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PubMedDate not supplied

Stepwise approach to developing point-of-care testing services in the community/ambulatory pharmacy setting.

OBJECTIVE: To provide a stepwise approach to development and implementation of a point-of-care testing (POCT) patient care service. SETTING: Community and ambulatory care pharmacy practice. PRACTICE DESCRIPTION: To provide community and ambulatory pharmacists with the steps involved in integrating POCT services into their pharmacy practice site. PRACTICE INNOVATION: Authors used various resources to detail the process of implementing pharmaceutical care in community or ambulatory pharmacy settings in combination with individual practice experiences. The five steps involved in developing a POCT service include conducting a needs assessment, researching and organizing information, developing program materials, implementing the service, and evaluating the service. The narrative description of each step is illustrated by a case study example. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS/CONCLUSION: POCT patient care services are a valuable addition to a pharmacy's services, benefiting patients, health care providers, and the pharmacy. This article presents a structured, deliberate approach with resources that can be used to develop a successful POCT service within a community or ambulatory pharmacy setting.

Ambulatory Care↗
PubMedDate not supplied

Pharmacy placement of nonprescription nicotine replacement therapy products and community pharmacists' counseling for product use.

OBJECTIVE: To investigate the relationship between nonprescription nicotine replacement therapy (NRT) product placement within community pharmacies and the number of patients whom pharmacists report counseling for use of these products. DESIGN: Cross-sectional study. SETTING: Four Northern California counties. PARTICIPANTS: 327 community pharmacists. INTERVENTIONS: Survey mailed in 1999-2000. MAIN OUTCOME MEASURES: Estimated number of NRT purchasers who received counseling in their pharmacy and pharmacists' level of control over NRT purchases and counseling as functions of the location of the NRT products within the pharmacy setting. RESULTS: Of 327 community pharmacists surveyed, 26 (8.0%) reported that all nonprescription NRT products were stocked behind the pharmacy counter (full control over NRT purchases and counseling), 46 (14.1%) reported that all NRT products were stocked outside of the pharmacy department in an area that could not be seen easily by the pharmacist (no control), and the remainder (n = 255; 78.0%) indicated that all NRT products were located within their visual field but not behind the counter and/or that NRT products were located in more than one of the three previously described store locations (i.e., behind counter, not behind counter but within visual field, and outside visual field) (partial control). While adjusting for known confounders (pharmacists' self-efficacy for counseling, practice setting, and perceived pros of counseling), NRT product location was significantly associated with counseling of four or more patients a month for use of these products (P = .005). Specifically, compared with pharmacists with no control over NRT purchases and counseling, pharmacists with full control were 4.73 (95% CI, 1.46-15.37) times as likely to counsel four or more patients per month, and pharmacists with partial control were 2.95 (95% CI, 1.47-5.94) times as likely. Compared with pharmacists with partial control, pharmacists with full control were 1.60 (95% CI, 0.58-4.41) times as likely to counsel at least four patients monthly (P = .361). CONCLUSION: The location of nonprescription NRT products within the community pharmacy setting is associated with the number of patients whom pharmacists report counseling for use of these products.

Administration, Cutaneous↗
PubMedDate not supplied

The spread: pilot study of an undocumented source of pharmacy benefit manager revenue.

