Act 101 and the pharmacist--is it appropriate for the pharmacist to prescribe?
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Drug Prescriptions↗
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ASHP guidelines on the pharmacist's role in home care. American Society of Hospital Pharmacists.
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Home Care Services↗
Factors influencing pharmacists' preference for the legal classification of Rx-to-OTC switched drug products.
The United States is one of the few developed countries that has only two legal classifications of drug products, prescription (or legend) and non-prescription. U.S. pharmacy associations, however, are lobbying for legislation that will classify drugs which are switched from prescription to non-prescription (Rx-to-OTC) status as a third class of pharmacist-legend or pharmacy-only drug products. Pharmacists have indicated that their demand for a third class of drugs is to enable safer use of switched drug products by consumers through pharmacist supervision. Critics of the third class concept, however, have attributed the pharmacists' demand to a desire to gain economic control of the products. In order to assess empirically pharmacists' motivations, data collected from 389 randomly selected U.S. pharmacists, forming part of a larger study, were used to assess: (i) pharmacists' preferences for five selected conditions of sale for drug products switched from prescription to non-prescription status and (ii) the role of selected demographic and practice characteristics on pharmacists' preferences. Analyses of the data indicated that 'permanent pharmacist supervised sale (or a third class status)' and 'general unsupervised' sale were pharmacists' most and least preferred conditions of sale for switched products, respectively. Overall, pharmacists preferred conditions of sale that involved pharmacist supervision over those that did not. Pharmacists' preferences differed significantly when compared on the basis of their employment status. Owner or partner pharmacists indicated a greater preference for the pharmacist-supervised third class status for switched drug products and a lesser preference for unsupervised sale of switched drug products than staff, employee, director, or manager pharmacists. Pharmacists' preferences for the conditions of sale also differed by the nature of the professional association in which they were members. Pharmacists who were members of the American Society of Hospital Pharmacists (ASHP) indicated a greater preference for 'unsupervised sale after initial diagnosis and prescription from a physician', than pharmacists who were not members of the association. Pharmacists who were members of the National Association of Retail Druggists (NARD) viewed unsupervised sale of switched products with greater disfavour than the non-members of that association. Overall, it appears that some pharmacists may be governed by safety concerns and some by economic concerns in their demand for a third class or pharmacy-only status for Rx-to-OTC switched drug products.
Drug Prescriptions↗
Pharmacist participation in the workforce: 1990, 2000, and 2004.
OBJECTIVE: To examine work variables for licensed pharmacists for 1990, 2000, and 2004. DESIGN: Three cross-sectional, descriptive studies. SETTING: United States. PARTICIPANTS: Licensed pharmacists: 1,623 in 1990; 2,092 in 2000; and 1,564 in 2004. These numbers of usable responses to the three respective surveys represented 54.0%, 42.7%, and 33.8% of those receiving surveys. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey; data from the national studies of the pharmacist workforce conducted in 1990 and 2000. MAIN OUTCOME MEASURES: Characteristics of pharmacists; work setting, work position and age distribution of actively practicing pharmacists. Work status of licensed pharmacists; proportion actively practicing pharmacy. Proportion of pharmacists working part-time overall and by age group, weekly hours worked by actively practicing pharmacists, and full-time equivalents (FTEs) by age group. Proportion of pharmacists with secondary pharmacy employment; work setting, hours worked, and weeks worked in secondary pharmacy employment. RESULTS: In each year studied, more than 86% of licensed pharmacists were actively practicing pharmacy. In 2004, the largest proportion of actively practicing women pharmacists was between the ages of 31 and 45, and the largest proportion of actively practicing men pharmacists was between the ages of 46 and 60. Across the survey years, the proportion of all actively practicing pharmacists working part-time increased, and the proportion of women working part-time was at least double that of men except in 2004. In 2004, the FTE contribution for women was 0.81 and 0.91 for men. CONCLUSION: The decrease in FTE contributions by all pharmacists and the aging of the male pharmacist population raise concerns about the adequacy of current and future pharmacist supply. As the demand for pharmacists continues to evolve, pharmacy must continue to monitor the pharmacist workforce to show how pharmacists react to changes to better inform projections of the pharmacist workforce.
