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PubMedDate not supplied

Community pharmacists' participation in health education and disease prevention activities.

Community pharmacists are faced with many opportunities to participate in health education and disease prevention activities. This study sought to determine the extent to which community pharmacists in British Columbia participate in such activities. A mail questionnaire was distributed to a systematic, stratified sample of 625 community pharmacists in B.C. (response rate = 83.6%). A five-point Likert-type scale was used to examine the frequencies of pharmacist involvement in 33 different health education/disease prevention activities. Results of the study indicate that pharmacists most frequently participate in health education/disease-preventing activities directly related to the dispensing or selling of medications. Activities exhibiting the lowest participation among pharmacists included speaking to community groups on health-related matters, participating in disease screening programs, querying clients on their level of occupational stress, counselling clients on AIDS prevention, and querying clients on their smoking status.

British Columbia↗
PubMed1994

Pharmacists' role in clozapine therapy at a Veterans Affairs medical center.

A program in which pharmacists have an active role in prescribing and dispensing psychoactive drugs is described. The Department of Veterans Affairs (VA) has established a National Clozapine Coordinating Center (NCCC) that must approve all clozapine therapy in VA medical centers. Clinical and demographic information is required for all new patients, and weekly status reports are required throughout clozapine therapy. To comply with NCCC requirements, pharmacists with specialized training in psychopharmacology organized a clozapine clinic at one VA medical center, in conjunction with the psychiatry service. The pharmacists screen potential candidates for clozapine therapy and forward the required information to the NCCC for approval. During treatment, they ensure that necessary laboratory tests and clinical evaluations are performed for inpatients and recommend dosage adjustments to the psychiatry residents. The pharmacists see outpatients receiving clozapine weekly to monitor and record vital signs, laboratory results, and response to therapy and make dosage adjustments accordingly. For both inpatients and outpatients, the pharmacists send weekly patient evaluations to the NCCC. Pharmacists at a VA medical center provide direct care to patients receiving clozapine and help their institution comply with the stringent therapy-monitoring requirements of the NCCC.

California↗
PubMed1994

Pharmacist-managed monitoring of adverse reactions to contrast media.

A pharmacist-managed program for reporting, treating, and monitoring adverse drug reactions (ADRs) to contrast media is described. The radiology pharmacist at a 1000-bed multihospital medical center worked with the radiology department to revise departmental policies and procedures for reporting ADRs to contrast media. Under the revision, an ADR report must be completed and forwarded to the pharmacy department and radiology pharmacist for review. In the radiology department itself, ADRs must be documented in the computerized radiology information system in two fields, the patient's radiology file and the radiology study report. The radiology pharmacist developed guidelines for preventing and treating ADRs to contrast media. Boxes containing drugs specifically indicated for the treatment of these ADRs were distributed throughout the radiology department. The radiology pharmacist prepares a quality improvement report each quarter. ADRs documented in the patient's radiology file and in the radiology study report are compared with the total number of ADRs reported. The incidence of ADRs is determined and compared with that for previous quarters and with published data. The treatment of each reaction is evaluated for compliance with the guidelines, the need for follow-up, and any unusual problems. Between July 1991 and December 1992, ADR documentation in the radiology file and in the radiology study report increased substantially in several divisions of the radiology department. The rates of ADRs to contrast media remained fairly constant and paralleled published rates. Compliance with the treatment guidelines was excellent. Pharmacist involvement led to improved reporting of adverse reactions to contrast media in a radiology department and to greater awareness of measures for treating and preventing them.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Pharmacist management of a hyperlipidemia clinic.

