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Evaluation of pharmacy and therapeutics committee drug evaluation reports.

Pharmacy and therapeutics (P & T) committee drug evaluation reports prepared by pharmacies and drug information centers (DICs) and product package inserts were compared with standard guidelines to evaluate their quality. Letters were sent to 143 hospital pharmacies asking them to submit a previously prepared drug evaluation report on temazepam, moxalactam disodium, or atenolol. The reports and package inserts for these three drugs were evaluated by the presence of 40 elements derived from the published ASHP guidelines for drug evaluation report preparation. Responses were obtained from 124 (87%) pharmacies; however, only 80 reports (60 DIC-prepared and 20 pharmacy-prepared) were received. The reports contained a mean of 28 of the 40 (70%) possible elements. The most frequently omitted elements were AHFS number, potential unlabeled uses, drug-drug interactions, drug-disease-laboratory test interactions, risk and benefit data, prevention and treatment of side effects, comparisons with established treatment, and disadvantages of the drug under consideration. Although the reports prepared by the DICs and pharmacies contained the same amount of information, the DIC-prepared reports included data more frequently on supply sources, therapeutic indications, approved labeling, comparison with established treatment, bioavailability and pharmacokinetics, and recommendations. Most of the reports contained more elements than the corresponding package inserts. The product package inserts did not contain the comparative elements required for P & T committee decisions. Both the pharmacy- and DIC-prepared reports failed to contain all 40 elements recommended in the standard guidelines, suggesting the need for more thorough reports.

Atenolol↗

Pharmacy and freedom.

The development of pharmacy in Western civilization has been influenced by ideas of individual liberty; the impact of these ideas is traced. For a short time during the French Revolution, individuals without qualifications could practice pharmacy, but abuses prompted return of regulation; from 1803, pharmacy was closely regulated by the state. Liberal thinking in 19th-century Britain left control of pharmacy mainly within the profession; regulation was definitive rather than restrictive. With the influence of Jacksonian Democracy and freedom of trade in the United States, there were no effective pharmacy regulations until the late 19th century and few educational requirements for licensure until the 1920s. In Germany, the old system of concessions and privileges was upset after World War II when any qualified pharmacist was allowed to open a shop wherever desired in the American-occupied zone; the courts upheld this policy as the basis for establishment of pharmacies in West Germany. Liberty in dispensing drugs has been limited out of concern for the well-being of individuals and of society as a whole. In Great Britain and the U.S., restrictions on dispensing antedated laws establishing qualifications for pharmacists. The history of pharmacy demonstrates that there are moral and social barriers to realization of the ideals of liberty. History also suggests that if pharmacists assume responsibilities that use their specialized training, they can defend against inroads by nonpharmacists.

Civil Rights↗

Contractual relationships between colleges of pharmacy and university hospitals.

The relationships that exist between colleges of pharmacy and university hospitals located in academic medical centers were investigated, and the types of pharmaceutical services that are being offered by these institutions were profiled. Questionnaires were mailed to 35 directors of pharmaceutical services located in academic medical centers. Of the 30 institutions represented by respondents, 27 had a college of pharmacy on the same campus, and 13 had a formal agreement between the hospital and the college. Ninety-seven percent of the hospitals surveyed had unit-dose or partial unit-dose programs, and all of the hospitals had i.v. admixture services. Nine of the 13 hospitals with formal agreements and 13 of the 17 hospitals without formal agreements had decentralized pharmaceutical services. The staffing patterns in these institutions showed that only 10.3% of the pharmacist FTE positions were funded by the college of pharmacy. There was no difference in trends as related to faculty appointment, title, or tenure between directors in hospitals with and without affiliation agreements. Seven of the directors of pharmacy were in tenure-track positions, and the director's reporting mechanism in the college was either to the dean or the chairman of pharmacy practice. No differences were found between the pharmaceutical services offered, staffing patterns, or status of the director of pharmacy in hospitals with or without formal agreements with colleges of pharmacy. These authors believe that a firm relationship between the college and hospital might prove advantageous to both parties.

Contract Services↗

Strategy to effect change in pharmacy practice.

