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PubMed1979

Clinical toxicology consultation by pharmacists.

The functions of pharmacists in a clinical toxicology consultation service are described. Pharmacists provided three basic services in conjunction with poisonings treated by the emergency department of a children's hospital: (1) assisted with obtaining the history and assessment of the toxicologic proglems, (2) recommended a plan for rational management, and (3) discussed poison prevention with the parents of the victims. Pharmacists were consulted for 189 poisoning cases over a six-month period; 80% of the cases were attended at the bedside and the remainder were monitored by telephone. Drugs were involved in 58% of the patient exposures. Median time for the pharmacist to reach the emergency room after the patient's arrival was 5 to 10 minutes. Physicians and nurses rated the pharmacists' contributions favorably. These results suggest that pharmacists can play an important role in clinical toxicology.

Adolescent↗
PubMed1983

Pharmacist liability for suicide by drug overdose.

Conditions that affect pharmacist liability for suicide by drug overdose are discussed. Traditionally, courts have refused to find liability on the part of a pharmacist who negligently dispenses medication to a patient who then commits suicide with the medication. The rationale has been that the act of suicide is not reasonably foreseeable to the pharmacist, and therefore it is an independent intervening act that breaks the chain of causation between the pharmacist's negligent act and the death of the patient. This legal precedent was followed in a recent case involving hospital pharmacists in Dallas, Texas. Analysis of the facts in the Dallas case shows that the pharmacists could reasonably have foreseen the patient's suicide, and the court's reliance on precedent might have been misplaced. This case and review exemplifies a pharmacolegal situation in which practitioners cannot strictly rely on reported case law to guide their actions. Pharmacies should develop policies and procedures to prevent patients from accumulating medications with which suicide can be consummated.

Humans↗
PubMed1982

Use of clinical pharmacists to reduce cefamandole, cefoxitin, and ticarcillin costs.

The financial impact of using cefamandole and cefoxitin rather than cefazolin and of using ticarcillin rather than carbenicillin in one institution was assessed; the effectiveness of clinical pharmacists in reducing the costs associated with these drugs also was determined. During Phase 1 (July 1, 1980-March 31, 1981), the numbers of intravenous piggyback cefazolin, cephalothin, cefamandole, cefoxitin, carbenicillin, and ticarcillin doses prepared were recorded. Quarterly purchase data for each drug were determined from invoice records. During Phase 2 (April 1, 1981-September 30, 1981), eight clinical pharmacists reviewed all patient charts for cefamandole, cefoxitin, and ticarcillin orders. If the indication for these orders was missing or considered inappropriate, the pharmacist contacted the prescriber and recommended substituting appropriate doses of cefazolin for cefamandole and cefoxitin and of carbenicillin for ticarcillin. The number of doses prepared and quarterly purchase data were collected as in Phase 1. The projected savings resulting from clinical pharmacist input relating to these drugs was calculated. Based on Phase 1 data, the total theoretical expense resulting from cefamandole and cefoxitin use instead of cefazolin and from ticarcillin use in place of carbenicillin was projected to be $233,448 annually. Cefamandole and cefoxitin accounted for 59.8 and 39.7% of total cephalosporin use in Phases 1 and 2, respectively. Ticarcillin accounted for 77.1% of the total ticarcillin and carbenicillin doses in Phase 1, and 16.6% in Phase 2. A projected annual savings of $156,756 was achieved because of clinical pharmacist input at a cost of $16,000 for time devoted to the effort. Clinical pharmacists were effective in reducing the use of cefamandole, cefoxitin, and ticarcillin in situations where cefazolin or carbenicillin could be substituted.

Anti-Bacterial Agents↗
PubMed1995

Assessment of pharmacists' experience with ophthalmic drug products.

