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PubMed1993

Continued cost justification of an operating room satellite pharmacy.

Cost justification for the establishment and continued operation of an operating room satellite pharmacy is described. Establishment of an operating room satellite pharmacy can be justified based on the need to recover lost revenue, regulate controlled substances, monitor inventory, and enhance communication between operating room personnel and the department of pharmacy. At a 510-bed community hospital, an internal audit performed before the satellite pharmacy was opened revealed an average loss of $14.53 in drug charges per surgical procedure; 16 months after the pharmacy opened, changes in the way drugs are distributed to the departments of surgery and anesthesia has resulted in a decrease in this loss to $9.61, or a 34% improvement. To regulate controlled substances, the pharmacy attaches a drug-use log to each dispensing kit, which has resulted in 98% agreement between recorded administration of controlled substances and actual amounts signed out and ultimately returned. Recommendations made by the department of pharmacy regarding the use of high-cost drugs during surgery has resulted in an annual savings of more than $100,000, and improvements in drug packaging reduced, and in some cases eliminated, wastage. Direct contact between operating room personnel and pharmacists has fostered discussions regarding cost-effective application of pharmacotherapy, and the potential for cost savings is substantial. Although the remaining loss of $9.61 per case must still be addressed, considerable progress has been made in a relatively short period of time. The satellite pharmacy in the operating room has led to increased revenue recovery, improved regulation of controlled substances and monitoring of drug inventory, and better communication among the involved personnel.

Cost-Benefit Analysis↗
PubMed2002

Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam.

The objective of this study was to assess the effects of a multicomponent intervention on private pharmacy practice. From 641 private pharmacies in Hanoi, 68 pharmacies were randomly selected and matched into 34 pairs. Each pair consisted of a control and an intervention pharmacy. Three interventions were applied sequentially: Regulatory enforcement, Education, and Peer influence. Four tracer conditions were selected: uncomplicated acute respiratory infection (ARI), sexually transmitted disease (STD), requesting the prescription-only drugs prednisolone, and a short course of cefalexin. Practice was assessed through the Simulated Client Method (SCM). The intervention pharmacies improved significantly compared to the control pharmacies (P <.05) in all tracer conditions. For ARI, antibiotic dispensing decreased (P <.02) and questions regarding breathing increased (P <.01). For STD, advice to go to the doctor and dispensing the correct syndromic treatment increased (P <.01). Dispensing of prednisolone and cefalexin decreased (P <.01) and prescription requests increased (P <.01). Our conclusion is that it is possible to improve private pharmacy practice with a multicomponent intervention.

Anti-Bacterial Agents↗
PubMed2000

Ethical cognition and selection-socialization in retail pharmacy.

There is a great deal of support for the contention that the ethical cognition of health care professionals are of consequence to the level of patient care provided. The present study examines the ethical cognition of what has traditionally been deemed a profession of incomplete or marginal status: the retail, or community, pharmacy setting. An empirical examination of ethical cognition compares a systematic random sample of retail pharmacists with pharmacy students. Additional comparisons are made with a baseline of ethical cognition abilities of other health care professionals, such as physicians and nurses. Based on cognitive-developmental theory and using a well-known measure of ethical reasoning, two hypotheses are explored regarding the ethical reasoning skills of retail pharmacy practitioners and pharmacy students. Results indicate that, contrary to cognitive moral development theory, students possess greater ethical reasoning skills than do their practitioner counterparts. In addition, baseline comparisons with other health professional groups reflect unfavorably on the retail pharmacists. It is suggested that the selection-socialization processes inherent in the retail pharmacy setting may result in on or more of the following outcomes: 1) the selection of lower ethical reasoners to the community pharmacy setting, 2) the exodus to other pharmacy settings of higher reasoners, and 3) a possible retrogression in the ethical cognition of community practitioners. Implications for retail practice and limitations are discussed.

Cognition↗
PubMedDate not supplied

Student pharmacist perspectives of rural pharmacy practice.

