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PubMed1985

Improving patient-oriented pharmacy services: panel discussion.

A panel discussed ways to improve patient-oriented pharmacy services, drawing on the proceedings of a recent conference on directions for clinical practice in pharmacy. Clinical pharmacy should be defined in terms of responsibility rather than by a list of specific functions. Pharmacists are responsible for drug use, not just for dispensing; this implies responsibility for educating physicians and nurses to ensure optimal patient outcomes. Clinical practice cannot be separated from pharmacy practice; although pharmacy practice requires different kinds of tasks, all have the goal of patient care. Pharmacists can exercise their responsibility for control of drug use without prescriptive authority or mandated review of physician prescribing. Pharmacists can increase their influence on drug therapy through the formulary system and through their physical presence on patient-care units. A mission statement that recognizes responsibility for patient outcomes can serve as the basis for a management system that supports clinical practice. The panel members believed that pharmacy leaders at the conference were unified by a commitment to increase the profession's clinical orientation.

Humans↗

PubMed1984

Simulated analysis of patient waiting time in an outpatient pharmacy.

The cost of various options for reducing patient waiting time in an outpatient pharmacy was studied through computer simulation. The time required to complete prescription filling tasks was recorded for a baseline of five pharmacy employees: technicians A, B, and C, a typist , and a pharmacist. A fixed factorial design of 12 configurations was used in which the number of pharmacy employees was varied (one, two, or three technician As; one or two typists ; and one or two technician Bs). Patient waiting time for each configuration was determined through computer simulation. Pharmacy employee salaries were used to calculate the relative cost of six of the configurations that were predicted to reduce waiting time to less than 10 minutes. Configurations with additional technician Bs or typists , or both, exhibited reductions in total waiting time of comparable magnitude. One of these configurations was identified as the least expensive per daily hours saved. Without disturbing the operation of the pharmacy, computer simulation was found useful in identifying the least expensive method of reducing patient waiting time in an outpatient pharmacy.

Appointments and Schedules↗

PubMed1982

Quality circles as a management tool for hospital pharmacy.

A pharmacy department's experience with a quality circle program is described. The quality circle is a type of participative management where a group of employees within a department voluntarily meets on a regular basis to identify and research departmental problems and formulate alternative solutions for management. The pharmacy department formed one of the first five circles at the hospital. Each circle meets for one hour weekly on hospital time. The pharmacy quality circle includes three staff pharmacists, two support staff, and a pharmacy supervisor who serves as the leader. Through brainstorming sessions, the circle has identified problems within the department. The circle collects data to help define the problems, and specific solutions are presented to management. Among the solutions recommended have been: assigning a clerk as a receptionist at the pharmacy front window so that the pharmacist would not be interrupted; widening the front window to accommodate separate lines for inpatient and outpatient prescriptions; and instituting a double-ticket procedure to help retrieve employee prescriptions. Management accepted and instituted all of the circle's proposals. The quality circle has been a successful management tool in this pharmacy department.

Attitude of Health Personnel↗

PubMed1982

Documented effectiveness of clinical pharmacy services.

Articles documenting the effectiveness of clinical pharmacy services were reviewed and categorized. A list of articles describing clinical pharmacy services published in the primary pharmacy literature or presented at ASHP Midyear Clinical Meetings was prepared. Selected articles were evaluated further for documented evidence of the impact of these services on patient care. Impact was defined as any one of the following outcomes: decreased morbidity (side effects, toxicity, or adverse drug reactions), decreased mortality, improved prescribing or monitoring practices, improved therapeutic outcome, and increased compliance. Ongoing clinical pharmacy services were described in 144 meeting abstracts and 117 published papers. Of the 33 papers suitable for further review, 16 provided documentation of probable or definite impact on patient care as a result of clinical pharmacy services. Three types of clinical services were provided: patient education and counseling, pharmacokinetic monitoring, and clinical drug monitoring and information. Nine studies involved ambulatory patients; eight of these involved adult patients, while one used pediatric patients. Seven of the nine studies demonstrated increased compliance through patient education and counseling. Seven studies involved adult hospitalized patients. More well-designed studies documenting the effects of clinical pharmacy services on patient outcome are needed.

Documentation↗

PubMed1994

American hospital pharmacy from the Colonial period to the 1930s.