BACKGROUND: Pharmacists' recommendations on selection and proper use of eye care products are important in terms of patient compliance with therapy. A questionnaire was designed to determine if educational differences exist between North Carolina and Alabama pharmacists with regard to ophthalmic drugs and procedures. METHODS: Pharmacists in Raleigh, North Carolina and Birmingham, Alabama were surveyed since these areas have similar populations and demographic characteristics but differed in the prescriptive authority accorded optometrists. RESULTS: Relative to familiarity, dispensing experience, and patient instruction on proper use, North Carolina pharmacists seem to have a statistically significant (p < 0.05) better educational preparation and experience with three ophthalmic drugs and procedures: OTC decongestants, ointments, and eyedrop instillation procedures. Pharmacists of both cities felt they had insufficient knowledge and experience with numerous ophthalmic drug products, including antiglaucoma cap color codes, C-cap compliance caps, eyelid scrubs, contact lenses, and nasolacrimal occlusion procedures. CONCLUSIONS: Pharmacists appear to need more post-graduate education relative to ophthalmic drugs and procedures and could benefit from additional training on these subjects while in pharmacy school. Optometrists and ophthalmologists should educate patients about ophthalmic drug delivery, including eyedrop instillation procedures.

Alabama↗
PubMed1994

Pharmacist-managed medication review in a managed care system.

A medication-review service at a managed care facility was studied. The service, developed in 1991, provides in-depth analysis of medication use and patient consultation by a pharmacist. Patients are seen by referral. During a visit, the pharmacist reviews each medication for patterns of use, clinical response, and adverse effects and if necessary teaches the patient how to use the drugs more appropriately. The pharmacist may change some aspect of the prescription and may schedule follow-up visits. The investigators reviewed data on (1) medication-related problems for all new patients seen by the pharmacist during the first 12 months of the service, (2) patient demographics for the first 23 months, (3) utilization of the service and pharmacist productivity for the first 23 months, (4) utilization of medications and health care services in a representative subset of patients 12 months before and after they used the service, and (5) costs. A total of 2720 medications were reviewed during months 1-12. On average, 64.9% of the drugs reviewed each month were problematic. A total of 836 patients were seen during the first 23 months; most of the referrals were from physicians. The patients averaged 2.6 diagnoses and 4.7 drugs each and were not dominated by any one age group, gender, diagnosis, or drug therapy. A representative subgroup showed reductions in the number of unscheduled physician visits, urgent care visits, emergency room visits, and hospital days; a savings of $644 per patient per year was calculated. Patients used fewer health services during the year after they began participating in a pharmacist-managed medication-review program.

Adolescent↗
PubMed1993

Effect of pharmacists on health care outcomes in hospitalized patients.

The cost-effectiveness of pharmacists and their effect on inpatient health care outcomes were evaluated. For one year, data were collected on all patients receiving care from general medicine and general surgery teams at Walter Reed Army Medical Center, Washington, D.C. Two of five medicine teams and one of three surgery teams included a pharmacist. Teams that included a pharmacist were compared with teams that did not, in terms of patients' length of stay (LOS), mortality, and drug cost per admission. Data were compared for 3081 patients and collected for another 557 who were not included in the comparative study design. Health care teams that included a pharmacist had a shorter log LOS and lower log drug cost per admission but no difference in mortality. The average cost savings for teams that included a pharmacist was $377 per inpatient admission, and the benefit-to-cost ratio was 6.03:1. The inclusion of pharmacists on health care teams was cost-effective and provided a favorable benefit-to-cost ratio.

Adult↗
PubMedDate not supplied

Pharmacist's management of drug-related problems: a tool for teaching and providing pharmaceutical care.

