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Attitudes of Ohio hospital pharmacy directors toward national voluntary pharmacy technician certification.

Ohio pharmacy directors' attitudes about national voluntary pharmacy technician certification were surveyed. In May 1996 a questionnaire was mailed to all 224 hospitals in Ohio. The questionnaire contained 29 attitudinal statements constructed as forecasts of the effects of certification; pharmacy directors were asked to rate their level of agreement or disagreement with each statement using a 7-point Likert scale. The response rate was 61.4% (137 questionnaires returned). Respondents indicated modest agreement with 21 of 27 attitudinal statements and therefore had a generally positive view of certification. For example, they agreed that certification will improve technicians' knowledge, image, confidence, skills, and job satisfaction. They disagreed that certification will allow technicians to function independently, result in the replacement of pharmacist positions with technicians, or eliminate the need for on-the-job training of technicians. There were significant differences in scores between directors working at hospitals employing certified technicians and directors working at hospitals not employing certified technicians for only three statements. Overall, Ohio hospital pharmacy directors had positive attitudes about pharmacy technician certification.

Adult↗

Nuclear pharmacy, Part I: Emergence of the specialty of nuclear pharmacy.

OBJECTIVE: Nuclear pharmacy was the first formally recognized area in pharmacy designated as a specialty practice. The events leading to nuclear pharmacy specialty recognition are described in this article. After reading this article the nuclear medicine technologist or nuclear pharmacist should be able to: (a) describe the status of nuclear pharmacy before recognition as a specialty practice; (b) describe the events that stimulated pharmacists to organize a professional unit to meet the needs of nuclear pharmacists; and (c) identify the steps by which nuclear pharmacists become board certified in nuclear pharmacy.

History of Medicine↗

Clinical pharmacy services in hospitals educating pharmacy students.

In 1995 we conducted a national survey of 1102 acute care hospitals in the United States to determine types of clinical pharmacy services, patient-focused care, and pharmaceutical care used to educate and train pharmacy students, and compared outcomes with surveys in 1989 and 1992. Clinical pharmacy services offered in 50% or more of Pharm.D.-affiliated hospitals (core services) were drug-use evaluation, in-service education, pharmacokinetic consultations, adverse drug reaction management, drug therapy monitoring, protocol management (most common for aminoglycosides, nutrition, antibiotics, heparin, warfarin, theophylline), nutrition team, and drug counseling. Comprehensive pharmaceutical care programs were established in 64%, 42%, and 33% of Pharm.D., B.S., and nonteaching hospitals, respectively. Patient-focused care programs were beginning or established in 77%, 71%, and 60%, respectively. Pharmacists served as care team leaders in 23% of hospitals affiliated with a college of pharmacy. Most common ambulatory care clinics were oncology, anticoagulation, diabetes, geriatrics, refill, and infectious diseases/HIV. For-profit hospitals rarely provided education for pharmacy students. Thus patient-focused and comprehensive pharmaceutical care programs exist according to a hospital's academic program affiliation with Pharm.D. or B.S. degree program.

Data Collection↗

Changes in pharmacy practice due to a clinical pharmacy training programme for a group of community hospitals.

Education for and the practice of Clinical Pharmacy in South Africa have been neglected. This paper describes one attempt to improve matters. An initial survey of pharmacies, pharmacists and other staff in a small group of private hospitals determined the level of Clinical Pharmacy organization and services. The results were used to design a Clinical Pharmacy (training) Programme for selected pharmacists in the group. The programme consisted of six units, each of which was presented in at least a full-day session, with strong audiovisual support, small group discussion and rigorous exercises. During and after each session, implementation and application in the respective hospitals were monitored, as were participants' reactions. Clinical Pharmacy services increased markedly as a result of the programme, as did job satisfaction and motivation among most of the participating pharmacists.

Curriculum↗

Integrating postgraduate pharmacy training programs into colleges of pharmacy.

An important issue facing colleges of pharmacy is the integration of postgraduate clinical training programs into the mainstream of pharmacy education. Colleges of pharmacy have a major role to play in postgraduate clinical training programs to the benefit of the college, resident, and institution. Students must be provided with information about residencies during their first year, and this information must be continually reinforced throughout their academic career. Residency and fellowship programs contribute significantly to the education of pharmacy students. Colleges must take an active role, working in partnership with institutions to enhance postgraduate pharmacy training programs.

Career Choice↗

Advice-giving in community pharmacy: variations between pharmacies in different locations.