A hyperlipidemia clinic in which a pharmacist provides primary care is described. The clinic was established at a Veterans Affairs medical center in January 1990. A pharmacist performs limited physical assessments, refers patients to other clinics as necessary, orders laboratory and diagnostic tests, and selects and monitors the use of lipid-lowering medications. Interventions are performed according to the pharmacist's clinical judgment; there is no set protocol. Recommendations for patient management are approved by an attending physician, who prescribes the antilipemic drugs. The pharmacist teaches patients about hyperlipidemia, the impact of diet and life-style, and the mechanism of action, administration, and adverse effects of the antilipemics prescribed. The pharmacist also monitors compliance, laboratory test values, and the response to treatment. Treatment is modeled after the recommendations of the National Cholesterol Education Program. If a patient has not achieved the targeted cholesterol concentration after receiving dietary therapy for three months, further education about diet and lifestyle is provided. If, after three more months, the cholesterol level remains high, drug therapy is begun. Four antilipemic drugs--colestipol, gemfibrozil, lovastatin, and niacin--are used in the clinic. Since it began operating, the clinic has enrolled 284 patients. Compliance with the lipid-lowering agents has ranged from 43% to 100%. Adverse effects have accounted for the majority of cases of noncompliance. A pharmacist provides primary care for patients with hyperlipidemia in an ambulatory-care clinic.

Chicago↗
PubMed1977

Involving staff pharmacists in management decisions.

Various administrative techniques used to bring staff pharmacists in a decentralized, satellite pharmacy system into the managerial decision-making process are discussed. These techniques include a staff pharmacist on-call procedure to discourage absenteeism, and the concept of a head pharmacist to serve as a link with departmental administration. The head pharmacist works in the satelite pharmacy, is responsible for its daily operation and is the spokesman for the satellite. Active roles for the head pharmacist in the selection and evaluation of technicians are outlines. Management skills are developed in head pharmacists through a program of special classes and discussion groups. It is concluded that this program has improved the credibility of administrative decisions and has tapped an underused source of ideas and talent.

Absenteeism↗
PubMed1977

Pharmacist as applied pharmocologist in association with a pediatric clinical pharmacologist.

The ability of a pharmacist to act as an applied pharmacologist and assist the pediatric clinical pharmacologist in providing influential drug information to attending pediatricians was studied. One hundred consecutive admissions to a pediatric unit of a university hospital were studied. The pharmacist, acting as a member of the department of pharmacology, attended ward rounds and closely followed patient therapy. He attempted to provide all information requested by the attending team of pediatricians and identify all problems in therapy without involving the pharmacologist. Regular meetings were held with the clinical pharmacologist in which the pharmacist made patient presentations and sought assistance in answering those requests for which he had been unable to provide sufficient information. The information provided by the pharmacist during the patient presentations was judged adequate for the clinical pharmacologist's evaluation of patient therapy 96% of the time. The pharmacist successfully answered 81% of the information requests and made 88% of the recommendations directed at change in therapy without involving the pharmacologist. It was concluded that the pharmacist performed successfully as an applied pharmacologist in this study.

Drug Information Services↗
PubMed1977

The clinical pharmacist in emergency medicine.

The function of a pharmacist in emergency medicine, encompasing clinical practice, education and research, are described, and an evaluation of physicians' and nurses' attitudes toward pharmacist involvement in these areas is presented. In July 1974, a pharmacist joined the staff of a department of emergency health services in a medical center. In June 1976, a 14-item questionnaire was administered to physicians and nurses associated with the department. Seventy-two percent of the questionnaires were completed and returned. All respondents felt the pharmacist was an important component of the department and a benefit to its patient care and educational programs. Eighty-seven percent of the physicians stated that the pharmacist is capable of offering primary care to certain patients once the diagnosis has been made by a physician; 95% felt the role of the pharmacist is transferrable to other emergency room facilities and 83% were willing to have their patients charged for his services.

Attitude of Health Personnel↗
PubMed1977

Primary care by a pharmacist in an outpatient clinic.