OBJECTIVE: To evaluate the level of interest of upper-level doctor of pharmacy students in rural pharmacy practice, rural pharmacy ownership, and a proposed rural pharmacy practice model. DESIGN: Cross-sectional study. SETTING: Minnesota, North Dakota, and South Dakota in October through December 2003. PARTICIPANTS: Third- and fourth-year professional student pharmacists at the University of Minnesota, North Dakota State University, and South Dakota State University. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Student interest in rural pharmacy practice and potential future directions for maintaining access to medications and the knowledge of pharmacists in rural communities. RESULTS: Of 177 respondents, 62.7% has given serious consideration to practice in rural communities with populations of 5,000 or fewer residents. Of these 111 students, 81% would be interested in the proposed practice model explained in the survey. Of the 108 total students expressing interest in the proposed rural pharmacy practice model, 63% had not previously given serious consideration to pursuing ownership (full or partnership) of a community pharmacy. CONCLUSION: Students from the schools that have traditionally supplied the majority of Minnesota rural pharmacists indicated an interest in practicing in rural areas as long as opportunities align with their personal and professional interests.

Community Pharmacy Services↗
PubMed2000

Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance.

OBJECTIVE: To determine the economic impact of an interventional programme aimed to increase the rate of clinical interventions undertaken in community pharmacy. STUDY DESIGN AND PERSPECTIVE: A randomised controlled trial of 4 parallel groups of pharmacies, conducted from a government perspective. Economic evaluations were based on savings/costs attributable to healthcare costs avoided, healthcare costs incurred by the pharmacists' actions, change in medication costs, pharmacy time and telephone calls made by the pharmacist. The study was conducted during November and December 1996 and costings were based on 1997 figures. INTERVENTIONS: A professional fee-for-service [10 Australian dollars ($A; $A1 = 6.50 US dollars) per intervention] and education (an intensive 1-week course or advanced education) were implemented in an attempt to increase clinical interventions by the pharmacists. Group A pharmacies (n = 10) served as a control group and received neither education nor remuneration; group B received education and professional remuneration (n = 9); group C had received prior continued education and now received advanced education and professional remuneration (n = 11); and group D received professional remuneration with no education. MAIN OUTCOME MEASURES AND RESULTS: The proactive clinical interventions in group C saved a mean of $A85.35 per 1000 prescriptions [95% confidence interval (CI)-$A157.11 to $A24.95). This was 4 times greater than savings generated by pharmacies in group B (mean savings of $A25.65 per 1000 prescriptions) and 6 times greater than control pharmacies. A sensitivity analysis which extrapolated results to Australian prescription figures showed that the control group was capable of generating savings in the order of $A2.4 million per year while pharmacists in group C would save the healthcare system $A15 million per year. CONCLUSIONS: These results provide the first economic estimates for the provision of clinical interventions in Australian community pharmacies. It is believed that they illustrate the value of pharmaceutical services to the healthcare system and to the Australian community in terms of both quality of care and savings.

Australia↗
PubMed2006

[Professional views of pharmacy faculty graduates].

The purpose of this study was to define new professional ideals of pharmacists and to prove or refute a hypothesis stating that role model of the representatives of this profession is currently changing. In a survey a group of Pharmacy Faculty graduates were asked about the motives for the choice of their pharmacy studies, constancy of the conviction of this choice's validity, the desired place of work, expectations concerning their professional function, the opinion on the future of that profession in Poland, the attitude to pharmacists' chamber and to the phenomenon of self-therapy. The responses collected provided information on the professional views of the queried group. The author also defined the notion of professional views themselves, vocation, professional attitude and professional model. The results show that the respondents in their majority wish to become pharmacists (64%). High estimation of this profession influenced their choice of studies (71%). Only 18% felt called to do it. The queried group, as a whole, are not satisfied with their pharmacy studies, and only 38% would firmly undertake to study it again. The subjects declare to be fairly active in performing their civic duties (58% take part in elections), yet remain relatively passive within the context of their own professional government (15%). From their professional activity they expect personal satisfaction and money. Most subjects predict that adverse changes are going to take place in pharmacy (to 2005): pharmaceutical concerns will buy out pharmacies, the number of pharmaceutical wholesale stores will decrease considerably, pharmaceuticals will be delivered straight to patient's door, the system of obtaining drugs on doctor's prescription will decline. However, they doubt that the physicians are going to take over the sale of pharmaceuticals, that the number of new pharmacies is going to increase, that few will become owners of most pharmacies, and that the Polish pharmaceutical industry will collapse. Pessimistic views of the respondents outnumber the optimistic ones, however only 4% are doubtful about their own, professional success. In evaluating the phenomenon of self-therapy the respondents show judiciousness, perceiving more negative than positive aspects of it. The views of the studied group are precise and clear, while in the assessment of own professional role the pro-social attitude prevails.