The advice and services provided by community pharmacies are viewed by policy makers as having an increasingly important contribution to make as a primary health care resource to local populations. However, little attention has been given to the variations which may exist between pharmacies operating in different localities. Findings from an ethnographic study of pharmacies illuminate differences in the nature and quality of advice and services provided by pharmacies operating in disparate localities. Analysis of qualitative data suggests that differences in the environment within which pharmacies are located and organised influence the type of service provided to local populations. The possibility of an inverse care law operating in relation to the nature of services in poor urban localities compared to those in rural areas is also discussed.

Adult↗

Clinical or industrial pharmacy? Case studies of hospital pharmacy automation in Canada and France.

Automated medication dispensing systems for hospital pharmacies, heralded as an important means of reducing drug errors and improving labor productivity, have also been seen as a means of furthering the transformation of the pharmacy profession from its role in dispensing prescriptions to a clinical profession concerned with treatments and patient outcomes. Automation aids this transformation by transferring the responsibility for routine dispensing to technicians performing rationalized and computer-mediated tasks. Not all pharmacists agree with these trends. Some fear a loss of professional status and employment as their knowledge is expropriated and incorporated into machinery operated by those with lesser qualifications. They fear an industrial rather than a clinical future. Their concerns are compounded by health care cutbacks. These issues were studied at two hospitals in Canada and one in France, all mid-sized public hospitals with automated unit dose drug delivery systems installed in the late 1980s and early 1990s. Preliminary results indicated national differences in approaches to hospital pharmacy automation. In Canada, pharmacists have resisted major changes in their control of the dispensing process and in their traditional roles vis à vis doctors and pharmacy technicians. In France, where hospital pharmacy as a profession is less developed than in North America, automation has brought about a far more radical substitution for pharmacists' labor.

Automation↗

Unit dose pharmacy workload forecasting: validation of the pharmacy service unit model.

Departmental efficiency is a priority issue for hospital administration as third party payers maintain or reduce the level of reimbursement. This study validates the PHASU (PHArmacy Service Unit) model, which predicts the workload and productivity of a unit dose pharmacy. A PHASU equivalency system enabled the authors to develop a comparative standard for all pharmacy procedures. The procedure most reflective of workload is unit dose orders. Predicted productivity and staff requirements compare favorably to management engineering determinations. The PHASU model represents a reliable workload forecasting instrument that pharmacy managers can prospectively incorporate in the support of current and future pharmacy services.

Efficiency↗

The structure and function of urban pharmacies: visits to community pharmacies in inner-city Chicago.

Visits were made to 21 pharmacies in two poor neighborhoods on the west side of Chicago and interviews conducted with pharmacists-in-charge. The objective of the study was to provide a comprehensive description of the function, capabilities, and problems of urban pharmacy. We present results on the structure and function of these inner-city pharmacies. The pharmacies fit one of three structural forms: chain, independent, or medical center. The majority of respondents viewed the function of the inner-city pharmacy as patient-centered but also identified several barriers to effective patient communication. The results suggest that inner-city physicians and pharmacists should communicate with patients more often and in ways that patients understand. Also, Medicaid and other drug insurance programs should develop patient information networks and coverage packages intended to maximize patient health status.

Chicago↗

[Paul Dorveau (July 21, 1851 - January 7 1938), a librarian of the Ecole supérieure de pharmacie de Paris and cofounder of the Société d'histoire de la pharmacie].

Paul Dorveaux was appointed librarian of the Ecole supérieure de pharmacie de Paris in 1884. He was associated to the foundation of the Société d' histoire de la pharmacie in 1913 because of his numerous national and international relations. This physician scholar devoted his life to the study of the medical and pharmaceutical history. Born in Lorraine he published studies on Metz pharmacy history. We owe him publications on the statutes of apothecary communities, pharmacy shops and libraries inventories, apothecaries biographies, new editions of ancient pharmacy books and a host of medical sciences studies. Paul Dorveauz published about 300 books and articles.

Education, Pharmacy↗

The transition to more clinically oriented pharmacy education and the clinical practice of pharmacy.

Major changes have occurred in the practice of pharmacy and the practice opportunities for pharmacists during the past 20-25 years. As a consequence, the advances in pharmacy practice have necessitated significant changes in pharmaceutical education and the basic courses which constitute the curriculum. The recent changes which have occurred in pharmaceutical education have been more dramatic than curricular changes at any time in the history of pharmacy. Furthermore, many faculty members have found these changes to be very traumatic, particularly with respect to recommendations involving the deletion of all or part of a required course in the curriculum which an individual may have taught for many years. The advent of the clinical practice of pharmacy has had a significant impact on pharmaceutical education, and will be the central focus of this paper.

