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PubMedDate not supplied

Concordance among three self-reported measures of medication adherence and pharmacy refill records.

OBJECTIVE: To evaluate the level of agreement among three previously validated self-reported medication adherence measures and pharmacy refill records (RRs). DESIGN: Cross-sectional study. SETTING: Five primary care physician office sites in rural northeast Georgia. PARTICIPANTS: 139 adult patients with one or more of these chronic diseases: hypertension, diabetes mellitus, hypercholesterolemia, hypothyroidism, or a condition requiring hormone replacement therapy. INTERVENTIONS: Study participants completed the Brief Medication Questionnaire (BMQ), the Medication Adherence Survey (MAS), and the Medical Outcomes Study (MOS) instruments; pharmacy RRs for the medication or medications being used to treat the target disease were obtained from pharmacies used by the study participants. MAIN OUTCOME MEASURES: Adherence to medication therapy for target disease. RESULTS: Participants were nearly all white (98.6%), consistent with the Appalachian area in which the study was conducted, and mostly women (71.9%). While 91.4% of study participants reported taking their study medication most or all of the time, RRs showed mean adherence rates of 82.6%, 82.1%, 79.1%, 74.6%, and 69.8% for diabetes mellitus, hypertension, hypothyroidism, hypercholesterolemia, and hormone replacement therapy, respectively. Moderate correlations of .234, .261, and .213 were found between RRs and the MAS, MOS, and BMQ belief screen, respectively. Spearman correlations ranged from .091 between RRs and the BMQ regimen subscale to .313 between MOS and MAS. Pearson chi-square tests showed that only the BMQ belief subscale was significant in this study. CONCLUSION: Because of the weak to moderate concordance found among validated measures of adherence, the selection of a useful adherence measure in pharmacy practice is difficult. These findings underscore the difficulty in both assessing patients' medication-taking behavior and assessing and comparing the results of adherence research. The development of valid and reliable measures for easily assessing medication adherence behavior in community pharmacies is needed.

Adult↗
PubMedDate not supplied

Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.

OBJECTIVES: To implement an osteoporosis screening and referral program in community pharmacies and evaluate the use of the Osteoporosis Self-Assessment Tool for Asians (OSTA) as the screening instrument. DESIGN: Uncontrolled study. SETTING: Three community pharmacies in Bangkok, Thailand. PATIENTS: 51 women aged 50 years or older without prior diagnosis of osteoporosis; three community pharmacists; six hospital-based physicians. INTERVENTION: OSTA assessment by community pharmacists of the risks of osteoporosis in patients; counseling of patients about diet and exercise; referral of patients at high risk (OSTA index value less than -4) to hospitals where pharmacists had made arrangements in advance; and assessment of satisfaction and opinions of participating patients and physicians. RESULTS: Of the 51 patients, 32 (62.7%) were categorized as low risk (OSTA index value > -1) and 19 (37.3%) as intermediate risk (OSTA index value range, -4 to -1). The majority of patients (97%) were satisfied with the program and the knowledge gained. Even though no high-risk patients were identified and referred for medical care, all six participating physicians agreed with having risk assessment service in community pharmacies and the prearranged referral system, and five of six physicians believed that OSTA results were valuable in the management of osteoporosis. CONCLUSION: Community pharmacy-based osteoporosis risk assessment services using OSTA were well accepted by the patients and participating physicians. Public health benefits may result from the provision of osteoporosis risk screening services in community pharmacies in Thailand and other Asian countries.

Community Pharmacy Services↗
PubMedDate not supplied

Documentation of patient care services in a community pharmacy setting.