Adult↗
PubMed1987

Pharmacy practice in the United States Navy.

The current status of pharmaceutical services in the United States Navy Medical Department is described. The mission of the Navy Medical Department is to provide comprehensive health care to the more than 2.7 million active-duty and retired Navy personnel and their dependents. A total of 144 Navy pharmacy officers, 50 civilian pharmacists employed by the Navy, and 650 Navy-trained technicians practice in 32 Naval hospitals. All Naval hospitals have unit dose drug distribution systems and complete i.v. admixture services as well as an extensive series of ambulatory-care clinics. Clinical pharmaceutical services provided in these facilities vary depending upon the size and purpose of the facility. Pharmaceutical services are supported by the TRIPHARM computer system. Navy pharmacy officers may choose to pursue full-time graduate studies or may follow career paths outside of pharmacy. Navy pharmacists currently serve in a variety of administrative positions, as instructors and curriculum directors in the two Navy technician training schools, and as commanding officers of drug screening laboratories. In times of combat, Navy pharmacists may be assigned to hospital ships or to medical facilities near the line of combat. The ability of Navy pharmacists to respond to innovations in pharmacy practice will be the key to the future success of Navy pharmacy practice. One of the major challenges facing Navy pharmacy in the next few years is the recruitment of qualified pharmacy officers.

Ambulatory Care↗
PubMed1985

Management seminar miniseries for training pharmacy residents.

A management seminar miniseries for training hospital pharmacy residents is described. A series of lectures and workshops on the administrative aspects of hospital pharmacy practice are an integral part of a 2400-hour residency training program. Hospital pharmacy practice, clinical pharmacy practice, communication skills, and pharmacy administration and personnel management are the four major areas covered by the program. The section on pharmacy administration and personnel management is initiated in the middle of program after the residents have gained an appreciation of the intricacies of the department. The management workshops emphasize role playing and actual case-study analyses. The program's faculty members are members of the professional staff who have received formal training in the topics they teach. Twenty-two of this program's 53 graduates have assumed management positions. The management miniseries described can provide residents with the managerial skills they need to become effective pharmacy leaders.

Education, Pharmacy, Graduate↗
PubMed1984

Pharmacy practice in a small pediatric hospital.

Pharmaceutical services provided in a 72-bed pediatric hospital are described. One full-time pharmacist, one full-time technician, and a half-time pharmacy assistant staff the pharmacy, which is open 40 hours per week, and a pharmacist is on call when the pharmacy is closed. The technician makes hourly rounds to nursing units to pick up new orders and deliver medications. Unit dose carts are exchanged at 4 p.m. The pharmacy prepares individual doses of i.v. medications that are used Monday through Friday. More than 80% of new orders are filled during pharmacy hours; a night cabinet provides 75% of medications needed when the pharmacy is closed. The pharmacist provides drug information to physicians and nurses and counsels parents of discharged patients. Workload data and logs that reflected calls received and drugs obtained after hours were used to justify expansion of pharmacy hours, which is expected for 1984. Pharmacists in small hospitals must balance distributive, clinical, and administrative demands to provide reliable and consistent service during limited hours of operation.

Drug Labeling↗
PubMed1977

Health care and hospital pharmacy in Denmark.