The formulation of a strategy for change in pharmacy practice is described. Pharmacy has focused more on improving efficiency for existing functions than on identifying and adapting to the changing needs of society. The survival of the profession will depend on its ability to meet the present and future needs of society. Structural and procedural aspects of strategy formulation should focus on building a consensus within the profession. Interests of professional leaders, educators, practitioners, and the public should be incorporated into the profession's strategy. A center for strategic planning, supported by national pharmacy organizations, is suggested. Formulation of a strategy for pharmacy should involve: (1) an assessment of health-care needs relevant to pharmacy; (2) comparative evaluations of methods for delivering needed services; (3) integration with other health-care services; (4) organization and management of pharmacy practice; (5) financing considerations; and (6) legislative and regulatory changes. Planned strategic change will provide pharmacy with a mechanism for channeling its future activity in a direction that can effectively and efficiently meet the needs of society.

Delivery of Health Care↗

Comparison of two methods of observing work areas in a hospital pharmacy.

Two methods of observing the work area within a pharmacy of an acute care, 140-bed hospital were compared. A work activity recording form was developed from the literature and from discussion with the pharmacy staff. The instrument was coded, tested, and refined in a pilot study. One hospital pharmacy department work area was personally observed for a period of time equal to an entire work week. A time-motion camera was placed in the pharmacy which recorded the activities in the same pharmacy work area for a second work week. The results indicated that the two methods of observation were approximately equivalent for observing the work activities of the nonpharmacists but not for the work activities of the pharmacists. The camera method of observing work areas of a hospital pharmacy appeared to be reliable and inexpensive, but it lacked the precision obtained with the personal observation mode. Further use of time-motion cameras within the hospital pharmacy setting are indicated.

Evaluation Studies as Topic↗

[Establishment of pharmacy education from 1803 to 1994].

Schools of pharmacy were created by the law of germinal 21, year XI (of the French Republican calendar) in Paris, Montpellier and Strasbourg, and also in Turin and Genoa where these schools have been in existence for three or four years. From 1846, at various dates, the first three schools called themselves higher schools without any enactment. With the addition of the school of Nancy, which had replaced that of Strasbourg from 1871 to 1918, the schools became Faculties of pharmacy by the decree of may 14, 1920. Considering that three schools were insufficient for teaching pharmacy, about twenty preparatory schools of medicine and pharmacy were created by the order of march 12, 1840, in which studies in pharmacy lasted only three years. From 1874, some of those schools were turned into mixed faculties of medicine and pharmacy or into full practice schools. In 1955, the eleven remaining schools became national schools, and by 1968 all had become mixed faculties. The law of november 12, 1968 converted faculties into UERs (Units of Education and Research) and that of june 26, 1984 into UFRs, attached to the new universities. The faculty of pharmacy of Paris was divided into two, one half being attached to the University of Paris V and the other to the University of Paris XI.

Education, Pharmacy↗

Automated decentralized pharmacy dispensing systems.

Automated decentralized pharmacy dispensing systems (ADPDSs) are medication management systems that allow hospitals to store and dispense drugs near the point of use. These systems, which can be compared with the automated teller machines used by banks, provide nurses with ready access to medications while maintaining tight control of drug distribution. In this study, we evaluated three ADPDSs from two suppliers, focusing on whether these systems can store and dispense drugs in a safe, secure, and effective manner. When rating the systems, we considered their applicability to two different implementation schemes: The use of a system with a pharmacy profile interface. This feature broadens the capabilities of the system by allowing more information to be provided at the dispensing cabinet and by providing better integration of the information from this cabinet with the pharmacy's information system. Two of the evaluated systems have this feature and were rated Acceptable. The use of a system without a pharmacy profile interface. We rated all three of the evaluated systems Acceptable for such implementations. To decide which scheme is most appropriate for a particular hospital, the facility will need to determine both how it intends to use the ADPDS and what it hopes to achieve by implementing the system. By performing this type of analysis, the facility can then determine which ADPDS features and capabilities are needed to accomplish its goals. To help facilities make these decisions, we have provided an Equipment Management Guide, "Improving the Drug Distribution Process-Do You Need an Automated Decentralized Pharmacy Dispensing System?," which precedes this Evaluation. In addition, readers unfamiliar with the roles of both the pharmacy and the pharmacist within the hospital can refer to the Primer, "Functions of a Hospital Pharmacy," also published in this issue.

Automation↗

Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.