Primary care by a pharmacist in an outpatient clinic of the Indian Health Service is described. Primary care responsibilities of the pharmacist included the diagnosis and treatment of certain acute illnesses and the management of selected chronic disease patients. Protocols were written by the pharmacist and physician to cover 31 acute illnesses and seven chronic conditions. The pharmacist was also trained to perform many routine laboratory tests. Further, the pharmacist provided patient consultation as to the use, storage, benefits and expected side effects of prescribed medications. Pharmacy visits accounted for nearly one-third of the clinic visits in 1975. Diagnosis and treatment of 10 common acute illnesses made up more than 40% of the pharmacy visits; another 40% of these visits were for pharmacist monitoring of chronic conditions.

Health Services↗
PubMed1998

[Multiple demands for assistance from pharmacists. Analysis and evaluation].

The pharmacist is a member of the health care community readily accessible to the public. Beyond his/her normal attributes, the pharmacist is called upon to offer assistance, sometimes in an emergency setting, or, more generally, in situations requiring compassion and support. We conducted a study of 349 observations of requests for assistance and analyzed this free often discrete but highly important service offered daily by pharmacists. For each experience presented, the intervention was conducted by the pharmacist and required a considerable amount of effort and time. As for all professional activities, the pharmacist engaged his/her own responsibility. Four main categories of interventions were observed. Several "colorful" examples are presented, demonstrating that assistance provided by the pharmacist is an important asset of the profession which is widely appreciated and used by the public.

Emergency Treatment↗
PubMed1998

[The current situation surrounding pharmacies and pharmacists].

As Japan's society continues to age, the Medical Insurance System has been substantially reviewed. As a result, 1. The medical care system has been separated from the custodial care system with the allocation of medical and custodial care insurance benefits. 2. The basis has been laid in terms of the legal provisions and the medical remuneration requirements for the establishment of a home care system. Amidst the major transformation of Japan's social order in the wake of these moves, the pharmacy and pharmacist are called upon to play a positive role in:1. Fostering the correct use of drugs through the sale of drugs and by filling prescriptions. 2. Assisting patients in self-medication. 3. Being involved in, and supporting, custodial medical care for the elderly and home care. While some 9,000 pharmacists join the profession each year, the situation regarding the training of pharmacists is marked by a serious dilemma between the demand for pharmacists as a medical resource and the practical conditions for obtaining the qualifications of a pharmacist. The system for training pharmacists is about to enter a new era with the review of the university and graduate school courses and the introduction of clinical training in the course. These changes are expected to produce very positive results.

Drug Therapy↗
PubMed1996

Quality of adverse drug experience reports submitted by pharmacists and physicians to the FDA.

The US Food and Drug Administration (FDA)'s Spontaneous Adverse Experience Reporting System is a computerized database with over one million adverse drug experience (ADE) reports. In 1992, the FDA received over 100,000 ADE reports and pharmacists were major contributors to these reports. In 1993, the FDA launched MEDWatch, a new initiative to enhance direct reporting of adverse events by health professionals. thus far, majority of reports to MEDWatch are from pharmacists. Drug regulatory agencies of some countries do not accept reports submitted by pharmacists. We performed a study to assess the quality of information in ADE reports submitted directly to the FDA by pharmacists and physicians and compared that with manufacturer-channelled 15-day reports. We evaluated 589 ADE reports with serious outcomes associated with nine new molecular entities. Data were analysed using Epi Info. Our results showed no substantial difference in a subjective assessment of the quality of information in the reports submitted by pharmacists or physicians, irrespective of whether these reports were submitted directly or via manufacturers. This study suggests that reports from hospital pharmacists are valuable and of comparable quality. We believe that all health professionals contribute to the success of FDA's MEDWatch programme and thereby play an important part in protecting public health by promptly reporting serious adverse events.

Journal Article↗
PubMedDate not supplied

Effect of a training program on community pharmacists' detection of and intervention in drug-related problems.

