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PubMed2002

The lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services--results of focus group discussions.

BACKGROUND: This article presents the results of a study on quality of pharmacy services and perceived risk of pharmaceuticals. The results presented here are part of a multi-study evaluation of major changes in drug distribution in Iceland. OBJECTIVES: This sub-study addressed the question: what is the lay user perspective on pharmaceuticals and pharmacy services, including their perception of risk? METHODS: To answer this question, seven focus group discussions were conducted with pharmacy customers in different locations in Iceland following new drug distribution legislation in 1996. RESULTS: The lay perspective emphasizes a definite split between lay and expert views on the value and quality of pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk. Participants voiced spontaneous criticism of the roles of both physicians and pharmacists in drug therapy; and expressed concern about the quality and safety of pharmaceuticals. Some scope for shared values was noted between the legislative goals and the lay user perspective, despite the fact that the public was in no way involved in the drafting of the new legislation. CONCLUSION: The results of this study raise questions about the nature and extent of the perceived gap between the medical and pharmacy professions on the one side and the lay public and health policy decision-makers on the other side in their views on the quality and safety of pharmaceuticals and pharmacy services.

Adult↗
PubMed2003

Internet pharmacy: issues of access, quality, costs, and regulation.

Internet pharmacy has been the focus of heightened interest over the past 3 years since the first major Web site was introduced in the United States. This paper addresses issues pertaining to Internet pharmacies that sell prescriptions and other products to consumers at the retail level. The Internet pharmacy industry has shifted rapidly in the short time span. This paper begins with a summary of historical considerations and the shifting organization of Internet pharmacy. The advantages and disadvantages of online pharmacy practice are listed. Issues of access, quality, and cost are described. The challenges in regulation at the state and federal levels are presented. Advice to consumers is offered regarding the use of Internet pharmacy sites for purchasing prescription drug products.

Drug Costs↗
PubMed1998

Agreement between the pharmacy medication history and patient interview for cardiovascular drugs: the Rotterdam elderly study.

AIMS: To study whether there is agreement between cardiovascular drugs presented at patient interview and pharmacy records in an elderly population. SETTING: The Rotterdam Elderly Study, a prospective population based cohort study of people older than 55 years of age. METHODS: We compared cardiovascular drug use as presented during patient interview with the computerized pharmacy medication history. Concordance of cardiovascular drug use in patient interview and pharmacy data was measured by merging the two data sets and assessed in two episodes: in a period of 6 months before patient interview and within the legend duration of each cardiovascular drug. RESULTS: We found 2706 concordant pairs in a total of 3365 prescriptions (80.4%) in the merged data. There were 195 prescriptions presented at patient interview which had not been filled at the pharmacy, and 464 which had been filled but were not presented by the patient. The percentage of concordant pairs slightly increased to 80.6% (2275 of a total of 2824) for prescriptions of which the legend duration included the date of patient interview. The highest agreement was noted with beta-adrenoceptor blocking agents with Kappa statistics of 0.97 for atenolol and metoprolol. The lowest Kappa statistic was found for organo-heparinoid, mainly as ointments against haemorrhoids (0.26). CONCLUSION: The agreement between patient interview and pharmacy records is good for prescription only drugs, and pharmacy records are a useful resource for pharmacoepidemiological studies on cardiovascular agents.

Adult↗
PubMed1995

University-based sports pharmacy program.

Ways for pharmacists to become involved in sports pharmacy are discussed, and a university-based sports pharmacy program is described. Sports pharmacy encompasses treating athletic injuries, distributing drugs and sports-related supplies, counseling patients, and monitoring therapeutic outcomes, along with educating athletes, trainers, and others about drug use and abuse. Pharmacists can contribute their expertise by presenting information at schools, health clubs, and other exercise-related organizations. They can serve on drug-testing crews at collegiate athletic events. Pharmacists can also provide supplies and services to schools or athletic facilities; ideally, this could be a contractual arrangement to provide comprehensive pharmaceutical care. A sports pharmacy program was implemented at the University of North Carolina at Chapel Hill in 1980. Pharmacists provide drug therapy monitoring and patient education to all patients at the school; patients' level of athletic activity is taken into consideration. Pharmacists also ensure proper use, storage, and distribution of drugs kept in clinics, training rooms, and sports medicine travel bags, as well as identifying and providing drugs and supplies that might be needed at an off-campus event. They provide inservice education to athletic trainers and physicians. The program has improved patient outcomes and helped to ensure adequate drug supplies and minimum waste. There are numerous opportunities for practitioners to become involved in sports pharmacy. A university-based sports pharmacy program improved the care of student athletes and helped contain drug costs.

