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PubMed1992

The components of satisfaction with outpatient pharmacy services.

The true objective of a pharmacy manager is not just to measure satisfaction, but to improve it by identifying and meeting the needs of the patient. This study was undertaken with the objective of determining the relevant components of outpatient pharmacy service which impact the patient's perception of satisfaction, and to develop an on-going instrument to track satisfaction with pharmacy services over time. A survey was mailed to 391 outpatients. Simple correlation was used to identify the salient components of patient satisfaction. Multiple regression was used to determine the relative contribution of each of these components to overall satisfaction. Principle components analysis (PCA) provided the basis for delineating the underlying dimensions of which patient satisfaction is comprised. The two most meaningful factors derived from these data can be defined as professional communication and the physical and emotional well-being of the patient. By understanding the dynamics of the components of satisfaction, pharmacy managers can emphasize those areas which will produce a more satisfied patient, repeat patronage, and enhanced viability for the pharmacy.

Factor Analysis, Statistical↗
PubMed2000

Patient compliance and blood pressure control on a nuclear-powered aircraft carrier: impact of a pharmacy officer.

The impact of a pharmacy officer on patient compliance and blood pressure control on a deployed nuclear-powered aircraft carrier for a 2-week at-sea period was evaluated. Before any counseling by a pharmacy officer, 43 crewmembers on chronic medications anonymously completed a compliance questionnaire. The pharmacy officer then counseled these crewmembers. A follow-up compliance questionnaire was completed 2 weeks later. After counseling, compliance had increased 58% (p < 0.0001) from compliance measured before counseling. The pharmacy officer also initiated therapeutic interventions. Among 26 crewmembers diagnosed as hypertensive, preintervention blood pressure (BP) measurements were obtained. Ten to 14 days after the initial BP measurement, BP was remeasured. After intervention, 31% (p < 0.02) more crewmembers were at BP goal compared with before intervention. A pharmacy officer, working closely with a medical officer, improved patient compliance and blood pressure control. One problem identified was that these warships require computer software that can prospectively identify drug-drug interactions.

Blood Pressure↗
PubMed2001

Responsive regulation of Internet pharmacy practice.

Professor Brushwood discusses the effectiveness of the Internet as a medium for carrying out pharmaceutical care. A proponent of Internet pharmacy, Professor Brushwood argues that pharmacy regulators could best protect and promote public health through responsive Internet regulation. Wary of state paternalism, the article advocates the Verified Internet Pharmacy Practice Site program of the National Association of Boards of Pharmacy as a model method for regulating pharmacy practices over the Internet.

Commerce↗
PubMed2002

Can the profession of pharmacy serve as a model for health informationist professionals?

Pharmacy could serve as a model for the health informationist profession proposed by Davidoff and Florance in their 2000 editorial in the Annals of Internal Medicine. The current training and practice roles for pharmacists suggest a way to prepare health sciences librarians for work with clinical health care teams. The influences that spurred the transformation of pharmacy parallel in many respects those suggesting the need for more information professionals prepared to practice in clinical health care settings. During the same decades that health sciences librarians have been debating and experimenting with new professional roles such as clinical medical librarians, pharmacy has undergone an intensive review of its core values, mission, practice roles, and educational preparation methods. Until recently, most pharmacists graduated from five-year baccalaureate programs preparing them to understand drug products, sources of supply, and effective ways to dispense them to patients as prescribed by physicians. Today, almost all pharmacy students graduate from six-year doctor of pharmacy programs that prepare them to be the primary providers of what their profession calls "pharmaceutical care." The pharmaceutical care model suggests that health information professionals in clinical settings could be educated and trained to provide what we might call health information care.