Adult↗
Prevalence of and interest in unionization among staff pharmacists.
BACKGROUND: Although the propensity for staff pharmacists to join a labor union has never been high, conditions in the profession and workplace have changed over the last decade. Some of these changes may result in staff pharmacists joining a labor union, as well as increased interest in staff pharmacists who are currently not union members to join. OBJECTIVES: The objectives of this study were to (1) assess the degree of union membership among staff pharmacists in 6 states, (2) compare the practice settings, work activities and conditions, compensation, and demographic characteristics between union and nonunion staff pharmacists, (3) assess the level of interest in joining a union among nonunion staff pharmacists, and (4) compare the practice settings, work activities and working conditions, wages and benefits, and demographic characteristics between nonunion staff pharmacists interested in joining a union and nonunion staff pharmacists who were not interested in joining a union. METHODS: A biennial pharmacist compensation study was conducted in 6 states (Florida, Iowa, Illinois, Minnesota, Tennessee, Wisconsin) in late 2003. Randomly selected pharmacists were mailed a self-administered questionnaire asking about their practice setting, work activities and conditions, wages and benefits, and demographic characteristics. Respondents were also asked to indicate current membership in a union and, if not a member, their desire to unionize their workplace. RESULTS: Compensation and unionization data were provided by 2,180 respondents (27% usable response rate), of which 1,226 (56%) were staff pharmacists. Eight percent of the staff pharmacists were union members, whereas 18% of nonunion members would vote to unionize their workplace. There were few statistically significant differences between union and nonunion staff pharmacists regarding work activities, working conditions, and hourly wages. However, the benefits provided to union staff pharmacists differed from those provided to nonunion staff pharmacists in several ways. Union staff pharmacists were younger than their nonunion counterparts (40.9 vs 44.5 years, P=.01), yet had worked for their current employers a longer time (11.1 vs 7.3 years, P=.03). Nonunion staff pharmacists interested in joining a union differed from those who would not by practice location and setting, working conditions, and benefits. CONCLUSIONS: Although the union membership rate among staff pharmacists is relatively low, there are geographic and practice areas where membership rates are higher. Differences in work activities, working conditions, wages, and benefits were noted between union and nonunion staff pharmacists as well as between those who would join a union and those who would not. These differences merit further investigation, especially with respect to evaluating the effectiveness of unions and identifying factors that may lead nonunionized staff pharmacists to join a union.
Adult↗
Pharmacist involvement with immunizations: a decade of professional advancement.
OBJECTIVE: To review achievements in pharmacist-administered immunizations, emphasizing the period 1995 to 2004. DATA SOURCES: Published articles identified through PubMed (1995-2004) using the search terms pharmacist, pharmacy, and vaccine, immunization, or shots. Additional sources were identified from personal bibliographies collected by the authors during this decade, as well as the bibliographies of the retrieved articles. The later two sources resulted in manuscripts of primarily historical significance. STUDY SELECTION: More than 300 manuscripts were identified. The authors selected 15 studies that most clearly document the effect of pharmacist-administered immunizations for review. DATA EXTRACTION: By the authors. DATA SYNTHESIS: While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, only 10 years have passed since pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine administration in 1994. On November 1, 1996, the American Pharmaceutical (now Pharmacists) Association (APhA) began its nationally recognized training program for pharmacists, Pharmacy-Based Immunization DELIVERY: A National Certificate Program for Pharmacists. By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement. CONCLUSION: Pharmacists have made significant strides in immunizations over the past decade. Limited activities in the hospital sector have been particularly well documented, as have the perceptions of patients regarding acceptance of pharmacists as immunizers. The activities of community pharmacists are less well documented. More research is needed into novel approaches to pharmacist involvement in public health-focused immunization initiatives, along with continued research evaluating the current practice of pharmacist-administered immunizations.
Adolescent↗
[General practitioner's recognition of service cooperation with community pharmacists related to home care in a suburban area].