Athletic Injuries↗
PubMed2003

Role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness.

The role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness was studied. Study participants were recruited from three primary care clinics. They were provided a pharmacy scenario that contained information that could be used to form causal and authoritative arguments. The participants rated the trustworthiness of the pharmacist in the scenario on a 10-point, Likert-type scale and provided the arguments used to form the trustworthiness belief. Information that contradicted the pharmacist's trustworthiness was then presented in the form of an addendum, and the participants reassessed the pharmacist's trustworthiness. Participants rated the pharmacist using a Likert-type scale. Responses were coded and analyzed. Initial trustworthiness and post-trustworthiness scores were calculated. Participants' pharmacy experience score was also determined. Reliability and principal components analyses were conducted to determine the quality of the trustworthiness and pharmacy experience scores. A total of 130 patients participated in the study. There was a positive correlation between pharmacy experience and the number of causal arguments that subjects used to form their beliefs about pharmacist trustworthiness (r = 0.223, p = 0.012). Results of t tests revealed that belief strength was similar among subjects using more causal than authoritative arguments to form beliefs and in those using fewer causal arguments (t = 1.35, p = 0.179), but belief tenacity differed significantly between the groups (t = -2.303, p = 0.023). The role of external sources in influencing the formation of beliefs about trustworthiness of a pharmacist may be limited as a patient gains pharmacy experience, as experience is based on causal associations. Moreover, causal arguments are correlated with belief tenacity.

Adolescent↗
PubMed1998

The structure of satisfaction with pharmacy services.

OBJECTIVES: The objectives of this investigation were to evaluate the dimensional structure of satisfaction with pharmacy services, to determine whether satisfaction is best viewed as a unidimensional or multidimensional construct, and to determine the degree of correspondence between a general satisfaction scale and satisfaction with specific aspects of pharmacy services. METHODS: Data was collected via telephone interviews of 509 patrons of traditional retail pharmacies and analyzed using structural equation modeling techniques. RESULTS: The hypothesized, multidimensional measurement model fit the observed data reasonably well. However, correlations between the latent dimensions of satisfaction with pharmacy services indicated that some dimensions were empirically indistinguishable. CONCLUSIONS: Considering item content and theoretical considerations, modifications to the structure of previously used measures of satisfaction with pharmacy services were suggested. The data also support the hypothesis of a hierarchical model in which general satisfaction could be simultaneously represented as both an overall domain and as a set of distinct dimensions tapping unique aspects of satisfaction with pharmacy services. Depending on the purpose of the measurement, either or both levels of analysis may be useful.

Adult↗
PubMed2002

Measuring medication: do interviews agree with medical record and pharmacy data?

BACKGROUND: Medication measurement is crucial in assessing quality for chronic conditions yet agreement of alternate data sources remains uncertain. OBJECTIVES: To evaluate medication agreement between interviews, medical records, and pharmacy data; to assess data source contribution to attributing medication exposure; and to describe the impact of combining data sources on models that predict medication use. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Probability sample of HIV-infected participants in the HIV Cost and Services Utilization Study. MEASURES: Medications reported in 2267 interviews, 1936 medical records, and 457 pharmacy records were compared using crude agreement, kappa, and the proportion of average positive and negative agreement. The percent of medications reported in each source alone was used to assess their relative contribution to attributing exposure status. We performed weighted logistic regression in alternate data sources. RESULTS: Kappa varied from 0.38 for nucleoside reverse transcriptase inhibitors to 0.70 for protease inhibitors, when comparing drug classes in interview versus medical record, interview versus pharmacy data, and medical record versus pharmacy data. The percentage of medications reported in medical records was greater than that reported in interviews or pharmacy data. Pharmacy data contributed little to the attribution of medication exposure. Adding medication data to interview data did not appreciably change analytic models predicting medication use. CONCLUSIONS: For specific medications, agreement between alternative data sources is fair to substantial, but is lower for key drug classes. Relying on one data source may lead to misclassification of drug exposure status, but combining data sources does not change the results of analytic models predicting appropriate medication use.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Case-mix adjusting performance measures in a veteran population: pharmacy- and diagnosis-based approaches.

