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PubMed1986

Clinical pharmacy on-call program in the emergency department.

This is a descriptive and evaluative report regarding a clinical pharmacy residency in-house on-call program that facilitates the provision of 24-hour clinical pharmacy consultative services within the emergency department. During the two-year evaluation period, clinical pharmacy residents completed 3.1 consultations per 14-hour call period. Additionally, greater than 90% of the clinical pharmacy recommendations were accepted and completely followed by physician cohorts. These consultations were usually solicited by internal medicine physicians within the emergency department, involved patient-specific drug therapy recommendations, and required about 100 minutes (mean per consultation) of the clinical pharmacist's time. Thus, clinical pharmacy consultative services can be a useful addition to health care within the emergency department in teaching hospitals.

Chicago↗
PubMed2004

A survey of attitudes to Traditional Chinese Medicine in Hong Kong pharmacy students.

OBJECTIVES: To study the attitudes and personal experiences with Traditional Chinese Medicine (TCM) use in pharmacy students. DESIGN: Prospective cross-sectional study. SETTING: University School of Pharmacy. METHODS: Pharmacy students were asked 17 questions according to an anonymous survey questionnaire. RESULTS: All 91 students (46% males) participated in the survey. The attitude toward TCM use was positive in 40%, neutral in 59% and negative in only 1%. On scales from 0 to 10, the mean (SD) scores for the adequacy of the current curriculum in TCM training and state of TCM knowledge were 3.2 (2.0) and 3.6 (1.6), respectively. Of the 35 participants who had used TCM in the past year, nearly half did so without any TCM practitioner consultation. Seventy-four percent reported that they had not been told of any side effects of TCM. When comparing the third year with first or second year students, there was no significant difference between any of these findings. CONCLUSION: The training in TCM within this 3-year pharmacy curriculum appears inadequate. Most students are not aware of any possible side effects in TCM. The attitude and practice do not appear to vary significantly between successive year of pharmacy students.

Age Factors↗
PubMed2003

The use of pharmacy immunization services in rural communities.

Pharmacies have been recommended as alternative sites for the delivery of immunization services, especially to medically underserved adults and children in inner cities and rural areas. Currently, 35 of 50 states in the USA have legalized the administration of vaccines by pharmacists on the basis of certain training requirements and specific protocols. Since the role of pharmacists is expected to expand, it is important to assess the factors that would enable them to improve the delivery of immunization services and the acceptance of these services by communities. It is particularly important for pharmacists to have knowledge of community circumstances and be able to respond to community needs. This case study of a pharmacy immunization programme (PIP) in rural West Virginia assessed how well pharmacists were aware of community circumstances and which community factors affected the utilization of pharmacy-delivered immunizations. Our findings suggest that although pharmacists played important roles as facilitators, hosts and motivators in PIP, they overestimated the trust placed in them by community members. The convenient locations of pharmacies and the convenient times when they offered immunization services were found to be the determining factors of mothers' decisions to take their children to these places for their vaccinations. The study concludes that as the use of pharmacies as sources of immunization is expected to continue to expand, pharmacists should take these factors into consideration when they decide to offer immunizations.

Chi-Square Distribution↗
PubMed2000

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource].

OBJECTIVE: To find what the pharmacy office represents socially to the population that uses it most. DESIGN: Qualitative study. Analysis of the contents of two discussion groups. PARTICIPANTS: Women from 30 to 60 years old, urban residents of the Community of Madrid. MEASUREMENTS AND MAIN RESULTS: The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy". CONCLUSIONS: Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.

Adult↗
PubMed1999

Pharmacy and herbal medicine in the US.

Herbal medicine is increasing in popularity in the United States. The market continues to grow, with a presence being established for commercially-prepared herbal products in community pharmacies throughout the nation. This survey was conducted to describe that presence in pharmacies and to describe pharmacists' perceptions of this product class. A response rate of 26.3% (n = 512) was achieved for a five-page mail survey sent to a geographically stratified random sample of community pharmacies in the United States. Approximately 73% of pharmacists responding indicated that their pharmacy carried commercially-prepared herbal products. Attitudinal items were included to measure pharmacists' perceptions toward these products, as those perceptions have the potential to influence attitudes and subsequently behavior (such as clinical involvement with patients wishing to integrate herbal products into an existing regimen). Pharmacists, on average, did not believe that herbal products are well standardized, or that the products are well accepted by the Food and Drug Administration or the National Association of Boards of Pharmacy. Much potential exists for pharmacists to fill a role as information provider to patients who self-medicate with herbal medicines; must their perceptions of the product class be changed first?

