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PubMed2006

Clinical and economic outcomes of pharmacist-managed antiepileptic drug therapy.

This study explores the associations between pharmacist-managed antiepileptic drug therapy in hospitalized Medicare patients and diagnoses indicating the need for these drugs. It also explores the following major heath care outcomes: death rate, hospital length of stay (LOS), Medicare charges, drug charges, laboratory charges, complications, and adverse drug reactions. Data were drawn from the 1998 MedPAR and 1998 National Clinical Pharmacy Services databases. Pharmacist-managed antiepileptic drug therapy was evaluated in a study population of 9380 Medicare patients with diagnosed epilepsy or seizure disorders treated in 794 United States hospitals. This population was derived from the 38,311 hospitalized Medicare patients with epilepsy or seizure disorders (MedPAR). In hospitals without pharmacist-managed antiepileptic drug therapy, death rates were 120.61% higher, with 374 excess deaths (chi(2)=5.983, df=1, p=0.014, odds ratio [OR]=1.553, 95% confidence interval [CI] 1.102-2.189). Hospital LOS was 14.68% higher, with 8069 patient-days (Mann-Whitney U test [U]=3833132, p=0.0009); total Medicare charges were 11.19% higher, with 14,372,550 dollars in excess total charges (U=3644199, p=0.0003); per-patient drug charges were $115 +/- $92 higher (p=NS); laboratory charges were 32.24% higher, with 5,664,970 dollars in excess charges; and aspiration pneumonia rate was 54.61% higher (chi(2)=5.848, df=1, p=0.015, OR=1.233, 95% CI 1.081-1.901). Although the frequencies of other complications and adverse effects were higher, these differences were not statistically significant compared with hospitals with pharmacist-managed antiepileptic drug therapy. Clinical and economic outcomes were improved among hospitalized Medicare patients whose antiepileptic drug therapy was managed by pharmacists.

Anticonvulsants↗
PubMed2005

Pharmacist response to alerts generated from Medicaid pharmacy claims in a long-term care setting: results from the North Carolina polypharmacy initiative.

OBJECTIVE: In response to burgeoning drug costs, North Carolina (NC) Medicaid encouraged pharmacists and prescribers to develop collaborative programs to reduce drug expenditures. One of these programs, the North Carolina Polypharmacy Initiative, was a focused drug therapy management intervention aimed at reducing polypharmacy in nursing homes. This intervention targeted patients with more than 18 prescription fills in 90 days, beginning in November 2002. These patients were believed to have a high likelihood of experiencing potential drug therapy problems (PDTPs). Consultant pharmacists were asked to utilize profiles displaying alerts generated from pharmacy claims to guide interventions in addition to usual-care drug regimen reviews. The pharmacists documented their reviews, recommendations, and resulting changes in drug therapy. Our objectives were to determine (1) the persistence of PDTP alerts following interventions by consultant pharmacists and (2) the impact of these interventions on patient drug costs from a payer perspective. METHODS: A before-after study with comparison group design was used. Medicaid prescription claims data were compared for the 90-day periods prior to the intervention (June-August 2002) and following the intervention (March-June 2003). The 90-day post-intervention period allowed for 2 to 3 follow-up prescriptions and reduced the drop-out rate. The 5 categories of potential problem alerts included potentially inappropriate medications (Beers criteria), substitution opportunity for a lower-cost drug, 16 drugs or drug classes with specific quality improvement opportunities (Clinical Initiatives list), therapeutic duplication, and length of drug therapy evaluation. RESULTS: A total of 253 nursing homes, involving 110 consultant pharmacists and 6,344 patients, were in the intervention arm, with 5,160 patients (81.3%) remaining at the end of the follow-up period. At baseline, study-group patients used an average of 9.7 prescriptions per month, costing the NC Medicaid program 517 US dollars per patient per month (PPPM). There were 6,360 recommendations offered for 3,400 patients, or an average of 1.87 recommendations per patient. Physicians concurred with 59.8% (3,801 of 6,360) of all recommendations to change drug therapy, about half involving a switch to a lower-cost drug. Two of 5 alert categories had significant (P <0.01) reductions in alert persistence: -10.8% for the study group versus -0.7% for the comparison group for the Clinical Initiatives list and -29.7% for the study group versus -14.1% in the comparison group for the drug substitution opportunity. Median drug costs per patient in the study group decreased by 12.14 US dollars (-0.92%), from 1,329.46 US dollars to 1,317.32 US dollars, and increased in the comparison group by 44.98 US dollars (3.35%), from 1,341.25 US dollars to 1,386.23 US dollars, creating a relative cost reduction of 57.12 US dollars per patient in the 3-month follow-up period, or 19.04 US dollars PPPM. CONCLUSION: A supplemental program of medication reviews for nursing home patients targeted by high drug utilization resulted in a reduction in the persistence of PDTP alerts and was cost beneficial based solely on drug cost savings. This intervention may be a model for future medication therapy management services provided by prescription drug plans under Medicare Part D for patients in long-term-care settings and possibly ambulatory patients.