CONTEXT: It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible and used. OBJECTIVE: To evaluate the effect of direct access to EC through pharmacies and advance provision on reproductive health outcomes. DESIGN, SETTING, AND PARTICIPANTS: A randomized, single-blind, controlled trial (July 2001-June 2003) of 2117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. INTERVENTION: Participants were assigned to 1 of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control). MAIN OUTCOME MEASURES: Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assessed at 6 months; secondary outcomes were changes in contraceptive and condom use and sexual behavior. RESULTS: Women in the pharmacy access group were no more likely to use EC (24.2%) than controls (21.0%) (P = .25). Women in the advance provision group (37.4%) were almost twice as likely to use EC than controls (21.0%) (P<.001) even though the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P = .46). Only half (46.7%) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12% acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71) or increase in STIs (pharmacy access group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P = .73; advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P = .79). There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group. CONCLUSIONS: While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics.

Adolescent↗

Varying health care provider objectives and cost-shifting: the case of retail pharmacy in the US.

In this paper we investigate the relationship between health care provider objectives, cost-shifting, and prices by exploring the relationship between state Medicaid pharmacy reimbursements and average prices paid by pharmacy retail customers for four distinct pharmaceutical products across the US in 1994. We develop a more general theory than past researchers to enable provider objectives to vary with Medicaid pharmacy reimbursement levels. We find that provider objectives and the direction of relationship between Medicaid pharmacy reimbursements and retail prices vary with Medicaid pharmacy reimbursement levels. At high Medicaid pharmacy reimbursement levels we find a consistent negative relationship across products. At low Medicaid pharmacy reimbursement levels, the direction of the relationship is product-specific. As a result, policy-makers should be aware that policies affecting reimbursements from government-sponsored health insurance will also affect retail customers that include the uninsured. Paradoxically, for certain products if a state cuts a generous Medicaid reimbursement level this could hurt uninsured patients, whereas cuts in a stingy Medicaid reimbursement rate may help uninsured patients.

Cost Allocation↗

Reliability of Group Health Cooperative automated pharmacy data by drug benefit status.

PURPOSE: Evaluate the reliability of health plan pharmacy records in determining medication use among seniors with and without a drug benefit. METHODS: Subjects included 3610 seniors, enrolled in Group Health Cooperative's Medicare (GHC) + Choice program during 1998-1999, receiving care in an integrated group practice (IGP), and diagnosed with one or more of four chronic conditions (hypertension, diabetes, congestive heart failure, and coronary artery disease). We compared pharmacy records to self-reported medication use for antidepressant, antihypertensive, acid suppressant, cardiac, diabetic, hormone, and lipid lowering drugs. RESULTS: Agreement between pharmacy records and self-report was substantial to almost perfect (prevalence-adjusted and bias-adjusted kappa (PABAK) range: 0.69 for antihypertensives to 0.95 for cardiac agents) among seniors with a drug benefit. Agreement was slightly less for seniors without a drug benefit (PABAK range: 0.51 for antihypertensives to 0.92 for cardiac agents) and differences varied by drug class. Among seniors without a benefit, the prevalence of medication use was lower when based on pharmacy records than when based on self-report for all medication classes of interest. CONCLUSIONS: While GHC may not be representative of all health plans, our study indicates that health plan pharmacy records are a reliable source of data for seniors receiving care within an IGP. However, the reliability of pharmacy records appears better among seniors with a drug benefit. Researchers should consider factors such as drug benefit status when conducting studies using pharmacy data. More studies are needed in different populations and delivery systems, as well as over varied types of drug benefits.

Aged↗

Non-steroidal anti-inflammatory drug prescribing patterns in general practice: comparison of a general practitioner-based survey and a pharmacy-based survey in France.

PURPOSE: In order to assess biases occurring in primary care prescription studies, we compared non-steroidal anti-inflammatory drug (NSAID) prescribing patterns reported by general practitioners directly (GP-based survey) and from a pharmacy-based survey of general practitioner prescribing (pharmacy-based survey). METHODS: Volunteer GPs of the administrative area of Côte d'Or (France) returned a mailed questionnaire on NSAID prescribing patterns for consecutive patients seen during a 2-month period. In order to obtain a reference basis, pharmacies of the same administrative area provided all prescriptions that included NSAIDs during a 1-week period originating in general practice. RESULTS: The rate of participation was 25% for the GPs and 40% for the pharmacies. Participant GPs were representative of GPs of the area with regard to sex, year of graduation and practice area but pharmacies from rural areas were over-represented. The GP-based survey and the pharmacy-based survey provided respectively 770 and 1050 prescriptions. There were no differences between either survey in the type of NSAIDs prescribed and in the most frequently associated drugs. GPs who volunteered in the GP survey prescribed NSAIDs more frequently orally and at higher doses than GPs involved in the pharmacy-based survey. They also prescribed more gastroprotective drugs, especially in the elderly. None of these results could be explained by differences in patient characteristics and GP practice areas. CONCLUSION: GPs who actively participate in prescription surveys exhibit prescribing patterns that fit better with official recommendations than the average. Although selection biases cannot be ruled out, it is suggested that some changes in GP prescription habits may have been induced by the survey itself.

