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PubMed1999

Roles for pharmacists in the prevention and control of sexually transmitted diseases.

As the most accessible and trusted health care professionals in the United States, pharmacists can be an important resource for sexually transmitted disease (STD) prevention and control. Pharmacists and pharmacies are located in every type of community throughout the United States. The profession of pharmacy is positioned well to make a meaningful contribution to STD prevention and control. The accessibility to the public, the large number of pharmacy locations, and the trust shared between pharmacists and the public they serve combine to afford a unique opportunity to reach millions of individuals with STD prevention and control messages and other strategies. The numerous innovative activities involving pharmacists and pharmacies in STD-related services suggest an expanded role for pharmacy.

Adolescent↗
PubMed1998

A sterile syringe for every drug user injection: how many injections take place annually, and how might pharmacists contribute to syringe distribution?

Our objectives were to estimate the annual number of injections by injection drug users (IDUs) in the United States of America, and to describe the potential role of pharmacists in providing IDUs with a sterile syringe for every injection. We estimated the number of annual injections by IDUs for the United States, selected U.S. states, and selected U.S. cities according to the following formula: number of injections per year = (number of IDUs) x (average number of injections per IDU per day) x 365. Data were obtained from published articles, personal communications with local experts, and selected national databases. We also reviewed published and unpublished studies of pharmacy kits, pharmacist attitudes, and pharmacist practices in the United States and abroad. Between 920 million and 1.7 billion injections by IDUs take place each year in the United States. We estimated 12 million injections per year in San Francisco and >80 million in New York City. A similar number of syringes would be needed to satisfy the goal of a sterile syringe for every injection. Pharmacy-based strategies, including the sale of kits for injection drug use, have provided sterile syringes to IDUs in Europe, Australia, and New Zealand. Modification of laws restricting syringe purchase and possession has led to marked increases in purchase of syringes from pharmacies and reductions in needle-sharing. In conclusion, large numbers of syringes would be required to provide a sterile syringe for every injection, but significant numbers of pharmacists seem to be willing to play a central role in syringe sale and distribution. Outreach programs should emphasize that using a sterile syringe for every injection is the optimal HIV prevention practice for IDUs who cannot or will not stop injecting. Pharmacy-based syringe sale or distribution has the potential to augment current efforts to prevent HIV infection in IDUs, their sex partners, and their children.

Australia↗
PubMedDate not supplied

A prospective study of the impact of a critical care pharmacist assigned as a member of the multidisciplinary burn care team.

A critical care clinical pharmacy specialist was assigned to the burn center to make scheduled rounds with the physicians and to attend the weekly multidisciplinary burn team rounds. A prospective 6-month study was completed to 1) determine the clinical impact of the pharmacist's interventions and 2) quantify cost savings generated by these interventions. Prospective data concerning clinical interventions by the pharmacist were collected during a 6-month period. Each intervention was independently reviewed by two attending burn surgeons to determine its importance. A total of 165 interventions in 76 patients were documented. Following an independent review of each intervention by burn surgery attendings, 121 of 165 interventions were felt to have improved overall patient care, 42 of 165 prevented possible drug-related toxicity or organ dysfunction, 1 of 165 prevented a possible life-threatening event, and only 1 of 165 was considered insignificant. Drug changes suggested by the pharmacist resulted in a savings of Dollars 11,081.14 for the 6-month period. The integration of the critical care pharmacist into clinical rounds results in significant cost avoidance and improves overall patient care.

Burn Units↗
PubMed2006

The critical care clinical pharmacist: evolution of an essential team member.

OBJECTIVE: To review the history, training requirements, contributions to patient care outcomes, and workforce issues of critical care pharmacists. DATA SOURCE AND SELECTION: Literature obtained through Medline search with manual cross-referencing. DATA EXTRACTION AND SYNTHESIS: Original and selected review articles and guideline documents were reviewed for references to critical care pharmacists and their role on the multiprofessional critical care team. CONCLUSIONS: Critical care pharmacists are recognized as essential members of the critical care team as a result of contributions to medication safety, improved patient outcomes, and reduced drug costs and as a source of drug information and provider of education. A growing number of pharmacists practice in critical care. Additional opportunities exist and can be met if an adequate supply of trained specialists can be developed.