During the development of education and practice models based on the philosophy of pharmaceutical care (PC), six pharmacists worked with the University of Toronto Faculty of Pharmacy to implement the PC model in their practice sites. These pharmacists found it necessary to modify existing tools to create one that explicitly guided them through the PC process, including the phase of monitoring patients for desired outcomes. This resulted in the development of the Pharmacist's Management of Drug Related Problems. This tool requires pharmacists to collect patient drug and medical data and write responses to specific questions about the data to interpret their significance. As proficiency in providing PC is attained, the questions and space for written responses can be eliminated, leaving a comprehensive documentation system of patient outcomes and the data collected, recommendations made, and monitoring completed by the pharmacist. This tool has been adopted by the University of Toronto Faculty of Pharmacy and is being used in various continuing education programs and by practicing pharmacists across Canada.

Drug Monitoring↗
PubMed1997

Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care?

BACKGROUND: The content of discharge prescriptions/summaries to improve communication about medication provided at discharge has been the subject of recent studies. To date, the authors are not aware of any literature that assesses the need for primary care health professionals to receive information on reasons for drug therapy changes incurred during hospital admission. Owing to increased emphasis on seamless care, patient education, and increased accountability for drug costs, general practitioners (GPs) and community pharmacists may consider the receipt of information on the reasons for drug therapy changes incurred during hospital admission to be an essential requirement. AIM: To determine whether GPs and community pharmacists want, and receive, information on the reasons for drug therapy changes implemented by secondary care. The preferred method of acquiring this information is also investigated. METHOD: A questionnaire was posted to all GPs and community pharmacists within the catchment area of Glasgow Royal Infirmary University NHS Trust. Data were collected between June 1995 and July 1995. RESULTS: Replies were received from 71 (64%) GPs and 33 (80%) community pharmacists. Of the respondents, 96% of GPs and 94% of community pharmacists would like information on one or more reason types for drug therapy changes, but the majority do not receive the desired information. Ninety per cent of GPs and 85% of community pharmacists seek this information of facilitate continuity of patient care. The preferred method of receiving the information is by postal delivery via a modified hospital discharge prescription. CONCLUSION: The existing hospital discharge prescription requires modification to facilitate the completion of the reasons for drug therapy changes. The issue of patient-held cards requires consideration. These factors may facilitate continuity of patient care on hospital discharge.

Attitude of Health Personnel↗
PubMed1997

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training.

AIMS: To investigate the attitudes of community pharmacists towards HIV prevention services for drug misusers and the relationship between these and their involvement in service provision. DESIGN: Postal survey of a one in four random sample of community pharmacies (N = 2654) in England and Wales, stratified by Family Health Service Authority, in 1995, using up to four mailshots. SETTING: Community pharmacies in England and Wales. PARTICIPANTS: The community pharmacist in charge of the dispensary at the random sample of community pharmacies. MEASUREMENTS: Information on attitudes and behaviour were collected through self-completion and postal return of structured questionnaires using questions with both category responses and Likert scales. FINDINGS: A 74.8% response rate was achieved. Community pharmacists were positive about their role in HIV prevention and the provision of clean injecting equipment to injecting drug users--positive attitudes that were more evident among those pharmacists already providing these services. However, they had concerns over the effect drug misusers may have on business and indicated a need for more training and for more role support. Only a minority had taken part in training on drug misuse and HIV prevention (34.7% and 21.3%, respectively). Many community pharmacists supported the proposal that there should be extensions of their involvement, to include services such as supervising the consumption of methadone in the pharmacy (38.6%) and collecting used prescribed ampoules from patients (33.8%). Positive relationships were identified between training and attitude, and between attitude and service provision. Changes in attitude responses between this 1995 survey and the earlier 1988 survey are also presented. CONCLUSIONS: Recommendations are made for further training and greater communication between prescriber/carer and the community pharmacists, for involvement of community pharmacies in new possible forms of service provision, and for there to be greater attention to the value of role support.

Attitude of Health Personnel↗
PubMed2005

A qualitative study of the contribution of pharmacists to heart failure management in Scotland.