OBJECTIVE: To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. DATA SOURCES/STUDY SETTING: The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N = 126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. STUDY DESIGN: We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. PRINCIPAL FINDINGS: Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. CONCLUSIONS: Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.

Aged↗
PubMed1995

Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies.

A pharmaceutical care programme for pharmacy customers/patients with skin disorders was carried out at all Swedish pharmacies in 1993 (Skin Year). The objective of the campaign was to increase awareness, compliance and appropriateness of the treatment of skin diseases in patients attending pharmacies. The campaign was carried out primarily at pharmacies and in close contact with other health-care professionals. A variety of promotional material was produced and made available to the pharmacies. The activities were primarily directed towards pharmacy customers but also towards the staff of local health-care centres. To avoid large-scale and costly population surveys in the national evaluation of the Skin Year campaign, evaluation was carried out indirectly by following four disease groups and monitoring the influence that the campaign may have had on the use of medicines by patients with those disorders. The groups chosen were dry skin, eczema, athlete's foot and acne. There was a substantial increase in the use of medication for skin disorders in the campaign year 1993 and in 1994. If it is assumed that the level of drug use is a reflection of the level of treatment it can be concluded that treatment of the four diseases increased substantially, indirectly demonstrating 'increased awareness, compliance and appropriateness of treatment' as stated in the objectives. It is estimated that the campaign may have reduced the number of physician consultations for skin problems and that this has led to a cost reduction of at least SK100 million (equivalent to $15 million) or 5-10% of the health-care costs for skin disorders. Comparable data on patient outcome as a result of the campaign are not available.

Acne Vulgaris↗
PubMed2006

The effect of pharmacy benefit design on patient-physician communication about costs.

BACKGROUND: Incentive-based formularies have been widely instituted to control the rising costs of prescription drugs. To work properly, such formularies depend on patients to be aware of financial incentives and communicate their cost preferences with prescribing physicians. The impact of financial incentives on patient awareness of and communication about those costs is unknown. OBJECTIVE: To evaluate the relationship between enrollment in incentive-based pharmacy benefit plans and awareness of out-of-pocket costs and rates of communication about out-of-pocket costs. DESIGN: A matched telephone survey of patients and their primary care physicians. SETTING: Los Angeles County. PARTICIPANTS: One thousand nine hundred and seventeen patients aged 53 to 82 (73% response rate). MEASUREMENTS: Patient-reported pharmacy benefit design, knowledge of out-of-pocket costs, and discussion of out-of-pocket costs with physicians. RESULTS: Sixty-two percent of patients who had prescription drug coverage and were aware of their pharmacy benefit design reported being enrolled in incentive-based plans. The majority of these (54%) were "never" or only "sometimes" aware of their out-of-pocket cost requirements at the time of the physician visit. After controlling for numerous physician and patient level variables, we found that patients enrolled in pharmacy benefit designs requiring no copayments were more likely to report they "never" discuss out-of-pocket costs with physicians compared with patients enrolled in incentive-based pharmacy benefit designs (81% vs 67%, P=.001) and patients with no prescription drug insurance (57%, P<.001). CONCLUSIONS: Incentive-based pharmacy benefit plans and lack of insurance are associated with increased rates of discussions about out-of-pocket costs. Nonetheless, most incentive-based enrollees are unaware of out-of-pocket costs when prescriptions are written and never discuss out-of-pocket costs with their physicians, likely mitigating the effectiveness of financial incentives to guide decision making. Considering that out-of-pocket costs are associated with adherence to medical therapy, interventions to improve patient access to out-of-pocket cost information and the frequency of patient-physician discussions about costs are needed.

Aged↗
PubMed2004

Pharmacy cost evaluation of risperidone, olanzapine, and quetiapine for the treatment of schizophrenia in acute care inpatient settings.

