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PubMed1999

Survey of drugs sold in pharmacies in Afghanistan.

OBJECTIVE: To compare retail prices and manufacturers of drugs sold in pharmacies in the developing country Afghanistan. SETTING: Jalalabad, Afghanistan, and pharmacies located around the secondary referral centre and teaching hospital Public Health hospital. DESIGN AND METHODS: Descriptive survey of 10 pharmacies, where hospital patients purchase medication. The pharmacies were interviewed about retail prices and manufacturers of paracetamol, chloroquine, metronidazole, ampicillin, and levamizole. RESULTS: Paracetamol tablets were offered by eight different producers (seven in Pakistan, one in the United Kingdom). The price range per tablet was Afghani 15-120 (mean Afghani 59). The different manufacturers (six in Pakistan, two in the United Kingdom, one in Germany, one in India) offered paracetamol syrup with a price range per bottle between Afghani 800-3000 (mean Afghani 1544). Chloroquine tablets were offered by six different producers (one in Pakistan, one in China, one in France, one in Iran, one in India, one in Germany). The price range per tablet was Afghani 45-100 (mean Afghani 76). Three producers from Pakistan offered chloroquine ampoules and the price range was Afghani 250-1020 (mean Afghani 412). Chloroquine syrup was offered by 11 different producers (eight in Pakistan, one in Afghanistan, one in India, one in France). The price range was Afghani 500-2000 (mean Afghani 1226). Metronidazole tablets were offered by five different producers (two in Pakistan, one in France, two in India). The price range was Afghani 60-300 (mean Afghani 175). Metronidazole syrup was offered by four different producers (three in Pakistan, one in France). The price range was Afghani 1000-4500 (mean Afghani 2800). Ampicillin capsules were offered by five different producers (one in Pakistan, one in the United Kingdom, one in India, two in Iran). The price range was Afghani 140-650 (mean Afghani 238). Ampicillin ampoules were offered by five different producers (one in China, one in Germany, one in India, one in France, one in Yugoslavia). The price range was Afghani 600-1700 (mean Afghani 1207). Ampicillin syrup was offered by eight different producers (six in Pakistan, one in China, one in the United Kingdom). The price range was Afghani 900-3500 (mean Afghani 2450). Levamizole tablets were offered by two producers from Pakistan, and three from India. The price range was Afghani 30-500 (mean Afghani 110). CONCLUSION: Up to 11 producers (chloroquine syrup) offered the same drug with price differences up to 1600% (levamizole).In developing countries with scarce resources for health care and no free health care, regulation and control of drugs could improve efficient use of resources and in hospital medicine patients should obtain all mediation from one supervised hospital pharmacy.

Journal Article↗
PubMed2004

Quality safeguards and regulation of online pharmacies.

Using econometric evidence, this article confirms that distribution of medicines online is split into two market segments of very diverse quality, and identifies the factors that drive quality and quality assurance in this activity. Unlike fraudulent, 'rogue,' websites, which offer scant guarantees and usually sell just a few medicines without prescription, online pharmacies offering insurance coverage and linked to conventional pharmacies typically sell a whole range of drugs, require third-party medical prescriptions and provide abundant information to patients. It is shown that, where online pharmacies are allowed to act legally, market forces enhance quality, as private insurers require professional standards, and specialized third parties make a business of certifying them. Furthermore, older online pharmacies and those running conventional operations offer higher quality, probably because of reputational investments. Overall, this evidence supports licensing online pharmacies, especially considering that prohibiting them is ineffective against fraudulent sites.

Commerce↗
PubMed2007

Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions.

