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PubMedDate not supplied

Pharmacists' decision to undertake a mid-career residency.

OBJECTIVE: To outline factors motivating a pharmacist who has been in practice for five or more years to pursue a residency, and to compare the advantages and disadvantages of completing a residency. DESIGN: Descriptive study. Program directors from all residency programs accredited by the American Society of Health-System Pharmacists were contacted by mail to inquire about the number of past or current residents of their programs who could participate in the survey. From their responses we identified 111 potential participants. Postage-paid survey packets were then sent to the program directors, to be forwarded to the residents. The first section of the survey gathered demographic information; the second section focused on respondents' reasons for pursuing a pharmacy residency, the obstacles they had to overcome, and the benefits gained from completion of a residency. RESULTS: 62 respondents (56.0%) were eligible for inclusion in the data analysis. Professional growth was the most important reason given for pursuing a mid-career residency (n = 25; 40.3%). For 20 (32.3%) respondents, money or a decrease in salary was the "biggest obstacle" to pursuing a residency, and 18 (29.0%) cited family obligations. The most important benefits gained from the residency experience were improved marketability (40.0%) and skills (33.3%). CONCLUSION: Although challenging and demanding, a mid-career residency can be a rewarding experience for the practicing pharmacist. A residency will be of value to a mid-career pharmacist seeking professional growth and job satisfaction, rather than an increase in salary, through a change in career direction.

Adult↗
PubMed1999

The role of the French community pharmacist in drug dispensing.

Pharmacists are in charge of decreasing the risk of drug related morbidity and then enhance the quality of drug therapy. A survey of the optimization of pharmacotherapy carried out by 37 pharmacists during six weeks. When dispensing drugs, pharmacists have detected drug related problems, such as lack of precision in prescriptions, abnormalities in dosing, interactions, contraindications, adverse drug events or noncompliance. Among 727 reported cases, 45% led to a major change in the prescription after contact with the physician. These results confirm that a close cooperation between physicians and pharmacists is essential for the safety and the efficiency of pharmacotherapy.

Community Pharmacy Services↗
PubMed1998

Quality of life assessment by community pharmacists: an exploratory study.

Implicit in the evolving role of pharmacy is that its practitioners embrace the concept of quality of life (QoL). In recent years there has been an increased interest in incorporating health-related quality of life (HRQoL) measures into clinical practice, primarily focusing on the physician as the user of this information. Pharmacists may be able to use these instruments in their practices to provide better pharmaceutical care. To explore the feasibility of such an undertaking, questionnaires were mailed to a national sample of community pharmacies. In addition to the questionnaire, the respondents were provided with examples of two instruments: the Duke Health Profile and the QOLIE-10. A definition of HRQoL was provided to the respondents. After two mailings and a reminder postcard, a usable response rate of 27.2% was achieved. The results revealed that over 80% of the respondents currently discuss HRQoL issues with their patients. In addition, 66% reported that they attempt to assess the HRQoL of their patients, albeit usually on a subjective, informal basis. After viewing examples of HRQoL instruments, over three-quarters of the respondents reported a willingness to use HRQoL assessment tools in their practices. However, only 53.7% of the respondents were familiar with the concept of HRQoL. Less than 5% reported familiarity with formal instruments. The self-reported knowledge of pharmacists concerning HRQoL was low and the respondents recognized a significant gap between their current knowledge and the level of knowledge needed to assess the HRQoL of their patients formally. The results suggest a possible role for the pharmacist in HRQoL assessment. However, the use of HRQoL instruments in community pharmacies will require further training and education on the part of pharmacists concerning the concept of HRQoL, the issues involved in its measurement and how they can use HRQoL information in their practices. In addition, a number of unanswered questions must be addressed through the research process in order for HRQoL questionnaires to become clinical tools in the practice of pharmacy.

Adult↗
PubMed1997

The association of prescription status, patient age, patient gender, and patient question asking behavior with the content of pharmacist-patient communication.

