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PubMed1995

The future of pharmacy: Armageddon or Pollyanna?

OBJECTIVE: To review important events and predictions about pharmacy that have occurred in the practice since my career began and describe changes in opportunities that have developed over the past 35 years. DATA SOURCES: I used personal recollections and information from the State of Florida Pharmacy Association journal over a 35-year period. Other supporting data were used to describe current practice opportunities. DATA SYNTHESIS: Over the past 35 years many people have predicted the demise of the pharmacy profession. The reasons stated for this demise have varied over the years and include government interference, the expansion of chain and mail-order pharmacies, managed care, loss of the compounding function, Medicaid reimbursement, national health insurance, and pharmacy technicians. Despite these gloomy predictions, community and hospital pharmacies have flourished over the past 35 years and new roles for pharmacists have emerged in managed care, consultant pharmacy, academic pharmacy, and the pharmaceutical industry. With the enactment of the Omnibus Budget Reconciliation Act of 1990 requirements, it appears that the public has even greater expectations from community pharmacists as medication advisors. The pharmacy profession is changing more rapidly than ever and pharmacists must prepare for these rapid changes. Colleges of pharmacy should inculcate in their students the importance of lifelong learning to keep abreast with change. CONCLUSIONS: Society will always need experts on drugs. Pharmacists must rise to the challenge and accept new and changing roles in drug therapy management. If that occurs the future of pharmacy will be ensured.

Forecasting↗
PubMed1995

A comparison of six intra-oral X-ray films.

OBJECTIVES: To compare objectively and subjectively national-brand dental X-ray films with widely available and less costly brands. METHODS: A range of dental films, including the recently released Kodak Ektaspeed Plus, was purchased from mail-order suppliers at the lowest published price. Objective measurements (film speed, contrast, fog levels, costs, physical characteristics) and subjective evaluations (ease of use, film graininess, overall appearance) were made. RESULTS: Private-label films were obtained at less cost than those of major vendors. Not all film speeds, sizes and wrapping materials were available from individual manufacturers. Objective measures and subjective appraisals showed that Ektaspeed Plus was the fastest film and had good contrast with the clinically useful density ranges. Agfa Dentus was the next fastest film, but it had rather low contrast and was grainier than the other films. The non-proprietary brands were difficult to open with primary glove barriers, making effective infection control practices arduous. All films were relatively stable over a 16-week period regardless of storage location. CONCLUSIONS: The major manufacturers offered more choices of film sizes and speeds than did private label suppliers. The films from the major manufacturers, although more expensive, were more conducive to effective infection control practices. Ektaspeed Plus had a performance comparable with or better than the other available films. Based on this preliminary study, it is recommended that this new film is considered as an alternative to D-speed films.

Absorptiometry, Photon↗
PubMedDate not supplied

Impact of health plan design and management on retirees' prescription drug use and spending, 2001.

We examined 2001 prescription drug claims for a range of employer-based retiree plans administered by a national pharmacy benefit management firm, to understand how use and spending differ with various cost-sharing approaches and other drug use management techniques among the elderly. In these plans, most of which had generous benefits and substantial use of mail order, more aggressive cost-sharing requirements combined with other management strategies were associated with greater member cost sharing, a shift to less costly medications (generic and mail order), and lower total prescription drug spending. Although we did not find lower rates of use in plans with aggressive cost sharing, this may be attributable in part to their higher drug use associated with mail-order incentives.

Aged↗
PubMedDate not supplied

Generic dispensing and substitution in mail and retail pharmacies.

Mail-order pharmacies have lower aggregate generic-dispensing rates than their retail counterparts. This fact has been used as evidence of self-dealing that could arise when a pharmacy benefit manager (PBM) is both a plan administrator and a pharmacy owner. Using the aggregate generic-dispensing rate, however, is problematic because it confounds variation in performance with differences in demand. Controlling for therapeutic mix alone explains 87 percent of the apparent difference in aggregate dispensing rates. An alternative measure--one that fully controls for differences in price and indications across molecules within a category--eliminates the discrepancy in dispensing rates.

Administrative Personnel↗
PubMed2004

The feasibility of implementing an evidence-based core set of clinical pharmacy services in 2020: manpower, marketplace factors, and pharmacy leadership.