Health services and community and hospital pharmacy practice in Denmark are discussed. Topics covered include the education and training of pharmacists and technicians, pharmaceutical manufacturing by community and hospital pharmacies, hospital drug distribution, and drug information services. Pharmacy is unique in Denmark inthe 40% of the drug products on the market are manufactured by pharmacies, under the auspicies of the pharmacy proprietors' association. As in other Scandinavian countries, the number and location of community pharmacies are controlled by the state. Ninety pharmacists are employed in 13 hospital pharmacies; half of the pharmacists are occupied bb drug product manufacturing.

Delivery of Health Care↗
PubMed2006

Pharmacy provision of medical abortifacients in a Latin American city.

PURPOSE: Access to legal abortion services is restricted in Latin America. Nonetheless, previous research suggest that women frequently use misoprostol to self-induce abortion. In many settings, women obtain the medication from a pharmacy. This study was conducted to better understand pharmacy staff knowledge and provision practices of misoprostol and other medical abortifacients. METHODS: We first interviewed staff at a random sample of 102 pharmacies in a Latin American city. Mystery clients were subsequently sent to the same pharmacies to ascertain prescribing practices and counseling. RESULTS: Nearly half of the pharmacy staff interviewed reported that they were familiar with at least one abortifacient, and an abortifacient was recommended in 74% of the mystery client encounters. Hormonal injections were most frequently recommended as abortifacients in the survey (67%) and the mystery client encounters (71%), followed by misoprostol (60% and 39%, respectively). Few of the pharmacy staff (6% in the survey and 17% in the mystery client encounters) recommended a misoprostol dosing regimen that is potentially effective. CONCLUSION: Abortifacient provision is common at pharmacies but knowledge about medications is low among pharmacy staff.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

The role of commercial nuclear pharmacy in the future practice of nuclear medicine.

It has been estimated that today 70% to 80% of all radiopharmaceutical doses are dispensed through commercial nuclear pharmacy channels. These services are provided by the approximately 250 facilities in the United States, with some multisite corporations dispensing in excess of 20,000 unit-dose prescriptions per day. As pressures mount within health care institutions to reduce manpower, increase cost-effectiveness, increase participation in managed care contracts, and to seek outside vendors for many services that were previously provided in-house, the future role of the commercial nuclear pharmacy in the practice of nuclear medicine will only continue to increase. The essence of nuclear pharmacy practice is the dispensing of a full range of high quality radiopharmaceuticals in patient-specific unit doses. These doses must be delivered in a timely and cost effective manner, without compromising quality or patient safety. Commercial nuclear pharmacies have expanded to provide such varied functions as radiation safety and waste management, as well as consultative and marketing activities directed towards clinicians within a nuclear medicine practitioners own facility. In-service continuing education programs directed towards physicians and technologists are frequently offered by many commercial nuclear pharmacies. Changes in health care economics, merging and down-sizing in the hospital industry, and the overall impact of managed care on the viability of hospitals in general has resulted in slow growth, or even a small decline in the number of institutionally based nuclear pharmacists. As a result, nuclear medicine practitioners will be looking to the commercial nuclear pharmacies to meet a larger portion of their radiopharmaceutical needs, as well as to value added services, such as education and research and development. Specialized practice settings, such as nuclear cardiology and free-standing nuclear medicine clinics, are especially well suited to the services provided by commercial nuclear pharmacies. Involvement in the distribution of positron-emission tomography radiopharmaceuticals will continue to increase regardless of the results of current regulatory debates on this issue. In the future, nuclear medicine practitioners will look to the commercial nuclear pharmacies for an increasing portion of their radiopharmaceutical needs and the industry should be ready and able to meet these demands in a safe, timely, and cost efficient manner.

Costs and Cost Analysis↗
PubMedDate not supplied

Pharmacy service alliances: a tool to reduce uncertainty and create new revenue streams.