Adult↗
PubMed1999

Purchasing a quick fix from private pharmacies in the Gaza Strip.

Increasingly, it is recognised by health planners and social scientists that self medication with drugs bought over the counter in private pharmacies is extremely widespread. Some anthropologists see this trend as an aspect of the 'commodification of health'. In this study, group interviews with health service users and providers in Gaza revealed many health service users reporting an inadequate supply of drugs resulting in the purchasing of drugs in private pharmacies. As a result, a survey of the pattern of utilization of three private pharmacies in three contrasting urban areas within the Gaza Strip was undertaken. Using a questionnaire, data were collected from all customers buying drugs. The results show that variations in the patterns of health seeking behaviour were associated with socioeconomic status. Adult males were the most frequent customers of all three pharmacies. They were buying medicines for members of their nuclear family more often than for themselves. Overall, pain and influenza were the most commonly reported conditions. The drugs purchased most frequently for women were for reproductive health problems, particularly infertility. Customers of the pharmacy in the relatively prosperous area more commonly purchased drugs which were prescribed by a private doctor.

Adult↗
PubMed2001

The diffusion process of patient education in Dutch community pharmacy: an exploration.

Patient education activities in pharmacies are receiving much attention. These activities are relatively new and implementation requires individual and organisational change in pharmacies. The aim of this study is to identify barriers and facilitators to the implementation of patient education in community pharmacies and to classify these barriers and facilitators into the diffusion stages of Rogers' 'Innovations in Organisations' model [Rogers, EM. Diffusion of innovations. 4th ed. New York: The Free Press, 1995]. Six focus group interviews, three with pharmacists and three with pharmacy technicians (total n = 38) were carried out. The initiation phase has been dealt with by community pharmacies, whereas the implementation phase has not. The barriers and facilitators in the redefining/restructuring stage were mainly related to the organisation of patient education. In the clarifying and routinizing stages, barriers were related to repetition and knowledge transfer. The facilitators in these stages relate to performing and talking about patient education. Interventions for implementation of patient education should aim at these barriers and facilitating factors.

Community Pharmacy Services↗
PubMed2003

The effect of an intervention programme to improve health education leaflet uptake and distribution in community pharmacies.

The effect of an intervention programme to improve health education leaflet uptake in community pharmacies was conducted with a small convenience sample of 12 community pharmacies in North Staffordshire, UK. The intervention consisted of four different modes of leaflet provision. Modes 1 and 2 (without and with overt offer of advice from pharmacist respectively) relied upon the pharmacy client to actively obtain a leaflet, whereas Modes 3 and 4 (without and with offer of advice from pharmacist respectively) relied upon pharmacy staff to actively provide a leaflet. All 12 community pharmacies received 50 copies of a purposefully designed leaflet. The intervention extended over one calendar month. Data was collected during the intervention via monitoring forms completed by the pharmacist on a day to day basis, and interviews were conducted with the pharmacists at the end of the study. The overall uptake or distribution rate of leaflets was 64%. In both modes which offered advice (Modes 2 and 4), approximately one of every five leaflet recipients sought advice. The community pharmacists considered the intervention to be feasible, effective and enabled the utilisation of their skills.

Attitude of Health Personnel↗
PubMedDate not supplied

Pharmacy immunization partnerships: a rural model.

OBJECTIVES: To describe the Pharmacy Immunization Project, a pharmacy/county health department (CHD) partnership model for immunizing infants and adults in rural areas, and to develop service procedures and disseminate lessons learned for adapting the model to different settings. SETTING: Independent community pharmacies in five contiguous rural counties in West Virginia. PRACTICE DESCRIPTION: Participating pharmacies varied markedly in space, prescription volume, and population of service areas. PRACTICE INNOVATION: Childhood and adult immunization service. INTERVENTIONS: Pharmacists partnered with nurses from CHDs to offer year-round immunizations at times when other providers were typically closed. Working under standing orders of the CHD medical directors, nurses also conducted routine well-baby examinations in the pharmacy. Promotions involved direct mailing, posters, fliers, direct communication, and ads in newspapers, radio, and TV. MAIN OUTCOME MEASURES: Pharmacists' and CHDs' continued willingness to participate, use of the service by local citizens, and feedback from participants and other health care providers and the West Virginia Immunization Program (WVIP). RESULTS: All sites except one continued their participation through the life of the project. The one exception was a pharmacy with few infant patients, which discontinued participation during year 4 of the project. Remaining sites were used and well accepted by the community. The WVIP remains a loyal supporter, and no problems arose with local health care providers. CONCLUSION: The model appears adaptable to urban as well as rural practice and to chain as well as independent practice in states not authorizing pharmacists to administer vaccines, for pharmacists who for other reasons prefer not to administer, and for those who prefer to offer adult immunization on a seasonal basis. From the CHD perspective, the partnership model is useful in establishing "satellite" locations to target hard-to-reach patients. Recommendations regarding agreements and responsibilities are available, as are lessons learned during project development.