Development of a national plan to implement a core set of clinical pharmacy services in United States hospitals by 2020 requires assertive leadership from pharmacy organizations and state boards of pharmacy, and a commitment from the profession. Factors that may affect the development are grouped into three areas: manpower, marketplace variables, and pharmacy leadership. Although the number of pharmacy school graduates (7000) was about the same in 1990 and 2000, a greater number of pharmacy schools and high student enrollment, coupled with the Accreditation Council for Pharmacy Education's acceptance of foreign-trained pharmacists, suggest that the number of pharmacists will increase substantially in the near future. We estimate that the net increase in pharmacists (new pharmacy graduates less pharmacists who retire or die) in the United States will be 139,929 from 2000-2020, for a total of 335,040 pharmacists (71% increase). The number of pharmacy technicians increased substantially (66%), from 150,000 in 1996 to 250,000 in 2002. The number of residents in programs accredited by the American Society of Health-System Pharmacists increased 148%, from 435 in 1990 to 1080 in 2002. We conservatively project an increase of 33,000 pharmacists who complete residencies from 2000-2020. The pharmacy marketplace has changed dramatically over the last 12 years, with 10,754 independent community pharmacies closing (2.46 pharmacies/day) and 8459 chain outlets opening (1.93 chains/day). In recent years, mail-order pharmacies have expanded faster than other retail outlets and now process over 18% of U.S. prescriptions. Increased use of robotic systems (some can process 5000 prescriptions/hr) and technicians will diminish the demand for dispensing pharmacists. In addition, up to 10% of U.S. retail prescriptions may be filled outside the country's borders. These data indicate that there will be a sufficient supply of pharmacists and technicians in the future. Thus, it is feasible, based on manpower, marketplace factors, and pharmacy leadership, to implement a core set of clinical pharmacy services for patients in U.S. hospitals by 2020.

Education, Pharmacy↗
PubMed2004

Onset of ischemic colitis following use of electrical muscle stimulation (EMS) exercise equipment.

Our patient was a 71-year-old man who presented with lower abdominal pain, and bloody and white mucosal stools. He purchased by mail-order an electrical muscle stimulation (EMS) device, which he strapped onto his lower abdomen, and for 2 consecutive days he underwent muscle stimulation comprising 600 contractions at 2.40 mA and 1.20 V over a 10 minute period. He experienced the onset of lower abdominal pain immediately following muscle stimulation on the second day, and then passed stools containing blood and white mucus. The cause was thought to be electrical and mechanical stimulation of the lower abdomen by the EMS equipment, either inducing colonic or vascular spasm, or dislodging thrombi associated with atrial fibrillation or atherosclerosis. This is the first known report of ischemic colitis associated with the use of EMS exercise equipment. We report this case in the belief that this condition is likely to become more common with increasing use of such devices.

Aged↗
PubMed1998

Safety recommendations for laser pointers.

The use of laser diode pointers that operate in the visible radiation region (400-760 nm) is becoming widespread. These pointers are intended for use by educators while presenting talks in the classroom or at conventions and meetings. They are also useful in any situation where one needs to point out special items during any instructive situation. The pointers can be purchased in novelty stores, mail-order magazines, office supply stores, common electronic stores, and over the internet. The power omitted by these laser pointers ranges from 1 to 5 mW. The potential for hazard with laser pointers is generally considered to be limited to the unprotected eyes of individuals who might be exposed by a direct beam (intrabeam viewing). No skin hazard usually exists. There are, however, even more powerful laser pointers now appearing. The units are imported into the U.S. often without proper manufacturer certification or labeling. The potential for hazards with these devices is not well understood by the general public and workers, and numerous exposure incidents have been recorded by the authors. Users of these products need to be alerted to the potential hazards and be encouraged to follow appropriate safety recommendations. These factors are discussed and safety recommendations for laser pointers are presented.

Certification↗
PubMed1994

[The dedicated amateur].