OBJECTIVES: (1) Present conceptual support for a type of pharmacy network, a pharmacy service alliance (PSA), (2) describe the development of a PSA in eastern Iowa, and (3) discuss how other types of PSAs can be developed. DESIGN AND PARTICIPANTS: 12 independent pharmacies in eastern Iowa. SETTING: Community pharmacy practice. MAIN OUTCOME MEASURES: Formation of a PSA. RESULTS: Pharmacy members of the Certified Pharmaceutical Care Network, a PSA, have jointly developed new pharmacy services. Collaborative efforts have involved disease state management programs, group marketing activities, and a quality improvement process. CONCLUSION: PSAs offer an organizational model that pharmacies could use to successfully develop new pharmacy services.

Iowa↗
PubMedDate not supplied

Development of pharmaceutical care in The Netherlands: pharmacy's contemporary focus on the patient.

OBJECTIVE: To describe how developments in the pharmacy profession in The Netherlands converged into the current movement toward pharmaceutical care. SETTING: Dutch community pharmacy. DESCRIPTION: Literature was reviewed for key elements of pharmacists' professional development over the last 40 years--the pharmacist-physician relationship, the pharmacist-patient relationship, the education of the pharmacist, provision of information to patients, medication surveillance, clinical pharmacy, and social pharmacy. Consideration was given to how, when and if these elements interacted and contributed to the movement toward pharmaceutical care. RESULTS: During the early years of the 20th century the professional role of the pharmacist, based on preparing medications, declined because of the increased industrial production of drugs. In The Netherlands, a number of developments, starting around 1995, led to a "reprofessionalization" movement in pharmacy, characterized by pharmacists' increased awareness of social and ethical responsibilities with respect to drugs and patients. These developments included an improved relationship between pharmacists and physicians, the implementation of clinical pharmacy and medical surveillance in daily community pharmacy practice in the 1970s and 1980s, and the increased awareness of the rights of patients to quality drug information and counseling in the 1980s and 1990s. By the end of 1980 these trends had coalesced into a professional movement supporting the need for a pharmaceutical care model of practice. CONCLUSION: Dutch pharmacy is gradually implementing pharmaceutical care in daily community practice. However, a proactive attitude, not only from the "front runners," but from all pharmacists, is desirable if pharmaceutical care is to be incorporated into routine community practice.

History, 20th Century↗
PubMed2000

Kentucky pharmacists' opinions and practices related to the sale of cigarettes and alcohol in pharmacies.

The objective of the study was to augment important findings from a 1996 statewide survey of Indiana pharmacists regarding their opinions and practices related to the sale of cigarettes and alcohol in pharmacies. More specifically, this study was designed (1) to determine opinions and practices of Kentucky pharmacists' related to the sale of cigarettes and alcohol; (2) compare these findings with results from the Indiana study; and (3) to gather information on health promotion activities by Kentucky pharmacists. A structured survey questionnaire was designed and reviewed by a jury of experts and subsequently administered to half of the 1182 pharmacies in Kentucky. Collected data were analyzed by using descriptive and inferential statistical methods. Findings reveal that 45 percent of responding pharmacists sell cigarettes in their stores even though 88 percent think that their stores should not sell cigarettes. Approximately 34 percent of the pharmacies in non-dry counties sell alcoholic beverages while more than four-fifths of the pharmacists (81%) think pharmacies should not sell alcoholic beverages. After adjusting by type of pharmacy, no statistical difference was found in retail-chain pharmacy sales of cigarettes and alcohol in either Kentucky or Indiana. However, independent pharmacies in Kentucky were less likely to sell cigarettes and alcohol compared to independent Indiana pharmacies. Study results also revealed that most pharmacists agree the use of cigarettes and alcohol are important causes of morbidity and pre-mature mortality and that pharmacists should play a role in health promotion and disease prevention through their relationship with the public. However, the majority do not ask their patients about their smoking and alcohol habits and do not participate in health education/promotion programs for the general community.

Adult↗
PubMed2001

The Medicaid Rx model: pharmacy-based risk adjustment for public programs.

