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PubMed2003

Impact of pharmacist recommendations on the cost of drug therapy in ICU patients at a Malaysian hospital.

OBJECTIVES: To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions. METHODS: A clinical pharmacist reviewed drug prescriptions during one month. Drug-related problems were documented on a prepared from including a suggestion for a change in prescribing. Such recommendations were submitted to the nursing/medical staff. Acceptance of the recommendation was entirely at the discretion of the medical staff. All recommendations were analysed with respect to potential pharmaco-economic impact: cost savings, cost avoidance or cost addition. RESULTS: The ICU pharmacist made 57 recommendations, of which the medical staff rejected only 5%. The majority of detected drug-related problems referred to unnecessary drug therapy (37%). Recommendations resulted in net cost savings of RM 15,227 (USD 4,007). This corresponded with RM 634 per patient intervened by the pharmacist. CONCLUSION: Pharmacists interventions in the ICU of a Malaysian hospital resulted in significant cost savings in terms of drug expenses and can therefore be suggested as a routine practice in our hospital.

Cost Savings↗
PubMed2004

Continuing education and community pharmacists in Galicia: a study of opinions.

AIM OF THE STUDY: To determine the opinions of a volunteer group of community pharmacists concerning general and specific issues related to continuing education. METHODS: Participants were required to complete questionnaires before and after attendance at a refresher course, and score the relevant options provided on a scale from 0 to 10. The responses of the survey were analyzed to identify preferences and to detect any possible changes in opinion. MAIN OUTCOME MEASURE: Arithmetic means of pharmacists' opinions. RESULTS: The teaching methods preferred by the community pharmacists were workshops for resolution of practical cases (9 +/- 0.25 and 8.88 +/- 0.13) and the distance-learning computer programmes (6.74 +/- 0.25 and 8.18 +/- 0.20). In selecting which topics that should be taught, the participants gave the highest ratings to healthcare needs (8.75 +/- 0.14 and 8.57 +/- 0.15) and the demands of the pharmacists (8.15 +/- 0.16 and 8.40 +/- 0.16), with pharmaceutical care being the most requested topic (29 points). Participants preferred courses lasting 20 to 50 hours (6.94 +/- 0.26 and 7.89 +/- 0.16), without preference for schedule. CONCLUSION: Community pharmacists in Galicia show a great interest in the provision and organization of continuing education activities that meet their needs and expectations.

Adult↗
PubMed2001

A physician-pharmacist model for the surveillance of blood pressure in the community: a feasibility study.

Hypertension is poorly managed. Hospital-based pharmacists working with physicians have been shown to improve the rate of achievement of "target" blood pressure in selected patients. It is unknown if such schemes can operate in the community and to what extent they would attract volunteers with poorly managed blood pressure. We assessed the feasibility of pharmacists to provide community-based, open-access, blood pressure monitoring. In addition, we describe the blood pressure profile of the group in comparison to that of the 1994 Health Survey of England (HSE). Pharmacists from six pharmacies were trained to deliver the service. Adults living within the postal districts of the pharmacies were invited, through an advertising campaign, to volunteer to have their blood pressure measured. Blood pressure data and information on treatment for hypertension and/or diabetes were collected on 263 registrants. Patients were advised to have their blood pressure managed by the general practitioner immediately (category 1), re-measured within 2-3 months (category 2) or in 12 months time (category 3). The mean (s.d.) blood pressure of patients in categories 1 (n = 16), 2 (n = 117) and 3 (n = 130) was 186(16)/97(29), 151(13)/94(9) and 139(22)/86(13) mm Hg respectively; P < 0.001. Ninety-one patients (35%) were in receipt of antihypertensive therapy. Forty-five percent of the treated group had controlled blood pressure (<160/95 mm Hg) compared with 30% in the HSE dataset. A large proportion of known hypertensive patients with poor blood pressure control who had visited their general practitioner within the previous 6 months were detected by the pharmacist-led service. Pharmacists operating an open-access blood pressure monitoring service may be of value in improving the management of hypertension.

Adult↗
PubMed2005

Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a regional survey.

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n = 893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n = 350) only had BP figures <140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n = 185) were equipped with an automatic device. A total of 77% (n = 779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n = 79). Only 18% (n = 29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n = 135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.

Aged↗
PubMed2006

Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse.