Curriculum↗

An eleven-year review of the pharmacy literature: documentation of the value and acceptance of clinical pharmacy.

The primary objectives of the article were accomplished by providing both a bibliography of articles dealing with clinical pharmacy services in acute-care facilities and summaries of those constituting original research reports on clinical pharmacy services. However, in the process, we made the following interesting observations. We found that articles reporting impacts on cost, quality, and attitude numbered 48, 58, and 24, respectively. Most articles relating to drug therapy monitoring, with minor exceptions, dealt with either the quality or cost-savings impact or a combination of both. Also, articles concerning drug therapy monitoring comprised almost half of all those summarized (40 articles). Articles detailing drug information and education (category 2) numbered 28 and dealt mainly with attitudes or quality impacts with minor reference to cost-savings. It was also interesting, albeit expected, to observe that the bulk of attitudinal studies fell in category 2. We found category 5, controlling medication administration, had 13 articles, primarily concerned with cost and or quality. Category 4, reporting and detection of adverse drug reactions, contained a total of eight articles mainly studying the impact on quality. The other categories contained very few, if any, articles. From these results, it is evident that the profession has made significant strides in building a strong scientific data base to support the value of its clinical services. However, there is ample room for additional original research reports. Although it can be argued that alone many of the studies could not justify clinical pharmacy as cost-effective, organized as one reference they provide an invaluable resource. Although it might be unreasonable to expect each pharmacy department to be able to cost-justify its existence, this work presents the background data needed to begin or develop such efforts.

Bibliographies as Topic↗

Assessment of clinical service contracts between hospital pharmacies and colleges of pharmacy.

The purpose of this study is to assess the advantages and disadvantages of various annual financial clinical contract options between the Atlanta metropolitan area hospital and the Mercer University Southern School of Pharmacy (Atlanta, GA). Forty-five surveys with 17 statements in a Likert scale format were mailed to all directors, clinical staff of each hospital (adjunct faculty), and full-time clinical faculty to validate the perceived advantages and disadvantages of financial contracts between their hospital and the School of Pharmacy. The survey questionnaire was returned by 84% of the participants. Survey results indicate that the School of Pharmacy and area hospital pharmacies appear to have benefited from this marriage of common interests in clinical program development with 79% agreeing that the overall benefits of the educational affiliation and contract out-weighed the disadvantages.

Attitude of Health Personnel↗

Physician and pharmacy student expectations of pharmacy practice.

This study was initiated to examine the attitudes of some of the future health care providers, family practice residents, toward various ambulatory pharmacy services. Pharmacy students were then asked to predict what the resident attitudes would be and the results were compared. This project addressed the following questions: (i) What are the expectations of family practice residents of what today's pharmacists should be doing? and (ii) How accurately can pharmacy students judge what the responses of the residents will be? The survey results indicated that the family practice residents' perceptions of certain pharmacist behaviors rated significantly higher than how the pharmacy students thought they would respond. Such behaviors included: (i) maintain and review patient profiles; (ii) counsel patients; (iii) take medication/allergy histories; (iv) provide therapeutic information to physicians; and (v) stock a wide variety of generic drugs. Most of these behaviors reflect direct involvement of the pharmacist in disseminating information to the patient and/or physician. Other expanded roles of the pharmacist such as triage, refill determination, reimbursement for consultation services, and chronic care management were given low priority.

Attitude of Health Personnel↗

Clinical pharmacy in primary care and community pharmacy.

The role of the community pharmacist involved in primary care has been undergoing change. In the late 1970s and early 1980s, developments in computerized medication surveillance within the Netherlands enabled pharmacists to react to prescriptions and detect inappropriate pharmacotherapy in community pharmacy sites. This activity became more clinically or patient-oriented in the late 1980s. In the early 1990s, pharmaceutical care was introduced in community pharmacy practice, and emphasis was given to providing patient-centered care and documenting cognitive services. The key features of pharmaceutical care provided in the primary care setting are described based on a review of the literature and on experiences in the Netherlands. Patient outcomes have yet to be shown to be improved by community pharmacy practice; methods for measuring performance are still lacking. Methods to evaluate the extent of integration of community pharmacy services into the clinical team are also lacking but are needed in order to define the future role of community pharmacists in the primary care setting. Integrated care needs to be developed in the Netherlands in order to present the next phase in the process of the "pharmaceutical evolution."