OBJECTIVE: To document the difference between what pharmacy benefits management companies (PBMs) charge employers and what they pay dispensing pharmacies for the drug ingredient portion of prescription transactions (the "spre DESIGN: Descriptive, cross-sectional study. PARTICIPANTS: Two large employer groups, each of which used a different PBM, and six independent community pharmacies participating in these plans during 2002. INTERVENTIONS: Two sets of financial records issued by each of two PBMs were reviewed retrospectively, including 129 line-item prescription transactions billed to the employer and the line-item transaction information that accompanies the PBM payment to the dispensing pharmacy. MAIN OUTCOME MEASURE: Spread between drug ingredient cost billed to the employer by the PBM and drug ingredient cost paid to the dispensing pharmacy by the PBM for brand name versus generic drug products. RESULTS: For both PBMs, the mean (+/- SD) spread was dollar 12.29 +/- 27.93 per prescription, with a range of -dollar 1.67 to dollar 201.65. Considering all 129 transactions, the mean spreads for brand name and generic medications were significantly different from one another, with mean (+/- SD) spreads of dollar 4.65 +/- 10.47 and dollar 23.45 +/- 39.47 per prescription, respectively. The two PBMs differed significantly in their spreads for brand name drugs (dollar 3.20 +/- 2.85 and dollar 5.93 +/- 14.12), but the spreads for generic products did not achieve statistical significance in absolute dollars (dollar 10.83 +/- 13.58 and dollar 31.74 +/- 48.11) because of their greater variation (as reflected in the larger standard deviations). However, the percentages difference for generic products differed significantly. CONCLUSION: This pilot study indicates the possibility of substantial and widely varying differences in the spread and spread percentage between PBMs for brand name and generic medications. A more transparent business model for the PBM industry could produce better relations with PBM clients and business partners, including community pharmacies.

Contracts↗
PubMedDate not supplied

Impact and feasibility of a community pharmacy bone mineral density screening and education program.

OBJECTIVE: To assess the impact of a community pharmacy-based bone mineral density (BMD) screening and education program and determine the feasibility of providing such a service in community pharmacies. DESIGN: Uncontrolled study using convenience sample combined with economic feasibility analysis. SETTING: Two independent and four chain community pharmacies. PARTICIPANTS: Women age 18 years and older. INTERVENTION: Pharmacy patrons were invited to a free BMD screening. Demographic information was collected, and patients were screened using an ultrasound BMD analyzer. BMD results were reviewed with the participant during an education session and forwarded to primary care providers. Questionnaires were completed at baseline and after 3 months. MAIN OUTCOME MEASURES: Time spent with each participant, project costs, and willingness to pay for screenings were used to estimate feasibility; questionnaire responses assessed impact of the intervention on participants' health care decisions, lifestyle modifications, and communications with their prescribers about osteoporosis. RESULTS: Of the 140 women screened at baseline, 82% indicated the screening was "very useful" for making health care decisions, and 91% believed it encouraged them to talk with their physicians about osteoporosis. At 3 months, 11% of patients reported having improved exercise habits, and 30% had increased their calcium and vitamin D intake. A total of 41% of respondents indicated a willingness to pay dollar 20 or more for the BMD screening service. The average screening time was 23 minutes. Based on fixed costs of the screening device and materials and variable costs associated with personnel time, a community pharmacy could generate a positive net income with a BMD screening program. Cost of the BMD analyzer could be recovered through revenue generated in 24-35 screening days, depending on the fees charged. CONCLUSION: A community pharmacy osteoporosis program had a positive impact on patient health care by influencing lifestyle modifications, increasing use of medications, and encouraging participants to discuss osteoporosis with their physician. Patients are willing to pay for this service; feasibility varies depending on available resources and patient population served.

Adult↗
PubMed2000

Ambulatory care pharmacy services: has the agenda changed?

OBJECTIVE: To provide an extensive review of ambulatory care clinical pharmacy services and evaluate the services and research data in the field. DATA SOURCES: MEDLINE was searched from January 1992 through July 1999. Search terms included pharmacy, clinical pharmacy, and pharmaceutical care, cross-referenced with ambulatory care, primary care, family medicine, and managed care. STUDY SELECTION: Relevant peer-reviewed studies and reports since our previous article in 1992 were selected and described. Literature prior to 1992 was briefly reviewed. DATA SYNTHESIS: The relevant literature was reviewed and some examples from the authors' institutions are provided. Much research has continued to be published documenting the value of clinical pharmacy services in ambulatory care, including in community pharmacy, anticoagulation services, family medicine, primary care clinics, Veterans Affairs Medical Centers, and managed care. However, these innovative services are underrepresented in the community at large. The vast majority of the public does not have access to these types of services. CONCLUSIONS: There will be continued and dramatic expansion of ambulatory care pharmacy services in the new decade beginning in the year 2000. It will be critical that standards of practice be very high. We believe there is a critical need for visible demonstration projects and large multicenter research projects that demonstrate the value of these services.