Critical Care↗
PubMed2005

Impact of a community pharmacist-directed clinic in improving screening and awareness of osteoporosis.

RATIONALE, AIMS AND OBJECTIVES: There is a need to increase screening and awareness of osteoporosis risk in order to prevent fractures and related morbidity. Although one in two women are at risk of developing the condition, only one in five receives bone mineral density screening. The purpose of the current study was to investigate the effectiveness of an osteoporosis screening and awareness programme directed by a pharmacist in the community setting. METHODS: The study design to test for improved awareness was a prospective, pre-post trial with no control group. The level of awareness of risk was assessed both before the screening and following an educational intervention on osteoporosis provided in the pharmacy. Based on assessed risk level, a recommendation was made for follow-up with a doctor for a dual-energy X-ray absorptiometry (DEXA) scan and/or pharmacotherapy. Patients at medium or high risk were also surveyed as to their intention to follow-up with lifestyle modification recommendations. RESULTS: There was a significant improvement in tested awareness from pre- to post-intervention at 26%; as well in self-rated awareness. There was also a significant correlation between self-rated and tested awareness. Participants indicated satisfaction with the pharmacist interaction and with their role in improving awareness. A large percentage of participants indicated that they intended to follow-up with the pharmacist's recommendation for calcium intake, exercise and/or consulting with their doctor. CONCLUSION: The results indicate that the community pharmacist can successfully screen individuals for risk of osteoporosis and improve their awareness about steps to prevent or delay fractures.

Absorptiometry, Photon↗
PubMedDate not supplied

Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective.

OBJECTIVE: Using a conceptual model of collaborative working relationships between pharmacists and physicians, a measure for physician-pharmacist collaboration from the physician perspective was developed. The measure was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. METHODS: An initial 27-item Physician-Pharmacist Collaboration Instrument (PPCI) was developed to assess seven themes about professional relationships using Likert scales. The PPCI was mailed to a random sample of 1000 primary care physicians. Principal component analysis was used to assess the structure and uncover underlying dimensions of the initial instrument. Items were evaluated for inclusion or exclusion into a refined instrument. Internal consistency was assessed by calculating Alpha coefficients for each identified factor. Convergent validity was assessed using Spearman correlations between the identified factors and a previous measure of collaborative care. After measure refinement, confirmatory factor analysis was used to evaluate the fit of both versions of the instrument. RESULTS: Three hundred forty usable surveys were returned for a response rate of 34%. Almost 70% of the respondents were male with a mean age of 45.8. A majority were family practice physicians (72.1%) in private practice (67.3%). Three unique factors were identified during principal component analysis and utilized in a confirmatory factor analysis. Both a full and a 14-item reduced model were constructed and tested. Cronbach's alpha for the three factors of the full model ranged from 0.91 to 0.97, while the reliability for the reduced model ranged from 0.86 to 0.96. Comparative fit indexes of 0.97 and 0.98 were obtained, indicating good fit for the models. CONCLUSIONS: The results indicate good reliability and validity of the refined (14-item) PPCI. This instrument can be useful as a research tool for assessment of the physicians' perspective about a physician-pharmacist relationship. Further research is warranted to examine if the extent of relationship development, as measured with the PPCI, can affect patient care outcomes.

Attitude of Health Personnel↗
PubMed1984

Clinical pharmacists prescribing drug therapy in a geriatric setting: outcome of a trial.