OBJECTIVE: To assess the types of patient care documentation systems currently being used by community pharmacists and determine the preferred characteristics of an ideal patient care documentation system. DESIGN: Mailed survey. SETTING: United States. PARTICIPANTS: One pharmacist from each of 125 targeted community pharmacies. INTERVENTION: Survey mailed in February 2003, followed by a second mailing to nonrespondents in March 2003. MAIN OUTCOME MEASURES: Responses to survey items about (1) patient care services provided at the pharmacy, (2) characteristics of the current documentation system, and (3) characteristics of an ideal documentation system. RESULTS: A total of 48 usable responses were received from 106 pharmacies to which surveys were delivered (45.3%). Independent pharmacies accounted for 50% of survey respondents. More than 80% of respondents were providing patient screening or management services associated with a chronic disease such as diabetes, hypertension, or dyslipidemia. Approximately 54% of the pharmacists were using a paper documentation system. However, challenges identified with a paper system included documentation time, retrieval of patient data, tracking patient outcomes, and storage. Respondents indicated that an ideal documentation system would be comprehensive, easy and efficient to use, and affordable. CONCLUSION: Pharmacists recognize the importance of documenting patient care services. While the majority of respondents are using paper charts to document patient care services, computerized systems appear to offer advantages over paper charts. This information offers community pharmacists a summary of previous experiences and a starting point when trying to identify or modify a documentation system that would better meet the pharmacies' needs.

Community Pharmacy Services↗
PubMedDate not supplied

Depression screening in a university campus pharmacy: a pilot project.

OBJECTIVE: To evaluate the usefulness of a depression screening tool in a university campus pharmacy. DESIGN: Uncontrolled study. SETTING: University campus pharmacy. PARTICIPANTS: 25 individuals were screened while waiting for a prescription to be dispensed or while browsing in the pharmacy. INTERVENTIONS: Completion of a depression screening tool and a follow-up participant satisfaction survey to rate the usefulness of the depression screening tool. MAIN OUTCOME MEASURES: Scores on the depression screening tool and descriptive analysis of participant satisfaction survey. RESULTS: One participant was rated as depressed and one participant as "borderline" depression on the screening tool. Overall, 64% (16/25) of participants rated the screening tool as very useful, 92% (23/25) felt very comfortable while completing the screening tool, 40% (10/25) were very likely to read the provided written information, and 60% (15/25) learned about depression or themselves by participating in the survey. CONCLUSION: Depression screening is feasible in a university campus pharmacy. Participants reported feeling comfortable discussing depression with a pharmacist in a university campus pharmacy. In addition, they considered the information provided by the pharmacist on depression to be useful.

Adolescent↗
PubMed2002

Discrepancies between medical and pharmacy records for patients on anti-HIV drugs.

OBJECTIVE: To compare and evaluate drug notations in outpatient medical records and in pharmacy records in a cohort of HIV-1-infected patients treated with antiretroviral drugs. METHODS: Data on 103 patients were obtained from January 1, 1998, through December 31, 1999, by medical chart review and collection of pharmacy records. Two analyses were performed. First, antiretroviral drugs and comedication in the pharmacy records were documented and compared with their appearance in the outpatient medical records. Second, a detailed comparison was performed at 5 time points during the study period for the antiretroviral drugs. Generic name, formulation, strength, and frequency of dosing as registered in the outpatient medical records were compared with those registered in the pharmacy records. RESULTS: Total drug dispensation was 1607 (366 and 1241 antiretroviral drugs and comedication, respectively). The first screening resulted in a total discrepancy of 55.1% (n = 885), of which 97.1% (n = 859) was attributed to the comedication and 2.9% (n = 26) to the antiretroviral drugs. The discrepancy for the antiretroviral drugs at the specific time points ranged from 5.1% to 12.6% when the generic name only was used, and from 7.1% to 17% when formulation, strength, and frequency of dosing were also taken into account. CONCLUSIONS: The observed discrepancy between outpatient medical records and pharmacy records mainly concerns the comedication. For the antiretroviral drugs fewer, but still substantial, discrepancies were observed. These results indicate that full exchange of information conceming drug use in this population between general practitioners and specialists (infectious disease) is lacking.

Adult↗
PubMed2005

Provision of emergency hormonal contraception through community pharmacies in a rural area.