This study assessed the knowledge, attitudes, and professional practices of pharmacists regarding addiction and patient use of controlled medications. This research project explored the relationship between pharmacy education, perceived and actual knowledge, and professional interactions as it pertains to problems surrounding dependency and addiction. A questionnaire of 25 items was administered at three separate continuing education programs in Florida in 2005. A total of 484 surveys were completed. Pharmacists (67.5%) reported participating in two hours or less of addiction/substance abuse education in pharmacy school. Of particular concern was that 29.2% reported having received no addiction education. Pharmacists who had greater amounts of addiction-specific education had a higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling. In addition, pharmacists who reported more education counseled patients more frequently and felt more confident about counseling. A majority of respondents (53.7%) reported that they had never referred a patient to drug treatment in their career. These findings suggest that the neurobiological basis for addictive diseases, standards of care, and pain management guidelines were not widely understood by the sample. More research should be undertaken to determine the educational needs of practicing pharmacists to enable them to assume a leadership role in detecting, preventing, and treating prescription drug abuse.

Adult↗
PubMed1995

Pharmacists' role in a smoking-cessation program at a health maintenance organization.

A comprehensive smoking-cessation program sponsored by a health maintenance organization (HMO) and the role of pharmacists in the program are described. Group Health Cooperative of Puget Sound is an HMO serving more than 385,000 enrollees in western Washington State. Group Health established a smoking-cessation program in 1985. The smoking-cessation benefit consists of interventions by providers to determine smoking status, a formal behavioral modification program, and nicotine-replacement therapy (beginning in 1993) for patients undergoing behavioral modification. The behavioral modification program is offered in group or individualized format. A team of trained nursing, medical, and pharmacy staff members provides consultative support to the program's smoking-cessation specialists. A tobacco-use road-map team has been created as part of the quality-improvement effort at Group Health; a pharmacist serves on this team. The ultimate goal of the team is to reduce the percentage of adult enrollees who smoke from the current 20% to 12.5% by 2000. A procedure for promoting smoking cessation was presented to all the pharmacists, along with continuing-education sessions. The pharmacists are encouraged to be brief but consistent in their antismoking message and to apply the "four A's" (ask about the patient's smoking status, advise the patient to quit smoking, assist in the patient's efforts to quit, and arrange follow-up). The inclusion of nicotine-replacement products in the smoking-cessation program in 1993 provided pharmacists with a key role in determining dosages and monitoring patients. Although the program is leading many smokers to quit, efforts will have to be intensified if program goals are to be realized by 2000.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1997

Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital.

The influence of pharmacist participation on economic and morbidity outcomes at a tertiary care teaching hospital was studied. Patients admitted to internal medicine wards during a nine-month period were assigned to either a treatment team or a control team. Each team consisted of an attending physician, senior and junior medical residents, and medical students; the treatment team included a pharmacist who reviewed all patient charts, made rounds with the team, and recommended modifications of drug therapy. Pharmacy interaction with the control team was limited to contacting physicians about potentially dangerous orders, answering questions from the medical team, and handling orders for items not on the formulary or otherwise unavailable. After discharge, data from patient records were analyzed for pharmacy costs and total hospital costs and length of stay (as markers of the pharmacist's effect on economics and morbidity, respectively). Analysis of baseline characteristics showed that the two groups of patients were statistically comparable. Treatment team patients who were included in the data analysis (414) had significantly shorter stays (by a mean of 1.3 days) and lower pharmacy and total hospital costs (by a mean of $301 and $1654, respectively) than those included in the control team analysis (453). The direct participation of a pharmacist on a patient care team significantly decreased pharmacy and hospital costs, as well as length of stay, compared with minimal participation of a pharmacist.

Analysis of Variance↗
PubMed1997

Peer review and continuous quality improvement of pharmacists' clinical interventions.

A peer-review-based continuous quality improvement (CQI) program for improving pharmacists' clinical interventions at a hospital is described. With the implementation of pharmaceutical care at Detroit Receiving Hospital came the need for a CQI system to validate and improve this type of patient care. A peer-review group (PRG) was formed. The PRG decided to review 60 pharmacist interventions per month for clinical appropriateness, accuracy of entry into the computer, documentation in the medical record by the pharmacist, and implementation if accepted by the physician. Interventions are assigned to individual reviewers, and final decisions on the appropriateness and correctness of the selected interventions are made at periodic PRG meetings. In its first year the PRG met nine times and evaluated 409 interventions; 96% of the interventions were judged clinically appropriate, 62% were accurately entered into the computer, 62% were documented in the medical record by the pharmacist, and 92% were implemented if accepted by the physician. Meetings, additional reviews, and inservice sessions were used to address deficiencies in the interventions; these efforts led to improvements. The clinical appropriateness of documented interventions was included as a medication use indicator in the hospital CQI program. A peer-review-based CQI process allowed a hospital to effectively monitor and improve the quality and documentation of interventions recommended by pharmacists.