The history of hospital pharmacy in the United States from the Colonial period to the 1930s is explored. America's first hospital pharmacist was Jonathan Roberts, hired in 1752. Like most other early hospital apothecaries, Roberts was an apprentice physician. His successor, John Morgan, proposed that the practices of medicine and pharmacy be separate. By 1811 the New York Hospital had a full-time pharmaceutical practitioner. The niche available for hospital pharmacy was small during the nineteenth century because most Americans were treated at home. Two pioneers who advanced the profession during the nineteenth and early twentieth centuries were Charles Rice and Martin Wilbert. Hospital pharmacists were sought out during the Civil War because of their experience in manufacturing drug preparations and as buyers. Immigration after the Civil War soon doubled the number of hospitals. The post-Civil War expansion of hospitals also coincided with the reform movement in nursing and the rise of scientific medicine. Hospital pharmacists became indispensable as supply masters and manufacturers. Physicians demanded professional pharmaceutical services for handling more complex therapies. Administrators learned that it was more economical to fill inpatient prescriptions inhouse. While community pharmacy had long since abandoned manufacturing and some compounding, hospital pharmacists retained these roles. However, the image of pharmacists as corner druggists was hard to shake. During the 1920s voices called for hospital pharmacists to organize. Edward Spease led in aligning schools of pharmacy with hospitals. In 1927 the first hospital pharmacy internship program was begun. A section for hospital pharmacists within the American Pharmaceutical Association was established in 1936, and the first state associations were founded during the 1920s. By the end of the 1930s, the stage was set for the national movement that followed. By the 1930s, American hospital pharmacists had reached the critical mass necessary for group identity on a national level.

Emigration and Immigration↗

PubMed1993

[A study on anti-infective agent self-medication in 2 pharmacy offices].

OBJECTIVE: To describe and analyse the demand for unprescribed drugs against infections in two pharmacy departments, as a first step towards constructing closer cooperation between primary care physicians, chemists from the pharmacy service and chemists from a pharmacy department. DESIGN: A descriptive and prospective study based on observation. SITE. This study was carried out at two pharmacy departments: the Embajadores Health Centre and the pharmacy service of the hospital to which patients were referred from Embajadores. PATIENTS AND PARTICIPANTS: The target population were all those patients who requested a drug to combat infection in the pharmacy departments during the six months of the study (July to December, 1991). MAIN MEASUREMENTS AND RESULTS: A total of 186 requests without a prescription for drugs to combat infection was recorded. The profile of those so requesting was of an almost equal number for men and women between 31 and 50 years old. The main reasons behind the requests were throat, dental and urinary-genital infections. The consumption of drug per category of illness was, from greater to lesser, penicillin, sulfamides, urinary chemotherapies, tetracyclines, macrolides and cephalosporins. CONCLUSIONS: Although there appears to be consistency between the drug infection requested and the reason for requesting it, some health education activities aimed at the general population need to be organised, in order to raise awareness of the use and abuse of antibiotics.

Adolescent↗

PubMed2006

Re-examining 'professionalism' in pharmacy: a South African perspective.

Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.

Drug Costs↗

PubMed1999

Factors influencing the detection rate of drug-related problems in community pharmacy.

This study analyzes relationships between the number of drug-related problems detected in community pharmacy practice and the educational level and other characteristics of pharmacy personnel and their work sites. Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn nationwide in Sweden. One hundred and forty-four (63%) of those meeting the inclusion criteria agreed to take part. The participants documented medication-related problems, interventions and patient variables on a data collection form. The drug-related problems were weighted by the number of patients served by each professional. The regression analysis showed the educational level of the professional to have a statistically significant effect on the detection rate, with pharmacists finding on average 2.5 more drug-related problems per 100 patients than prescriptionists and about 3.6 more than technicians. Previous participation in a study or activity on drug-related problems and the size of the pharmacy also had statistically significant effects on the problem detection rate. The use of open-ended questions to create a dialogue with the patient seemed to be a successful means to discover problems. The results of this study indicate the importance of education and training of pharmacy personnel in detection of drug-related problems. This findings speaks in favor of increasing the pharmacist to other personnel ratio, provided the higher costs will be offset by societal benefits.

Drug-Related Side Effects and Adverse Reactions↗

PubMed1994

Pharmacy in Iceland.