OBJECTIVES: The provision of emergency hormonal contraception (EHC) through community pharmacies was introduced in Hambleton and Richmondshire, North Yorkshire, UK in December 2001 to contribute to the Teenage Pregnancy Strategy. The study aimed to establish how well the service is used, whether it is reaching the original target group, why people use the service and where it is accessed. METHODS: This was a descriptive study conducted in a rural primary care trust. RESULTS: From 1 January 2001 to 31 December 2003, there were 1412 pharmacy consultations for EHC and 1260 courses of EHC provided. General practitioner (GP) prescribing of EHC decreased but there was an overall increase in provision of EHC from pharmacies, GPs, family planning clinics, and accident and emergency departments. By December 2003, community pharmacies had become the largest provider of EHC. CONCLUSIONS: The supply of EHC through community pharmacies provided clients with wider choice and improved access to services, which resulted in increased overall provision of EC in this rural area.

Adolescent↗
PubMed2006

Increased access to unrestricted pharmacy sales of syringes in Seattle-King County, Washington: structural and individual-level changes, 1996 versus 2003.

We examined pharmacists' attitudes and practices related to syringe sales to injection drug users before and after legal reform and local programming to enhance sterile syringe access. We replicated a 1996 study by conducting pharmacist phone surveys and syringe test-buys in randomly selected pharmacies. Test-buy success increased from 48% in 1996 to 65% in 2003 (P=.04). Pharmacists agreeing that syringes should be available to injection drug users through pharmacy purchase increased from 49% to 71% (P<.01). Pharmacy policies and pharmacist attitudes were strongly associated with syringe access. Structural changes, including policy reform and pharmacy outreach, appear to increase syringe access. Interventions should address pharmacy policies and pharmacist attitudes and policies.

Attitude of Health Personnel↗
PubMed2005

Use of pharmacy data to evaluate smoking regulations' impact on sales of nicotine replacement therapies in New York City.

OBJECTIVES: Recently, New York City and New York State increased cigarette excise taxes and New York City implemented a smoke-free workplace law. To assess the impact of these policies on smoking cessation in New York City, we examined over-the-counter sales of nicotine replacement therapy (NRT) products. METHODS: Pharmacy sales data were collected in real time as part of nontraditional surveillance activities. We used Poisson generalized estimating equations to analyze the effect of smoking-related policies on pharmacy-specific weekly sales of nicotine patches and gum. We assessed effect modification by pharmacy location. RESULTS: We observed increases in NRT product sales during the weeks of the cigarette tax increases and the smoke-free workplace law. Pharmacies in low-income areas generally had larger and more persistent increases in response to tax increases than those in higher-income areas. CONCLUSIONS: Real-time monitoring of existing nontraditional surveillance data, such as pharmacy sales of NRT products, can help assess the effects of public policies on cessation attempts. Cigarette tax increases and smoke-free workplace regulations were associated with increased smoking cessation attempts in New York City, particularly in low-income areas.

Health Promotion↗
PubMed2006

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2005.

PURPOSE: Results of the 2005 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. METHODS: A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. RESULTS: The response rate was 43.5%. Most hospitals had a centralized drug distribution system; however, there is evidence of growth in decentralized models compared with data from 2002. Automated dispensing cabinets were used by 72% of hospitals and robots by 15%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. However, the percentage of medication preparation and dispensing quality-improvement programs declined over the past six years. Medication administration records (MARs) have become increasingly computerized over the past six years. Consequently, the use of handwritten MARs has declined substantially. Technology implemented at the administration step of the medication-use process is continuing to grow. Bar-code technology was implemented by 9.4% of hospitals, and 32.2% of hospitals had smart infusion pumps. Pharmacy hours of operation were stable, with 30% of hospitals providing around-the-clock services. About 12% of hospitals are using off-site medication order review and entry after hours. Pharmacy staffing has steadily increased over the past three years; however, hospital pharmacies reported a 5.6% vacancy rate. CONCLUSION: Safe systems continue to be in place in most hospitals, but the adoption of new technology is changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.

Drug Compounding↗
PubMed2002

Cost-benefit analysis of the detection of prescribing errors by hospital pharmacy staff.