Ambulatory Care Facilities↗
PubMed2005

Adverse drug reaction and medication error reporting by pharmacy students.

BACKGROUND: The reporting of adverse drug reactions (ADRs) and medication errors is the responsibility of all who are involved, particularly pharmacists. Since pharmacists are often privy to information surrounding ADRs and medication errors, it is of utmost importance that they are educated regarding the procedures of reporting. OBJECTIVE: To determine pharmacy students' knowledge of and ability to report ADRs and medication errors. METHODS: A total of 1322 students from 9 colleges of pharmacy were surveyed. RESULTS: The largest group of respondents was fifth-year pharmacy students (38%) followed by third-, fourth-, and sixth-year students (28%, 26%, and 8%, respectively). The majority of students reported learning about ADR and medication error reporting programs via didactic experiences. In comparison, fewer students cited alternative mechanisms of learning, including experiential rotations and work experience. Overall, respondents demonstrated the most experience with MedWatch and the least experience with the Vaccine Adverse Event Reporting System (VAERS). As students progressed through pharmacy curricula, there was a positive trend in the ability to locate and complete MedWatch forms. For VAERS and Medication Error Reporting (MER) program forms, however, this positive trend was broken at year 4. For all programs, significantly fewer students demonstrated appropriate use of the forms compared with those indicating familiarity with the programs. CONCLUSIONS: This study demonstrated that students are becoming familiar with ADR and MER programs via the college curriculum; however, there is opportunity for greater exposure and understanding. Colleges of pharmacy should continually seek methods to strengthen the education provided to pharmacy students regarding these programs.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

An update on evidence of clinical pharmacy services' impact on health-related quality of life.

OBJECTIVE: To describe and critique recent studies of clinical pharmacy services that have evaluated impact on health-related quality of life (HRQL) and to determine whether studies that lacked a control group were more likely to report a statistically significant impact on HRQL. DATA SOURCES: MEDLINE, EMBASE and International Pharmaceutical Abstracts were searched (March 1999-December 2004) using terms for HRQL and clinical pharmacy services. STUDY SELECTION AND DATA EXTRACTION: All original research articles in English identified from the data sources were examined. Abstracts were screened by 2 reviewers, and studies were included if a clinical pharmacy service was evaluated and pre-/post - HRQL outcomes were reported. DATA SYNTHESIS: Of 1152 citations identified by the literature search, 36 articles met the inclusion criteria. Twenty-two studies had a condition-specific focus. Fifteen studies incorporated a generic HRQL measure (primarily the short-form-36 items), 13 studies used a condition-specific measure, and 8 studies included both. Significant impact on one or more domains of HRQL was predominantly demonstrated in interventions relating to asthma, hypertension, and chronic heart failure. Statistically significant change in HRQL was reported in 8 of 21 studies that used a randomized controlled design (38%), in 2 of 5 studies with a nonrandomized design with control group (40%), and in 6 of 8 studies without a control group (75%; chi2 2.00; p = 0.16). CONCLUSIONS: Since 1999, the number of published studies of clinical pharmacy services that evaluated HRQL as an endpoint has more than tripled. Study designs have improved in terms of longer length of follow-up, and a wider breadth of clinical services has been evaluated. Certain pharmacy services, such as asthma management, appear to offer the most convincing evidence for the value of clinical pharmacy services in terms of measurable short-term HRQL benefit.

Health↗
PubMed2006

Current state of community pharmacy in Japan: practice, research, and future opportunities or challenges.