Aged↗
PubMed2005

Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy.

PURPOSE: The associations between pharmacist-managed aminoglycoside or vancomycin therapy for hospitalized Medicare patients who had diagnoses indicating probable treatment with these antibiotics and the major health care outcomes of death rate, length of stay, Medicare charges, hearing loss, and renal impairment were explored. METHODS: Pharmacist management of drug therapy was evaluated in a study population composed of 199,082 Medicare patients treated in 961 hospitals. RESULTS: In hospitals that did not have pharmacist-managed aminoglycoside or vancomycin therapy, death rates were 6.71% higher (1,048 excess deaths [chi(2) (1) = 43.801, p < 0.0001]), length of stay was 12.28% higher (131,660 excess patient days [U = 4.701 x 10(9), p < 0.0001]), total Medicare charges were 6.30% higher (140,745,924 US dollars in excess total Medicare charges [U = 4.864 x 10(9), p < 0.0001]), drug charges were 8.15% higher (34,769,250 US dollars in excess drug charges [U = 4.785 x 10(9), p < 0.0001]), laboratory charges were 7.80% higher (22,530,474 US dollars in excess laboratory charges [U = 4.860 x 10(9), p < 0.0001]), hearing loss was 46.42% higher (134 more patients with hearing loss [chi(2) = 54.423, df = 1, p < 0.0001]), renal impairment was 33.95% higher (2,801 more patients with renal impairment [chi(2) = 118.13, df = 1, p < 0.0001]), and the death rate in patients who developed complications was 10.15% higher (231 excess deaths [chi(2) = 22.345, df = 1, p < 0.0001]) than in hospitals with pharmacists managing these drugs. CONCLUSION: The presence of pharmacist-managed aminoglycoside or vancomycin therapy was associated with significant improvement in health care and economic outcomes for Medicare patients who received these drugs.

Aminoglycosides↗
PubMed2006

Survey of pharmacist collaborative drug therapy management in hospitals.

PURPOSE: The extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals and pharmacy directors' perceptions regarding CDTM were studied. METHODS: A survey was developed after reviewing the literature on CDTM. The sample for the study was obtained from the 2001 American Hospital Association Guide. The mail survey was pretested in January 2002 with 30 hospital pharmacy directors in Illinois, Indiana, and Michigan. A national random sample of 1000 hospital pharmacy directors stratified by state were mailed surveys in March 2003. Two follow-up surveys were mailed at approximately four-week intervals. RESULTS: Responses were received from 327 hospitals, a 32.7% response rate. A total of 158 respondents (49.7%) indicated that some pharmacists in their hospital were engaged in CDTM. Most hospitals with CDTM authorized pharmacists to adjust a drug's strength (86.7%), order laboratory or related tests (84.2%), and change a drug's frequency of administration (81.6%). The CDTM-related activities pharmacists performed varied with disease and treatment area. Payment or reimbursement for some CDTM was received by 12.7% of hospitals with CDTM. Respondents from hospitals with CDTM perceived significantly greater support for CDTM and greater strategic impact of CDTM than those from hospitals without CDTM. Respondents perceived positive support for CDTM but believed that CDTM had little or no financial impact on pharmacy departments. CONCLUSION: Approximately 50% of respondent hospitals had some pharmacists engaged in CDTM. Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was perceived as having a positive strategic impact by improving the views of upper administration regarding the value of pharmacists and facilitating implementation of other pharmacy services.

Attitude of Health Personnel↗
PubMed2006

Pharmacists' perceptions of the effectiveness of antimicrobial control programs.