PURPOSE AND METHODS: Data from 358 pharmacist-patient encounters in 12 community pharmacies were used to investigate the association of prescription status, patient age, patient gender, and patient question asking with the content of pharmacist-patient communication. RESULTS: There was an association between prescription status and the provision of five types of information, patient age and gender were associated with the provision of the same two types of information, and patient question asking was associated with the provision of eight types of information. CONCLUSIONS: An important cue for improvement of pharmacist-patient communication was patient question asking. Thus, it is imperative to find ways to increase question asking by patients and understand why some patients are reluctant to ask their pharmacist questions.

Adolescent↗
PubMed2002

Factors related to pharmacists' over-the-counter recommendations.

The primary purpose of this study was to investigate influences on pharmacists' over-the-counter (OTC) recommendations. A structured survey questionnaire covering medical, social, and marketing factors related to eight OTC product categories was designed and reviewed by a jury of experts and subsequently mailed to one-half of the 1440 pharmacies in Indiana. A total of 526 pharmacists responded to the questionnaire, providing a 73.1% response rate. Findings revealed that pharmacists were most likely to make favorable OTC recommendations related to nutritional supplements and smoking cessation products. Results also indicated that medical forces were significantly more important in influencing OTC product decisions than social and marketing forces. Based on the findings in this study, pharmacists are making OTC product recommendations in accordance with their health care training and expertise.

Counseling↗
PubMed2004

The pharmacist shortage and medication errors: issues and evidence.

The paper, as part of this special issue in error prevention, reviews and discusses evidence in the literature related to the impact of the pharmacist shortage on medication errors. The paper examines past research regarding the impact of pharmacists on medication errors, as well as a recent unique survey that attempted to directly examine the impact of the shortage on medication errors. The paper finds a collection of suggestive anecdotal evidence indicating the pharmacist shortage is having a negative impact on medication errors. In addition, several suggestions are made for future research regarding the relationship between pharmacists, the health system, and medication errors.

Humans↗
PubMed1999

Clinical pharmacy interventions by community pharmacists during the dispensing process.

AIMS: To evaluate the professional contact between the community pharmacist and general practitioner during the dispensing process on issues other than the legality or simple clarification of the prescription. METHODS: Fourteen community pharmacists from five adjacent localities completed details of each clinical pharmacy intervention during 1 week of each month for a period of 1 year. Each week of the month was randomly selected. When a community pharmacist had to contact the prescriber, during the dispensing of a prescription, the following data were recorded: brief patient details, the prescribed drug therapy, the reason for intervention, the outcome and the time taken. The main outcome measures were the type and nature of each intervention, the BNF category of the drug involved and the time taken. A multidisciplinary clinical panel assessed the potential of each intervention to alter the outcome of the patient's clinical management and to prevent a drug related hospital admission. These assessments were ranked between 0 and 10 (100% confident). RESULTS: During a period covering 1 week per month over 1 year, 1503 clinical pharmacy interventions were made out of 201 000 items dispensed. When normalized for the dispensing volume of each community pharmacy the lower the number of items dispensed then the greater was the percentage of interventions (P=0.013). The clinical panel decided that between 19 (0.01% of the total items dispensed) and 242 (0.12%) interventions may have prevented a drug-related hospital admission, 71 (0.04%) to 483 (0.24%) could have prevented harm whilst 103 (0.05%) to 364 (0.18%) had the potential to improve the efficacy of the intended therapeutic plan. The panel also decided that 748 (0.37%) interventions improved the clinical outcome and could have saved a visit to or by the general practitioner. Conclusion Clinical pharmacy provided by a community pharmacist during the dispensing process has the potential to provide a valuable contribution to health care.

Community Pharmacy Services↗
PubMed2002

Medication compliance problems in general practice: detection and intervention by pharmacists and doctors.

Medication compliance; the role of a portable Medical Summary Card as a compliance aid; and the role of a medical practice-based clinical pharmacist in identifying medication-related problems in a rural general practice setting is evaluated. A clinical pharmacist checked the medications of 50 predominantly aged patients against their medical summary and noted inconsistencies and potential medication problems. From this information the general practitioner (GP) assessed patient compliance with prescribed medications and transcribed the correct medication regimen and medical problems onto a Medical Summary Card for the patient to carry. Forty per cent of the patients were non-compliant. A Medical Summary Card alone was unable to improve compliance. Issues noted by the clinical pharmacist warranted a change in therapy for 8% of patients. Eighteen per cent of patients provided medical information to the clinical pharmacist of which the GP was unaware. Non-compliance with prescribed medications is common. A portable Medical Summary Card may not rectify this problem. Patients' withholding medical information from their medical practitioner is of particular concern.