OBJECTIVE: To describe the activities related to pharmaceutical care and research in community pharmacies in Japan. FINDINGS: Japan is an aging society; the proportion of elderly people aged at least 65 years was 19.9% in 2005 and is expected to rise to 26.0% by 2015. This increase will result in ballooning healthcare costs. To curb the huge and rapidly increasing expenditure on medical treatment, many structural reforms have been undertaken in Japan. The healthcare services in community pharmacies will also undergo reforms to meet social needs and patient/customer requirements. In 2006, the undergraduate pharmacy program offered by universities was changed to a 6 year program, including 6 months of clinical training in both hospitals and community pharmacies. This change should provide an opportunity for community pharmacists and academics to communicate with each other, and we anticipate that it will further the research in community pharmacies. Accreditation programs will also improve the level of health care. DISCUSSION: The healthcare system should undergo reforms to address the problems related to Japan's low birth rate and the needs of an aging population. Such reforms are also required to ensure a healthy aging society and should not have adverse effects on socially vulnerable children and the elderly. Pharmacists should contribute to the development of a healthcare system for an aging society by providing appropriate pharmaceutical care. Since a large number of prescriptions are dispensed through community pharmacies, pharmacists have a greater opportunity to improve health care. In addition, pharmacist associations are encouraging their members to actively participate in home medical care services. An effective community healthcare program should reduce the need for institutional care. CONCLUSIONS: Although Japanese pharmacists are not fully capable of providing pharmaceutical care at this stage, they will play a crucial role in ensuring a healthy aging society in the future, particularly in the community setting.

Forecasting↗
PubMedDate not supplied

[Evaluating the potential of an intervention aimed at promoting oral rehydration therapy (ORT) by educating pharmacy employees].

Diarrhea is a major cause of morbidity and mortality in childhood, and Brazilians rely heavily on pharmacies for the resolution of this and other health problems. To promote the rational use of both pharmaceuticals and oral rehydration therapy (ORT), an intervention study was performed in pharmacies in Southwestern Brazil. Semi-structured interviews showed oral rehydration solution, or ORS (50%), antidiarrheals (39%), trimethoprim-sulfamethoxazole (27%), and yeast (22%) to be the most frequently suggested drugs, whereas questionnaire responses were ORS (75%), trimethoprim-sulfamethoxazole (25%), and yeast (25%), thus revealing that more than one methodology is needed if reliable data are to be obtained. An educational intervention was applied to 86.7% of pharmacies, but acquisition of knowledge on management of diarrhea did not prevent pharmacy workers from suggesting antidiarrheal drugs instead of ORS alone. In order to have pharmacy workers comply with official protocols for episodes of diarrhea, interventions should include regulatory measures on drugs that are contraindicated for children, and the role of pharmacies and pharmacists should be reviewed.

Child, Preschool↗
PubMed1999

Clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals.

We evaluated direct relationships and associations among clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Multiple regression analysis, controlling for severity of illness, was employed to determine the associations. The study population consisted of 934 hospitals. Four clinical pharmacy services were associated with lower drug costs: in-service education, $77,879.19+/-$56,203.42 (a total of $48,518,735.37 for the 623 hospitals offering this service, p=0.016); drug information, $430,579.84+/-$299,232.76 ($90,852,346.24 for the 211 hospitals offering this service, p=0.015); drug protocol management, $137,333.67+/-$98,617.83 ($45,045,443.76 for the 328 hospitals offering this service, p=0.049); and admission drug histories, $213,388.21+/-$201,537.85 ($5,548,093.46 for the 26 hospitals offering this service, p=0.011). As staffing increased for hospital pharmacy administrators (p<0.0001), dispensing pharmacists (p<0.0001), and pharmacy technicians (p<0.0001), drug costs increased. As staffing increased for clinical pharmacists, drug costs decreased (p=0.018). The results of this study show that increased staff levels of clinical pharmacists and some clinical pharmacy services are associated with reduced hospital drug costs.

Data Collection↗
PubMed2003

A pharmacy-based health promotion programme in hypertension: cost-benefit analysis.