Community Pharmacy Services↗

Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in United States hospitals.

Adverse drug reactions (ADRs) were examined in 1,960,059 hospitalized Medicare patients in 584 United States hospitals in 1998. A database was constructed from the MedPAR database and the National Clinical Pharmacy Services survey. The 584 hospitals were selected because they provided specific information on 14 clinical pharmacy services and on pharmacy staffing; they also had functional ADR reporting systems. The study population consisted of 35,193 Medicare patients who experienced an ADR (rate of 1.8%). Of the 14 clinical pharmacy services, 12 were associated with reduced ADR rates. The most significant reductions occurred in hospitals offering pharmacist-provided admission drug histories (odds ratio [OR] 1.864, 95% confidence interval [CI] 1.765-1.968), drug protocol management (OR 1.365, 95% CI 1.335-1.395), and ADR management (OR 1.360, 95% CI 1.328-1.392). Multivariate analysis, performed to further evaluate these findings, showed that nine variables were associated with ADR rate: pharmacist-provided in-service education (slope -0.469, p=0.018), drug information (slope -0.488, p=0.005), ADR management (slope -0.424, p=0.021), drug protocol management (slope -0.732, p=0.002), participation on the total parenteral nutrition team (slope 0.384, p=0.04), participation on the cardiopulmonary resuscitation team (slope -0.506, p=0.008), medical round participation (slope -0.422, p=0.037), admission drug histories (slope -0.712, p=0.008), and increased clinical pharmacist staffing (slope -4.345, p=0.009). As clinical pharmacist staffing increased from the 20th to the 100th percentile (from 0.93+/-0.77/100 to 5.16+/-4.11/100 occupied beds), ADRs decreased by 47.88%. In hospitals without pharmacist-provided ADR management, the following increases were noted: mean number of ADRs/100 admissions by 34.90% (OR 1.360, 95% CI 1.328-1.392), length of stay 13.64% (Mann-Whitney U test [U]=11047367, p=0.017), death rate 53.64% (OR 1.574, 95% CI 1.423-1.731), total Medicare charges 6.88% (U=111298871, p=0.018), and drug charges 8.16% (U=108979074, p<0.001). Patients in hospitals without pharmacist-provided ADR management had an excess of 4266 ADRs, 443 deaths, 85,554 patient-days, $11,745,342 in total Medicare charges, and $1,857,744 in drug charges. The implications of these findings are significant for our health care system, especially considering that the study population represented 15.55% of 12,261,737 Medicare patients and 5.71% of the 34,345,436 patients admitted to all U.S. hospitals.

Adverse Drug Reaction Reporting Systems↗

Automation and the future practice of pharmacy--changing the focus of pharmacy.

Automation technology offers great potential in pharmacy practice. To realize the full benefits of the potential inherent in automation systems, it is necessary to understand basic concepts of automation and to realize that automation is simply a tool to help achieve the goals of practice. The goal of pharmacy practice is pharmaceutical care. Through using the techniques of reengineering, pharmacies can be redesigned with the help of automation to facilitate the accomplishment of that goal. Essential to achieving that goal is the necessity to change the focus of pharmacy from distribution to pharmaceutical care. Reengineering and automation are the tools to help make that change in focus.

Automation↗

Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic.

The private sector is a dominant actor in the provision of pharmaceuticals, particularly in developing countries. Private provision of drugs has been associated with risks regarding availability, affordability, rational use and drug quality. Ensuring an effective regulatory framework is therefore a major challenge for governments, yet the capacity of regulatory authorities is often outstripped by private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a poor, landlocked country in South East Asia, the private provision of drugs has increased dramatically since the liberalisation of the economy in the late 1980s. This paper aims to describe the quality of the private pharmacy services in the Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument which serves to make the concept of Good Pharmacy Practice (GPP) operational was developed and applied to a sample of pharmacies. Service quality, as measured by three facility-specific indicators, showed a tendency to be lower in the most distant districts. Poor dispensing practices were manifest by a lack of information about drugs sold in 59% of cases, drugs not being labelled in 47% and different drugs being mixed in the same package in 26% of cases. The prices of four sample drugs were slightly higher in the remote districts. A 10-fold price difference for the same drug was recorded in one district. After reporting the findings, the paper discusses the possible influence of district and pharmacy variables on the quality of services, and goes on to discuss the price differences. It is concluded that further government interventions are needed in order to improve the quality of services and to focus regulatory action on a limited number of aspects, to ensure that drugs can be traced before trying to establish a comprehensive regulatory system.

Developing Countries↗