Humans↗
PubMedDate not supplied

[Critical elements for the extension of working hours in an in-hospital Pharmacy Department]

INTRODUCTION: Individualised drug dispensation facilitates compliance with validated prescriptions, the application of criteria for rational use, the prevention and solution of drug-related problems. However, its complexity entails a risk for errors in procedure design and implementation, which renders quality assessment and continual improvement mandatory. OBJECTIVE: To analyse critical elements justifying the extension of working hours in an in-hospital Pharmacy Department, and other improvements within the pharmaco-therapeutic process through activity and hospital care quality indicators. METHODS: This is an observational, analytic study wherein seven activity and quality indicators were established. Regarding the latter, a qualitative and quantitative cause analysis was performed. The study period was from April to June 2001. RESULTS: Monthly average of hospital admissions was 641+/-50; of these, 40% take place during the evening-night hours, and 559+/-197 scheduled surgical procedures were performed. A total of 1,499+/-158 monthly prescriptions were processed, representing 36,790+/-733 doses. Eighteen percent of daily prescriptions were received at 14-15 h, and 21% were offset 24 h with respect to prescription date. During the evening-night period the on-call supervisor visited the Pharmacy 4 times a day to dispense 10 drugs corresponding to 4 patients; 47.7% of cases took place at 15-21 h, patient admissions and pharmacy dispensation errors being the main reason for visits. CONCLUSIONS: Extending the hours of operation in a Pharmacy Department would improve pharmaco-therapeutic patient care, but this should be associated with an integral improvement of doctor and both ward and pharmacy nursing staff work procedures.

Journal Article↗
PubMed2005

Employee knowledge of a managed pharmacy benefit in a large corporation.

Knowledge about prescription drug benefits is necessary for consumers to choose appropriate health benefits plans in a consumer-directed health plan market. The objective of this study was to describe employees' knowledge of their prescription drug benefits. A one-group, cross-sectional survey of full-time university employees with a tiered pharmacy benefit was performed. Correct responses to knowledge questions were described individually and as an aggregate index score. Respondent understanding of pharmacy benefits was low to moderate. Specifically, knowledge of pharmacy benefits was most limited with respect to formulary management, cost sharing, and financial implications of out-of-network use and the selection of a branded or generic medication. Future research should refine methods for assessing knowledge of pharmacy benefits, explore knowledge of pharmacy benefits in diverse samples, and assess the consequences associated with variations in knowledge of prescription drug benefits.

Adult↗
PubMed2003

Women's perception of bone-mineral density testing and osteoporosis education in the community pharmacy.

OBJECTIVE: The objective of this study was to assess women's level of acceptance and attitudes toward bone-mineral density (BMD) testing and osteoporosis education in the community pharmacy. DESIGN: The study design was a questionnaire with 13 statements using a five-point scale anchored from "strongly disagree" to "strongly agree." The statements focused on the value and comfort level of BMD testing in a pharmacy, confidence in pharmacists, osteoporosis education in the pharmacy, and payment for such services. One-sample t-tests were used to assess whether the responses statistically differed from the midpoint scale value. Comparisons also were made between demographic characteristics (education level, family history of osteoporosis, and daily calcium intake). SETTING: An independently owned grocery store chain (Bashas') in the Phoenix, and Tucson, Arizona, metropolitan areas. PATIENTS: The survey was administered to women upon completion of a BMD screening. MAIN OUTCOME MEASURES: Responses to 13 statements and demographic questions. RESULTS: Eighty women completed the survey. Women strongly agreed that BMD testing in community pharmacies was valuable and that it would increase the public's awareness of osteoporosis. For all 13 statements, respondents strongly agreed or agreed with the importance and role of BMD testing. All responses were statistically significantly greater than the midpoint scale value (P<0.001). There were no statistically significant differences in responses among women with higher education, with a family history of osteoporosis, and who take daily calcium (P>0.05). CONCLUSIONS: These women's opinions suggest that BMD testing has a useful role in community pharmacies.

Journal Article↗
PubMed1981

History of clinical pharmacy and clinical pharmacology.