OBJECTIVES: To clarify the factors affecting a general practitioner's demands and the recognition of service cooperation with community pharmacists related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was administered to 215 general practitioners in a suburban area. Gender, age, specialty, length of practice, status of home visiting, requests for community pharmacists, awareness of a home visiting service by community pharmacists, status of issues about home visiting orders to community pharmacists and the criteria for deciding to issue an order, recognition of the necessity of a home visiting service by pharmacists, expectation value to the community of the pharmacists' participation in the home care service and requests, recognition of cooperation with other home care related professions, ease of cooperation with community pharmacists, disincentives for cooperation with community pharmacists, factors necessary to promote cooperation between practitioners and community pharmacists, and factors necessary to promote the home care system were surveyed. Using the results, chi 2 test and principal component analysis were performed. RESULTS: It was found that the general practitioners' main demands were support and management of pharmaceutical therapy. Meanwhile, the practitioners' low cognition of pharmacists' home visiting seemed to be one disincentive to cooperation with pharmacists. Every practitioner who had issued visiting orders to pharmacists practiced home visiting and issued the visiting orders based on patients' condition at home. Practitioners who practiced home visiting were more active in promoting the home care system and had a better cognition and more extensive demands for pharmacists' home visiting compared to practitioners with no home visiting. Practitioners with good recognition of cooperation with community pharmacists had better cognition, realized the necessity of, and expected pharmacist's home visiting compared to practitioners with low awareness. However, practitioners' overall recognition of cooperation with pharmacists was relatively low. As disincentives, practitioners pointed out lack of acquaintance, the unclear function of pharmacists, and no opportunity for cooperation. So, enhancing practitioners' awareness of home care, clarifying the pharmacist's role, establishing a relationship of mutual trust through information feedback and/or exchange based on practice would be effective in promoting service cooperation with community pharmacists.
Adult↗
Increasing clients' knowledge of community pharmacists' roles.
PURPOSE: The pharmaceutical care framework requires an active client-pharmacist partnership, particularly with respect to consultation about medications. With low client expectations for pharmacist consultation documented by several studies, this research sought to identify: 1) what information clients want from pharmacists, 2) what barriers prevent clients from asking pharmacists their questions, and 3) whether an inexpensive intervention could increase client short-term knowledge of pharmacist roles related to patient consultation and monitoring prescription appropriateness. Role theory provides a framework for this study. METHODS: Nineteen community pharmacies and 355 pharmacy clients participated in the study. Each client completed a survey on their needs for information and knowledge of pharmacist roles, with clients in the experimental arm receiving a short brochure on pharmacist roles while a control group did not. RESULTS: Sixty percent wanted information about side effects; 51% wanted directions for how to take the medication correctly. Most frequently listed barriers to asking pharmacists questions were client embarrassment and ignorance that it was appropriate to seek information from pharmacists. Significantly more experimental group clients than control group clients correctly answered survey questions about pharmacist roles and training. Only 52% of the control group believed the pharmacist always checks for possible drug interactions. Only 55% believed pharmacists were required to provide appropriate patient consultation for prescriptions under state law. CONCLUSIONS: Brief exposure to a short pamphlet about pharmacists' activities increased knowledge of pharmacist roles and training, suggesting that inexpensive interventions can impact on client short term knowledge of pharmacist roles.
Community Pharmacy Services↗
Work redesign and role restructuring in a pharmacy department with pharmacist assistants.
A new staffing model for decentralized pharmacists and support staff at a university hospital is described. A new technical support position--the pharmacist assistant--was created, and activities were reallocated among the pharmacists, pharmacist assistants, and pharmacy technicians according to the recommendations of two total quality management teams. Pharmacist assistants were to perform many of the drug distribution and record-keeping functions previously performed by pharmacists. The activities marked for reallocation accounted for about 50% of pharmacist time in the existing staffing model; they would not be performed by experienced pharmacy technicians who received brief training to be pharmacist assistants. Nine pharmacists and nine technicians tested the new staffing model on four patient care units over a four-week period. The reassignment of pharmacist tasks to pharmacist assistants theoretically gave pilot-unit pharmacists more time for providing and documenting patient-specific clinical activities and an additional 12 hours a week to participate in such global patient care activities as critical-pathway and quality improvement meetings. By the end of the study, the pharmacist assistants demonstrated that they could perform the reassigned activities; however, the pharmacists were not yet confident in the assistants' ability to do so. A pilot study of a new decentralized pharmacy staffing model demonstrated that technical support personnel can perform many distributive and record-keeping activities traditionally performed by decentralized pharmacists.