Aged↗
PubMed1998

Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension.

OBJECTIVE: To assess the effect of a physician and pharmacist teamwork approach to uncontrolled hypertension in a medical resident teaching clinic, for patients who failed to meet the recommended goals of the fifth Joint National Commission on Detection, Evaluation and Treatment of High Blood Pressure. HYPOTHESIS: Physician and pharmacist teamwork can improve the rate of meeting national blood pressure goals in patients with previously uncontrolled hypertension. DESIGN: A single-blinded randomized controlled trial lasting 6 months. SETTING: A primary care outpatient teaching clinic. PATIENTS: A sample of 95 adult hypertensive patients who failed to meet national blood pressure goals based on three consecutive visits over a 6-month period. INTERVENTION: Patients were randomly assigned to a control arm of standard medical care or to an intervention arm in which a physician and pharmacist worked together as a team. MAIN RESULTS: At study completion, the percentage of patients achieving national goals due to intervention was more than double the percentage in the control arm (55% vs 20%, p < .001). Systolic blood pressure declined 23 mm Hg in the intervention arm versus 11 mm Hg in the control arm (p < .01). Diastolic blood pressure declined 14 and 3 mm Hg in the intervention and control arms, respectively (p < .001). The intervention worked equally as well in men and women and demonstrated noticeable promise in a minority of mixed-ancestry Hawaiians in whom hypertension is of special concern. CONCLUSIONS: Patients who fail to achieve national blood pressure goals under standard outpatient medical care may benefit from a program that includes a physician and pharmacist teamwork approach.

Adult↗
PubMed1998

Skin cancer prevention counseling by pharmacists: specific outcomes of an intervention trial.

The purpose of this study was to evaluate the effects of an intervention on pharmacists' behaviors, knowledge, and attitudes related to skin cancer prevention counseling. Fifty-four pharmacy sites (N = 178 pharmacists) were randomly assigned to the intervention or control condition. Intervention consisted of video-based training, prompts installed in the pharmacy to promote pharmacist-patient discussions on the topic, and group-based feedback on previous week's counseling rates. Outcomes were measured using a mailed survey. The proportion of patients counseled at post-test was significantly higher among intervention subjects, adjusting for pretest values. Similar results were found for pharmacists' skin cancer knowledge and self-rated expertise, but not for counseling-related attitudes. The intervention was successful. If implemented on a wide scale, large segments of the U.S. population would be exposed to skin cancer prevention advice.

Adult↗
PubMed2001

Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care.

BACKGROUND: regular medication review has been recommended for those over 75 and those on multiple drug therapy. Pharmacists are a potential source of assistance in reviewing medication. Evidence of the benefits of this process is needed. OBJECTIVE: to study the effect of medication review led by a pharmacist on resolution of pharmaceutical care issues, medicine costs, use of health and social services and health-related quality of life. DESIGN: randomized, controlled trial. SETTING: general medical practices in the Grampian region of Scotland. SUBJECTS: patients aged at least 65 years, with at least two chronic disease states who were taking at least four prescribed medicines regularly. METHODS: pharmacists reviewed the drug therapy of 332 patients, using information obtained from the practice computer, medical records and patient interviews. In 168 patients, a pharmaceutical care plan was then drawn up and implemented. The 164 control patients continued to receive normal care. All outcome measures were assessed at baseline and after 3 months. RESULTS: all patients had at least two pharmaceutical care issues at baseline. Half of these were identified from the prescription record, the rest from notes and patient interview. Of all the issues, 21% were resolved by information found in notes and 8.5% by patient interview. General practitioners agreed with 96% of all care issues documented on the care plans in the intervention group. At the time of follow-up, 70% of the remaining care issues had been resolved in the intervention group, while only 14% had been resolved in the control group. There were no changes in medicine costs or health-related quality of life in either group. There were small increases in contacts with health-care professionals and slightly fewer hospital admissions among the intervention group than the control group. CONCLUSIONS: pharmacist-led medication review has the capacity to identify and resolve pharmaceutical care issues and may have some impact on the use of other health services.