Adult↗
PubMedDate not supplied

Performance of community pharmacy drug interaction software.

OBJECTIVE: To evaluate the performance of computerized drug-drug interaction (DDI) software in identifying clinically important drug-drug interactions. DESIGN: One-time performance test of computer systems using a standard set of prescriptions. SETTING: Community pharmacies or central corporate locations with pharmacy terminals identical to those used in actual pharmacies. PARTICIPANTS: Chain and health maintenance organization (HMO) pharmacies with seven or more practice sites in Washington State. A total of nine different DDI software programs were installed in 516 community pharmacies represented by these chains and HMOs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of software in detecting 16 well-established DDIs contained within six fictitious patient profiles. RESULTS: The software systems failed to detect clinically relevant DDIs one-third of the time. Sensitivity of the software programs ranged from 0.44 to 0.88, with 1.00 being perfect; specificity ranged from 0.71 to 1.00; positive predictive value ranged from 0.67 to 1.00; and negative predictive value ranged from 0.69 to 0.90. For software packages that were installed at different locations, between-installation differences were observed. CONCLUSION: The performance of most DDI-detecting software programs tested in this study was suboptimal. Improvement is needed to advance their contribution to detection of DDIs.

Drug Interactions↗
PubMed1998

Pharmacists' concerns and suggestions related to the sale of tobacco and alcohol in pharmacies.

A random sample of Pharmacists in Indiana was selected and surveyed regarding their thoughts and comments on the sale of tobacco and alcoholic products by pharmacies. A total of 212 pharmacists provided written responses to an open-ended question. The replies were then synthesized into major themes. The majority of comments categorized revealed strong opposition to pharmacies selling tobacco and alcohol products. The most frequently occurring message regarding the sale of these products by pharmacies was that it goes against the pharmacist's role as a professional health care provider and may harm their image. For some pharmacists, this issue posed a moral dilemma between caring for patient safety and the economic incentives provided by the sale of tobacco and alcohol. Based on these findings, a follow-up phone survey was conducted to solicit suggestions from pharmacists on how to advocate against the sale of tobacco and alcohol by pharmacies. The majority of pharmacists strongly recommended that they need to do more among themselves and within their store environment, rather than have regulations imposed on pharmacies when it comes to limiting the sale of these products.

Adult↗
PubMed2002

Purchasing restricted medicines in New Zealand pharmacies: results from a "mystery shopper" study.

OBJECTIVE: New Zealand has a class of drugs (Restricted Medicines) which are available over the counter in pharmacies, but must be sold by qualified pharmacists. Patient names must be recorded for each sale. Many restricted medicines have recently been reclassified from prescription only, with the expectation that pharmacists provide professional input into their sale. The study described here explored whether pharmacists do fulfill this expectation. METHOD: In late 1999, 12 mystery shoppers made 360 visits to 180 pharmacies around New Zealand. Shoppers were of different ages, genders, ethnic and socio-economic backgrounds. Two kinds of products were purchased: diclofenac 25 mg, which was requested for "back pain" and vaginal anti-fungals requested for "thrush". MAIN OUTCOME MEASURE: The main outcome measure described here is whether the shoppers received specified items of counselling. These included questions about the shopper's health status, contraindications to medicine use, advice about the use of the product and the health problem presented. Other outcome measures are whether sales of restricted medicines were carried out by pharmacists or other staff, and whether sales were recorded. RESULTS: In spite of the requirement that pharmacists sell restricted medicines, shoppers often found it difficult to distinguish pharmacists from other pharmacy staff. Shoppers were able to confirm that a pharmacist was definitely involved in only 46% of visits. In 8.8% of the diclofenac visits, and 10.8% of the visits for vaginal anti-fungals, no counselling was provided. The vaginal anti-fungal visits tended to be more product-focussed than the diclofenac visits. When they purchased diclofenac, most pharmacists asked shoppers if they had, or had had, stomach problems (74.6%) or asthma (65.4%). A minority asked about the symptoms of the vaginal fungal infection which the female shoppers presented with. While most pharmacies recorded patient names, many did so in a way which compromised patient confidentiality. CONCLUSION: Pharmacies varied widely in the amount of counselling they provided to people purchasing restricted medicines.