Hospital Restructuring↗
Community pharmacists' actions when patients use complementary and alternative therapies with medications.
OBJECTIVE: To assess actions of community pharmacists in response to their patients' concurrent use of prescription medications and complementary and alternative medicine (CAM). DESIGN: Nonexperimental, cross-sectional mail survey. SETTING: Texas. PARTICIPANTS: 107 community pharmacists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pharmacists' self-reported rate of patient inquiry about CAM use and actions taken in response to CAM use. RESULTS: A majority (71.0%) of pharmacists had encountered patients who were using CAM, which was defined broadly in the survey to include herbal products, vitamins and minerals, homeopathic products, massage, meditation, and other types of CAM. Pharmacists documented CAM use by patients in 11.0% of cases and reported monitoring for drug-related problems in 38.4% of users. Among CAM users, pharmacists most often encouraged CAM use if medically appropriate. Pharmacists were not comfortable with responding to CAM inquiries but believed they needed adequate knowledge about CAM. In general, pharmacists rarely asked patients about their CAM use. Pharmacists' rate of inquiry about CAM use increased significantly when this information could be documented in patient profiles and when pharmacists had additional training in CAM. Also, in pharmacies that stocked herbal or homeopathic products, pharmacists were significantly more likely to encourage the use of CAM when medically appropriate and to recommend other CAM therapies appropriate for patients' conditions. When no references were available to research CAM, pharmacists tended to neither encourage nor discourage CAM use based on lack of scientific evidence of their effectiveness. CONCLUSION: Most community pharmacists had patients who used CAM, but they were not proactive in inquiring about or documenting this use. They most often encouraged CAM use if deemed medically appropriate. Pharmacists' actions differed on the basis of professional and practice setting characteristics. To ensure optimal drug therapy outcomes, pharmacists should be more proactive in identifying and documenting CAM use by patients.
Community Pharmacy Services↗
Political and legal aspects of pharmacist prescribing.
The appropriateness of pharmacist prescribing is examined, and limits that should be incorporated into legislation are discussed. Arguments that support pharmacist prescribing are that (1) in current practice, pharmacist consultation has evolved into prescribing; (2) there is a need for pharmacists to prescribe; (3) nurse practitioners and physicians' assistants, whose training in clinical pharmacology is conducted by pharmacists, have authority to prescribe in many states; (4) as the need for dispensing functions decreases, new functions must be assumed; and (5) pharmacist prescribing in pilot studies has been safe, effective, and either equal or superior to physician prescribing. Negative aspects of pharmacist prescribing include (1) not all pharmacists are competent to prescribe, (2) pharmacists are not trained in diagnosis, (3) physicians oppose it, (4) it could increase patient-care costs, and (5) pharmacists' access to patient information is not adequate for competent prescribing. Based on these arguments, legislation regulating pharmacist prescribing should contain certain limits: (1) certification to prescribe should be based on demonstrated competence, (2) pharmacists who prescribe must have access to medical records, (3) pharmacists must prescribe within established working relationships with physicians, and (4) pharmacist prescribing should be limited to long-term therapy for chronic disease and therapy for acute self-limiting illnesses that are not diagnostically complex. These limitations have been incorporated into California law. A bill is pending that allows pharmacists, within specified guidelines, to initiate drug treatment.
California↗
Testing a pharmacist-patient relationship quality model among older persons with diabetes.