Aged↗
PubMed2002

Pharmacist time requirements for counseling in an outpatient pharmacy.

The correlation between the pharmacist time required for counseling patients and the characteristics of the services provided was studied. Data from the Kaiser Permanente/USC Patient Consultation Study were used to examine the relationship between pharmacist time and potential problems, actions to resolve the problems, and disposition of prescriptions. A regression model was estimated with pharmacist time as the dependent variable. An encounter consisting of patient contact to monitor adverse effects, duplicate therapy, or compliance took an estimated three minutes on average. Problems related to appropriateness of therapy or drug interactions required an additional 1.8 and 0.5 minutes, respectively. Four additional minutes were required for provider contact unless the contact involved a simple clarification (an additional 2.6 minutes). Patient referrals required an additional 2.5 minutes. The time requirements related to the problem addressed and action taken were not additive. The incremental time requirements across alternative problem-action clusters ranged from 2.9 to 9 minutes. A fee-for-service payment system appears to be feasible for pharmacist counseling services.

Ambulatory Care↗
PubMed2004

Current status of pharmacist-operated drug information centers in the United States.

PURPOSE: Pharmacist-operated drug information centers (DICs) in the United States and Puerto Rico were surveyed, and the results were compared with those of similar surveys conducted over the past 30 years. METHODS: In January 2003, surveys were mailed to 151 institutions that were thought to have an organized DIC, defined as a center that regularly accepts a broad scope of requests from health care professionals, regardless of the location or affiliation of those professionals. The survey covered such topics as affiliations, staffing, services, resources, quality assurance, involvement in education, and funding. RESULTS: One hundred nineteen DICs responded (79%), of which 81 met the criteria. Hospitals and medical centers and colleges and schools of pharmacy continued to be the most commonly reported affiliations. The number of DICs declined in the past decade, and the number of DIC pharmacists and other personnel was the lowest reported in the past 30 years. Drug information pharmacists appeared to be better trained than in the past, and a larger percentage had advanced degrees. Services provided by DICs remained consistent with previous findings, except for greater participation in the training and education of pharmacy students and residents. The resource most commonly reported by DICs as useful was Micromedex Healthcare Series, followed by MEDLINE and AHFS Drug Information. The percentage of DICs with formal quality assurance programs did not change significantly in the past decade. Funding sources and fee-for-service activities remained the same. CONCLUSION: The number of DICs has declined steadily since 1986, and the number of drug information pharmacists is at its lowest in 30 years. DIC services continue to be comprehensive. Only half of the DICs surveyed had a formal quality assurance program.

Drug Information Services↗
PubMed2004

ASHP Guidelines on the Pharmacist's Role in the Development, Implementation, and Assessment of Critical Pathways.

Because pharmacotherapy is a central component of many critical pathways, pharmacists should take leadership roles in their development, implementation, and assessment. Pharmacists can improve the development of critical pathways by ensuring the evidence-based selection of medications, establishing measures for monitoring patients for drug efficacy and adverse effects, and evaluating the proposed critical pathway for patient safety. Pharmacists can improve the implementation of critical pathways by documenting processes and outcomes, ensuring proper patient selection and medication use, monitoring patients for drug efficacy and adverse effects, and providing for continuity of care. Pharmacists can improve the assessment of critical pathways by measuring and analyzing processes and outcomes, disseminating the results of those analyses, and reviewing the critical pathways' pharmacotherapy to keep pace with changes in best practices.

Continuity of Patient Care↗
PubMed2005

Pharmacists' role in increasing pneumococcal and influenza vaccination.

PURPOSE: The role of the pharmacist in increasing pneumococcal and influenza vaccination rates and the clinical efficacy of pneumococcal and influenza vaccines are discussed. SUMMARY: Institutional pharmacists often play key roles on multidisciplinary committees and have the opportunity to make preventive therapies, such as vaccination, a priority. Standing-order programs authorize health care professionals to screen for vaccine eligibility and contraindications, administer vaccines, and monitor for adverse effects when following a physician- or institution-approved protocol. Current vaccination levels for the influenza and pneumococcal vaccines are suboptimal and well below the Healthy People 2010 goal of 90% of high-risk patients. Pharmacists should be familiar with the composition, immunogenicity, dosage, administration, efficacy, adverse reactions, contraindications, precautions, and cost-effectiveness of each vaccine, as well as with Advisory Committee on Immunization Practices recommendations and the supporting literature. CONCLUSION: Health-system pharmacists have the opportunity and responsibility to protect those at highest risk of pneumococcal disease and influenza through the use of standing-order vaccination programs.