PURPOSE: The perceptions of the effectiveness of antimicrobial control programs (ACPs) among infectious diseases (ID) pharmacists were studied. METHODS: A survey asking pharmacists to characterize the ACP in their hospitals and rate the program's effectiveness was distributed electronically in 1999 and by regular mail in 2000 to all 365 members of the Society of Infectious Diseases Pharmacists residing in North America. RESULTS: Of the 365 surveys distributed, 323 (88.5%) were completed, 233 of which were eligible for analysis. Most respondents (99%) indicated the use of one or more ACP components (mean +/- S.D., 4.3 +/- 1.9) in their hospitals. The ACP components used most frequently included prescriber education, review of patient medical records, formularies, prior authorization, infectious diseases consultation, and clinical practice guidelines. A similar percentage of respondents indicated that ID pharmacists and ID physicians directly participated in implementing and monitoring the effectiveness of ACPs (57% and 58%, respectively). Of the 231 respondents whose hospitals had an ACP, 73% perceived that their ACP effectively addressed antimicrobial resistance, patient outcomes, or costs, with cost reduction viewed as being accomplished more often than the improvement of patient outcomes or containment of antimicrobial resistance (62%, 35%, and 38%, respectively; p < 0.001). Many indicated uncertainty regarding the effectiveness of their ACP, with a substantial percentage of respondents believing that the level of support for these programs was inadequate. CONCLUSION: ID pharmacists in 231 North American hospitals perceived that their ACP was not sufficiently effective at improving patient outcomes, containing antimicrobial resistance, and decreasing medication costs, possibly due to inadequate institutional support for the program.

Anti-Infective Agents↗
PubMed1998

Drug therapy and the older person: role of the pharmacist.

Older people in the UK receive a disproportionate amount of medication. They comprise 18% of the population but receive 45% of all prescription items. Not surprisingly they experience drug-related illnesses - in 1980, 1 in 10 admissions to acute geriatric units were wholly or partly due to adverse drug reactions. Drugs which should be used with particular care or even avoided in older people include benzodiazepines, warfarin, digoxin, aminoglycosides, tricylic antidepressants, antipsychotics and long-acting oral hypoglycaemic agents. Pharmacists can promote safer prescribing practices by advising both patients and doctors. The community pharmacist can assist in drug compliance by providing patients with additional information about individual drugs, identifying potential adverse drug reactions and interactions, supplying appropriate drug containers or compliance aids, and even arranging home visits for patients unable to visit the pharmacist. Some community pharmacists provide pharmaceutical advice and services to residential and nursing homes. Pharmacists' advice to doctors can include one to one discussions in either primary or secondary care, assisting in medication review, providing information to prescribing committees, compiling drug formularies, assisting in auditing of prescribing practices and organising disposal of unwanted medicines and poisons campaigns.

Aged↗
PubMed2001

Do training programs work? An assessment of pharmacists activities in the field of chemical dependency.

OBJECTIVES: The primary objective of this study was to determine if a selected sample of pharmacists who had attended a chemical dependency training program were performing more chemical dependency related activities than a group of American Pharmaceutical Association (APhA) members who had not had this training. Additionally, an assessment of the perceived barriers to performing chemical dependencyrelated activities was performed. DESIGN: A confidential mail questionnaire was sent to 305 Utah School participants and 305 APhA members who had not participated in the program (See Appendix). RESULTS: Respondents who had received educational training in chemical dependency were more likely to perform the following activities: lecture to community groups and health care professionals about chemical dependency, participate in a pharmacists' recovery program, provide patients with information about treatment centers, and counsel patients about the alcohol in over-the-counter products. Respondents who had not received chemical dependency training indicated that the following barriers prevented them from taking a more active role in the chemical dependency field: lack of knowledge of chemical dependency resources in the community, unaware of how to get involved with the state recovery program, belief that involvement in the state recovery program would hurt their professional reputation, belief that chemically dependent individuals cannot be rehabilitated, and uncomfortable working with chemically dependent patients. CONCLUSIONS: Pharmacists who have attended substance abuse training programs are performing more chemical dependency activities than pharmacists who have not received training in chemical dependency. In addition, different barriers to performing chemical dependency related activities exist between pharmacists with and without training in this field.

Education, Pharmacy, Continuing↗
PubMedDate not supplied

Physician-assisted suicide and euthanasia: the pharmacist's perspective.

Pharmacists are in a critical position when pharmaceutical agents are prescribed for the purpose of physician-assisted suicide and/or euthanasia and they may need to decide whether dispensing a lethal dose of a medication is ethically and morally acceptable for a patient. In many cases, pharmacists may not even be aware that prescriptions are intended for physician-assisted suicide and/or euthanasia. Pharmacists have a special responsibility to protect patients who are contemplating end-of-life decisions such as physician-assisted suicide and euthanasia. Pharmaceutical care ("Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life ...") requires that the pharmacist not only understands the medications but also the individual patient and the complexities of their lives and suffering. Only in this way can pharmacists provide safe and effective use of medications for the patients they serve.