OBJECTIVE: To develop and present a pharmaceutical care training program for pharmacists, and to examine the ability of these pharmacists to provide pharmaceutical care in a community pharmacy setting. DESIGN: Prospective, randomized study. INTERVENTION: A 40-hour pharmaceutical care training program was developed and presented to pharmacists, and 1,078 patients were randomly assigned to receive either (1) traditional pharmacy services or (2) pharmaceutical care, consisting of initial patient work-up and follow-up with documentation in a patient record. MEASUREMENTS: The study period was six months. Pharmacists documented problems identified, actions taken, and time required for all patients. RESULTS: Pharmacists consistently identified and intervened to address problems in both study groups. Patients receiving pharmaceutical care were more than seven times as likely to have any problems identified (odds ratio [OR] 7.5; confidence interval [CI] 4.2-13.1), more than eight times as likely to have an intervention performed (OR, 8.1; CI 4.7-14.2), and more than eight times as likely to have a drug-related problem identified (OR 8.6; CI 4.8-15.5) than were patients receiving traditional pharmacy services only. Time spent counseling patients was similar for the two groups. CONCLUSIONS: The training program proved to be an effective way to increase the number of problems identified and addressed by pharmacists.

Community Pharmacy Services↗
PubMed1998

Teaching and counselling behaviour: an applied study with community pharmacists.

Continuing education aims at improving practice. In this article, three main research questions are addressed: Which methodology is optimal to improve counselling behaviour? Are learning outcomes influenced by learning style? Does knowing imply doing? Four educational methods, transferring information on cough medicines, are assessed: a lecture, an interactive workshop, an audiocassette and a textbook. Attendants of the first three methods also received the textbook. Pharmacists completed a learning-style inventory in addition to a pretest. After the instruction phase, they were interviewed by telephone (post-test). We also evaluated the counseling behaviour by an 'incognito' visit to participants as well as to controls. Seventy-eight pharmacists participated. Their learning-style cannot be related to the results of pre- or posttest. Each educational method improved the level of knowledge significantly, but none of them proved to be better than the others. The pharmacists who in addition read the textbook, acquired more knowledge than those who did not. Self-study at home led to more fundamental rather than practical knowledge. Improving knowledge does not result in better counselling: 75% of the pharmacists asked only one question, especially concerning the type of cough. However 9 out of 10 mentioned how to use the drug. About half of the pharmacists told the patient about the action of the medicine. Other items were hardly ever mentioned. There was no difference in counselling behaviour between the intervention group and a group of pharmacists who did not attend the course. This investigation does not reveal any particular method of in-service training as being more efficient. Active use of self-study materials helps to improve pharmacological knowledge. Implementing educational strategies to improve counselling behaviour remains a future aim.

Belgium↗
PubMed1998

Community pharmacist perspectives on HIV/AIDS and interventions for injection drug users in Canada.

In several countries, community pharmacies play a major role in the provision of HIV prevention services to injection drug users (IDUs). In this study, results from a national Canadian Survey of Community Pharmacies and HIV/AIDS Prevention are used to describe pharmacists' perspectives on HIV/AIDS and services to IDUs, and explore the relationship between personal and organizational characteristics and the level of support for HIV/AIDS prevention initiatives. A mailed questionnaire was directed to a random sample of 2,017 pharmacist owner-managers. The response rate was 84.6%. Results suggest that current services to IDUs primarily are limited to discretionary needle and syringe sales to non-diabetics, with almost three-quarters supportive. Staff safety was an important consideration in the provision of this service (77%), while remuneration was the lowest (27%). Community pharmacists were most comfortable with the provision of counselling, advice and literature (X = 2.6) and environmental and technological interventions (X = 2.4) and least supportive of provision of services as part of a programme (X = 1.6) and legalization of drugs or prescription of methadone (X = 1.9). Female pharmacists were more likely to support preventive measures such as the provision of counselling or advice, and males were more likely to promote legislative change. Pharmacists appear generally willing to expand their services in the fight against HIV/AIDS. However, it is not feasible to expect uniform programmes to be immediately introduced. While organizational, educational and policy changes may facilitate programme development, individual pharmacy and pharmacist discretion remains important.