This is the text of an inauguration lecture at Umeå Universitiy (a chair of the history of science and ideas). The lecture is based on a study of magazines like Populär Teknik (Popular Technology), popular science literature, handbooks for mechanical and electrical experimentation, mail-order catalogs etc. from 1920-50, and its theme is that amateurs and hobbyists interested in popular science, technology and "do-it-yourself" have played an important role in modern society. Here we find a world exclusively occupied by boys and men, where it is made a virtue of playing with technological toys, and where mechanical and electrical tinkering becomes a significant part of the construction of masculinity. But the activities of amateurs and hoppyists can also be seen as an important way of self-education where the boy may get in touch with the scientific and technological frontier of the time, and there are many examples (e.g. in early history of radio or personal computers) where amateurs invented and developed new technology. The spirit of amateurs and hobbyists can even contain elements of a modern civic ideal: don't become dependent upon professional experts, don't trust authorities or big business that want to control technology, trust yourself and your knowledge. In short: do it yourself.

Biotechnology↗
PubMed2003

Mind your pricing cues.

For most of the items they buy, consumers don't have an accurate sense of what the price should be. Ask them to guess how much a four-pack of 35-mm film costs, and you'll get a variety of wrong answers: Most people will underestimate; many will only shrug. Research shows that consumers' knowledge of the market is so far from perfect that it hardly deserves to be called knowledge at all. Yet people happily buy film and other products every day. Is this because they don't care what kind of deal they're getting? No. Remarkably, it's because they rely on retailers to tell them whether they're getting a good price. In subtle and not-so-subtle ways, retailers send signals to customers, telling them whether a given price is relatively high or low. In this article, the authors review several common pricing cues retailers use--"sale" signs, prices that end in 9, signpost items, and price-matching guarantees. They also offer some surprising facts about how--and how well--those cues work. For instance, the authors' tests with several mail-order catalogs reveal that including the word "sale" beside a price can increase demand by more than 50%. The practice of using a 9 at the end of a price to denote a bargain is so common, you'd think customers would be numb to it. Yet in a study the authors did involving a women's clothing catalog, they increased demand by a third just by changing the price of a dress from $34 to $39. Pricing cues are powerful tools for guiding customers' purchasing decisions, but they must be applied judiciously. Used inappropriately, the cues may breach customers' trust, reduce brand equity, and give rise to lawsuits.

Attitude↗
PubMed1989

Experience with staffing alternatives in a pediatric teaching institution.

Staffing alternatives and recruitment and retention strategies used by the pharmacy department of a pediatric teaching hospital are described. In addition to overtime compensation, the following alternative strategies have been implemented: (1) use of contingent or "on-call" personnel, (2) coverage by management staff, (3) use of temporary agencies, (4) review of ongoing activities, and (5) use of supportive personnel. All these strategies have been effective in compensating for shortages by supplying qualified individuals on an as-needed basis, eliminating nonessential departmental activities, or delegating nonprofessional duties to technicians and other supportive personnel. Effective recruitment and retention strategies include scholarship and training programs, communication with pharmacy staff about management efforts to improve salary and practice opportunities, and insight into the nature of the local competition from chain and mail-order pharmacies. Use of alternate approaches to staffing has helped the pharmacy department at this institution maintain adequate staffing during periods of pharmacist shortages.

Communication↗
PubMed1988

Dangerous information: product tampering and poisoning advice in revenge and murder manuals.

This paper reviews 18 publications that advocate the use of product tampering and other poisoning methods as techniques for exacting revenge against individuals and corporations, as methods of committing murder, and for other criminal purposes. Several of the particular techniques recommended in these publications subsequently have been used in criminal tampering incidents. The published sources of technical guidance for the would-be tamperer and poisoner are examined in detail to alert forensic scientists, law enforcement authorities, and the food and drug industry to the particular techniques that are being advocated. Possible criminal and civil liability of the publishers and authors is discussed. The author suggests that food and drug retailers consider the wisdom of selling magazines that advertise the availability of revenge and murder manuals advocating product tampering and poisoning, that food and drug manufacturers test the effects on their products of the contaminants that are being recommended, and that investigators be alert to the existence of such manuals and mail-order suppliers of poisons.

Crime↗
PubMed1987

[The Veterinary Drug Act and the practitioner].

The consequences of the Veterinary Medicinal Products Act to veterinary practitioners are described and assessed. Registration is favourably regarded, although there is a variety of views on directing veterinary drugs into specific channels, partly positive, partly negative. The position of the Group of Large Animal Practitioners of the Royal Netherlands Veterinary Association with regard to vaccination policy and 'mail-order veterinarians' is reported. In conclusion, a discrepancy in government policy is pointed out.

Animals↗
PubMed1994

Horseback riding injuries among children and young adults.