Clinical pharmacists, under the supervision of a family practitioner physician, assumed responsibility for drug management of geriatric patients in a Los Angeles skilled nursing facility. In a quasi-experimental, pretest-post-test control group design, outcome criteria were measured. Compared with the control group which received traditional patient care, the prescribing clinical pharmacists' group had a significantly lower number of deaths (P = 0.05), a significantly higher number of patients being discharged to lower levels of care (P = 0.03), and a significantly lower average number of drugs per patient (P = 0.04). The lower number of patients hospitalized approached significance (P = 0.06) in the prescribing clinical pharmacists' group. The practice of having clinical pharmacists prescribe drug therapy and render general care, under the supervision of a physician, has the potential for saving the health care system approximately $70,000 per year per 100 skilled nursing facility beds.

Aged↗
PubMed2004

Benefits of individualized counseling by the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong.

A prospective controlled study on the benefits of pharmacists' individualized counseling on drug compliance, cholesterol concentration reduction, attainment of National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) low-density lipoprotein cholesterol (LDL-C) goals, and patient satisfaction was carried out in a private community hospital in Hong Kong. All patients who were newly prescribed with lipid-lowering drugs for primary prevention were included. The patients in the individualized counseling group received "intense" counseling and follow-up of cholesterol concentration by a pharmacist for 3 months. The control group received routine counseling. Fifty patients completed the study (26 in the individualized group, 24 in the control group). Compliance was assessed, and those patients who achieved 75% compliance were defined as compliers. In the individualized group, 76.9% were compliers compared with 41.7% in the control group (p < 0.01). The individualized group achieved 28.3%, 27.7%, and 26.1% reduction in total cholesterol, LDL-C, and triglycerides, respectively, compared with 15.3%, 16.3%, and 10.6% in the control group (p < 0.05 for all). Also in the individualized group, 80.8% achieved the ATP III LDL-C goals compared to 58.3% in the control group (p < 0.05). Of patients in the individualized group, 85% felt that the pharmacist counseling service could improve their disease management. The study demonstrated that pharmacists' individualized counseling, together with the assessment of cholesterol concentrations, had positive impacts on the management of hyperlipidemia, including improved drug compliance, better treatment endpoints, and patient satisfaction.

Cholesterol↗
PubMed1978

Activity analysis and cost study of clinical pharmacists practicing in a university medical center: comparison with previously established criteria.

The activities of three staff clinical pharmacists practicing in a university medical center hospital were studied using work sampling direct observation techniques. The results of the activity analysis were compared with the functional criteria of the Task Force on the Pharmacist's Clinical Role. It was found that the clinical pharmcists devoted a large portion (72.36 percent) of their total practice time to accomplishing professional activities. A very low percentage (2.27) of time was observed to be spent in nonproductive idle time. The cost to provide clinical pharmacy services to the 165.23 average census of inpatients supported by the clinical pharmacists was calculated to be $1.18 per patient per day. It was concluded that the observed pharmacists were highly motivated and provided a wide variety and extensive amount of professional clinical pharmacy services. Recommendations were made calling for research of other clinical pharmacy practice models, standardization of pharmacy activity terminology, determination of clinical pharmacy outcomes and identification of motivational factors present in the study model environment.

Arizona↗
PubMed1983

Pharmacists' dispensing accuracy in a high-volume outpatient pharmacy service: focus on risk management.

A 12-day peer-review audit was performed in the outpatient pharmacy of a large teaching hospital. The audit process was not masked, that is, the pharmacists were aware of the peer-review evaluation. During the 12-day period, 9394 prescription forms and their corresponding pharmaceutical products were examined manually before being delivered to the patient. A total of 1165 (12.4 percent) dispensing errors were detected, with 141 (1.5 percent) of these considered potentially serious. Seventy-six prescriptions contained two errors and four prescriptions contained three. A linear relationship (r2 = 0.78; p less than 0.001) existed between the number of potentially serious errors and the total number of prescriptions filled. There were no statistically significant differences in the dispensing-error rate for the eight pharmacists audited. There was a trend for the number of pharmacist-hours containing at least one potentially serious dispensing error to increase as the prescription-filling rate accelerated. Outpatient pharmacies with high volumes should set a limit to the number of prescriptions filled by their pharmacists and should experiment with quality assurance systems to reduce dispensing errors and subsequent legal liabilities.