Hospital Bed Capacity, 300 to 499↗
PubMed1998

ASHP survey of ambulatory care responsibilities of pharmacists in integrated health systems--1997.

The results of a national survey of the ambulatory care functions of pharmacists in integrated health systems, including managed care organizations, are reported. Persons responsible for ambulatory care pharmaceutical services in 392 integrated health systems nationwide were interviewed by telephone and asked about their systems' organizational characteristics, information systems, pharmacist functions, and performance measures. Respondents reported a range of health-system components, including acute care hospitals, home health services, managed care products, and ambulatory care centers. Approximately 27% of respondents reported that their health system had an electronic medical records system, and 23% reported having one for ambulatory patients. Approximately 49% of respondents indicated that their system had an interdisciplinary care team for ambulatory patients that included a pharmacist. Overall, distributive functions consumed the largest portion (45%) of pharmacists' time, followed by clinical (30%) and administrative (21%) activities. The percentages of time spent on the different functions varied by geographic region and type of health system. Tracking adverse drug reactions, monitoring medication compliance, using pharmacoeconomic data for formulary decision-making, conducting medication management programs, and patient counseling were routinely provided as part of ambulatory care pharmaceutical services by 75% or more of health systems. Financial performance and patient satisfaction were the most frequently used performance-evaluation measures. Overall, pharmacists providing ambulatory care services in integrated health systems spent about 45% of their time on distributive, 30% on clinical, and 21% on administrative functions.

Ambulatory Care↗
PubMed1998

System for exchanging information among pharmacists in different practice environments.

A system for exchanging patient information among hospital, long-term-care (LTC), and ambulatory care pharmacies is described, and the influence of that system on pharmacist interventions is reported. Study sites consisted of three ambulatory care pharmacies, one LTC pharmacy, and one hospital in a small Midwestern city. Meetings were held by clinicians, the investigators, and hospital administrators to plan the information-exchange system. From January through June 1996, patients admitted to the hospital were checked to see if they came from a participating (source) pharmacy; if so, they were randomly assigned to experimental and control groups. The hospital requested preadmission information from the source pharmacy for experimental group patients and did not do so for control patients. After the information arrived, the hospital pharmacists could use it to identify and document drug therapy problems. When an experimental group patient was discharged, the hospital sent information to the appropriate source pharmacy. A total of 156 patients were enrolled in the study. Complete information transfer occurred for 75% of experimental group patients. Significantly more experimental group patients than control patients had at least one in-hospital pharmacist intervention recorded. Similarly, in the ambulatory care pharmacies (but not the LTC pharmacy) significantly more interventions per patient were documented for the experimental group. Hospital and ambulatory care pharmacists documented more interventions for patients about whom information had been supplied than for patients for whom that information had not been supplied. No difference in intervention rates was observed for LTC pharmacists, who were already being supplied information by the LTC facilities about patients discharged from the hospital.

Ambulatory Care Facilities↗
PubMed1998

Survey of inpatient counseling by hospital pharmacists.

A survey was conducted to determine the inpatient-counseling practices of hospital pharmacists. A questionnaire about the frequency of inpatient counseling, barriers to counseling, and suggestions for increasing the level of inpatient counseling was mailed to 667 hospital pharmacists. Recipients were asked to rate six attitudinal statements about inpatient counseling. The response rate was 30%. The largest group of respondents worked in institutions where discharge counseling was provided to specific populations or as needed. Some 67% of respondents reported not counseling any patients. Barriers to counseling most often cited were lack of time and inadequate staff; facilitators most often cited were decentralization and resource availability. The most frequent suggestions for increasing the amount of counseling were making changes that provide more time, having adequate staff to provide counseling, and having a well-designed counseling program in place. Responses about barriers and facilitators varied with practice setting and frequency of counseling. On average, pharmacists reported a belief that they are the health care professionals most qualified to counsel inpatients about medications and that this is their responsibility. More than two thirds of the responding hospital pharmacists reported counseling no patients; the barrier to counseling most frequently reported was lack of time, and the facilitator most often reported was decentralization; on average, pharmacists reported that they believed they should have a role in inpatient counseling.

Data Collection↗
PubMed1999

Clinical research: ASHP guidelines and future directions for pharmacists.

