require careful planning. It is anticipated that change in this area will be incremental in nature, and that it is necessary to introduce programs and services into community pharmacies gradually. Successful implementation will require extensive community development and collaboration with other health professionals, public health officials, police, groups who represent IDUs, and persons living with HIV/AIDS. Careful monitoring and evaluation of these programs will be necessary to enhance their effectiveness.

Canada↗
PubMed2002

[Prof. Alfonsas Kaikaris -- the founder of the Lithuanian Pharmacy Museum: his personality and scientific activities].

Alfonsas Kaikaris (1922-1997) was a professor of pharmacy at the Kaunas Medical Institute (now University), historian, museologist, founder of the Lithuanian Pharmacy Museum and of the field of pharmacy history in Lithuania. A. Kaikaris was born in Zagare in 1922. He received his pharmacy diploma in 1947 and began work at the university. Following the reorganization of the university into two institutes, he went to work in the Medical Institute, where he served as the vice dean of the Pharmacy and Stomatology Department from 1957 until 1963. He began to collect pharmaceutical artifacts in 1957. In 1973, the Institute provided a small room in the attic for these objects and so a small pharmacy museum, the first in Lithuania, was born. Thanks to the hard work of A. Kaikaris and others, today this museum has grown into the Pharmacy and Medical History Center of Lithuania, whose work is widely known throughout Europe. A. Kaikaris was also a member of the board of the Lithuanian Scientific Society and head of the Society's Pharmaceutical History Section from 1964 until he retired in 1987. He is the author of 67 scholarly papers and numerous popular articles and conference presentations. In 1988, he received the Paul Stradins Award from the Paul Stradins Medical History Museum in Riga, Latvia, and until his death in 1997 worked as a consultant to the Lithuanian Museum of the History of Medicine and Pharmacy.

History of Pharmacy↗
PubMedDate not supplied

Pain management content in curricula of U.S. schools of pharmacy.

OBJECTIVES: To identify individuals in schools of pharmacy in the United States who are responsible for covering the topic of pain management in courses for doctor of pharmacy students and to describe how and at what depth pain management is covered in pharmacy school curricula. DESIGN: One-time qualitative assessment. SETTING: Schools of pharmacy in the United States. PARTICIPANTS Twenty-eight faculty members with the rank of professor, associate professor, or assistant professor who had been employed in their current positions for at least 2 years and who were directly involved in preparing and teaching didactic courses that address pain management. INTERVENTION: In-depth telephone interviews. MAIN OUTCOME MEASURES: Qualitative responses to open-ended interview questions. RESULTS: While pain management was included in the curricula of all 28 schools of pharmacy, it was generally covered in a fragmented way, usually as part of presentations on diseases with pain as a prominent feature (e.g., cancer pain addressed during oncology lectures) or as part of discussions of analgesics. Only two schools offered stand-alone courses in pain management, and both of those courses were electives that were taken by an average of 15 students per year. Three-fourths of respondents believed that pain was being given too little emphasis in their schools' curricula. Palliative care and the use of medications in the treatment of cancer pain was not presented in a standardized manner, and respondents were unsure of how the subject was covered in pharmacy law classes. Instruction about the diagnosis of pain, patient assessment, and physical examination was reported as "minimal" by most respondents. Respondents perceived a need for a single, complete reference and teaching resource that would address the entire spectrum of pain management as it applies to pharmacy. CONCLUSION: The topic of pain management is poorly presented and inadequately developed in the curricula of many U.S. schools of pharmacy.

Curriculum↗
PubMed1990

Hospital pharmacy-based service for patient-controlled analgesia.

A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.

Analgesics↗
PubMed1986

Designing a modern hospital pharmacy.

Cooperation between the pharmacy director and the hospital's architects in planning a modern hospital pharmacy is described. The pharmacy director at an 870-bed voluntary nonprofit institution and the hospital's architects planned the design for a new 3250-square foot pharmacy department. They developed a preliminary floor plan based on the following functions that the pharmacy would perform: centralized unit dose drug distribution; compounding; bulk and unit dose prepackaging; preparation of sterile products; controlled substance storage; outpatient and employee prescription dispensing; reserve stock storage; purchasing, receiving, and inventory control; drug information services; and administrative services. A final floor plan was designed that incorporated these functions with structural and utility requirements, such as placement of the computer system and dispensing and lighting fixtures. By integrating modern material management concepts with contemporary hospital pharmacy practice, the pharmacy director and the hospital's architects were able to plan and construct a pharmacy that receives, processes, and dispenses medication efficiently.