The purpose of the Symposium on Clinical Pharmacy and Clinical Pharmacology is to describe the present and future functional roles of clinical pharmacists and clinical pharmacologists in drug research, professional education, and patient care. Clinical pharmacy is a relatively new professional discipline, being only about 15 years old. This new breed of pharmacists is patient rather than drug product oriented. The discipline arose out of dissatisfaction with old practice norms and the pressing need for a health professional with a comprehensive knowledge of the therapeutic use of drugs. The clinical pharmacy movement began at the University of Michigan in the early 1960s, but much of the pioneering work was done by David Burkholder, Paul Parker, and Charles Walton at the University of Kentucky in the latter part of the 1960s. Clinical pharmacology is a professional discipline that combines basic pharmacology and clinical medicine. Its development began in the early 1950s, primarily as a result of the efforts of Harry Gold. It has had a slower growth than clinical pharmacy but it has made many important contributions to our knowledge of human pharmacology and the rational use of drugs.

Drug Information Services↗
PubMedDate not supplied

International pharmacy.

Several worldwide initiatives involve pharmacy education and practice; however, the International Pharmaceutical Federation is the only worldwide pharmacy organization currently in existence. This is the first report of the good pharmacy practice initiative published in the United States. We hope that it will stimulate interest in international pharmacy.

Drug Utilization↗
PubMed2005

Clinical pharmacy at the university hospital from São Paulo, Brazil.

Clinical Pharmacy includes all services performed by pharmacists practicing in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used. Clinical Pharmacy activities may influence the correct use of medicines at three different levels: before, during and after the prescription is written. At the same time, pharmaceutical care philosophy is coming to Brazil. This paper comments on the development of the Clinical Pharmacy concept in Brazil, mainly in its practice and experience in the University Hospital of São Paulo.

Brazil↗
PubMed2026

A systematic literature review of cultural concepts taught by pharmacist preceptors during pharmacy student experiential placements.

BACKGROUND: Cultural concepts such as cultural intelligence, awareness, competency and safety are essential in guiding culturally responsive care in health professional practice. Pharmacist preceptors play a pivotal role in sharing both clinical and cultural safe practice with pharmacy students. Culturally responsive care can contribute to achieving health equity, which is especially important for Indigenous communities. AIM: To review literature on cultural concepts in pharmacist preceptorship practices, and how these concepts are taught and communicated to pharmacy students during experiential learning. METHOD: The systematic review followed the PRISMA 2020 guideline. Scopus, PubMed, and Google Scholar were used to identify articles specific to pharmacist preceptors and pharmacy students published between 2015 and 2025, and available in English. RESULTS: Three full-text articles met the inclusion criteria. Major themes and subthemes were identified; pharmacist preceptors lacked preparedness to teach cultural concepts, resulting in variability in preceptors' understanding of cultural concepts and confidence in fulfilling preceptor responsibilities, underutilised structured frameworks to guide students' learning, challenges with preceptorship due to limited resources and support, and the influence of preceptorship on student learning, which impacted students' learning and competency. CONCLUSION: Pharmacy students had minimal exposure to culturally informed pharmacist preceptorship. It is likely that pharmacist preceptors require country-specific educational resources to support culturally safe preceptorship. Future research is required to substantiate these findings, and to guide culturally responsive practice and promote equitable health outcomes in diverse populations.

Humans↗
PubMed1993

Inner-city pharmacies: can they meet the OBRA '90 mandates?

Visits were made to 21 pharmacies in two poor Chicago neighborhoods as one component of the University of Illinois at Chicago's commitment to help improve health care delivery, ensure that pharmacy services are not overlooked in local health reform efforts, and understand the implications of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). Pharmacists report that Medicaid reimbursement policies result in: (1) prescribing patterns that have no consistent therapeutic or economic rationale; (2) dispensing of expensive drugs, some of which are then sold on the street or to other pharmacies; and (3) dispensing of unnecessary and often expensive legend drugs when other legend drugs and generics or over-the-counter products would perform just as well. On the positive side, 76% of the pharmacies possess computerized patient-profile systems, and 72% maintain background information on their prescribers. These results suggest that OBRA '90's mandates should contribute toward improving the Medicaid program, but that implementation is likely to be difficult and uneven.

Chicago↗
PubMed2000

Hospital pharmacy automation: collective mobility or collective control?