Attitude of Health Personnel↗
PubMed1987

Oklahoma pharmacists' explanations of professional satisfaction and dissatisfaction.

This study examined whether the theoretical constructs of role conflict and incomplete professionalization serve as valid explanations of pharmacists' professional satisfaction or dissatisfaction. A sample of registered pharmacists in Oklahoma responded to a mail-out questionnaire containing indicies designed to measure job satisfaction and professional satisfaction. The questionnaire also included a satisfaction inventory of 17 facets considered to characterize pharmacy as a profession. From the questionnaire respondents, samples of pharmacists demonstrating extreme professional satisfaction and extreme dissatisfaction were randomly selected for telephone interviews. This study found pharmacists' professional satisfaction to be significantly less than satisfaction with their job. The study results would indicate that incomplete professionalization and internalized career goals rather than role conflicts are significantly related to pharmacist professional satisfaction.

Conflict, Psychological↗
PubMed1987

Self-reported burnout among HMO pharmacists.

This study examines self-reported burnout, potential risk factors and causes, and self-reported solutions to burnout among different types of pharmacists in a large prepaid group practice HMO. A substantial share of pharmacists reported that burnout is or has been a problem with them. The quality of the job was mentioned as the most frequent cause of burnout by all types of pharmacists. More variety and responsibility and decreased workloads were the most frequently offered solutions to burnout by both staff and supervisor/specialist pharmacists. The findings suggest that pharmacists' burnout should be of concern to management.

Attitude of Health Personnel↗
PubMed2005

[Simon Morelot (1751-1809). A pharmacist out of the common].

He was born in a family of pharmacists of Beaune. He was a pharmacist in Paris, successively in four different places. He played an important part in the life of the Collège de pharmacie, which became in 1793 the Société libre des Pharmaciens de Paris. In the school of pharmacy, which was conducted by this Society, he had large charges in the administration and the teaching. With these offices, he was obliged to leave his pharmacy and to live in the school, Arbalètre street. In 1803, this school was replaced by a State school, and he was deprived of these functions. He joined in the armies of Napoléon, and successively was: a pharmacist of first class at Brest, a pharmacist in chief during the campaign of Prussia and Poland, and in the end major pharmacist in the army of Spain. He died in Cataluna in 1809, as a result of an "adynamic" fever. He wrote four important books, between 1800 and 1809, dedicated to pharmacy and to natural sciences, which gave a large view of the teaching he had previously made.

Education, Pharmacy↗
PubMed2006

Pharmacists at the forefront: reducing medication errors.

Pharmacists are in a constant battle to prevent medication errors. It is something most pharmacists do not even realize they are doing every day. Some people call it "pharmacist radar." As pharmacists review charts, talk with patients and staff, and interact with prescribers, they are constantly filtering information about medications from numerous sources to ensure that something has not "slipped by" that might cause a medication error. Is that the right dose? Why did the prescriber choose that drug? Where has the facility been keeping that medication? These are just a few questions that are part of the internal dialogue swirling around in senior care pharmacists' heads as they try to ensure the highest level of care for patients.

Drug Prescriptions↗
PubMed2006

An educational intervention to train community pharmacists in providing specialized asthma care.

OBJECTIVES: The development, implementation, and evaluation of an educational intervention to facilitate specialized asthma care provision by community pharmacists. DESIGN: Formative evaluation and a parallel group repeated measures design were used to test the effect of an educational intervention on pharmacist satisfaction and practice behavior as well as patient outcomes. The educational intervention was based on practitioner needs and principles of adult learning using flexible delivery formats. ASSESSMENT: In the intervention area, 15 pharmacists were trained with the educational intervention, and they provided specialized asthma care to 52 patients over 6 months, while in the control area, 12 pharmacists provided "usual care" to 50 patients. The intervention pharmacists were highly satisfied with the education received and rated most aspects highly. Improvements in patient clinical, humanistic, and economic outcomes in the intervention area were obtained. CONCLUSION: The positive results of the educational intervention demonstrate the effectiveness of an educational approach grounded in the theory that inducing behavioral changes in pharmacy practitioners results in improved patient outcomes.

Asthma↗
PubMed1998

Adverse drug reaction reporting by general medical practitioners and retail pharmacists in Harare--a pilot study.