BACKGROUND: Considering recent changes to the Medicare program, pharmacists will have unique opportunities to be reimbursed for providing Medication Therapy Management Services to older persons with diabetes. A high-quality pharmacist-patient relationship can lay the foundation for effective provision of Medication Therapy Management Services and improved care in this cohort. OBJECTIVE: To test a pharmacist-patient relationship quality model in a group of older persons with diabetes from the patient's perspective. Antecedents to relationship quality were pharmacist participative behavior/patient-centeredness of relationship, patient participative behavior, and pharmacist-patient interpersonal communication. Pharmacist-patient relationship commitment was the outcome of relationship quality studied. METHODS: Data were collected via mailed questionnaire from a random sample of 600 community-dwelling adults in the United States who (1) were 65 years of age and older, (2) had type 1 or type 2 diabetes, (3) used at least one prescription medication to treat their diabetes, and (4) used some type of nonmail order pharmacy as their primary source of obtaining prescription medications. Model relationships were tested using path analysis. RESULTS: The adjusted response rate was 41.6% (221/531). The models explained 47% and 49% of the variance in relationship quality and relationship commitment, respectively. In the relationship quality model, pharmacist participative behavior/patient-centeredness of relationship (beta=.51, P<.001) and pharmacist-patient interpersonal communication (beta=.17, P=.008) had direct effects on relationship quality. In the relationship commitment model, relationship quality had a direct effect on relationship commitment (beta=.60, P<.001). Pharmacist participative behavior/patient-centeredness and pharmacist-patient interpersonal communication had indirect effects on relationship commitment through their effects on relationship quality, which is a mediator in the model. CONCLUSIONS: Results affirm findings from previous research showing that patients' perceptions of pharmacist participative behavior/patient-centeredness of relationship and pharmacist-patient interpersonal communication are positively related to perceptions of relationship quality. Also, relationship quality is a strong mediator between pharmacist participative behavior/patient-centeredness of relationship and relationship commitment, as well as between pharmacist-patient interpersonal communication and relationship commitment.
Age Factors↗
Assessing the needs of pharmacists and physicians in caring for patients with epilepsy.
OBJECTIVE: To obtain primary care physicians' and community pharmacists' opinions of the Pharmacist Note, a model epilepsy patient profile maintained by the pharmacist and transmitted to the physician as needed, and the information it contains. DESIGN: A cross-sectional descriptive study design was used for collecting and analyzing data. Separate surveys were developed and mailed to physicians and pharmacists. PARTICIPANTS: 554 primary care physicians and 114 community pharmacists in Ohio who interact regularly with epilepsy patients. MAIN OUTCOME MEASURES: Pharmacist and physician opinions on the Pharmacist Note program. RESULTS: Physicians ranked seizure frequency as their most useful piece of information, followed by medication compliance and drug interaction screening. For medication profile and drug interaction screening, most physicians currently use themselves as their primary source of information, although a significant number would prefer to use pharmacists as information sources in these areas (p < .05). A majority (62%) would like to have pharmacists more involved in the care of their patients. Pharmacists identified lack of time and lack of appointments with patients, inadequate pharmacy staff, and insufficient reimbursement as barriers to implementing the Pharmacist Note program. CONCLUSION: Physicians desire pharmacist involvement in specific areas of care for patients with epilepsy, and the feasibility of implementing the Pharmacist Note and similar programs appears promising. However, pharmacists identified barriers to implementation, and these barriers need to be addressed if this type of program is to be successful.
Adult↗
Self reported clinical pharmacist interventions under-estimate their input to patient care.
OBJECTIVE: Pharmacists' impact on individual patient care is difficult to measure especially the contribution made by clinical pharmacy ward visits. This study set out to determine what activities pharmacists actually undertook on a clinical pharmacy ward visit and compare this with the usual method of measuring clinical pharmacist performance, self-reported pharmacist interventions. METHOD: Observational analysis was carried out on 16 pharmacists providing a ward clinical pharmacy service in four acute hospitals. MAIN OUTCOME MEASURE: Percentage of pharmacist interventions recorded. RESULTS: A total of 34 wards were visited during the study which included both medical and surgical specialties. Average time spent per patient was less than two minutes for most pharmacists and three-quarters of the pharmacists checked over 80% of patient drug charts. Interventions represented 68% of pharmacist activities on the wards but on questioning the pharmacists reported that they would record only 31% of those interventions. Comparison of the interventions the pharmacists stated they would record with an historical sample of recorded interventions from the four hospitals showed a similar pattern in each intervention category. However, pharmacists were more likely to record interaction type interventions and less likely to record interventions on incomplete/illegal prescriptions, which were regarded as routine practice. CONCLUSION: Pharmacists reported they would record less than one-third of interventions observed. If recorded pharmacist interventions continue to be used the main source of evidence of outputs of clinical pharmacy service, a better way of capturing this data needs to be developed.