Canada↗
PubMed1995

Pharmacist-managed Helicobacter pylori clinic.

A pharmacist-managed Helicobacter pylori assessment clinic for ambulatory patients is described. The pharmacy service at a 400-bed Veterans Affairs Medical Center established a pharmacist-managed clinic to assess patients who were receiving long-term acid-suppressive medications (histamine H2-receptor antagonists, sucralfate, or omeprazole). Patients with active ulcer disease and those receiving ulcer prophylaxis are screened for the presence of H. pylori. Those who test positive are treated with combinations of the following agents: omeprazole, clarithromycin, amoxicillin, tetracycline, and metronidazole. The pharmacist also may adjust or discontinue acid-suppressive drug regimens. The pharmacist is responsible for ordering all appropriate laboratory tests, monitoring patients for adverse effects, collecting data on patient outcomes, and providing patient education. The clinic provides opportunities for pharmacists to study the clinical effectiveness and pharmacoeconomics of various regimens for treating H. pylori-associated disease and for pharmacy students and residents to interact with patients. As of fall 1994, 20 patients had been evaluated at the clinic: 12 tested positive for H. pylori and were treated with antimicrobials and all were pain-free without medication at the end of treatment. An H. pylori assessment clinic enabled pharmacists to assume a primary care role, document improvement in patient outcomes, and study the effectiveness of various antimicrobial regimens.

California↗
PubMed1997

Clinical training program for distributive pharmacists.

A training program to enable staff pharmacists in a state correctional system to shift their practice from distributive to clinical is described. Under a contract with the Texas Department of Criminal Justice (TDCJ), the University of Houston College of Pharmacy provides pharmaceutical services to 145,000 patients in 100 correctional facilities. An automated centralized distribution site was built in 1993 and four regional pharmacies were subsequently closed, resulting in the reallocation of eight distributive pharmacists positions to clinical services. Four of the eight pharmacists who would be displaced began a retraining program in preparation for decentralized clinical positions. The 18-month program, developed by university staff on contract to TDCJ and college faculty members, included 34 home-study modules, case studies, case presentations, seminars, and supervised practice experience. Three of the pharmacists completed the program, passed competency tests, and were certified for clinical practice privileges, including drug therapy assessment and written consultations. The three pharmacists now operate ambulatory care clinics at prison units. A clinical skills training program developed by a college of pharmacy correctional services division in cooperation with faculty members enabled staff pharmacists to convert their roles from distributive to clinical.

Education, Pharmacy, Continuing↗
PubMed1998

Staff development in pharmacist-conducted patient education and counseling.

A staff development program designed to improve pharmacists' counseling skills and to allow participants to achieve a minimum level of competence in counseling is described. The pharmacy service at a Department of Veterans Affairs medical center selected a workshop emphasizing the principles of the Indian Health Service (IHS) interactive counseling technique as the basis for a training program for staff pharmacists. The program was expanded to meet the pharmacy's counseling training needs. Handouts on 70 of the most frequently prescribed outpatient medications; administration techniques for oral and nasal inhalers and ophthalmic agents; and 32 common diseases were included in training manuals. Seven standard cases were developed for role-playing sessions, the purpose of which was to increase pharmacists' level of confidence in using the IHS technique and in counseling patients about common diseases and medications. Each pharmacist's counseling technique was assessed by a facilitator. Knowledge of commonly prescribed medications was assessed by an open-book written examination. The pharmacists' self-reported level of confidence in counseling patients about common diseases and medications was significantly improved after the training program. A counseling training program enabled pharmacists to achieve a minimum level of competence in counseling and increased their confidence in their counseling skills.

California↗
PubMed2001

Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge.

BACKGROUND: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue. OBJECTIVES: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication. METHODS: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied. RESULTS: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient. CONCLUSIONS: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.

Clinical Pharmacy Information Systems↗