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PubMed2000

Television advertising of pharmacy medicines in the United Kingdom.

In the UK pharmacy is often promoted as the first port of call for minor ailments and the pharmacist's armamentarium of products is increasing as further products are reclassified from prescription only control. Non-prescription medicines in the UK can be advertised directly to the public but the advertisements must comply with the law. Some medicines, namely pharmacy can only be sold from pharmacies by, or under, the supervision of a pharmacist. This report describes the major findings of a postal survey of community pharmacists on the subject of advertising of pharmacy medicines and put them into context by outlining the legal and quasi-legal requirements. Further other studies concerning the advertising of non-prescription medicines are discussed in the context of requests for, and sales of, medicines available without a prescription.

Advertising↗
PubMed2001

Evaluation of antiparkinsonian drugs in pharmacy records as a marker for Parkinson's disease.

AIM: The aim of this study was to determine whether use of antiparkinsonian drugs in pharmacy records can be used as a marker for patients with Parkinson's disease (PD). METHOD: Data were obtained from the Rotterdam Study, a community-based prospective cohort study among people aged 55 years or older who were all screened for PD. For 5510 persons, of whom 74 had PD, pharmacy records were available. Stepwise logistic regression analysis was used to evaluate whether age, sex and use of the antiparkinsonian drugs amantadine, anticholinergics, dopamine agonists, levodopa and selegiline, were predictive variables for PD. For each individual a probability for having PD was calculated. Sensitivity, specificity and positive predictive value (PPV) were calculated at different cut-off values based on calculated probabilities. RESULTS: More than 90% of the users of levodopa, bromocriptine, selegiline, and users of at least two different antiparkinsonian drugs had PD. Age, use of amantadine, anticholinergics, bromocriptine, levodopa, and selegiline were predictive variables for PD. After application of different cut-off values, sensitivity was at most 66.2%, and specificity was at least 99.8%. A PPV of higher than 90% was obtained at higher probabilities. CONCLUSION: Based on the high PPV of our predictive model, antiparkinsonian drugs can be used as a reliable marker for PD in pharmacy records. Because sensitivity is low, pharmacy records cannot be used to estimate prevalence of PD.

Aged↗
PubMed2003

Referrals of dyspeptic self-care patients from pharmacies to physicians, supported by clinical guidelines.

OBJECTIVE: It is important that self-medication customers with potentially serious diseases are correctly referred from pharmacies to physicians. The aim of this study was to determine the appropriateness of pharmacy practitioners in referring customers suffering from dyspepsia to a general practitioner (GP). METHOD: Practitioners in 12 pharmacies, supported by clinical guidelines and training, recorded information regarding the dyspeptic customers they referred to a physician on a data collection card. The card was sent to a GP participating in the study, who did a regular medical history of the referred customer over the phone and assessed whether the referral was appropriate or not. RESULTS: Out of 133 referred customers with dyspepsia, 132 completed the study. The GPs found that 119 (90%) needed a medical examination and/or prescription drugs and thus assessed these referrals as appropriate. In three cases (2%) the referral was doubtful and in ten cases (8%) not adequate, as the symptoms were more likely to come from an irritable bowel syndrome than dyspepsia. CONCLUSION: The results confirm the role of pharmacy practitioners as important members of the primary health care team. Provided with the appropriate referral guidelines and training, they are in a position to operate as 'filters', promoting the adequate use of other primary care services.

Adult↗
PubMed2001

Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications.

BACKGROUND: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-transplant care. This randomized, controlled trial evaluates the impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive agents. METHODS: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the intervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histories and review of patients' medications with an emphasis on optimizing medication therapy to achieve desired outcomes and minimizing adverse medication events. The clinical pharmacist also provided recommendations to the nephrologists with the goal of achieving desired outcomes. To promote medication compliance by using compliance enhancement strategies, the clinical pharmacist counseled patients concerning their medication therapy and instructed them how to properly take their medications. Patients in the control group received the same routine clinic services as the intervention group except that they did not have any clinical pharmacist interaction. Compliance rate (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month, and the mean time patients were compliant were compared between groups. Whether there was a difference in the frequency of patients achieving 'target' immunosuppressive levels in the control and study groups was evaluated. RESULTS: The mean CR for patients who had clinical pharmacist intervention (n=12) was statistically higher than the control group's (n=12) mean CR (p<0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients in the control group (p<0.05). Additionally, patients who had clinical pharmacy services had a greater achievement of 'target' levels than patients who did not receive these services (p<0.05). CONCLUSIONS: Patients who received clinical pharmacy services with traditional patient care services had better compliance with immunosuppressants than patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharmacist as part of the care for post-transplant patients is beneficial for enhancing medication compliance.

Chi-Square Distribution↗
PubMed2001

Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.

Adolescent↗
PubMed1999

Clinical pharmacy interventions by community pharmacists during the dispensing process.

AIMS: To evaluate the professional contact between the community pharmacist and general practitioner during the dispensing process on issues other than the legality or simple clarification of the prescription. METHODS: Fourteen community pharmacists from five adjacent localities completed details of each clinical pharmacy intervention during 1 week of each month for a period of 1 year. Each week of the month was randomly selected. When a community pharmacist had to contact the prescriber, during the dispensing of a prescription, the following data were recorded: brief patient details, the prescribed drug therapy, the reason for intervention, the outcome and the time taken. The main outcome measures were the type and nature of each intervention, the BNF category of the drug involved and the time taken. A multidisciplinary clinical panel assessed the potential of each intervention to alter the outcome of the patient's clinical management and to prevent a drug related hospital admission. These assessments were ranked between 0 and 10 (100% confident). RESULTS: During a period covering 1 week per month over 1 year, 1503 clinical pharmacy interventions were made out of 201 000 items dispensed. When normalized for the dispensing volume of each community pharmacy the lower the number of items dispensed then the greater was the percentage of interventions (P=0.013). The clinical panel decided that between 19 (0.01% of the total items dispensed) and 242 (0.12%) interventions may have prevented a drug-related hospital admission, 71 (0.04%) to 483 (0.24%) could have prevented harm whilst 103 (0.05%) to 364 (0.18%) had the potential to improve the efficacy of the intended therapeutic plan. The panel also decided that 748 (0.37%) interventions improved the clinical outcome and could have saved a visit to or by the general practitioner. Conclusion Clinical pharmacy provided by a community pharmacist during the dispensing process has the potential to provide a valuable contribution to health care.