Adolescent↗

A qualitative study of health-care personnel's experience of a satellite pharmacy at a HIV clinic.

OBJECTIVE: The aim of the study was to investigate how health-care personnel at a HIV clinic perceived conventional pharmacies in Sweden and whether the decentralization of pharmaceutical services to the HIV clinic had led to an improved collaboration between other health-care professionals and pharmacists. METHODS: Doctors and nurses who had regular contacts with HIV patients and the satellite pharmacy were interviewed. The interviews were semi-structured, using open questions and was analysed according to the phenomenographic approach. RESULTS: The respondents perceived the existing co-work between conventional pharmacies and other health care professionals as limited. The availability of the satellite pharmacy enabled the health care professionals to understand the pharmacys' way of working, and to increase trust in the pharmacy staff. Collaboration was hence developed between the professions, leading to a consistent way of informing the patients about their HIV drugs, thereby avoiding contradictory information. The pharmacist also became involved in adherence promoting activities at the clinic. The perceived benefits for the patients were considered to be convenience and preservation of privacy as well as a better basis for safe and appropriate drug utilisation. CONCLUSION: Conventional pharmacies were shown to have several disadvantages in serving the HIV infected population. The health care professionals found the novel approach of dispensing HIV drugs at the clinic valuable. The approach led to increased communication and trust between the health care professions, and enhanced teamwork in medication management.

Attitude of Health Personnel↗

Quality of medication information available on retail pharmacy Web sites.

BACKGROUND: The Internet is becoming an important source for medication information. Although the quality of consumer medication information (CMI) in brick and mortar pharmacies has been reported to be suboptimal, little is known about the quality of CMI offered by pharmacy Web sites. OBJECTIVE: To evaluate the quality, readability, and provision of Web functionality of 4 popular medications (atenolol, nitroglycerin, atorvastatin, and glyburide) available on the websites of 3 of the largest retail pharmacies: Walgreens, CVS Pharmacy, and Rite Aid. METHODS: The quality of online medication information was evaluated by 2 reviewers using a preexisting evaluation instrument created by a national panel of experts. Readability level was assessed using the Gunning Fog Test. We also assessed the presence of 4 Web-specific functional criteria: (1) capability for font enlargement, (2) availability of a glossary of terms, (3) presence of an "Ask a pharmacist" feature, and (4) access to detailed medication information or full prescribing information. RESULTS: Overall, medication information was 77% adherent to the criteria evaluated. When broken down by drug, CMI was most adherent for atorvastatin (83%), followed by glyburide (77%), atenolol (76%), and nitroglycerin (75%). The average readability level was found to be 10th grade. No pharmacy Web site provided the ability for font enlargement, a glossary of terms, or access to detailed medication information; however, all pharmacy Web sites provided an "Ask a pharmacist" service. CONCLUSION: Although pharmacy Web sites were found to have an overall good content quality, the high readability level of text, areas of incomplete information, and limited use of desirable Web functionality suggest room for improvement.

Comprehension↗

Consumers' evaluation of value-added pharmacy services.

One proposal for community pharmacies to survive in an increasingly competitive market is to offer services that consumers want and need. This study examined the effects of such a value-added pharmacy services (VAPS) program implemented at 19 experimental pharmacies; another 16 pharmacies served as a control group. The study found that patrons of VAPS pharmacies received more pharmacy services and were more likely to report that the pharmacist talked to them about their medication than patrons of control pharmacies. This study demonstrates that a value-added services program can have an impact on pharmaceutical services.

Community Pharmacy Services↗

Pharmacy access to sterile syringes for injection drug users: attitudes of participants in a syringe exchange program.