This study examines the relationship between new technology and pharmacy's changing role in the division of labour in health care. Does automation advance pharmacy's collective mobility project and transition to its new role as a clinical rather than a merely technical profession? Alternatively, does it threaten pharmacy's cultural authority and control of medication dispensing? Does technology serve as an artifact demarcating occupational and gender boundaries in the drug distribution labour process? These issues were examined through qualitative case studies conducted at three hospital pharmacies located in mid-sized Canadian health care facilities. All three institutions had implemented automated drug distribution technology in the expectation that it would allow more pharmacist's time to be shifted from dispensing-related to clinical activities. It was found that pharmacists had attempted to maintain control of their labour process and had resisted peripheralization from drug dispensing. Technological processes did serve as artifacts reinforcing occupational demarcations as well as professional solidarity vis a vis hospital administrators although its impact on gender boundaries was less evident.

Automation↗
PubMedDate not supplied

A practical guide to establishing vaccine administration services in community pharmacies.

OBJECTIVE: This article describes requisite components of a community pharmacy-based vaccine administration program and provides resources for obtaining training and materials to facilitate implementation in the pharmacy. DATA SOURCES: Published medical literature accessed via Medline; interviews of pharmacists who initiated vaccine administration programs; government publications; professional publications including manuals and newsletters; and the resources of the Washington State Board of Pharmacy. DATA SYNTHESIS: Pharmacists in several states have initiated vaccine-administration programs for adults, adolescents, and children within their pharmacies with acceptance by patients, third party payers, and other health professionals. In some states, collaborative prescribing agreements between physicians or nurse practitioners and pharmacists enable pharmacists to implement high-volume immunization clinics as well as individual patients services. Standardized training is available from several sources, and in most settings vaccine administration services can be implemented with low initial investment. CONCLUSION: Vaccine administration may soon become an integral function in community pharmacists responsibilities for the health and well-being of patients.

Adolescent↗
PubMed2004

Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

BACKGROUND: Although pharmacotherapy can be beneficial in the elderly, it can also lead to drug-related problems (DRPs), including untreated indications, drug use without an indication, improper drug selection, subtherapeutic dosage, overdosage, medication error, medication nonadherence, drug interactions, adverse drug reactions, adverse drug withdrawal events, and therapeutic failure. OBJECTIVE: The goal of this article was to review evidence from randomized controlled studies to determine whether DRPs and the related health outcomes can be modified by providing clinical pharmacy services for the elderly in community-based settings. METHODS: Randomized controlled studies that assessed DRPs and health outcomes in persons aged > or =65 years after pharmacist interventions were identified through searches of MEDLINE (1970-March 2003), the Cochrane Database of Systematic Reviews (through March 2003), and International Pharmaceutical Abstracts (1966-March 2003). The search combined the terms clinical pharmacists, aged, outcomes, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors' own materials was also conducted. RESULTS: This literature review included 14 randomized controlled studies: 5 involved interventions in the home health setting, 3 were instituted at hospital discharge with home follow-up, 3 were clinic based, 1 was conducted in the community pharmacy setting, and 2 were conducted in long-term care facilities. These studies provided considerable evidence that clinical pharmacy interventions reduced the occurrence of DRPs in the elderly but showed limited evidence that such interventions reduced morbidity, mortality, or health care costs. CONCLUSIONS: Future large multicenter studies are necessary to test the cost-effectiveness of clinical pharmacy services for the community-based elderly and the impact of these services on such health outcomes as use of health services, timed functional-status measures, and adverse drug reactions.

Aged↗
PubMed1999

Activities, functions, and structure of pharmacy and therapeutics committees in large teaching hospitals.