STUDY OBJECTIVES: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management. SETTING: A mixed urban/ rural region in the west of Scotland. DESIGN: Semi-structured qualitative research interviews. PARTICIPANTS: A total of 50 people with CHF (NYHA Class II and III) due to left ventricular systolic dysfunction (33 males; mean age 67 years, 17 females; mean age 68 years) and 30 nominated caregivers recruited from the outpatient departments of two hospitals in the West of Scotland. Sampling was purposive to include patients from a range of CHF severity, ages and sexes. MAIN RESULTS: Managing medications was a responsibility shared by both the patients with CHF and caregivers. Treatment regimens were reported to be difficult to comply with. Health professionals were seen to provide little support for medication management. Pharmacists were viewed as being a good and accessible source of practical assistance who were also knowledgeable about the individual's heart health history. Participants reported valuing advice from pharmacists about the side effects of medications and for their assistance in reducing the complex logistics of medication management and in having medications delivered. CONCLUSIONS: Patients with CHF and caregivers voiced a willingness to try to manage their medication regimen accurately but had a limited capacity to do so. Pharmacists were viewed as providing valuable support to patients with CHF and their caregivers, in terms of medication management. The extended role of pharmacists in medication management of CHF should be encouraged.

Aged↗
PubMed2006

Awareness and perceptions of emergency contraception among retail pharmacists in Kuwait.

OBJECTIVE: To describe the awareness and perceptions of hormonal emergency contraception (EC) among retail pharmacists. SETTING: Private retail pharmacies in Kuwait City. METHOD: A self-administered questionnaire was developed to elicit pertinent demographic information as well as awareness of and concerns about EC and administered to the senior pharmacist in 51 randomly selected private retail pharmacies. MAIN OUTCOME MEASURE: Proportion of pharmacists aware of EC and who had recommended EC. RESULTS: The respondents had a mean (SD) age of 34.2 (7.7) years; 58.8% were male, and all but one were non-Kuwaiti. The median practice experience of the pharmacists was 6 years. Oral contraceptives and male condoms were universally available in the pharmacies, but none stocked emergency contraceptives, female condoms, or diaphragms. Twenty respondents (39.2%; 95% confidence intervals 25.5-53.9%) said they were aware of EC, and 4 (7.8%) that they had ever offered EC. Nine (17.6%) respondents saw EC as offering no advantages over other contraceptive measures and effectiveness was perceived to be low. Most cited concerns were of encouraging irresponsible behaviour and women relying on EC in place of regular contraceptive measures. Religious opposition (41.2%), lack of awareness by clients (51.0%) and lack of awareness by health providers (35.3%) were seen as the most significant obstacles to provision of EC. CONCLUSION: Knowledge of EC is poor among community pharmacists in Kuwait. Action is needed to address this deficit and to make EC more accessible to women who wish to use it.

Adult↗
PubMed2006

Validation of an instrument for the documentation of clinical pharmacists' interventions.

OBJECTIVE: To validate an instrument for documentation of clinical pharmacy interventions in French speaking hospitals in France and outside of France. METHOD: A panel of 12 French speaking clinical pharmacists (six from France; six from French speaking countries) was asked to analyse a set of 60 pharmacist's interventions on drug prescription. They used a form including (1) the identification of the drug related problems (DRPs) (10 items), (2) the pharmacist's intervention (7 items). We assessed the level of agreement between the 12 pharmacists on the test DRPs and on the interventions. MAIN OUTCOME MEASURES: Kappa coefficient of concordance was used to assess the level of agreement between experts for DRPs and interventions. We also assessed the userfriendliness of the instrument using Likert scales. RESULTS: The level of concordance observed in the validation was 0.76 for DRPs and 0.89 for the type of intervention. Eleven experts out of 12 were "very satisfied" or "satisfied" and one "not satisfied" with the tool. Ten out of the 12 experts were ready to use it in daily practise. CONCLUSION: The present instrument proposed by the French Society of Clinical Pharmacy (SFPC) is the first coding system for pharmacist's interventions with a French interface. The validation process using a standard statistical methodology helps support the external validity of our tool. The level of concordance between users can be considered as satisfactory, allowing the use of the tool in daily clinical pharmacy practise. To enhance the diffusion of the instrument and of the general process of routine documentation of interventions, a spreadsheet is provided on the French Society of Clinical Pharmacy website.