OBJECTIVE: To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. DESIGN: One-time, cross-sectional survey. SETTING: Baltimore, Maryland. PARTICIPANTS: 206 injection drug users who participate in the Baltimore SEP. INTERVENTIONS: Face-to-face interviews. MAIN OUTCOME MEASURES: Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. RESULTS: The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of $0.80 (median = $1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). CONCLUSION: If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

Adult↗

Pseudoepidemic of streptococcal pharyngitis in a hospital pharmacy.

CONTEXT: Streptococcus pyogenes has recently re-emerged as a significant pathogen causing disease ranging from pharyngitis to lethal systemic infection. Six hospital pharmacy employees were diagnosed as having streptococcal pharyngitis during 1 week, and antibiotic prophylaxis was requested to halt the outbreak. OBJECTIVE: Outbreak investigation. DESIGN: Review of initial cases and prospective evaluation of the remaining pharmacy employees and the antigen detection test being used. SETTING: Pharmacy and occupational health department of a university hospital. POPULATION: Sixteen employees of the hospital pharmacy and 19 other employees of the hospital. RESULTS: The 6 pharmacy employees who had positive streptococcal antigen detection tests did not have symptoms suggesting streptococcal pharyngitis. Of the 10 remaining pharmacy employees, none had a positive throat culture for S pyogenes. Specificity of the antigen detection test being used was 53% (95% CI, 30%-75%) in prospective evaluation. CONCLUSIONS: This was believed to represent a pseudoepidemic because none of the 6 cases had signs or symptoms typical of streptococcal pharyngitis, none of the remaining 10 pharmacy employees had positive throat cultures, and prospective evaluation found low specificity of the antigen detection test. Whereas use of an accurate test in such a low prevalence setting could have resulted in a higher percentage of results being false-positive, the low specificity of the antigen detection test being used also contributed to the pseudoepidemic.

Anti-Bacterial Agents↗

Pharmacy involvement in patient-focused care in Florida hospitals.

Hospital pharmacy directors in Florida were surveyed to determine the effects of patient-focused care on pharmacy practice. In a statewide mail survey in 1994, directors were asked whether their hospital had implemented patient-focused care or was planning to, what factors influenced this, whether and how the pharmacy was involved, what changes in structure and services resulted, and how they perceived the impact of patient-focused care on the practice of hospital pharmacy. They were asked to identify specific programs, interdisciplinary teams, and opportunities associated with patient-focused care programs. Usable surveys were returned by 148 respondents (48.8% response rate). Fifty-three (35.8%) of the respondents had implemented patient-focused care and 50 (34%) were planning to ; 82.5% of these respondents (85 of 103) said pharmacists were involved in the planning efforts. Respondents said hospital administration was most often responsible for initiating patient-focused care, and cost was the top-ranked reason. For pharmacy, patient-focused care brought more interdisciplinary activities and new services. Florida hospital pharmacy directors thought patient-focused care would change the practice of pharmacy and that the change would be positive.

Attitude of Health Personnel↗

Use and effectiveness of pharmacy continuing-education materials.

The use and effectiveness of pharmacy continuing-education (CE) materials were studied. A 31-item survey was administered to pharmacists via an Internet portal. A recruitment letter, which included a description of the study and the Internet address to access the survey, was mailed to 2000 pharmacists. Only pharmacists who were currently practicing pharmacy in a community pharmacy or in a health care setting were included in the analysis. Pharmacists were asked to indicate the format of CE they generally used, formats used in the six months prior to the survey, and the format of their most recent CE. They were also asked to assess the effectiveness of CE programs and their ability to enhance pharmacists' knowledge and clinical practice behavior. Descriptive statistics were computed for all variables. Chi-square analyses were performed to compare subgroup responses. Of the 373 pharmacists completing the survey, 365 met the inclusion criteria. Of these respondents, 31% worked in a chain pharmacy, 25% in an inpatient pharmacy, and 23% in an independent pharmacy. Pharmacists most commonly obtained CE from printed materials (92%), lectures and seminars (75%), Internet-based materials (53%), and symposia (44%). Respondents found all types of CE programs effective in improving their knowledge, but less effective in enhancing their clinical practice behavior. Pharmacists perceived different types of CE programs as valuable resources for their educational needs. Printed materials, lectures, and seminars were the most commonly used CE formats. Pharmacists considered CE programs very effective in enhancing their knowledge and less valuable in improving their pharmacy practice activities.

Adult↗