OBJECTIVE: Prescribing errors are a major cause of iatrogenic patient morbidity and therefore interventions aimed at preventing the adverse outcomes of these errors are likely to result in cost reduction. However, it is unclear whether the costs associated with these preventive measures are outweighed by the cost reductions (benefits). Therefore, a study was set up to analyse costs and benefits of detecting prescribing errors by hospital pharmacy staff. DESIGN: During 5 consecutive days in two Dutch hospitals in February 2000 all medication orders, in which prescribing errors were detected, were analysed. A cost-benefit analysis was performed, based on direct medical costs only. The benefit-to-cost ratio was calculated by taking into account the net time hospital pharmacy staff needed for the prevention of the error (this included potential time saving for nursing staff, when an error was prevented by hospital pharmacy staff instead of nursing staff), as well as taking into account the possible consequences of the prescribing error (were the error not prevented). RESULTS: A total of 3540 orders, of which 351 contained prescribing errors (9.9%), were analysed. During the 1-week period investigated, time-investment of the pharmacy staff had net costs of EUR285 (2000 values). During the same period estimated benefits related to this investment were EUR9867. The finding of higher benefits than costs was robust in sensitivity analysis. CONCLUSIONS: From this study it can be concluded that prevention of prescribing errors by hospital pharmacy staff results in higher benefits than the costs related to the net time investment.

Cost-Benefit Analysis↗
PubMed2006

Clinical risk management in Dutch community pharmacies: the case of drug-drug interactions.

BACKGROUND: The prevention of drug-drug interactions requires a systematic approach for which the concept of clinical risk management can be used. The objective of our study was to measure the frequency, nature and management of drug-drug interaction alerts as these occur in daily practice of Dutch community pharmacies. METHODS: In total, 63 Dutch pharmacies collected all drug-drug interaction alerts during 153 research days (on average 2.4 days/pharmacy), as well as variables related to these alerts, such as involved medicines, first time or recurrent drug-drug interaction, same or different prescribers, patient data (age, sex) and information about the management of drug-drug interactions by the pharmacy. The latter was discriminated into internal procedures only and external action, such as communication with the patient, the prescriber or the anticoagulation clinic and prescription modification. All drug-drug interactions were classified into categories of clinical relevance (A-F) and available evidence (0-4). RESULTS: A total of 43,129 prescription-only medicines were dispensed during the study period. On average, 16.8 interaction alerts per day per pharmacy were collected. Approximately 6% of all prescriptions generated a drug-drug interaction alert. Of all alerts (n = 2572), 31.1% occurred for the first time and with 21% two different prescribers were involved. The 20 most frequently occurring drug-drug interaction alerts accounted for approximately 76% of all alerts. Cardiovascular drugs, NSAIDs, oral contraceptives and antibacterials were most frequently involved. External action was taken in response to 27.3% of the alerts, meaning either a modification of one of the concerned prescriptions (n = 65; 9.3%), communication with the prescriber or anticoagulation clinic (n = 90; 12.8%) or communication with the patient or a relative (n = 547; 77.9%). Where there was no external action (n = 1860; 72.3%), pharmacists concluded in about two-thirds of cases that the drug-drug interaction had been managed in the past. Other reasons not to intervene externally were for instance: incorrect alert; acceptable drug-drug interaction; or outcome of the interaction considered irrelevant. Adjusted for several variables, a first alert was found to be a main determinant for external action. After stratifying for first alerts no other significant determinants were found. CONCLUSIONS: A high frequency of drug-drug interaction alerts was found. Most concerned recurrent alerts, which were the main reason not to act externally. Concerning the assessment phase in the risk-management process, drug-drug interactions with no or low evidence/relevance should be reconsidered. Concerning the management of drug-drug interactions in pharmacies, the opportunity to actively suppress alerts for a certain period of time should be studied in more detail. There are indicators that the management of patient-orientated advice could be improved and a greater degree of consistency developed for the management of first and recurrent interaction alerts.

Adolescent↗
PubMed2004

Pharmacy data for tuberculosis surveillance and assessment of patient management.