BACKGROUND: Risk adjustment models typically use diagnoses from claims or encounter records to assess illness severity. However, concerns about the availability and reliability of diagnostic data raise the potential for alternative methods of risk adjustment. Here, we explore the use of pharmacy data as an alternative or complement to diagnostic data in risk adjustment. OBJECTIVES: To develop and test a pharmacy-based risk adjustment model for SSI and TANF Medicaid populations. RESEARCH DESIGN: Pharmacological review combined with empirical evaluation. We developed the Medicaid Rx model, a system that classifies a subset of the National Drug Codes into categories that can be used for risk-assessment and risk-adjusted payment. SUBJECTS: Subjects consisted of 362,370 persons with disability and 1.5 million AFDC and TANF beneficiaries in California, Colorado, Georgia, and Tennessee during 1990-1999. MEASURES: We compare pharmacy and diagnostic classification for three chronic diseases. We also compare R2 statistics and use simulated health plans to evaluate the performance of alternative models. RESULTS: Pharmacy and diagnostic classification vary in their ability to identify specific chronic disease. Using simulated plans, diagnostic models are better at predicting expenditures than are pharmacy-based models for disabled Medicaid beneficiaries, although the models perform similarly for TANF Medicaid beneficiaries. Models that combine diagnostic and pharmacy data have superior overall performance. CONCLUSIONS: The performance of risk adjustment models using a combination of pharmacy and diagnostic data are superior to that of models using either data source alone, particularly among TANF beneficiaries. Concerns regarding variations in prescribing patterns and the incentives that may follow from linking payment to pharmacy use warrant further research.

Adult↗
PubMed1996

The asthma year in Swedish pharmacies: a nationwide information and pharmaceutical care program for patients with asthma.

OBJECTIVE: To increase the understanding of asthma among patients and the general public in Sweden and to increase the collaboration among healthcare personnel for the benefit of asthma patients. DESIGN: Based on the results from problem detection studies, Apoteksbolaget, the national organization for pharmacies in Sweden, designed a program to educate healthcare professionals and the public about asthma. Entitled the "Asthma Year," all pharmacy staffs were offered education on asthma, patients were provided written information and audiovisual materials, and the general public was made more aware of asthma through local media. SETTING: Pharmacies, healthcare centers, hospital outpatient areas, libraries, places of work, and domestic airports. PARTICIPANTS: All pharmacy staffs (12,000 persons) were offered an education on asthma. Patients with asthma were offered brochures and leaflets in pharmacies and information in the pharmacy magazine Apoteket. The general public received information about asthma through posters, radio, and television. MAIN OUTCOME MEASURES: The evaluations of the Asthma Year indicate that the activities had an impact on the public, on patients with asthma, and on the pharmacy staffs. RESULTS: About 4.5 million people in Sweden (42% of the population) observed the Asthma Year or received information about asthma, and 49% of the patients learned something new about their disease. Twice as many patients used steroid therapy regularly after the campaign than before. Of the pharmacy staffs, 96% were favorable to the idea of working with campaign years and 85% believed that they were personally involved with the activities. CONCLUSIONS: Patient outcomes in terms of reduced morbidity have not been possible to document, but the number of deaths from asthma in Sweden decreased from 438 during the previous year to 398 during the Asthma Year.

Adolescent↗
PubMed1992

Pharmacy promotion of tobacco use among children in Massachusetts.

The role played by pharmacies in the promotion and distribution of tobacco to children was assessed in a survey of 100 pharmacies. Of the 100 surveyed, 95 sold tobacco products, 50 advertised tobacco, 42 advertised the cigarette brands that are most appealing to children, and 23 displayed the Camel cartoon advertisements that have been identified as being targeted specifically at children. Candy tobacco products were sold in 22% of the pharmacies. Of the pharmacies selling tobacco, 81% were willing to sell it to minors illegally. The five pharmacies that did not carry tobacco products were independent stores. When compared to chain pharmacies, independent pharmacies more frequently advertised tobacco (p less than 0.05) but were not more likely to sell it to children. The authors contend that pharmacists who sell tobacco violate the profession's Code of Ethics and play an important role in the promotion of tobacco use among children.

Adolescent↗