Clinical Competence↗
PubMed1984

The role of the pharmacist in a geriatric nursing home: a literature review.

This review delineates the pharmacist's controversial clinical role in nursing homes as it has developed within the legal, social, and economic climate of the Medicaid and Medicare conditions of participation. Special problems of the geriatric institutionalized patient include polypharmacy, adverse reactions, the overuse of prn drugs, and inadequate physician contact. These problems are compounded by an impoverished scientific data-base for appropriate drug use in the aged. Studies that clarify the impact consultant pharmacists have on the number of drugs prescribed, adverse reactions, and cost containment are compiled and evaluated. It is shown that pharmacists can reduce the number and cost of drugs. Physician acceptance of pharmacists' recommendations was found to be at least 60 percent in these reports. Well-controlled studies are lacking in the literature.

Aged↗
PubMed1984

A study of pharmacists' involvement in drug use by the elderly.

Three hundred elderly persons in a single Mississippi county were interviewed to determine drug use patterns and relationships with pharmacists. Although three-fourths had used the same pharmacy for longer than five years, only one in six used that pharmacy as their usual source for over-the-counter (OTC) drugs. More than eight percent incorrectly identified the use of their prescription drugs and 140 instances of potential drug interaction were identified. Communications with pharmacists were limited, as only one-fifth had talked with the pharmacist at the time their last prescription was filled and only one in six mentioned the pharmacist as someone they would ask about prescription drugs.

Aged↗
PubMed1986

Survey of the professional interrelations between dermatologist and pharmacist.

A national survey of dermatologists and pharmacists was conducted to characterize the involvement of the community pharmacist in the area of skin diseases and to elicit suggestions to improve professional interrelations. The results show the dermatologists' major complaint is pharmacists' inability or unwillingness to compound prescriptions. The study clearly indicates the need for increased communication between the two professions in matters such as inventory control, prescription refill procedures, and substitution guidelines. The pharmacists, in general, admitted a deficiency in their educational preparedness to recognize common skin disorders, thus limiting their ability to assess the severity of patients' complaints.

Dermatology↗
PubMed1987

Impact of pharmacist intervention on oral theophylline therapy in adult inpatients.

The impact of clinical pharmacy services on the utilization of oral theophylline therapy was evaluated in a ten-week study involving 138 adult inpatients. The study initially involved an independent prospective five-week audit of theophylline use, in which clinical pharmacists monitored theophylline therapy and any interventions were designed so as not to influence future actions taken by medical officers with regard to oral theophylline therapy. The second part of the study involved active intervention by clinical pharmacists and a concurrent five-week audit of theophylline use. The study has demonstrated that clinical pharmacist intervention significantly increased the number of patients receiving a theophylline assay when indicated, from 43 to 83 percent; the number of assays appropriately sampled, from 58 to 85 percent; the number of appropriate dosage adjustments, from 63 to 86 percent; and the number of patients with a measured serum theophylline concentration in the therapeutic range, from 17 to 47 percent. These results show that clinical pharmacists can have a significant impact on patient care by efficient monitoring and individualizing theophylline therapy.

Administration, Oral↗
PubMed1992

Availability of narcotics and pharmacists' attitudes toward narcotic prescriptions for cancer patients.