OBJECTIVE: To summarize the practice of pharmacy in Iceland. DATA SOURCES: Human resources were the primary sources of data for this publication. Personal observation by Cleary is the basis of this publication. DATA EXTRACTION AND SYNTHESIS: Data on areas related to Icelandic history, practice of pharmacy, Icelandic health system, and the European Economic Community and Education were obtained through interviews. Information is presented to give an appreciation of pharmacy practice in a Nordic country. CONCLUSIONS: Pharmacy education and practice is progressive and flourishing in Iceland's National Health Service. Clinical pharmacy services are in their infancy; however, the potential for growth is immense. The Fulbright experience was educational and beneficial for all parties involved.

Education, Pharmacy↗

PubMed2005

Certified pharmacy technicians' views on their medication preparation errors and educational needs.

PURPOSE: The perceptions of certified pharmacy technicians about their medication preparation errors and educational needs were studied. METHODS: A nationwide random sample of 3200 certified pharmacy technicians was mailed a survey with open-ended questions soliciting information about how pharmacists have handled and should handle technicians' medication preparation errors. The participants were also asked about their training needs and continuing-education preferences. RESULTS: A total of 1004 responses (31.4%) were obtained, of which 835 were analyzed. Of the respondents, 44% reported working in chain community pharmacies and 27% in hospital pharmacies. The factors perceived to contribute most to technicians' medication preparation errors were interruptions and inadequate staffing. Pharmacists' most frequent response to an error was to make the technician aware of it and require him or her to correct it. Only about 17% of the respondents indicated that the pharmacist used the error as an opportunity to provide instruction on how to avoid future errors. CONCLUSION: A nationwide sample of certified pharmacy technicians ranked interruptions and inadequate staffing as the factors contributing most to their medication preparation errors.

Certification↗

PubMed2006

A predictive validity study of the Pharmacy College Admission Test.

OBJECTIVE: To examine the validity of Pharmacy College Admission Test (PCAT) scores for predicting grade point averages (GPAs) of students in years 1-4 of pharmacy programs. METHODS: Data were collected from 11 colleges and schools of pharmacy: entering cumulative and math/science GPAs, PCAT scaled scores, pharmacy program GPAs for years 1-4, student status after 4 years. Correlation, regression, discriminant, and diagnostic accuracy analyses were used to determine the validity of the PCAT for predicting subsequent GPAs. RESULTS: PCAT scaled scores and entering GPAs were positively correlated with subsequent GPAs. Regression analyses showed the predictive value of the PCAT scores, especially in combination with entering GPAs. Discriminant and diagnostic accuracy analyses supported these findings and provided practical suggestions regarding optimal PCAT scores for identifying students most likely to succeed. CONCLUSION: Both PCAT scaled scores and entering cumulative GPAs showed moderate to strong predictive validity as indicators of candidates likely to succeed in pharmacy school.

College Admission Test↗

PubMed1985

An evaluation of the education of hospital pharmacy directors.

The education received by hospital pharmacy directors was evaluated by the 1981 survey responses of the directors of pharmacy practicing in hospitals with over 300 beds. A total of 657 out of 1,531 (42.9 percent) usable questionnaires were returned. Directors ranked the following academic areas in decreasing order of importance to them; personnel and financial management, computers, hospital organization, clinical pharmacy practice, traditional pharmacy practice, and statistics. Directors with MBA degrees perceived themselves to be stronger in these same academic areas than did directors with MS, PharmD, and BS degrees. Only directors with MBA and MS degrees believed they had been adequately prepared through their academic programs for their administrative role as director. Recommendations for changes in the education received by future hospital pharmacy directors are included in this paper.

Education, Pharmacy↗

PubMed1990

Improving a hospital pharmacy externship program.

The revision and implementation of a pharmacy student externship program at a cancer treatment and research facility are described. The Department of Pharmacy Academic Programs evaluated the student externship program of the Division of Pharmacy at The University of Texas M. D. Anderson Cancer Center and identified a variety of weaknesses. These included scheduling conflicts, insufficient supervision and feedback, excessive task orientation, lack of defined roles and responsibilities of program participants, and generally poor organization. As a result, the program was revised by establishing specific goals, defining program participants and their roles, setting specific responsibilities for externs and encouraging self-initiated learning, developing standardized evaluation forms and documentation requirements, and educating the pharmacy staff about the program. Since the revised program was implemented in June 1988, 21 students have completed externship rotations. Their evaluations of the program suggest greater satisfaction with this important educational experience than was realized before the revision was undertaken. A more organized approach to the externship program gave pharmacy students a better opportunity to experience the range of professional activities and challenges that occur in the institutional practice setting.