OBJECTIVE: The pilot study was undertaken to investigate whether doctors and pharmacists in the private sector are willing to undertake Adverse Drug Reaction (ADR) reporting, to analyse their perceptions with regard to ADR reporting and to determine whether the concept of sentinel reporters could be of value in Zimbabwe. DESIGN: An open, prospective study where a selected group of private general medical practitioners and community pharmacists were asked to report any suspected ADRs over a six month period and to complete a structured self administered questionnaire. SETTING: Private medical and pharmacy practices in Harare. SUBJECTS: General medical practitioners and community pharmacists. MAIN OUTCOME MEASURES: Number of ADR reports received at Medicines Control Authority (MCA) and questionnaire responses. RESULTS: 19 reports were received from participants (eight pharmacists and five doctors) accounting for 79.2% of ADR reports to the MCA, during the study period. Seventeen (89.5%) of the reports generated from the study came from doctors. The 19 reports involved 15 different drugs, three (20%) of which had been registered in the last three years. Twelve questionnaires were completed. Serious and unexpected reactions were more likely to be reported. Most respondents knew what was expected and were willing to report, although five (41.7%) felt they were too busy. Seventy five percent of the doctors had not known that a reporting scheme existed in Zimbabwe and none of the participants had ever sent in a report prior to the study. Medical journals and the drug manufacturers were the most important sources of information about ADRs. CONCLUSION: Simply having interested pharmacists and doctors on the look out for ADRs and increased reporting of ADRs to the MCA. There are willing health care personnel but there is a need for larger studies to see if sentinel reporting of ADRs is applicable on a country wide basis.

Adult↗
PubMed1990

Pharmacist-managed patient-care services and prescriptive authority in the U.S. Public Health Service.

The Indian Health Service (IHS), an agency of the US Public Health Service, instituted a broad range of clinical pharmacy services for ambulatory patients in the 1960s and early 1970s. One outgrowth of these services was that pharmacists were authorized to provide certain prescription legend drugs directly to patients without physician preauthorization. Also, pharmacists monitored patients' progress and were authorized to make therapeutic substitutions of drugs. Pharmacist prescribing privileges in these programs were defined by P & T Committee-approved protocols. Success with these programs led to expanding the pharmacist's role to include physical assessment and differential diagnosis of patients with specific diseases and to manage their care when that care consisted primarily of medications. The development and implementation of these programs and the results of a study of pharmacist prescribing within the IHS are described in this article, as is the IHS clinical pharmacy training program.

Arizona↗
PubMed1991

Pharmacists have more responsibilities, liabilities than hospital materials managers. Part 1.

A hospital materials manager is also a registered pharmacist. In dealing with other materials managers at state and group meetings, he reports that a question often arises as to what professional responsibilities and liabilities a pharmacist has in addition to those of materials manager. In this dialogue, Dr. Decker reviews the professional responsibilities and liabilities of a pharmacist. In a subsequent article, the issue will be narrowed to the hospital pharmacist. This is Part 1 of a two-part series on pharmacist responsibility and liability.

Drug Labeling↗
PubMed1991

An analysis of pharmacist interventions.

In a 620-bed acute care teaching hospital, the hospital pharmacists are therapeutic specialists and have become integrated members of the health care team working on the nursing units. To determine the extent of cost avoidance and savings achieved by pharmacist monitoring of drug prescribing and administration, a six month study was undertaken in one of five pharmacy satellites. The pharmacists documented each clinical intervention on form designed for this investigation. Cost reductions or cost avoidance accrued due to the pharmacists' clinical interventions, such as monitoring overuse of drugs, unnecessarily prolonged hospitalization, correction of medication errors, and reassessment of prescriptions. This study suggests that pharmacists clinical expertise in drug use can benefit patients, physicians, nurses, and the hospital administrators who are confronted with ever increasing costs.

Communication↗
PubMed1993

Pharmacists' perceptions and practices regarding the purchase of multisource pharmaceuticals.

This article describes the results of a survey of the perceptions and practices of pharmacists towards the purchase of multisource pharmaceuticals. A questionnaire was mailed to 1,000 randomly selected hospital pharmacists, 670 managed-care pharmacy directors, and 900 consultant pharmacists in June, 1991. Recipients were asked to provide educational background data, information on pertinent aspects of their work setting, and responses to a variety of questions about multisource pharmaceuticals. Of the 2,570 surveys mailed, 531 (20.7%) usable responses were received. Although not completely satisfied, pharmacists perceive the quality of multisource products to be better than 2 years ago. A variety of factors were found to influence purchasing decisions. Differences among the three groups were evident in several areas including: the importance of purchasing groups, institutional criteria, and patient preference. Overall, pharmacists made their decisions based on a number of issues, and attitudes among the three groups regarding the purchase of multisource products were quite similar.

Attitude of Health Personnel↗