PURPOSE: To compare refill adherence data based on two different methods of data capturing, that is, manually collected repeat prescriptions and a pharmacy record database. METHODS: The study comprised a comparison of adherence data from manually collected repeat prescriptions of asthma and chronic obstructive pulmonary disease (COPD) drugs with fixed dosages dispensed in 2002 and the corresponding data from a pharmacy record database. Data were collected in the county of Jämtland in Sweden. Refill adherence was calculated for the different collection methods. RESULTS: Data from 285 manually collected repeat prescriptions for asthma/COPD drugs for 2002 showed that 35% of the prescribings had been satisfactory refilled, while 42% showed an undersupply and 23% an oversupply. The pharmacy record database had 490 prescribings for asthma/COPD drugs registered in 2002, 28% of these had a satisfactory refill adherence, while 43% showed an undersupply, and 29% an oversupply. Based on the database it could be shown that 11% of the individuals had used more than one repeat prescription of the same medicine during 2002. Based on the pharmacy record database for 1999-2002, it was shown that 29% of the prescribings had been satisfactory refilled whereas undersupply increased (53%) and oversupply decreased (18%) as compared to the 1-year data. CONCLUSIONS: Refill adherence determined from manually collected repeat prescriptions and from a pharmacy record database did not differ for a 1-year period. Four-year data might give a better overview of patients' refill adherence than 1-year data.

Anti-Asthmatic Agents↗
PubMed2000

Involvement of community pharmacists in the care of drug misusers: pharmacy-based supervision of methadone consumption.

This article examines the feasibility and acceptability of a supervised consumption of methadone service from local community pharmacies. It builds upon the British Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the range of services they offer to drug users. The article also takes up the ongoing debate on regulating the structure of prescribing and dispensing of methadone and the Department of Health's suggestion to consider methods to reduce the diversion of methadone, for example via supervised consumption of methadone. The pharmacy-based supervised self-administration of methadone scheme (SSA) at the Camden and Islington Community Health Services Trust Substance Misuse Services (CTDS) in London has been found to be valuable by clients, pharmacists and keyworkers. All pharmacists involved regarded the project as workable and expressed their willingness to continue with the provision of supervised dispensing of methadone in the future. Clients stated as main advantages: local access, which saved them time and travelling, and the longer opening hours enabled them flexibility in managing their time. The main negative comments were related to lack of privacy when drinking their methadone within the pharmacy. Most keyworkers welcomed the SSA scheme as another dispensing option available. The fact that another responsible and accountable health professional was involved was positively perceived by the key workers. The Camden and Islington pilot project of providing a supervised consumption of methadone service from local community pharmacies has successfully put into practice the Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the involved health range of services they offer to drug users. This suggests a positive future for the practice and implementation of pharmacy-based self-administered provision of methadone.

Journal Article↗
PubMedDate not supplied

Patients' perceived benefit from and satisfaction with asthma-related pharmacy services.

OBJECTIVE: To determine whether patients targeted to receive intervention from an asthma management program reported receiving more services and had greater perceived benefit and satisfaction with those services compared with asthma patients not targeted by the program. DESIGN: Mailed survey. SETTING: Community pharmacy. PATIENTS: 471 community-based patients receiving asthma medications from 44 intervention pharmacies and 1,164 patients from 46 usual care (control) pharmacies. MAIN OUTCOME MEASURES: Five-point agreement scale measuring asthma services received, perceived value of the services, and satisfaction. RESULTS: Usable surveys were received from 39.0% of intervention patients and 42.4% of controls. There were no statistically significant differences between groups in the frequency of provision of listed services. Approximately 60% of respondents from both groups received written materials on asthma medications and 54% received inhaler counseling; both were rated high for perceived benefit. Fewer than 20% reported being counseled about asthma triggers. Fewer than 5% reported pharmacists talking to physicians on their behalf. General satisfaction with pharmacy services was high (78.2% agree or strongly agree), but not statistically different between groups. More than 65% believed that pharmacists spend enough time counseling patients. Several comments indicated that patients did not expect or ask for information because they were unaware that services were available and/or they had already been counseled by their physician. Responses to the statement "my asthma is better controlled because of help given to me by the pharmacist" were equivocal and not different between groups. CONCLUSION: Overall, there were few differences between groups. General satisfaction with pharmacy services is high, but patients' perceived benefit and satisfaction with cognitive services is lower. Increased public awareness of pharmacists' capabilities and a more proactive approach to providing cognitive services is needed.

Adrenergic beta-Agonists↗
PubMed2005

Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.