Underreporting tuberculosis (TB) cases can compromise surveillance. We evaluated the contribution of pharmacy data in three different managed-care settings and geographic areas. Persons with more than two anti-TB medications were identified by using pharmacy databases. Active TB was confirmed by using state TB registries, medical record review, or questionnaires from prescribing physicians. We identified 207 active TB cases, including 13 (6%) missed by traditional surveillance. Pharmacy screening identified 80% of persons with TB who had received their medications through health plan-reimbursed sources, but missed those treated solely in public health clinics. The positive predictive value of receiving more than two anti-TB medications was 33%. Pharmacy data also provided useful information about physicians' management of TB and patients' adherence to prescribed therapy. Pharmacy data can help public health officials to find TB cases and assess their management in populations that receive care in the private sector.

Antitubercular Agents↗
PubMed2006

A senior care clerkship for pharmacy students.

OBJECTIVE: This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year period from 1998-2003. SETTINGS: This clerkship used community long-term resources of a 160+ bed skilled nursing facility, adult day care, and senior citizen centers involving medicine, pharmacy, and nursing preceptors. PRACTICE DESCRIPTION: The facility consultant pharmacist was the primary preceptor of students. He conducted pharmacy rounds and daily patient case reviews three times per week. He provided monthly drug regimen review (DRR) and quarterly drug utilization review (DUR) to the skilled nursing facility and, as needed, consultation and therapeutic recommendations to the adult day care center and the senior citizen center. PRACTICE INNOVATION: A 200-hour clerkship was developed with multidisciplinary preceptor experiences to orient internal and external PharmD students to long-term care adult consultation with the attending physicians and nurses in the three sites. Each student prepared for physician rounds by performing an intensive DRR process for selected nursing facility patients. This included a preliminary discussion with the charge nurse on the unit and the consultant pharmacist. As directed, each rotation group proposed and completed one DUR project and written report. The overall goal was to enable the student to serve as a consultant pharmacist and, upon graduation, become a certified geriatric pharmacist. Rotation-specific objectives, evaluation instruments, and DRR and DUR processes are described. MAIN OUTCOME MEASUREMENTS: Documentation of contact time, completion of DRR and DUR activities, and interprofessional communication activities. RESULTS: There were 96 students who completed a 200-hour clerkship over five, 40-hour weeks during a five-year period from 1998 to 2003. Students evaluated some 10,000 patient-months of skilled nursing facility drug therapy and completed 20 DUR projects. All former students who have provided verbal feedback on their clinical training in this rotation have indicated that the rounds and conference contact with the medical director and med passes with the nurse were the key components in that they contributed most to effective interprofessional communication beyond what the consultant pharmacist preceptor offered. CONCLUSIONS: A senior care clerkship can be enhanced with medical director preceptorship in conjunction with the facility consultant pharmacist and nursing staff. This clerkship offered an experiential training that enabled pharmacy students to more effectively communicate with attending physicians and nurses, provide senior pharmacy care, and orient students to the opportunity for geriatric pharmacist certification.

Aged↗
PubMed1994

Cancer morbidity among Danish female pharmacy technicians.

OBJECTIVES: Pharmacy technicians maintain a substantial production and packing of pharmaceuticals and other chemicals, many of which are carcinogens. This study reports on cancer incidence among Danish female pharmacy assistants and dispensers. METHODS: Altogether, 8499 compulsory members were identified in the archives of the Association of Danish Pharmacy Technicians and followed through the files of the Danish Cancer Registry (1970-1990); observed figures were compared with those expected on the basis of national cancer incidence rates. RESULTS: The overall standardized incidence ratio [SIR] for cancer was 1.0 [N = 219, 95% confidence interval (95% CI) 0.8-1.1]. A 1.5-fold (N = 34; 95% CI 1.1-2.1) elevated risk of nonmelanoma skin cancer was found, especially for long-term pharmacy assistants (N = 15, SIR 2.8, 95% CI 1.6-4.6). An increased risk for non-Hodgkin's lymphoma appeared among long-term pharmacy dispensers (N = 5, SIR 3.7, 95% CI 1.2-8.9). In the entire group, the risk of tobacco-related tumors was significantly reduced (N = 8, SIRW 0.4, 95% CI 0.2-0.9), together with the probably socioeconomic-associated cervical cancer risk (N = 18, SIR 0.6, 95% CI 0.4-0.9). CONCLUSIONS: Sunlight is usually the dominant cause of nonmelanoma and melanoma skin cancer, but occupational factors may have contributed in this study in view of the uncommon localization observed for many of these cancers and the unelevated melanoma risk. In addition to the increased risk of non-Hodgkin's lymphomas, which may have been associated with exposure to organic solvents, the results do not indicate any other notable cancer risks during the follow-up.