The results of a survey on the activities and functions of hospital-based pharmacy and therapeutics (P&T) committees are presented. Questionnaires were mailed to the pharmacy director or the person responsible for the pharmacy's drug information service at 267 teaching hospitals throughout the United States in 1994 and 1995. The survey questions covered P&T committee composition, functions, roles of members, policies and procedures, and formulary-maintenance activities. The overall response rate was 70%. The mean number of members on the P&T committees was 19.3, of whom 91% were allowed to vote. There was an average of 12.3 physicians on the committees. Each P&T committee had at least one pharmacist member, with an average of 3.2 pharmacist members; 69.5% of the institutions reported having a committee secretary, who was almost always a pharmacist. On almost all committees, pharmacists wrote the minutes, prepared the formulary review documents, and were responsible for monitoring formulary activities outside the meeting. The P&T committee functioned in a very formal manner. Most (87.7%) of the respondents reported that their institutions had a closed formulary. At all hospitals, the attending medical staff could request additions to the formulary, but at only 62.4% of the hospitals could pharmacy staff make a similar request. The committees were active in changing the formulary. P&T committees in large teaching hospitals are active in formulary management, are large and diverse, and consist mainly of physicians, although pharmacists play an important role in the meetings.

Formularies, Hospital as Topic↗
PubMed2004

ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2003.

PURPOSE: Results of the 2003 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education 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. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. RESULTS: The response rate was 47.1%. Virtually all hospitals (95.3%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2000; fewer respondents reported monitoring less than 25% of patients in the hospital, and most hospitals reported an increase in the amount of time pharmacists devoted to monitoring activities. Pharmacists were provided computer access to laboratory information in 78% of hospitals to facilitate this function. Detection and reporting of adverse drug events (ADEs) have substantially increased since 1999, with an increase of 42% in events reported internally. Strategies to improve ADE reporting were in place in 84% of hospitals, indicating that pharmacists are adopting the widely recommended philosophy of learning from errors. Errors were less widely reported externally, limiting the value of aggregated data for improving the medication-use process. Most hospitals (85.5%) had an interprofessional infrastructure in place to discuss and learn from voluntary reports of ADEs. Medication counseling continued to be relatively infrequent, with nearly three fourths of hospitals reporting fewer than 26% of inpatients received medication education. Pharmacist staffing in hospitals has risen significantly, from an average of 8.6 full-time equivalents (FTEs) in 2002 to 9.4 FTEs per hospital. Vacancy rates for pharmacists decreased from 7.3% in 2002 to 43%. It is now estimated that there are 1846 vacancies in hospital pharmacies. CONCLUSION: Notable improvements in hospital pharmacy practice have been made. The percentage of patients whose medication therapy is monitored by pharmacists has increased, and most hospitals reported that the amount of time pharmacists spent monitoring patients' medication therapy had increased. Internal and external reporting of ADEs has increased, and pharmacist vacancies have decreased from 2002. Staffing has also improved, suggesting an abatement of the critical shortage of pharmacists in the hospital setting.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.

BACKGROUND: Health care organizations may be able to use pharmacy data to identify patients with schizophrenia and poor antipsychotic adherence. OBJECTIVE: To determine whether a pharmacy-based measure of outpatient adherence, the medication possession ratio (MPR), is associated with adverse outcomes among patients with schizophrenia, as evidenced by increased psychiatric admission. RESEARCH DESIGN: Cohort study linking pharmacy and utilization data for veterans with schizophrenia. MPRs were calculated by dividing the number of days' supply of antipsychotic medication the veteran had received by the number of days' supply they needed to receive to take their antipsychotic continuously. Using multivariate regression, the relationship between MPRs and psychiatric admission was examined. SUBJECTS: Sixty-seven thousand seventy-nine veterans who received a diagnosis of schizophrenia and had outpatient antipsychotic medication fills between October 1, 1998 and September 30, 1999. RESULTS: Patients with MPRs close to 1.0 had the lowest rates of admission. As patients secured progressively smaller proportions of required antipsychotic medication (and had smaller MPRs), rates of admission climbed. Among patients on one antipsychotic (n = 49,003), patients with poor adherence (MPRs < 0.8) were 2.4 times as likely to be admitted as patients with good adherence (MPRs from 0.8-1.1). 23% of poorly adherent patients but only 10% of adherent patients were admitted. Once admitted, poorly adherent patients had more hospital days. Patients who received excess medication also had higher admission rates. CONCLUSIONS: Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

Adult↗