BACKGROUND: Medco Health Solutions, Inc. conducted a project to reduce medication errors in its home-delivery service, which is composed of eight prescription-processing pharmacies, three dispensing pharmacies, and six call-center pharmacies. IMPLEMENTING THE PROJECT: Medco uses the Six Sigma methodology to reduce process variation, establish procedures to monitor the effectiveness of medication safety programs, and determine when these efforts do not achieve performance goals. A team reviewed the processes in home-delivery pharmacy and suggested strategies to improve the data-collection and medication-dispensing practices. A variety of improvement activities were implemented, including a procedure for developing, reviewing, and enhancing sound-alike/look-alike (SALA) alerts and system enhancements to improve processing consistency across the pharmacies. RESULTS: "External nonconformances" were reduced for several categories of medication errors, including wrong-drug selection (33%), wrong directions (49%), and SALA errors (69%). Control charts demonstrated evidence of sustained process improvement and actual reduction in specific medication error elements. DISCUSSION: Establishing a continuous quality improvement process to ensure that medication errors are minimized is critical to any health care organization providing medication services.

Humans↗
PubMed2003

Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project.

OBJECTIVES: To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies. METHODS: Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the client's age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire. RESULTS: A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the 1 year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women. CONCLUSION: Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.

Adolescent↗
PubMed2003

Can pharmacy data improve prediction of hospital outcomes? Comparisons with a diagnosis-based comorbidity measure.

OBJECTIVES: The performance of comorbidity measures derived from the hospital discharge abstract, the outpatient pharmacy record, and from both sources combined, were compared in predicting all-cause and unplanned hospital readmission and length of stay. MATERIALS AND METHODS: Automated hospital and pharmacy data came from Kaiser-Permanente and included 6721 acute hospitalizations in Southern California from April 1993 to February 1995. The Deyo adaptation of Charlson's 17 comorbidities was derived from hospital discharge data and the 29 Chronic Disease Score (CDS) comorbidity markers were derived from outpatient pharmacy claims data. Logistic and OLS regression models were used to compare the performance of each measure in baseline models and to evaluate whether the CDS contributed additional explanatory power in a combined model. RESULTS: The CDS was a significant predictor of unplanned readmission (C = 0.68) and LOS (Adjusted R(2) = 0.26) in multivariable models adjusted for baseline patient demographic and hospitalization characteristics. The Deyo measure was a significant predictor of all-cause readmission (C = 0.63), unplanned readmission (C = 0.68), and LOS (Adjusted R(2) = 0.26). When pharmacy-based disease markers were added to the Deyo baseline model, modest, statistically significant improvements in predictive power were noted in the unplanned readmission and LOS models. CONCLUSIONS: The finding that both measures of comorbid disease demonstrated similar predictive power is noteworthy, because secondary diagnosis data document relevant illness in hospital patients and pharmacy claims data were never intended for that purpose. The results suggest that small improvements in model performance may come from combining both sources of data in models to predict hospital readmission and LOS.

Adolescent↗
PubMed2004

A HRG-based costing model for estimating pharmacy costs associated with surgical procedures.

OBJECTIVE: The present study addresses pharmacy expenditure within a surgical directorate in a UK hospital. The aim of the study was to develop a health care resource group (HRG)-based costing model that can be used to forecast pharmacy expenditure based on surgical casemix. Such a model will be of benefit as an expenditure projection tool at a time when hospitals are developing accelerated operation programmes in an attempt to decrease hospital waiting times. METHOD: During the period February-April 2000, nursing staff recorded all pharmacy sourced items for each individual operation in the theatres used for general surgery, ENT surgery and gynaecological procedures; each operation was also classified according to its HRG. The associated costs of the items per HRG were identified and the average pharmaceutical cost per HRG calculated and included in the costing model. The model derived costs over the study period were compared with the actual pharmacy expenditure which was obtained from the pharmacy computer system. Finally HRG data for operations carried out in February 2002 were costed using the model for validation purposes. RESULTS: The estimated pharmaceutical cost for surgery items for February-April 2000 was 121,235 UK pounds. This figure was 3.92% over the actual pharmaceutical expenditure as determined from computer records. The February 2002 casemix varied considerably from that of 2000. However, the model estimated pharmaceutical cost of surgery performed in February 2002 (38,054 UK pounds) was again very similar to the computer logged expenditure (1.09% under the actual expenditure for that period) indicating the robustness of the HRG-based costing approach.