Cancer Care Facilities↗

PubMed1989

Pharmacists' attitudes toward and use of cardiopulmonary resuscitation training received in pharmacy school.

Recent graduates of a pharmacy school were surveyed to determine their attitudes toward and use of cardiopulmonary resuscitation (CPR) and basic life support (BLS) training received as part of their pharmacy school instruction. Questionnaires were mailed to 215 pharmacists who had completed the mandatory CPR-BLS training; only those who had practiced pharmacy for at least 6 of the previous 12 months were asked to respond. Usable questionnaires were received from 187 of the pharmacists surveyed. Of the respondents, 134 (72%) believed that the CPR-BLS program should continue to be mandatory for graduation; 131 (70%) believed their training to be of value in their current practices, and 174 (93%) believed it would be of value in the future. Nine (5%) of the pharmacists had actually performed CPR since their graduation. Pharmacists practicing in small and large hospitals were more likely to participate in CPR than pharmacists in medium-sized hospitals, and such participation was associated with the presence of decentralized and clinical pharmacy services. Recent pharmacy graduates who had received mandatory CPR-BLS training in school had positive attitudes about the value of this training in their professional practices.

Attitude of Health Personnel↗

PubMed1985

Pharmacy in the twenty-first century: results of a strategic-planning conference.

The results of a strategic-planning conference that focused on what pharmacy in the United States would be like in the year 2010 are presented. The 50-plus conferees considered papers by 14 health-care thought-leaders and then, meeting in small groups, made projections for pharmacy based on four possible future scenarios: Continued Growth, Decline and Stagnation, Disciplined Society, and Transformation. Among the specific issues addressed in each scenario were the nature and quantity of pharmaceutical services sought, total drug volume, classes of drugs, and pharmacy practice location, pharmacy personnel needs, and which outcomes are most likely to occur. The Continued Growth option was thought to have the best chance of occurring. Major factors expected to influence pharmaceutical services over the next 25 years included an increasingly elderly population, more widespread health promotion and wellness activities, a decline in health-care expenditures as a proportion of Gross National Product, and an increase in home remedies. It was felt that most pharmacists will practice as part of mega-health-care enterprises or chain pharmacies.

Delivery of Health Care↗

PubMed1981

Some research opportunities in hospital pharmacy.

Research opportunities in hospital pharmacy, especially in administrative and managerial areas, are discussed. Six areas of hospital pharmacy practice that have potential for research are discussed: personnel, inventory, services, evaluation, management, and research/education. Specific topics mentioned are employee satisfaction, technicians and their impact on hospital pharmacy, purchasing, use of electronic data processing in inventory control, extent of decentralization of pharmaceutical services, pharmacy and therapeutics committees, reimbursement for consultations and pharmacokinetics services, quality assurance, evaluation of pharmacy management, and the cost-benefit ratio of research and education activities.

Costs and Cost Analysis↗

PubMed1994

Pharmacy manpower: implications for pharmaceutical care and health care reform.

Our understanding of the pharmacy work force has improved substantially over the past five years. Research efforts have described the existing work force and projected for the next decade the effect that changes in educational programs, increasing numbers of female pharmacists, and increasing numbers of employee pharmacists will have on the effective work force size. Projections about the effect of pharmacy technicians and automation are less certain. Continued research is needed to document the changing nature of the pharmacy work force, to provide work force data that are essential to representing pharmacy in health care policy decisions, and to help confirm the value of pharmacy services.

Adult↗

PubMed1977

Health care and hospital pharmacy in Finland.

Health care services and community and hospital pharmacy practice in Finland are discussed. Specific topics covered include the education of pharmacists, national health insurance, health care services, community pharmacy practice and hospital pharmacy practice. The drug supply in Finnish hospitals is organized in one of three ways. Hospital pharmacies have a chief pharmacist who has a "proviisori" degree (comparable to M.S.). Central medicine supplies in hospitals without hospital pharmacies are under the supervision of the chief physician; the caretaker in larger hospitals is usually a pharmacist with a "farmaseutti" degree (comparable to a B.S.), and in smaller hospitals it is a nurse. In very small hospitals or nursing homes the medicines are kept in one place and cared for by a nurse.

Delivery of Health Care↗