Documentation↗
PubMedDate not supplied

Pharmacist-managed intravenous to oral step-down program.

In an effort to provide cost-effective pharmaceutical care at a 650-bed community hospital, a pharmacist-managed intravenous to oral step-down program was developed and implemented. As part of this program, satellite pharmacists review daily the charts of patients receiving 1 or more of 10 targeted drugs given intravenously. Based on a predetermined set of criteria and their clinical judgment, pharmacists recommend that physicians switch to the oral formulation of the targeted drugs if appropriate. This program has been in place for 7 months, during which time 223 recommendations were made. Of these recommendations, 190 were accepted and implemented, resulting in a cost savings of $21,596.00. When annualized, the expected savings is $37,000.00 or nearly the salary of one full-time pharmacist. This program has been well accepted by physicians and pharmacists. It appears to be having a positive impact on physician awareness of using oral medications when appropriate.

Administration, Oral↗
PubMed1992

Patient education and compliance: a pharmacist's perspective.

Pharmacists are becoming more involved with patient education due to the increased emphasis being placed on primary patient care. Existing research in the area of patient education and compliance can provide pharmacists with the knowledge to enhance patient compliance. Changing noncompliant behavior can make a positive impact on patient's treatment plan. Such interventions involve the education of patients, whether it be during an outpatient consultation session or an inpatient education program. Of the five compliance theories identified in the literature, the Communication Model describes the best mechanism for pharmacists to educate their patients. During consultation sessions, essential knowledge and skills can be communicated to the patient that will maximize compliance. Monitoring medication refills is the most accessible method for pharmacists to identify noncompliant behavior. Determining patient noncompliance and making adjustments with patient education tactics will enable pharmacists to expand their professional role while improving patient outcomes.

Communication↗
PubMedDate not supplied

The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients.

The object of the study was to evaluate outcomes of a randomized clinical trial (RCT) of a pharmacist intervention for depressed patients in primary care (PC). We report antidepressant (AD) use and depression severity outcomes at 6-months. The RCT was conducted between 1998 and 2000 in 9 eastern Massachusetts PC practices. We studied 533 patients with major depression and/or dysthymia as determined by a screening test done at the time of a routine PC office visit. The majority of participants had recurrent depressive episodes (63.5% with >/=4 lifetime episodes), and 49.5% were taking AD medications at enrollment. Consultation in person and by telephone was performed by a clinical pharmacist who assisted the primary care practitioner (PCP) and patient in medication choice, dose, and regimen, in accordance with AHCPR depression guidelines. Six-month AD use rates for intervention patients exceeded controls (57.5% vs. 46.2%, P =.03). Furthermore, the intervention was effective in improving AD use rates for patients not on ADs at enrollment (32.3% vs. 10.9%, P =.001). The pharmacist intervention proved equally effective in subgroups traditionally considered difficult to treat: those with chronic depression and dysthymia. Patients taking ADs had better modified Beck Depression Inventory (mBDI) outcomes than patients not taking ADs, (-6.3 points change, vs. -2.8, P =.01) but the outcome differences between intervention and control patients were not statistically significant (17.7 BDI points vs. 19.4 BDI points, P =.16). Pharmacists significantly improved rates of AD use in PC patients, especially for those not on ADs at enrollment, but outcome differences were too small to be statistically significant. Difficult-to-treat subgroups may benefit from pharmacists' care.

Adult↗
PubMedDate not supplied

Description of a clinical pharmacist intervention administered to primary care patients with depression.