Cost Allocation↗
PubMed2006

Do pharmacy staff recommend evidenced-based smoking cessation products? A pseudo patron study.

OBJECTIVE: To determine whether pharmacy staff recommend evidence-based smoking cessation aids. METHODS: Pseudo patron visit to 50 randomly selected Sydney pharmacies where the pseudo patron enquired about the 'best' way to quit smoking and about the efficacy of a non-evidence-based cessation product, NicoBloc. RESULTS: Nicotine replacement therapy was universally stocked and the first product recommended by 90% of pharmacies. After prompting, 60% of pharmacies, either also recommended NicoBloc or deferred to 'customer choice'. About 34% disparaged the product. CONCLUSIONS: Evidence-based smoking cessation advice in Sydney pharmacies is fragile and may be compromised by commercial concerns. Smokers should be provided with independent point-of-sale summaries of evidence of cessation product effectiveness and warned about unsubstantiated claims.

Australia↗
PubMed2005

General medical and pharmacy claims expenditures in users of behavioral health services.

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. DESIGN: Retrospective cost trends and 24-month cohort analyses. SETTING: A Midwest health plan. PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

Adolescent↗
PubMed2006

Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial.

OBJECTIVES: To evaluate the effectiveness of two primary care strategies for delivering evidence based care to people aged 55 or over with knee pain: enhanced pharmacy review and community physiotherapy. DESIGN: Pragmatic multicentre randomised clinical trial. SETTING: 15 general practices in North Staffordshire. PARTICIPANTS: 325 adults aged 55 years or over (mean 68 years) consulting with knee pain; 297 (91%) reached six month follow-up. INTERVENTIONS: Enhanced pharmacy review (pharmacological management in accordance with an algorithm); community physiotherapy (advice about activity and pacing and an individualised exercise programme); control (advice leaflet reinforced by telephone call). MAIN OUTCOME MEASURE: Change in Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months. RESULTS: Mean baseline WOMAC pain score was 9.1 (SD 3.7), and mean baseline function score was 29.9 (SD 12.8). At three months, the mean reductions in pain scores were 0.41 (SD 2.8) for control, 1.59 (3.2) for pharmacy, and 1.56 (3.4) for physiotherapy; reductions in function scores were 0.80 (8.5), 2.61 (9.8), and 4.79 (10.8). Compared with control, mean differences in change scores for physiotherapy were 1.15 (95% confidence interval 0.2 to 2.1) for pain and 3.99 (1.2 to 6.8) for function; those for pharmacy were 1.18 (0.3 to 2.1) for pain and 1.80 (-0.8 to 4.5) for function. These differences were not sustained to six or 12 months. Significantly fewer participants in the physiotherapy group reported consulting their general practitioner for knee pain in the follow-up period, and use of non-steroidal anti-inflammatory drugs was lower in the physiotherapy and pharmacy groups than in the control group. CONCLUSIONS: Evidence based care for older adults with knee pain, delivered by primary care physiotherapists and pharmacists, resulted in short term improvements in health outcomes, reduced use of non-steroidal anti-inflammatory drugs, and high patient satisfaction. Physiotherapy seemed to produce a shift in consultation behaviour away from the traditional general practitioner led model of care. TRIAL REGISTRATION: UK National Research Register N0286046917; Current Controlled Trials ISRCTN55376150 [controlled-trials.com] .

Aged↗
PubMed1992

Assessment of the pharmacy service needs of HIV-positive outpatients receiving zidovudine.