Computers↗
PubMed1987

Relationship between intensity of hospital services and pharmacy workload.

The relationship between hospital census variables and pharmacy department workload was studied; intensity, which measures services provided per hospitalized patient per day, was used as the workload indicator. Quarterly data on inpatient pharmacy workload and hospital census were statistically analyzed for 1981 through 1985. Number of patient days, number of admissions, average length of stay (LOS), and pharmacy work units were examined. A work unit was one unit of inpatient pharmacy activity, such as one order for oral medication or one i.v. admixture; clinical services were excluded. Intensity was defined as the number of work units per patient day. Intensity as a function of intensive-care-unit (ICU) patient days was also analyzed. The number of pharmacy work units per quarter more than doubled from 1981 to 1985, while the number of admissions remained relatively constant. The average LOS decreased from 8.4 days in 1981 to 6.3 days in 1985, and the number of patient days decreased 27%. Quarterly workload intensity increased from 1.4 to 4.37 over the five-year period. Statistical analysis showed a strong inverse relationship between intensity and average LOS; LOS accounted for 92% of the variability in intensity. The number of ICU patient days, which increased 21%, had a significant effect on pharmacy workload; 30% of the variation in pharmacy workload was explained by ICU days. Intensity measures are useful in predicting pharmacy department workload.

Critical Care↗
PubMed1983

Pharmacy-based controlled substances distribution for a university campus.

A university-wide pharmacy-based controlled substances distribution system is described. The purchasing and control of controlled substances for the entire university campus is centralized in the hospital pharmacy department. The distribution system uses the concept of restricted versus nonrestricted drugs, where restricted drugs are all Schedule II controlled substances and other drugs needing restrictive control. The restricted or nonrestricted status of a drug is based upon suspected or observed abuse potential. After receipt by the pharmacy, all controlled substances and restricted drugs are stored in a vault. A 24-hour audit-disposition record system is used to control the inpatient distribution of restricted drugs, which are stored in locked cabinets on each nursing unit. In the outpatient pharmacy, a small supply of restricted drugs is stored in a locked cabinet; the inventory is reconciled weekly. Nonrestricted controlled substances, such as phenobarbital and chloral hydrate, are distributed to the inpatient satellite pharmacies and the outpatient pharmacy in the same manner as other prescription drugs. Campus practitioners and researchers order all controlled substances from the pharmacy using the appropriate order forms; each individual is responsible for maintaining a record and control system. A quality assurance program was established to review and improve the quality of service. The centralized pharmacy-based system improved the control, monitoring, and efficiency of controlled substances distribution for the entire university campus.

Academic Medical Centers↗
PubMed1995

Impact of increased legal access to needles and syringes on community pharmacies' needle and syringe sales--Connecticut, 1992-1993.

In May 1992, the Connecticut legislature passed new laws aimed at increasing injecting drug users' (IDUs) access to sterile needles and syringes (syringes); as of July 1992, pharmacists were permitted to sell and individuals were permitted to possess up to 10 syringes without medical prescriptions (nonprescription syringes). We evaluated the impact of the new laws by conducting (1) prospective surveillance of syringe sales and policies at selected community pharmacies (pharmacies) and (2) a telephone survey of pharmacy managers' reports of syringe sales and policies at a statewide stratified random sample of pharmacies. Our data provide direct evidence that most, but not all, Connecticut pharmacies sold nonprescription syringes when permitted to do so by the new laws. For example, using the telephone survey data, we estimate that during November, 1993, 83% [95% CI: 77-89%] of all Connecticut pharmacies sold nonprescription syringes and 56,000 [95% CI: 44,000-68,000] nonprescription syringes were sold, during November 1993. Our data provide indirect evidence that IDUs were purchasing nonprescription syringes at pharmacies. For example, in five Hartford pharmacies located in neighborhoods where injection drug use was prevalent, the total number of nonprescription syringes sold per month increased significantly from 460 in July 1992 to 2,482 in June 1993 (p = 0.0001). The data suggest that the new laws increased IDUs' access to sterile syringes in Connecticut.

Centers for Disease Control and Prevention, U.S.↗