OBJECTIVE: To weigh the costs and benefits of a pharmacy-based health promotion programme implemented in four pharmacies of the Quebec City area, Canada. This programme was developed to improve blood pressure control through activities aimed at improving the quality of prescribing and the adherence to treatment. DESIGN: Nine pharmacies in Quebec City were included, of which four pharmacies were assigned to the implementation of the health promotion programme. Each time a study participant came to one of these pharmacies to refill his/her antihypertensive medication, the pharmacist would measure and record the participant's blood pressure and assess adherence to drug treatment. The other five pharmacies delivered usual care. The duration of the intervention programme was 9 months. Costs included direct, indirect, and fixed costs, and the costs of pharmacist intervention. Benefits were measured using cost savings induced by pharmacist intervention. Willingness to pay was also considered. A bootstrap method was used to test the between-group difference. PERSPECTIVE: The study was performed from a societal perspective. STUDY PARTICIPANTS: 100 individuals aged between 34 and 80 years residing in the Quebec City area and taking antihypertensive medication. MAIN OUTCOME MEASURES AND RESULTS: Participants exposed to the programme had a significant decrease in mean direct costs and a significant increase in mean indirect costs compared with non-exposed participants. Pharmacist interventions involved a mean cost of 30.68 Canadian dollars ($ Can) per participant exposed to the programme. On average, exposed participants were willing to pay $ Can 0.54 per month after the intervention period. Benefits were about ten times higher than costs (1998 values). CONCLUSIONS: The implementation of this intervention programme seems promising in the quest to improve blood pressure control in terms of both costs and benefits.

Age Factors↗
PubMed1991

Operating room satellite pharmacies: demographics, services and implementation.

OR (operating room) satellite pharmacies are still a relatively new addition to the system of pharmacy-coordinated drug distribution. For the last ten years, however, hospitals creating OR satellite pharmacies have found that they provide improved service, reduced inventory, better narcotic control and more efficient drug delivery. Hospital Pharmacy and the OR Satellite Pharmacy Bulletin published a questionnaire to obtain information about OR satellite pharmacies from those actively involved in their planning, implementation, and operation. The questionnaire covered three major areas: demographics, functions and services. This article summarizes the results.

Centralized Hospital Services↗
PubMed1992

Comprehensive clinical pharmacy documentation in an out-patient cancer facility.

Clinical pharmacy activities that affect patient outcome are a high priority in pharmacy practice. A relatively simple method of documentation for analysis of these clinical pharmacy activities in an out-patient oncology setting is described. Policies and procedures for clinical pharmacy activities were developed and formalized in an effort to standardize pharmaceutical care in the cancer facility. Consultations or drug information questions originating outside the pharmacy, as well as interventions initiated by a pharmacist were all documented on a comprehensive activity form on a daily basis by each pharmacist. All medication counseling sessions by a pharmacist were also recorded. During a 12 month study period, a total of 1828 activities were recorded. Of these, 343 (18.8%) were pharmacist-initiated interventions to drug therapy. Recommendations were accepted by physicians in 293 (85.4%) of these interventions. In 125 (36.4%) cases, potentially serious negative patient outcomes were avoided by this clinical pharmacy activity.

Alberta↗
PubMed1993

Establishment of a bone marrow transplant satellite pharmacy.

The planning, establishment and operation of a bone marrow transplant (B.M.T.) satellite pharmacy in a 1100-bed teaching hospital are described. The B.M.T. satellite pharmacy was established because of the specialized pharmaceutical care needs of this patient population with a high risk for drug-related problems. The satellite pharmacy, which is located within a 19-bed Oncology Unit, provides integrated clinical-distributive services (unit-dose, IV-admixture system) to all B.M.T. patients. The satellite is open 10.5 hours per day, seven days per week. Staff consists of three full-time equivalent (F.T.E.) staff pharmacists, a 0.5 F.T.E. technician, and one F.T.E. clinical pharmacist. Staff pharmacists rotate between provision of B.M.T. pharmacy services, and provision of pharmacy services for the provincial Home Parenteral Nutrition program. The pharmacists are responsible for all aspects of drug distribution and clinical services for B.M.T. patients. Additional drug distribution and clinical services are provided to other Oncology Unit patients. The establishment of a satellite pharmacy has provided unique opportunities for pharmaceutical care of the B.M.T. patient.