OBJECTIVE: To determine the pharmacy service needs of HIV-positive outpatients. DESIGN: Anonymous mail-in survey. SETTING: Accredited, not-for-profit, outpatient pharmacy. PATIENTS: A total of 226 men receiving refill prescriptions for zidovudine. Relevant demographics: for 91 percent, homosexual behavior was the primary HIV risk factor; 75 percent were HIV positive with low CD4+ count; 68 percent had been receiving zidovudine for less than 12 months. MEASUREMENTS: Survey questions determined patients' past experience and satisfaction with pharmacy services, description of pharmacy service needs, drug history, and sociodemographics. MAIN RESULTS: Confidentiality was desired by 90 percent of patients. Patients also expected to receive private medication counseling on zidovudine routinely and to receive other information upon request. Twenty patients expected no medication counseling. Such patients were more likely to have contracted HIV by transfusion or intravenous drug abuse (p less than 0.05). CONCLUSIONS: The perceived pharmacy service needs of outpatients taking zidovudine can reasonably be met in all ambulatory settings. Pharmacists must be aware that all patients do not have the same needs and should tailor their activities to the needs expressed by individual patients.

Adolescent↗
PubMed2005

Pharmacy-based needle exchange in New Zealand: a review of services.

BACKGROUND: New Zealand has been offering needle exchange services since 1987. Over 170 community pharmacies are involved in the provision of this service. However, no recent detailed review of New Zealand's pharmacy-based needle exchange has been published. This study aimed to explore service provision, identify problems faced by pharmacists, and look for improvements to services. METHODS: The study used a cross-sectional survey of all needle exchange pharmacies. Postal questionnaires were used with postal and telephone follow-up. RESULTS: A response rate of 88% was obtained overall. Pharmacists had been providing the service for a mean of 6 years. Pharmacies had given out an average of 130 injecting units, in a mean of 62 transactions to a mean of 17 clients in the 4 weeks prior to completing the questionnaire. The majority had not incurred problems such as violence or intoxicated clients in the last 12 months, although almost one third had experienced shoplifting which they associated with service provision. Training and improving return rates were identified as potential areas for further development. CONCLUSION: New Zealand needle exchange pharmacies are providing services to a number of clients. The majority of service providers had been involved for a number of years, indicating the problems incurred had not caused them to withdraw their services--findings which echo those from the UK. Further training and support, including an exploration of improving return rates may be needed in the future.

Journal Article↗
PubMedDate not supplied

Clinical pharmacy services in the home: Canadian case studies.

OBJECTIVES: To describe clinical home care services provided by Canadian pharmacists and to identify facilitators of and barriers to the provision of these services. DESIGN: Home care practices in Canada were identified using key informant and snowball sampling methods. Case descriptions of each pharmacy were composed using data obtained via a faxed questionnaire and a follow-up telephone interview. SETTING: Community and institutional pharmacies across Canada. PARTICIPANTS: Sixteen pharmacists with practices that met three criteria: at least one home visit conducted per week, visits conducted specifically for clinical purposes beyond routine prescription counseling, and documentation of home care services. INTERVENTION: Faxed questionnaire and follow-up telephone interview. MAIN OUTCOME MEASURES: Pharmacist characteristics, pharmacy characteristics, types of clinical home care services, home care-related products and dispensing services, referral system, reimbursement, barriers and facilitators, and evaluative strategies. RESULTS: Twelve practices were in community pharmacies, nine of them independents. Home care services were provided primarily to address noncompliance and at the request of other health professionals. Elderly patients were the predominant service recipients. Services provided in most practices included compliance support, medication regimen review, monitoring of new medications, and patient education and training. Less than one-third of practices compiled evaluative data on these services. Most practices did not bill for services rendered. Lack of reimbursement was cited as the most important practice barrier, and having other sources of funding, such as high prescription revenues, was viewed as the major facilitator. CONCLUSION: Clinical home care practice is rare in Canadian pharmacy; reimbursement is a major barrier. Practices described in these case studies were initiated to address a perceived important patient need. To enable further dissemination of clinical home care practice, pharmacists need to establish formal linkages with other home care providers, evaluate their services, and use the data obtained to develop marketing and reimbursement strategies.

Canada↗
PubMed2005

Dispensing error rate in a highly automated mail-service pharmacy practice.