Data Collection↗
Provision of syndromic treatment of sexually transmitted infections by community pharmacists: a potentially underutilized HIV prevention strategy.
BACKGROUND: Sexually transmitted infections (STIs) are known risk factors for HIV infection. GOAL: The goal of this study was to assess the current and potential future role that community pharmacists in Western Cape, South Africa play in the treatment of STIs. STUDY DESIGN: A cross-sectional survey of community pharmacists in the Western Cape region of South Africa. A face-to-face interview that ascertained experience with requests from patients for STI treatment, current STI treatment practices, and willingness to provide syndromic STI treatment was administered to head pharmacists. RESULTS: Ninety pharmacies were selected and 85 (94%) of the head pharmacists participated; 55 from an urban area and 30 from a rural area. Pharmacists reported a median of 40 urban clients and 25 rural clients who sought STI treatment from community pharmacists. When provided with a hypothetical clinical situation, 13% of urban and 17% of rural pharmacists identified the correct medication for male urethral discharge, 8% of urban pharmacists and none of the rural pharmacists identified correct treatment for genital ulcers, and none of the pharmacists identified the correct medication for vaginal discharge. Fifty-three percent of pharmacists in urban regions and 47% of pharmacists in rural regions expressed willingness to provide syndromic STI treatment. Independent predictors of willingness to provide syndromic treatment were knowledge of the link between HIV transmission and STIs (adjusted odds ratio [OR]: 13.78; 95% CI: 2.69, 70.66), past experience prescribing syndromic STI treatment (OR: 11.1; 95% CI: 1.14, 108.6), and male gender (OR: 4.38; 95% CI: 1.15, 16.7). CONCLUSIONS: Pharmacists are frequently called upon to provide STI treatment but have limited knowledge of correct treatment recommendations. Training pharmacists to provide syndromic STI treatment may be one strategy to reduce STI morbidity and HIV transmission.
Community Pharmacy Services↗
[A prediction study on the supply of and demand for pharmacists in Japan].
Recently, the separation between dispensing and prescribing drugs has made rapid progress and the number of pharmacists' jobs at hospitals have increased, which means that pharmacists are contributing more than ever to medical treatment. Thus the relation between the supply of and demand for pharmacists has become a topic in the improvement of pharmacist quality. In this study, we used date on pharmacists including type of job, registration number, etc. to predict the relation between the supply of pharmacists at work and the demand for pharmacists. In addition, we analyzed the working trends of pharmacy pharmacists and predicted the in relation between the supply and demand. Due to progress in the separation of dispensing and prescribing drugs, the supply of pharmacists will nearly equal demand temporarily. However, the supply at work will always exceed demand, and we concluded that no shortage of pharmacists would occur. In addition, after the demand for pharmacists stops increasing, the excess supply of pharmacists will continue to increase. Based on analysis of working trends of pharmacy pharmacists, the in number will increase at the same rate as between 1996 and 1998 (approximately 6000 persons/year). Under this assumption, we concluded that no short-age of pharmacy pharmacists will occur, even if the separation of dispensing and prescribing drugs continues to occur at the rate of 5%/year.
Adult↗
Progress of pharmacist collaborative practice: status of state laws and regulations and perceived impact of collaborative practice.