Bone Marrow Transplantation↗
PubMed1992

Leadership orientations of hospital pharmacy directors.

This research is intended to improve understanding of the leadership orientations of hospital pharmacy directors. The results of the study suggest that these pharmacy directors have not assumed leadership roles within the network of social relationships in the organization. One explanation is that descriptive theories are of little relevance to current practice. Another explanation is that these pharmacy directors are not prepared to value and to be competent at leadership roles. In the absence of measures of effectiveness, these results are difficult to evaluate in terms of the need to cultivate leadership skills in pharmacy directors. Nevertheless, cultivating such skills may be desirable because the pharmacy directors participating in this study perceive that they are less prepared to engage in relationships with people external to the pharmacy department than with members of the department. Enhanced competence would create the potential for higher perceived value and may yield shifts in actual behavior.

Chicago↗
PubMedDate not supplied

Innovative nuclear pharmacy service. A comprehensive management plan for clinical investigations.

OBJECTIVE: To provide an overview of the investigational nuclear pharmacy service at the Medical University of South Carolina. DATA SOURCES: References were selected from published bibliographies of nuclear pharmacy and hospital pharmacy articles and from specific-topic searches of the MEDLINE computerized database (all languages, through 1992). STUDY SELECTION: Studies of clinical pharmacy functions that were considered relevant to the specialty practice of nuclear pharmacy were chosen. DATA EXTRACTION: Studies were reviewed for internal consistency and appropriateness. DATA SYNTHESIS: Data on the clinical impact of nuclear pharmacy services do not exist. CONCLUSIONS: Based on our experience in establishing an investigational drug service, we conclude that nuclear pharmacists should take an active role in clinical investigations. The outcomes of this kind of involvement are very rewarding.

Drug Evaluation↗
PubMed1981

A satellite pharmacy program in a community hospital.

A satellite (decentralized) pharmacy program in a medium-size community hospital is described. The hospital is a private institution consisting of three divisions: an acute-care division, a psychiatric division, and a long-term care division. Pharmacy services are provided on an around-the-clock basis, and the satellites are operational 16 hours daily. Pharmacy services include unit dose distribution, I.V. admixture services, and clinical pharmacy programs. Structurally, the department is divided into four satellite units and a central pharmacy unit to provide care to all areas of the health center. The professional staff is divided into several categories as a means to overcome the difficulties and take full advantage of all of the benefits of the satellite system. The Associate Director and the Assistant Director perform primarily administrative functions in order to maintain overall control, coordination, and quality assurance of the department. The Education Coordinator helps maintain the level of basic competence of the staff and coordinates the development and implementation of new departmental programs. Staff Pharmacists II provide both administrative and professional functions in their roles as team leaders of individual satellite units. Staff Pharmacists I serve the traditional staff functions in a satellite unit or in the central pharmacy.

Centralized Hospital Services↗
PubMed1986

The Canadian hospital pharmacy workload measurement study.

"One pharmacist for every 100 beds" has been the traditional rule of thumb used in determining hospital pharmacy staffing requirements in North America. Hospital pharmacy practice has undergone profound changes over the past 20 years. Staffing requirements for contemporary hospital pharmacy practice determined by the traditional guideline are outdated and of limited value. The Canadian government, through its National Health Research and Development Program, funded a $225,000 study to develop a Canadian Hospital Pharmacy Workload Measurement System which would provide a data base for a more accurate determination of staffing requirements for hospital pharmacies. Time studies were carried out to measure the personnel time required to perform defined activities that collectively formed a pharmacy service or function.

Canada↗