OBJECTIVE: This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics -- risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from 'labeled costs'. Recent research findings indicate the need for more robust evaluation of such pharmacy costs. RESEARCH DESIGN AND METHODS: This study used data from non-randomized inpatient retrospective charts from three acute care inpatient mental health facilities. The final pooled sample included 327 patients, of which 120 received risperidone, 153 received olanzapine, and 54 received quetiapine. Medication cost was defined as the average wholesale price (AWP) as listed in the 2001 'Red Book'. Propensity scoring methodology and multinomial regression were employed to reduce treatment selection bias. RESULTS: The observed mean daily antipsychotic drug doses were 4.45 mg (SD 2.44) for risperidone, 14.04 mg (SD 5.55) for olanzapine, and 350.33 mg (SD 228.24) for quetiapine. The corresponding mean daily drug costs were $7.66(SD $4.20) for risperidone, $8.11 (SD $5.29) for quetiapine and, $12.10 (SD $4.79) for olanzepine. Numbers adjusted for treatment selection bias show that the average daily total pharmacy cost of risperidone was $4.35 lower than olanzapine (p < 0.001) and $1.41 lower than quetiapine (p = 0.38). The adjusted average daily pharmacy cost of olanzapine was $4.02 higher than quetiapine (p < 0.001). After statistical adjustment there were no significant differences between study drugs in terms of length of stay or patient functioning. CONCLUSION: This study provides the first US comparison of medication utilization patterns and pharmacy costs for olanzapine, risperidone, and quetiapine administered in acute mental health care inpatient settings. While this study did not estimate the full economic value of the three antipsychotics in these inpatient settings, it demonstrated that the mean daily costs for risperidone were lower than the mean daily costs for olanzapine (p < 0.001) and quetiapine although the later difference was not statistically significant (p = 0.38).

Adult↗
PubMed1998

State pharmacy regulators' opinions on regulating pharmaceutical care outcomes.

OBJECTIVE: To examine the opinions of state pharmacy regulators regarding responsibility for the outcomes of drug therapy, and approaches that might be taken to regulate for pharmaceutical care outcomes. DESIGN: Surveys were sent to the executive secretaries of state pharmacy boards. The executive secretaries were encouraged to seek input from other board staff and board members in formulating a response. Reminder postcards were sent to all subjects 1 week after the initial mailing. MEASURES: The survey instrument was divided into three sections. The first section identified 10 approaches that state boards could use to regulate for outcomes and asked subjects to indicate the utility of each. The second and third sections asked the subjects to determine the extent to which pharmacies and pharmacists, respectively, should be responsible for outcomes potentially related to pharmaceutical care. RESULTS: Forty-one usable surveys were returned. All approaches to regulation were viewed as potentially useful, and scores for three approaches indicated that they would be consistently helpful for effective regulation of pharmaceutical care outcomes. The pharmacy was viewed as solely responsible for poor outcomes related to systems deficiencies, a lack of self-assessment, inadequate references, equipment, and technician support. Pharmacists were assigned greatest responsibility for outcomes related to prescription filling, and less responsibility for outcomes related to patient care. However, there was considerable variation in responses to many of the items, reflecting the diverse opinions of pharmacy regulators on these issues. CONCLUSIONS: While pharmacy regulators appear open to some outcomes-oriented approaches to regulation, there is no clear consensus on responsibility for pharmaceutical care outcomes.

Humans↗
PubMedDate not supplied

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the pharmacy benefit: implications for health plans, PBMs, and providers.

OBJECTIVE: To summarize and analyze the key provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the impact on pharmacies, health plans, pharmacy benefit managers, and others involved in the delivery of pharmacy services and managed pharmacy benefits. BACKGROUND: HIPAA was enacted by Congress in 1996 with the goals of administrative simplification in the health care system as well as protecting the privacy of individuals. HIPAA imposes new standards for health care transactions and patient privacy and defines new patient rights regarding their health care information. Transaction standards took effect October 16, 2002, while the privacy standards have a compliance date of April 14, 2003. Regulations, or.standards,. will apply to health plans, pharmacies, and other health care providers and other businesses involved in the delivery of health care services. Failure to comply will be punishable under the law. The U.S. Department of Health and Human Services estimated the 10-year cost of compliance to be $17.6 billion US dollars. CONCLUSION: HIPAA's new requirements will demand significant effort and expense for systems and business process development. Businesses from the smallest independent pharmacy to the largest health plans must be compliant by the deadlines imposed by HIPAA.

Health Insurance Portability and Accountability Ac↗
PubMedDate not supplied

[Evaluation of drug therapy knowledge in liver transplant patients after pharmacy counseling].