Humans↗
PubMed2002

Developing a partnership with NAMI and psychiatric pharmacists.

NAMI is a grassroots advocacy organization dedicated to improving the lives of people with severe mental illness. We conducted a survey of 8 local Southern California NAMI chapters and found the membership to be predominantly female (70%) and elderly (mean age = 61 years). The majority of respondents (92%) rated information on psychiatric medications as very important, and 79 percent reported needing more information on psychiatric medications. A second survey of psychiatric pharmacists nationwide revealed that 80 percent have heard of NAMI but only 17 percent are members of NAMI. Psychiatric pharmacists have expertise in psychopharmacology, and more than 50 percent have achieved board certification in psychiatric pharmacy (BCPP). A partnership between NAMI and psychiatric pharmacists can result in education of NAMI members about psychiatric medications. Furthermore, psychiatric pharmacists can become aware of issues that are pertinent to the experience of NAMI members.

Adult↗
PubMed2003

A survey of community pharmacists on prevention of HIV and hepatitis B and C: current practice and attitudes in Grampian.

BACKGROUND: Prevention of infection with the blood-borne pathogens (BBPs) HIV and hepatitis B and C remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacists in Grampian in prevention of HIV and hepatitis B and C. METHOD: A questionnaire survey of community pharmacies was carried out in Grampian, a mixed urban-rural Health Board area in NE Scotland with a population of 532,432. RESULTS: Ninety-nine out of 128 (77 per cent) community pharmacies responded. Many pharmacies were providing services for drug misusers. Nearly all pharmacies stocked condoms, 57 pharmacists stated that they stocked extra-strong condoms, and two stocked dental dams. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Less than half stated that they had lists of local agencies dealing with drug-related or sexual health problems. Knowledge of the BBPs, and confidence in giving advice, were greater for HIV than for hepatitis B and C. Few were aware of recommendatons for hepatitis B vaccination. The majority felt that in the future pharmacists could have a greater role in prevention of these infections. Principal barriers to preventive activity were described as time pressure, lack of a private area and lack of training. CONCLUSIONS: There is untapped potential for community pharmacists to be a focus for advice and information relating to prevention of HIV and hepatitis B and C; however, resources are needed to address the current barriers identified field.

Adult↗
PubMed2001

Can clinical pharmacists affect SF-36 scores in veterans at high risk for medication-related problems?

BACKGROUND: An objective of pharmaceutical care is for pharmacists to improve patients' health-related quality of life (HRQOL) by optimizing medication therapy. OBJECTIVES: The objective of this study was to determine whether ambulatory care clinical pharmacists could affect HRQOL in veterans who were likely to experience a drug-related problem. RESEARCH DESIGN: This was a 9-site, randomized, controlled trial involving Veterans Affairs Medical Centers (VAMCs). Patients were eligible if they met > or = 3 criteria for being at high risk for drug-related problems. Enrolled patients were randomized to either usual medical care or usual medical care plus clinical pharmacist interventions. HRQOL was measured with the SF-36 questionnaire administered at baseline and at 6 and 12 months. RESULTS: In total, 1,054 patients were enrolled; 523 were randomized to intervention, and 531 to control. After patient age, site, and chronic disease score were controlled for, the only domain that was significantly different between groups over time was the bodily pain scale, which converged to similar values at the end of the study. Patients' rating of the change in health status in the past 12 months was statistically different between groups, intervention patients declining less (-2.4 units) than control subjects (-6.3 units) (P < 0.004). This difference was not considered clinically meaningful. However, a dose-response relationship was observed for general health perceptions (P = 0.004), vitality (P = 0.006), and change in health over the past year (P = 0.007). CONCLUSIONS: These results suggest that clinical pharmacists had no significant impact on HRQOL as measured by the SF-36 for veterans at high risk for medication-related problems.

Aged↗