The objective of this article is to provide a detailed description of interactions between patients with depression and pharmacists. Analysis was conducted on patients from the intervention arm (n=268) of an randomized controlled trial that evaluated the impact of a clinical pharmacist on the outcomes for depressed primary care patients from nine metropolitan Boston practices. The main outcome measure was the amount of intervention time spent with patients, physicians, and other activities. Details of the behavioral intervention and a categorization of the activities are offered. Pharmacists reported 978 encounters with 268 patients in 6 months. Eighty percent of patient encounters occurred by telephone. Initial encounters took 45 min if in person and 13.3 min if by telephone. Subsequent encounters followed a similar pattern. Follow-up visits occurred 2.3 times per patient. Physician contact took considerably less time. In total, the pharmacist intervention took 70.3 min per patient over 6 months; 42.2% of encounters involved an activity related to non-antidepressant medication and 85% of encounters involved general support. Other activities (education, advocating antidepressants, and motivating adherence) occurred in at least 50% of encounters. Pharmacists repeated intervention activities in the same category approximately two to three times. Interventions to improve the care of depression in primary care patients must anticipate encountering intense needs for information, personal support, and help negotiating the healthcare system. Research that identifies relationships between the components (active ingredients) of an intervention and the outcomes of care will benefit future intervention strategies and contribute to improved and efficient care.

Adult↗
PubMed2005

Pharmacists' discussions of medication side effects: a descriptive study.

To improve efforts to assist patients in making informed decisions regarding medications, current methods of providing information, such as patient counseling by pharmacists, must be examined. This will require attention not only to what content is delivered, but also how it is phrased by this group. Ten community pharmacists were videotaped while providing their customary patient counseling to two standardized patients receiving new prescriptions within staged scenarios. All of the pharmacists discussed side effects and management strategies. Vague, verbal descriptors of frequency--rather than numerical indicators--were used which may inhibit accurate risk assessment by patients. Additionally, pharmacists focused on safety aspects of using medications and spent far less time discussing potential therapeutic benefits. Patient decision-making regarding medication may be affected by how pharmacists communicate such benefits and risks, meriting further investigation into patients' interpretations of information received.

Acute Disease↗
PubMed2005

Role theory: literature review and implications for patient-pharmacist interactions.

BACKGROUND: There is a need to describe how role theory has been used by researchers to describe various phenomena in pharmacy so as to identify gaps in knowledge and future research priorities. OBJECTIVE: The primary purpose of this article is to review how role theory has been used in the community pharmacy literature. Secondary objectives are to (1) examine the use of role theory over the evolution of the profession of pharmacy, (2) determine what role theory perspectives have been used, (3) explore the implications of role theory for patient-pharmacist interactions, and (4) explore implications for future pharmacy research using role theory. METHODS: A literature search of Web of Knowledge and International Pharmaceutical Abstracts was conducted. Articles were included if they examined some aspect of role theory in community pharmacy and were categorized based on their role theory perspective and "era" of pharmacy in which they were published. RESULTS: Thirty research articles were identified spanning from 1956 to 2004 with the majority (19 studies) using mail surveys. Articles used functionalist (9 studies), organizational (7), functional and organization (4), cognitive (10), and symbolic interactionist (1) perspectives to role theory. The number of articles using role theory has been increasing over time. The functional and symbolic interactionist perspectives provide rich descriptions of the multiple pharmacy roles and allow for a clearer understanding of the barriers affecting actors' experience. Using an organization perspective, role stressors such as role conflict, ambiguity, and overload were found to impact pharmacists' worklife. Cognitive role theory research has clearly shown that pharmacists' and patients' expectations for the encounter shape interaction. CONCLUSIONS: The use of role theory informs both researchers and practitioners about the practice of pharmacy and patient interactions. Still, there is much work to be done in role theory and pharmacy research. Experimental designs, longitudinal studies, and qualitative research methodologies may warrant greater use and attention. Role change should be identified as a priority, and research is needed to elucidate what interventions change patients' and pharmacists' expectations of the patient-pharmacist interaction.

Humans↗