Adult↗
PubMed2006

Characteristics, prevalence, attitudes, and perceptions of academic dishonesty among pharmacy students.

OBJECTIVES: To ascertain background factors that influence pharmacy students' willingness to cheat, describe attitudes regarding methods of cheating, assess prevalence of cheating and determine atmospheres that may aid in preventing academic dishonesty. METHODS: Third-professional year PharmD students at 4 institutions participated in a survey administered by a class representative. RESULTS: Of the 296 students who completed survey instruments, 16.3% admitted to cheating during pharmacy school. Approximately 74% admitted that either they or their classmates had worked on an individual assignment with a friend. Students who cheated during high school or in a prepharmacy program were more likely to cheat during pharmacy school (p < 0.0001). Those who possessed a bachelor of science (BS) degree prior to pharmacy school were less likely to cheat (p < 0.0001). CONCLUSIONS: Academic dishonesty is prevalent among pharmacy students. While few respondents directly admitted to cheating, many admitted to activities traditionally defined as dishonest.

Data Collection↗
PubMed1990

Cost containment measures in hospital pharmacy: a bibliography.

The pharmacy literature was searched for cost containment articles. The articles were classified according to content and the Canadian studies were identified. In total, 170 publications were identified, of which 51 (30%) were Canadian. Overall, 28.2% dealt with hospital administrative measures, 20.0% with pharmacy operations management, 14.7% with pharmacy materiels management, and 37.1% with clinical pharmacy services. The area of most frequent focus for Canadian articles was clinical pharmacy (43.1%), followed by hospital administrative measures (35.3%). References were provided for all articles.

Bibliographies as Topic↗
PubMed1991

A survey of pharmacy-coordinated investigational drug services.

Over the past few years, pharmacy involvement in investigational drug studies has grown. In 1986, Kingston General Hospital conducted a nation-wide survey assessing the extent of pharmacy involvement in clinical drug trials. The aims of the present survey were to show how Investigational Drug Services (IDS) have changed in recent years, to determine areas that need improvement, and to characterize methods of reimbursement for IDS. A total of 148 Canadian hospitals (300 or more beds) were mailed a detailed IDS questionnaire. A response rate of 68% was achieved. Survey results were grouped in the following categories: increase in clinical trials involvement, IDS staffing levels, sponsorship of trials, major areas of clinical drug research, areas of IDS needing improvement, and reimbursement issues. The results of this survey indicate that since 1986 pharmacy departments are becoming more involved in the coordination of clinical drug trials. Perceived areas for improvement in IDS were strikingly uniform between institutions, despite a large variation in the extent of existing services. Reimbursement procedures are not consistent and several methods are used to obtain pharmacy funding. Recommendations are offered for assistance in the development or expansion of pharmacy-coordinated IDS in Canadian hospitals.

Canada↗
PubMed1992

Movement of the i.v. room to the postanesthesia care area: an alternative to an operating room satellite pharmacy.

The Jewish Hospital of St. Louis decided to combine the need for an operating room (OR) satellite pharmacy with the need to upgrade the existing intravenous (IV) room. This decision resulted in the movement of the move not only provided an upgraded IV room but its location allowed for direct access to the OR suites. The IV room can now provide the additional services of an OR satellite pharmacy. Cost savings estimates for a dedicated OR satellite pharmacy did not provide the hospital administration with the financial justification for the project. Only by combining the pharmacy's personnel and physical resources did the proposal become inviting enough for the hospital administration to support. The steps in the creation of the combined IV room/OR satellite pharmacy are presented.

Cost Savings↗