BACKGROUND: Horseback riding injuries are responsible for an estimated 2300 hospital admissions annually among persons younger than 25 years of age in the United States, but injury rates, patterns of injury, and risk factors for this population have not been well studied. METHODS: Study participants were selected from a list provided by a national mail-order company that sells riding equipment. A total of 557 persons younger than 25 years of age who rode horses at least six times a year completed survey questionnaires. RESULTS: Among the study participants, 34 (6.1%) had been hospitalized at least once because of a riding injury and 153 (27.5%) had been treated by a physician within the previous 2 years for such an injury. The overall injury rate was 0.6 per 1000 riding hours. Among those injured, sprains or strains (41.8%), lacerations or bruises (40.0%), and fractures or dislocations (33.3%) were the most common types of injury. A total of 27.5% of those injured sustained concussions or other head injuries. Riding 15 to 24 hours per month (odds ratio [OR] = 2.04), being female (OR = 1.81), and riding English style (OR = 1.77) were the characteristics most strongly correlated with injury. CONCLUSIONS: Horseback riding injuries among participants in this study tended to be serious. Family physicians should inform their patients who ride horses about the risks associated with equestrian activities and should emphasize helmet use.

Adolescent↗
PubMed1994

Desiccated thyroid in a nutritional supplement.

Nutritional or vitamin supplements, which are largely unregulated by the Food and Drug Administration (FDA) and are sold in health food stores and through mail-order catalogs, may contain various combinations and doses of vitamins, minerals, herbs, chemicals, and animal tissues. Some of the products marketed as nutritional supplements contain desiccated porcine or bovine thyroid. A patient came to our family practice center with resting tachycardia, amenorrhea, and weight loss. She had been taking a nutritional supplement containing desiccated thyroid for 3 months. Laboratory studies confirmed the presence of hyperthyroidism. The daily recommended and consumed dose of the product she had been taking exceeded the normal replacement dose by two to three times. There is potential for harm in the unregulated availability and distribution of desiccated thyroid to the public.

Adult↗
PubMedDate not supplied

Helmets and horseback riders.

To determine patterns of helmet use and attitudes toward helmets among horseback riders, we analyzed a subset of data (n = 1,834) from a cross-sectional mail survey of horseback riders conducted from July to December 1991. Riders were randomly selected from the mailing list of a national mail-order company that sells horseback-riding equipment. Of 900 English-style riders, 517 (57.5%) wore helmets on their last ride, compared with only 81 of 684 (11.8%) Western-style riders. Among 546 riders who did not own helmets, their most commonly cited reasons included believing that helmets were unnecessary (43.8%) or uncomfortable (29.9%). Of the 1,263 helmet owners, nearly 62% had one or more complaints about helmets, but 41.1% of owners reported that their helmet had prevented at least one head injury. Increasing helmet use will require major educational efforts with horseback riders and design changes by manufacturers.

Adolescent↗
PubMed1998

Patient education programs and continuance with estrogen replacement therapy: evaluation of the women's health exchange.

OBJECTIVE: This study examined the impact of the Women's Health Exchange (WHE), a program aimed at educating women about menopause and estrogen replacement therapy, on patient continuance with Estraderm, a transdermal estrogen replacement medication. DESIGN: The prescription database of Express Scripts, Inc., a pharmacy benefits management company serving a large, nationwide insured population, was used for the study. All study subjects had one or more claims for Estraderm between 2/1/95 and 8/31/95. The intervention group consisted of 299 WHE enrollees, and the control group comprised a random sample of 1,513 patients who had not enrolled in WHE. RESULTS: A multivariate Cox regression model found that older age, longer prior length of Estraderm use, progestin use, and patronage of a mail-order pharmacy were associated with increased continuance. Controlling for these factors and for HMO enrollment and copay amount, the likelihood of discontinuing Estraderm was significantly lower for WHE enrollees compared to non-WHE enrollees. Sensitivity analyses tested the effects of preexisting differences between the WHE and control group subjects on study findings. Even when WHE enrollees were compared with control subjects having similar medication costs, disease severity, or continuance with chronic medications, WHE enrollment was associated with an increased length of Estraderm therapy. CONCLUSIONS: These findings suggest that patient education programs may improve continuance with transdermal hormone replacement therapy for patients with a prescription benefit.

Administration, Cutaneous↗