Adult↗
PubMed2004

The effectiveness of hospital pharmacy in the UK: methodology for finding the evidence.

OBJECTIVE: To describe the methodology used to identify United Kingdom (UK) hospital pharmacy practice research work from the last two decades. METHOD: A comprehensive search for citations that appeared to contribute to the overall evidence or in some way measure, demonstrate or evaluate the effectiveness of UK hospital pharmacy practice. This involved a search of thirteen electronic databases covering a wide variety of UK, European and international publications, hand searching of selected UK journals and conference proceedings, a written request for details sent to all UK Chief Pharmacists and Directors of Pharmacy and a bibliography search of each reference identified. All appropriate references were then added to a single computer database. MAIN OUTCOME MEASURE: Number of references identified by each strand of the search strategy. RESULTS: The search initially highlighted a total of 10,099 articles from the thirteen reference databases, but only 281 were considered suitable for inclusion in the final review. Hand searching of the selected journals and conference proceedings yielded another 173 references and the written requests to hospital chief pharmacists resulted in another 128 references being identified. Finally, bibliography searches of the articles identified by the above three methods resulted in another 242 references, bringing the total number of references to 824. CONCLUSION: This paper describes a strategy to identify a comprehensive collection of citations supporting the evidence for the effectiveness of hospital pharmaceutical services in the UK. The large number of references identified demonstrate that hospital pharmacists in the UK make significant contributions to both the research literature and to patient care. However, database searches alone highlighted just 34% of the total references finally included in this study, demonstrating that pharmacy practice research work may be difficult to access by conducting database searches alone. The results from this project provide a resource for the profession and can be utilised as a foundation for future developments in both the delivery and research of hospital pharmacy practice.

Databases, Factual↗
PubMed2005

An evaluation of the role played by community pharmacies in oral healthcare situated in a primary care trust in the north of England.

OBJECTIVES: To determine the existing state of oral healthcare advice, products and information provided by community pharmacies in Durham Dales Primary Care Trust area, and determine their potential role in the provision of oral healthcare services. METHODS: A semi-structured questionnaire was devised to examine the current role of community pharmacies in oral healthcare. An interview was arranged with each of the pharmacies. RESULTS: Ninety per cent of pharmacies participated from the Trust area. Common presenting complaints were ulcers and toothache/pain relief. Pharmacists advised customers to see a dentist in 94.1% of cases, 23.5% to see a doctor, 41.2% gave oral hygiene advice and 100% gave short-term pain relief. Pharmacists were keen to improve oral health knowledge. Most were aware of the nearest dental practices but few knew arrangements for emergencies/appointments. There were 14 pharmacists wanting active roles in promotional activities and national campaigns. Issues raised were lack of known key contacts for referrals/advice and lack of support on integration into primary healthcare teams. CONCLUSION: Through new pharmacy contracts and support/education, pharmacists could perform an increased role in oral healthcare provision.

Community Pharmacy Services↗
PubMed2004

Adverse drug reaction teaching in UK undergraduate medical and pharmacy programmes.

OBJECTIVES: To assess the extent of teaching about the Committee on Safety of Medicine's Yellow Card scheme and adverse drug reactions within UK Schools of Medicine and Pharmacy. METHODS: A self-completed questionnaire sent to all heads of undergraduate schools of medicine and pharmacy within the UK. RESULTS: The majority of undergraduate syllabi feature the Yellow Card Scheme. Knowledge of the Yellow Card Scheme was assessed in 79% of pharmacy programmes and 57% of medical schools. Specialist speakers on the Yellow Card Scheme were infrequently used. Fewer than half of respondents provided students with a guide to reporting ADRs (43% pharmacy and 43% medical). There is some disagreement about the value of supplying students with printed material about the Yellow Card Scheme. Half of medical Schools did not think that supplying 'Current Problems In Pharmacovigilance' would be useful. CONCLUSIONS: It was found that in both medicine and pharmacy, courses differed substantially in teaching about the Yellow Card Scheme and adverse drug reactions (ADRs). There is scope for increased involvement of the Medicines and Healthcare products Regulatory Agency in undergraduate education, in line with recommendations from the National Audit Office.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Subsidised nicotine replacement therapy in a community pharmacy setting.