STUDY OBJECTIVE: To measure the rate of dispensing errors and to identify the types and sources of dispensing errors in a highly automated mail-service pharmacy practice. DESIGN: Descriptive analysis of a random sample of completed prescriptions. SETTING: A high-volume mail-service pharmacy practice comprising a network of prescription processing and dispensing pharmacies in the United States. MEASUREMENTS AND MAIN RESULTS: During September and October 2003, new and refill prescriptions were retrieved before shipping and evaluated for dispensing accuracy. Container contents were compared against the container label, and the label record was compared against the original prescription order. The overall dispensing error rate was 0.075% (16 dispensing errors among 21,252 prescriptions, 95% confidence interval 0.043-0.122). Fourteen errors involved incomplete or incorrect directions on the final label. All dispensing errors were associated with the initial stages of prescription processing (including order entry); no errors were associated with the mechanical stages of product dispensing. CONCLUSION: A highly automated mail-service pharmacy can achieve a dispensing error rate of less than 1 error/1000 prescriptions, which is substantially lower than the rates reported for retail pharmacies. A high degree of automation in the mechanical aspects of dispensing appears to be a key factor in achieving this high dispensing accuracy.

Humans↗
PubMed2006

Monitoring of pharmacy staffing, workload, and productivity in community hospitals.

PURPOSE: The purpose of this survey was to identify and characterize pharmacy productivity monitoring systems used in community hospitals that were part of a national group purchasing organization (GPO). METHODS: A 50-item questionnaire was developed, pretested, and sent electronically to the directors of pharmacy at 242 member hospitals of Consorta, Inc., a national GPO. The questionnaire was designed to elicit information on (1) hospital pharmacy demographics, (2) systems used to measure hospital pharmacy productivity, and (3) staffing levels and workload. Hospital demographic data were also obtained for respondent and nonrespondent hospitals from the American Hospital Association's AHA Guide. Descriptive statistics, Student's t tests, and chi-square tests were used to characterize the data and compare respondents with nonrespondents. RESULTS: Responses were received from 110 hospitals (45.5%). No clinically significant differences were found when respondent and nonrespondent hospitals were compared based on AHA Guide data. The productivity workload ratios monitored most often by respondent hospitals were full-time equivalents (FTEs) per adjusted patient day, FTEs per dose dispensed, and FTEs per dose billed. Respondents reported a mean +/- S.D. of 21.90 +/- 18.83 actual FTEs and total doses dispensed, billed, or administered per year of 111,391.4 +/- 111,538.0. A major limitation of the productivity systems used in the hospitals was the inability of the systems to account for clinical services performed by the pharmacy staff. CONCLUSION: A survey of community hospitals indicated that although most engaged in productivity monitoring, systems for such measurement often failed to capture all relevant clinical workload data.

Hospitals, Community↗
PubMed1992

Use of health maintenance organization data bases to study pharmacy resource usage in diabetes mellitus.

OBJECTIVE: To evaluate use of medications by patients with diabetes. RESEARCH DESIGN AND METHODS: We analyzed the computerized pharmacy data base of a large health maintenance organization to evaluate cost impact and patterns of usage for all pharmacy products by a defined population of diabetic patients. RESULTS: Diabetic patients received 31.2 dispenses/yr compared with 11.5 for control patients. Total pharmacy costs were threefold higher for diabetic patients ($621 vs. 207/yr) and accounted for approximately 17% of their total health-care costs. Products specifically for the care of diabetes averaged $175/yr or approximately 4.5% of their total health-care costs: 57% received an oral hypoglycemic agent, 34% received insulin, and 6% received both. Cardiovascular drugs accounted for 29% of total costs. There was increased use of most classes of medication by patients with diabetes. CONCLUSIONS: Health maintenance organization management data bases, particularly those storing pharmacy dispensing data, provide useful information on the impact of chronic disease. People with diabetes receive a greater number of most types of medication with a greater overall cost than do nondiabetic people. Previous studies have underestimated the contribution of pharmacy purchases to the costs of caring for a diabetic population.

Adolescent↗