ASHP guidelines on the pharmacist's role in clinical drug research and future directions for pharmacists in clinical drug research are described. Health-system pharmacists have a responsibility to the patient and to the institution to ensure that clinical research systems are sound, that patients are protected, and that research is conducted in a safe, effective way. ASHP guidelines list minimum standards that are essential for improving performance. The ASHP Guidelines on Clinical Drug Research, approved in November 1997, update information previously found in the ASHP Guidelines for the Use of Investigational Drugs in Organized Health-Care Settings, approved in 1990, but have an expanded focus. Additions include recognition of relevant business practices, implications of technology, and the expansion of clinical research beyond the academic health center. At a minimum, all pharmacists involved in clinical research should handle the record keeping for drug accountability, provide drug information to patients and to other health care providers, ensure the appropriate care of patients at sites not involved in the study, and provide accountability at nonpharmacy locations. Managing and coordinating clinical drug research is an area of growth that represents a great opportunity for clinical drug research. By providing baseline and higher-level pharmaceutical services for clinical research projects, pharmacists can help to ensure data accuracy and completeness and patient safety.

Guidelines as Topic↗
PubMed1999

Health-system pharmacists' role in immunizing adults against pneumococcal disease and influenza.

The role of pharmacists in immunizing adults against pneumococcal disease and influenza is discussed. Pneumococcal disease and influenza each cause up to 40,000 deaths annually in the United States. Vaccination against these diseases is encouraged for all people 65 years of age or older and for those with certain chronic diseases or immunosuppression. Influenza virus vaccine should also be given to residents of long-term-care facilities, many pregnant women, and health care workers. Pneumococcal vaccine is usually given once in a lifetime; influenza virus vaccine is given annually in the fall. Advocacy of immunization is consistent with the precepts of pharmaceutical care, and pharmacists can promote immunization by assuming the roles of educator, facilitator, and immunizer. Despite lack of specific mention of it in accreditation standards, health-system personnel have a duty to vaccinate adults, just as they do pediatric patients. Pharmacists should review immunization records with patients periodically and at the time of immunization. As with other drug products, formulary decisions and the distribution, storage, and handling of vaccines are important pharmacist responsibilities. Pharmacoeconomic studies have demonstrated the value of pneumococcal and influenza virus vaccines. Medicare covers these vaccines under Part B. Pharmacists have an important role to play in promoting adult immunizations against pneumococcal disease and influenza.

Adult↗
PubMed2002

Physicians' expectations of pharmacists.

Physicians' current and future expectations of and current experiences with pharmacists were studied. A three-part questionnaire was mailed to 2600 practicing physicians in California, including office-based practitioners, hospital-employed (nonhouse staff) physicians, and medical residents. A 5-point Likert scale was used to measure respondents' level of agreement with statements in each part; part 1 dealt with current expectations, part 2 with current experiences, and part 3 with future expectations. Respondents were asked to confirm their practice setting (office-based, hospital-based, medical resident, or other) and to indicate the number of years since graduation from medical school. The mean values of physician agreement with each statement were reported. There was neither strong agreement nor strong disagreement with any statement regarding physicians' current and future expectations of and current experiences with pharmacists. There was no correlation between practice setting and level of agreement with statements in any part of the questionnaire. There was a correlation between the number of years since graduation from medical school and the level of agreement with statements about current and future expectations; in both cases, those physicians who graduated from medical school less than 10 years ago had higher expectations of pharmacists than those who graduated 10 or more years ago. Overall, physicians do not know what to expect of pharmacists. Physicians' expectations of pharmacists were most strongly correlated with the number of years since graduation from medical school and least strongly correlated with physicians' practice setting.

Analysis of Variance↗
PubMed2002

Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes.

The accuracy rates of board-registered pharmacy technicians and pharmacists in checking unit dose medication cassettes in the inpatient setting at two separate institutions were examined. Cedars-Sinai Medical Center and Long Beach Memorial Medical Center, both in Los Angeles county, petitioned the California State Board of Pharmacy to approve a waiver of the California Code of Regulations to conduct an experimental program to compare the accuracy of unit dose medication cassettes checked by pharmacists with that of cassettes checked by trained, certified pharmacy technicians. The study consisted of three parts: assessing pharmacist baseline checking accuracy (Phase I), developing a technician-training program and certifying technicians who completed the didactic and practical training (Phase II), and evaluating the accuracy of certified technicians checking unit dose medication cassettes as a daily function (Phase III). Twenty-nine pharmacists and 41 technicians (3 of whom were pharmacy interns) participated in the study. Of the technicians, all 41 successfully completed the didactic and practical training, 39 successfully completed the audits and became certified checkers, and 2 (including 1 of the interns) did not complete the certification audits because they were reassigned to another work area or had resigned. In Phase II, the observed accuracy rate and its lower confidence limit exceeded the predetermined minimum requirement of 99.8% for a certified checker. The mean accuracy rates for technicians were identical at the two institutions (p = 1.0). The difference in mean accuracy rates between pharmacists (99.52%; 95% confidence interval [CI] 99.44-99.58%) and technicians, (99.89%; 95% CI 99.87-99.90%) was significant (p < 0.0001). Inpatient technicians who had been trained and certified in a closely supervised program that incorporated quality assurance mechanisms could safely and accurately check unit dose medication cassettes filled by other technicians.