OBJECTIVE: To determine narcotic availability and pharmacist apprehension toward dispensing narcotics for cancer patients. DESIGN: Mailing of a one-page survey. SETTING: All pharmacies in the state of New Mexico. PARTICIPANTS: Of the 309 pharmacies, 76.1 percent (235) completed the survey. MEASUREMENTS AND MAIN RESULTS: Apprehension was significantly elevated for methadone, hydromorphone, and for morphine doses greater than 500 mg/d (p less than 0.001). The most common reasons listed for apprehension were forgery (46.4 percent), theft (40.4 percent), high dosages (23.8 percent), narcotic investigations (18.7 percent), and patient addiction (9.4 percent). Hydromorphone was available (in stock) in 80.5 percent of the pharmacies, followed by morphine 30-mg sustained-release tablets (64.5 percent) and methadone (53.4 percent). The vast majority of pharmacists were willing to order strong narcotics for specific patients. Pharmacists working in chain stores expressed a higher level of apprehension toward dispensing methadone and more frequently cited forgery as a reason for apprehension. Distance from a metropolitan area and practice setting best predicted apprehension to forgery (p = 0.01). CONCLUSIONS: Pharmacists do not appear to be a major obstruction to adequate analgesia for cancer patients in New Mexico but may require further education regarding lack of narcotic addiction and dosing in patients with cancer.

Attitude of Health Personnel↗
PubMed1993

1993 Bibliography: a 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists.

OBJECTIVE: To review the published literature on the value and acceptance of pharmaceutical services provided by pharmacists in ambulatory care settings. DATA SOURCES AND METHODS: Articles published between 1960 and 1992. A MEDLINE search of the English-language literature was conducted using the terms pharmacists, services, and ambulatory settings. Studies were selected for inclusion if they addressed services provided by pharmacists in ambulatory settings and dealt with the cost of patient care, quality of care, or attitudinal surveys. Original research reports were summarized according to objectives, sample size, duration of study, methods, and findings. Summaries were categorized according to reported positive impact, negative impact, or investigational reports with no outcome. RESULTS: One hundred seventy articles were identified; 104 of them reported research data and were summarized. The 1970s was the most prolific decade for publication of articles reporting positive, negative, or no impact, which numbered 47, 20, and 37, respectively. Positive correlation was found among studies conducted according to predetermined protocol and reporting positive impact. Moreover, academic interest in pharmacy varied for the different decades. CONCLUSIONS: Collectively, this article provides references of the published reports on pharmacy professional services in ambulatory care settings, and a summary of the articles reporting research data. Additional and more focused research on pharmaceutical services in the community is needed. Emphasis is required on practicing pharmacists' attitudes toward nondispensing, patient-oriented pharmaceutical services; the impact of educational changes on the practice of pharmacy and consumers' attitudes and willingness to pay for services; and the link between patient outcome and pharmaceutical services.

Ambulatory Care↗
PubMedDate not supplied

Use of Six Sigma to improve pharmacist dispensing errors at an outpatient clinic.

Hospital pharmacists have been challenged to face the paradigm shift in their model of services in the 21st century in Taiwan. Patients are increasingly concerned about drug safety and medication errors. Because of the financial crisis of our national insurance bureau, pharmacists are required to care for more patients, use fewer resources, and work faster, better, and more efficiently than ever before while striving to enhance customer satisfaction and quality of care. Under these circumstances, patient safety needs to be a priority of pharmacists. According to a preliminary report on medication error announced by the nonofficial medication error reporting system, pharmacist dispensing error ranked second in the list of errors in Taiwan. In our drive to improve quality, reduce costs, and enhance financial performance, our department has tried the traditional quality-improvement strategy with varying degrees of success. We wanted to achieve a breakthrough result, hence we implemented Six-Sigma methodology. This program is the catalyst needed to combine quality, cost, and patient safety. This article describes our experience using Six-Sigma methodology to reduce dispensing error in our pharmacy department.

Humans↗
PubMedDate not supplied

Auxiliary label use by pharmacists in South Carolina.

This study shows the variability in auxiliary labeling recommendations among reference sources as well as the variability in auxiliary label selection by pharmacists. Pharmacists' responses matched the Pharmex, USP DI, and Facts and Comparisons recommendations 6.1, 2.4, and 0.9 percent of the time, respectively. Pharmacists' use of auxiliary labels was correlated to professional setting, computer software, and years of pharmacy practice, but the interaction of these variables was not determined by our study. Finally, pharmacists are not satisfied with current auxiliary reference sources, including computer software programs.

Drug Labeling↗