OBJECTIVES: To determine the current status and features of states' laws on pharmacist collaborative practice, barriers and facilitators to the passage of such laws, pharmacists' satisfaction with present regulations, and pharmacy leaders' perceptions regarding the impact of collaborative practice on pharmacist-physician relationships and on patients' perceptions of pharmacists. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: Executives of state pharmacy organizations and officers of state pharmacy boards. MAIN OUTCOME MEASURES: Presence and features of collaborative practice law, perceptions regarding effects of collaborative practice on pharmacist-physician relationships, and patients' perceptions of pharmacists. RESULTS: Of 48 states responding to the survey, 32 (66%) had existing pharmacist collaborative practice laws; 23 states (48%) allowed pharmacists to initiate and modify therapy, whereas 9 (19%) allowed only modification of therapy. Dependent collaborative practice was permitted in 31 states (65%). Most state laws applied to hospital, long-term care, and community settings. Five of the 32 states with pharmacist collaborative practice laws had made changes to broaden the provisions since the original laws were enacted. Nine states out of 16 that did not have collaborative practice laws indicated plans to pursue passage of such laws. Overall, collaborative practice was viewed as having a positive effect on pharmacist-physician relationships and a slightly positive effect on patients' perceptions of pharmacists. Respondents believed that pharmacists currently involved in collaborative practice were mostly satisfied with present laws, although some respondents mentioned the need for further revisions to the laws. CONCLUSION: Significant progress has been made in passing and implementing laws on pharmacist collaborative practice. As positive experience is gained, good opportunities exist to broaden current laws and increase pharmacists' involvement in collaborative practice.
Attitude of Health Personnel↗
Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting.
BACKGROUND: Pharmacists have been shown to positively impact the outcomes of care for treatment of many different kinds of disease states. In particular, pharmacist-run lipid clinics have enjoyed varying degrees of success, depending on the outcome assessed. At our hospital, when a patient is transferred to the pharmacist-coordinated lipid clinic, the primary care pharmacist is responsible for ordering and interpreting labs and prescribing and monitoring lipid-altering therapy. OBJECTIVE: This study was designed to assess if there is a statistically significant difference between the magnitude of serum cholesterol reduction for patients receiving lipid-altering pharmacotherapy when clinically trained pharmacists are actively prescribing and adjusting the drug therapy compared to other health care practitioners (usual care). METHODS: Patient records from the hospital computer databases were retrospectively and randomly selected for analysis. Following evaluation for inclusions and exclusions, 41 patient records remained for statistical analysis for the cohort group, and 47 records remained from the group of patients managed by a clinical pharmacist. RESULTS: Management of dyslipidemia by a clinical pharmacist was associated with a significant reduction in overall mean low-density lipoprotein (LDL, 18.5%) compared to the cohort that did not have a clinical pharmacist as the primary manager of dyslipidemia (6.5%, P=0.049). This suggests improved clinical outcomes, defined as greater LDL reduction, when clinical pharmacists participate in lipid management, including drug prescribing. The magnitude reduction in LDL was found to be related to the number of clinical pharmacy visits (11.4% for 1 visit, 23.2% for 2 visits, and 23.7% for >3 visits), compared to the usual care group (-11.0%, 18.0%, and 7.4%; statistically significant, P=0.038, for >3 visits only). These results occurred even though the group of dyslipidemic patients managed primarily by a clinical pharmacist contained a statistically greater number of patients with 2 or more risk factors and high-density lipoprotein (HDL) levels less than 40 mg/dL. CONCLUSION: Interdisciplinary medical teams that include clinical pharmacists who are actively prescribing and adjusting lipid drug therapy may achieve greater reductions in LDL for patients who have been assessed with multiple risk factors compared to patients managed without clinical pharmacists. Active participation by clinical pharmacists in lipid management for patients with elevated LDL resulted in improved treatment success as measured by the magnitude reduction in LDL. The reduction in LDL was between 5% and 22% per visit greater for patients being treated by clinical pharmacists versus usual care, even in a patient population with more risk factors. These intermediate outcomes may translate into long-term outcomes in fewer cardiovascular events, improved quality of life for patients with dyslipidemia, and lower costs associated with sequelae of dyslipidemias.
Ambulatory Care Facilities↗