The analysis of the literature demonstrated that pharmacy counselling influenced patient outcome after transplantation. This was the reason we established pharmacy consultation in 1999. The aim of this study was to determine patient knowledge before and after pharmacy counselling. Twenty-nine patients were questioned about the identification, role and dosage of prescribed drugs. The mean duration of pharmacy counselling was 54 minutes. Before pharmacy consultation, the knowledge score was 53.7%. Afterwards, the mean score value reached 75% and seven patients had a score of 100%. The anti-rejection therapy was understood by 93% of patients. However, the associated drugs were poorly known: less than 15% of patients initially knew about the purpose of the antimicrobial agent, compared with 50-60% after counselling. During counselling, two women were identified as regularly using St John's Wort and were informed that this herbal medicine can endanger the success of organ transplantation. Five patients or family members called the pharmacist to obtain additional information. Among these, two medication errors, both with corticosteroid drugs, were reported by family members of patients of foreign origin who had difficulty in understanding and speaking French. Pharmacy counselling improved patient knowledge about therapy after transplantation.

Adult↗
PubMed1987

Predictors of patient satisfaction with pharmacy services in a health maintenance organization.

In a study of Health Maintenance Organization (HMO) patients, five variables were shown to be predictive of patient satisfaction with pharmacy services through multiple regression analysis. The variables of satisfaction with the HMO in general, convenience of prescription filling, self-assessed positive health status, communication between provider and patient, and the view of prescription drugs as being inexpensive accounted for 26.4% of the variance in patient satisfaction with HMO pharmacy services. The results suggest areas in which attention should be directed toward maintenance of patient satisfaction with pharmacy services, especially when considering that patients may have the option of utilizing in-house or out-of-plan pharmacies for services. The authors suggest administrators of HMOs, pharmacy directors, and out-of-plan vendor pharmacists should periodically assess HMO pharmacy patient satisfaction.

Consumer Behavior↗
PubMed1980

Pharmacy competencies: their relative importance to consumers, practitioners, educators, and students.

The pharmacy profession increasingly is involved in developing and maintaining competency standards as objective criteria in evaluating the educational process and in judging practitioners' continuing competence. This study compared the rankings of various pharmacy competencies among diverse populations, specifically, consumers, practicing pharmacists, pharmacy educators, and pharmacy students. The competencies were assessed through a questionnaire which required the respondents to rank 17 competency labels in order of importance. The questionnaire was completed by 104 metropolitan residents and additional samples included 450 practitioners, 39 pharmacy educators, and 217 pharmacy students. Interesting differences appear between the rankings of the competencies among the consumers, practitioners, faculty, and students. Results indicate that consumers highly ranked the traditional roles of the pharmacist as a drug distributor. Faculty tend to rank highly the clinical roles of the pharmacist. The highest rank correlations on pairs occurred between students and faculty (0.89) and between pharmacists and consumers (0.89). The lowest rank correlation occurred between faculty and consumers (0.64).

Attitude of Health Personnel↗
PubMed1987

Implementation of pharmacy computerization in long-term care.

A computerized pharmacy service is ideal for long-term care and a fairly stable resident census at the 812-bed Jewish Home and Hospital for Aged (JHHA). The skilled nursing facility (SNF) now uses pharmacy-generated medication administration records (MARs), drug stop-order lists, and formulary listings. The health-related facility (HRF) self-medicated residents receive individual counseling during pharmacy computer-mediated medication refill appointments. Improvements in clinical services have involved antibiotic and drug use review through selected drug category, computerized drug profiles, and drug regimen review. Administrative and financial benefits have been realized through cost reports and budget reduction, and streamlined internal pharmacy operations. Although most software packages are designed for retail use, pharmacy personnel at JHHA have successfully implemented and tailor designed the AIMS system to the needs of long-term care pharmacy.

Aged↗
PubMedDate not supplied

[Internal invoicing of end products manufactured by a hospital Pharmacy Department]

OBJECTIVE: To calculate actual costs of end products manufactured by a Pharmacy Department. MATERIAL AND METHODS: Quality standards, overall production in relative value units (RVUs), and complexity degree of a pharmacy department are assessed. Actual cost of RVUs and manufactured end products is calculated. RESULTS: The Pharmacy Department is classified as quality level II. The total number of produced RVUs is 2,334,355.86, with a complexity degree of 2.20 and a cost per RVU of 0.87 euros. Pharmacy Department cost imputation per RVU has relevant discrepancies when compared to traditional shared cost systems regarding drug consumption. CONCLUSIONS: The inclusion of a product catalogue within Pharmacy Departments allows overall and department-specific activities to be acknowledged, as well as mean complexity, strengths and issues in need of improvement, in order to include them within pharmacy department planning. Furthermore, it allows for more realistic product charging to requesting departments.

Journal Article↗