Drug Packaging↗
PubMed2003

Using personal digital assistants to document pharmacist cognitive services and estimate potential reimbursement.

The use of personal digital assistants (PDAs) to document pharmacist cognitive services and estimate potential reimbursement was studied. Between September 2001 and February 2002, four pharmacy residents and four clinical pharmacists used PDAs for documenting cognitive services. Interventions recorded on paper during the same six-month period one year earlier were reviewed for comparison. Potential reimbursement for these services was calculated by linking current procedural terminology codes and charges to the electronically documented services. Over the six-month study period, pharmacists recorded 7319 interventions with PDAs, compared with 5028 documented on paper during the earlier six-month period. Potential claims for pharmacists' cognitive services documented with PDAs amounted to more than $1 million in the six months, assuming a 100% reimbursement rate. PDAs provide a simple, efficient paperless system for documenting pharmacists' clinical services and generating reimbursement claims.

Computers, Handheld↗
PubMed2004

Applying the theory of planned behaviour to pharmacists' beliefs and intentions about the treatment of vaginal candidiasis with non-prescription medicines.

BACKGROUND: It is important to understand health professionals' attitudes and beliefs about practice and the barriers to achieving best practice. The theory of planned behaviour (TPB) has been widely used to understand behaviour. In this study, TPB was used to explore the psychological variables that influence community pharmacists and the supply of non-prescription medicines. OBJECTIVES: The objectives of the study were to: (i) apply the TPB to community pharmacy behaviour; (ii) identify barriers to/facilitators of evidence-based practice; (iii) describe psychological variables and responses to written scenarios of patients presenting in community pharmacies for non-prescription antifungals for the treatment of vulvovaginal candidiasis; and (iv) to examine the relationships between beliefs and behavioural intention. METHODS: A questionnaire survey was constructed using the TPB and disseminated to pharmacies in Grampian, Scotland. The purpose of the study was to explore community pharmacists' attitudes, beliefs and intentions about the supply of non-prescription antifungals for the treatment of vulvovaginal candidiasis. RESULTS: Of the 121 questionnaires disseminated, 76 (63%) were returned. Behavioural intention to sell antifungals to women with vulvovaginal candidiasis symptoms was strong. Attitude towards recommending these medicines was positive. However, only half of the sample responded appropriately to all four patient scenarios (n=42, 54%). Most pharmacists felt that they were able to recommend antifungals if they wished, but did not feel under social pressure to recommend them. Local doctors did not appear to be influential with respect to selling antifungals. If a customer was elderly, pregnant or if the pharmacist was uncertain of the diagnosis of candidiasis, an antifungal was less likely to be recommended. CONCLUSION: TPB provides a valid and useful summary of the key psychological variables influencing practice. There is more to pharmacy practice than the knowledge and attitudes of the pharmacist.

Antifungal Agents↗
PubMed1983

A randomized trial comparing pharmacists and technicians as dispensers of prescriptions for ambulatory patients.

This article describes a study on the impact of utilizing technicians in the dispensing of prescriptions for ambulatory patients. The two hypotheses were 1) there is no difference in error rate for prescriptions dispensed by pharmacists versus technicians, and 2) there is no change in the amount of time pharmacists spend counseling patients after technicians begin dispensing prescriptions. Power analysis indicated that a sample size of 900 prescriptions would need to be randomized into each group to adequately compare error rates. Results showed that there was no significant difference in error rate between pharmacists (5.17 per cent) versus technicians (4.17 per cent), supporting the first null hypothesis. Pharmacists did spend significantly more time counseling patients (p less than 0.001), leading to a rejection of the second null hypothesis. Since the number of staff did not change during the study, it is calculated that, based on annual salary plus fringe benefits, +20,080 in additional pharmacists' time was freed up for patient counseling when technicians were dispensing the prescriptions.

California↗