ISSUES ADDRESSED: Nicotine replacement therapies are effective, but are mostly under-utilised and often not used for an appropriate duration. The paper reports on a pilot project that used subsidies for NRT as a means to engage community pharmacists to deliver tobacco cessation to the Arabic-speaking community. METHOD: Arabic-speaking community pharmacists were recruited through direct mail-outs and trained in tobacco cessation brief intervention. Fifteen selected pharmacies recruited Arabic smokers through their pharmacies. Pharmacy follow-up was conducted three months after the program was implemented. RESULTS: A total of 65 participants attended the seminar. A total of 31 pharmacy customers received at least one packet of subsidised NRT patches. Twenty (64.5%) clients received both the first and second subsidised pack. Fifteen clients continued to use patches after the third packet, however only three clients continued the patches to the eighth pack. CONCLUSION: The pilot was successful in improving recruitment of pharmacies into training for smoking cessation counselling as well as engaging community pharmacists to deliver tobacco cessation intervention with small incentive.

Arabs↗
PubMed2000

Changes in pharmacy, nursing, and total personnel staffing in U.S. hospitals, 1989-1998.

Pharmacy, nursing, and total hospital personnel inpatient staffing in U.S. medical-surgical hospitals for 1989, 1992, 1995, and 1998 was studied. Nursing and total personnel staffing data were obtained from the American Hospital Association, and pharmacy personnel data were obtained from the National Clinical Pharmacy Services database. Between 1989 and 1998, mean +/- S.D. registered-nurse staffing per 100 occupied beds increased from 124.46 +/- 92.24 to 196.57 +/- 131.92, or 57.94%. Pharmacist staffing per 100 occupied beds increased from 6.47 +/- 3.01 to 7.95 +/- 4.88, or 22.87%. The total number of registered nurses increased by 126,960 (15.78%), and the total number of pharmacists declined by 320 (0.72%). The increase in pharmacist staffing per 100 occupied beds was due almost entirely to decreases in hospital census between 1989 and 1998. Total hospital personnel staffing per 100 occupied beds and the absolute number of hospital employees increased at much higher rates (55.2% and 12.95%, respectively) than pharmacist staffing. Pharmacy technician staffing per 100 occupied beds increased by 42.96%, and pharmacy clerk staffing increased by 25.37%. Between 1989 and 1998, pharmacist staffing in U.S. medical-surgical hospitals increased at less than half the rates for registered nurses and total hospital personnel.

Humans↗
PubMed2000

ASHP national survey of pharmacy practice in acute care settings: dispensing and administration--1999.

Results of the 1999 ASHP national survey of pharmacy practice in acute care settings that pertain to drug dispensing and administration practices are presented. Pharmacy directors at 1050 general and children's medical-surgical hospitals in the United States were surveyed by mail. The response rate was 51%. About three-fourths of respondents described their inpatient pharmacy's distribution system as centralized. Of those with centralized distribution, 77.4% indicated that their system was not automated. Decentralized pharmacists were used in 29.4% of the hospitals surveyed; an average of 58.9% of their time was spent on clinical, as opposed to distributive, activities. About 67% of directors reported pharmacy computer access to hospital laboratory data, 38% reported access to automated medication-dispensing-unit data, and 19% reported computer access to hospital outpatient affiliates. Only 13% of hospitals had an electronic medication order-entry system; another 27% reported they were in the process of developing such a system. Decentralized medication storage and distribution devices were used in 49.2% of hospitals, while 7.3% used bedside information systems for medication management. Machine-readable coding was used for inpatient pharmacy dispensing by 8.2% of hospitals. Ninety percent reported a formal, systemwide committee responsible for data collection, review, and evaluation of medication errors. Virtually all respondents (98.7%) reported that their staff initiated manual reports. Only two thirds tracked these reports and reported trends to the staff. Fewer than 15% reported that staff were penalized for making or contributing to an error. Pharmacists are making a significant contribution to the safety of medication distribution and administration. The increased use of technology to improve efficiency and reduce costs will require that pharmacists continue to focus on the impact of changes on the safety of the medication-use system.

Ambulatory Care↗