Community Pharmacy Services↗
PubMed2003

Evaluation of the quality of amodiaquine and sulphadoxine/pyrimethamine tablets sold by private wholesale pharmacies in Dar Es Salaam Tanzania.

OBJECTIVE: There are several independent reports in Tanzania of treatment failures with commercially available sulphadoxine/pyrimethamine (SP) and amodiaquine (AQ) brands. The aim of this work was to assess the quality of SP and AQ tablets marketed by wholesale pharmacies in Dar Es Salaam, Tanzania. METHODS: All eight wholesale pharmacies authorized to import medicines and located in Dar Es Salaam were included in the study. From each pharmacy, samples of all SP and AQ brands available at the time of sampling were bought, provided they had a shelf-life of at least 1 year. A sample was either an intact box of 100 tablets or a sealed tin of 100 tablets. To ensure blinding, 30 tablets of each sample were removed from their original containers, coded and sent to the quality control laboratory for analysis. The name, strength, batch number, manufacturer and the expiry dates of the tablets were recorded. In total 15 AQ and 18 SP samples were collected. Identity, assay for content of active ingredients and dissolution assay were performed as described in the United States Pharmacopoeia (USP). RESULTS: All samples passed the identity test. Among the AQ samples collected, two of 15 (13%) failed the dissolution test but all passed the assay for content, whereas two of 18 (11%) and eight of 18 (44%) SP samples failed the assay for content and dissolution tests, respectively. None of the pharmacies stocked all AQ and SP brands. CONCLUSION: This work reveals the availability of poor quality antimalarial drugs on the Tanzanian market. Use of substandard drugs could have serious clinical consequences to patients. The results support the need for continuous monitoring of the quality of marketed drugs to ensure safety and efficacy of these products in the treatment of malaria in endemic areas.

Amodiaquine↗
PubMed2001

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning.

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.

Attitude of Health Personnel↗
PubMed2006

The professional subcultures of students entering medicine, nursing and pharmacy programmes.

This study sought to determine the attitudes, beliefs and values towards clinical work organization of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. In the Faculty of Medical and Health Sciences, The University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organized. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemized. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemized work and team based approaches. These include issues of professional socialization which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.

Attitude of Health Personnel↗
PubMed2005

Antimicrobial consumption data from pharmacy and nursing records: how good are they?

OBJECTIVE: To determine whether randomly selected intravenous (IV) antimicrobial doses dispensed from an inpatient pharmacy were administered. DESIGN: This was a prospective, cross-sectional study in which dose administration was confirmed by direct observation and by assessment of the medication administration record (MAR). A retrospective analysis of the return rate of unused IV antimicrobial doses was performed subsequently. SETTING: Medical and surgical intensive care units (ICUs) and non-ICUs of a 550-bed urban public teaching hospital. PARTICIPANTS: Hospitalized patients with an order in the pharmacy database for an IV antimicrobial during 9 non-consecutive weekdays in June 1999. RESULTS: Of 397 doses, 221 (55.7%) assessed by bedside observation and 238 (59.9%) assessed by MAR review were classified as administered; 139 doses (35.0%) were dispensed but changes in the drug order or the patient's status prevented their administration. In the subsequent assessment, of 745 IV antimicrobial doses dispensed during 24 hours, 322 (43.2%) were returned to the pharmacy unused; 423 (56.8%) of the doses-consistent with our prior observations-were presumably administered. CONCLUSIONS: Because computerized pharmacy data may overestimate actual antimicrobial consumption, such data should be validated when used in studies of hospital antimicrobial use. Dispense-return analysis offers a simple validation method.

Anti-Bacterial Agents↗
PubMed1995

An iconoclastic perspective on progress in pharmacy practice.

Progress in pharmacy practice is examined and areas for improvement are identified. Data from surveys of hospital and health system pharmacy practice from 1957 to 1994 show that the steady progress from 1974 to 1985 was not sustained over the past decade. Changing to a profession in which all practitioners provide pharmaceutical care will be difficult when practice in hospitals, where the most acutely ill patients are treated, does not meet the profession's recommended standards. Many pharmacists may be resigned to a reality in which their services are viewed as ancillary. The number of medication misadventures that occur indicates that there is an unmet need for effective medication management. Pharmaceutical care offers the promise of better patient outcomes as well as "reprofessionalization" of pharmacists. To elevate the level of pharmacy practice, individual practitioners need will; too much attention has been given to skill. Many new practitioners have earned Pharm. D. degrees but not received enough nurturing from colleagues to develop into innovators who will continue the profession's progress. It is crucial that the pharmacy practice and education communities cooperate to prepare pharmacists to function in the changing health care system. Also, professional organizations must set aside their fragmented interests and focus together on pharmacists' survival. The restructuring and economic pressures in health care may offer pharmacists the opportunity for progress, since improving drug use would help to decrease health problems and cost.

Awards and Prizes↗
PubMed1995

Pharmacy benefit management companies.

The principal services offered by pharmacy benefit management companies (PBMs) are described. A PBM contracts with employers, insurers, and others to provide accessible and cost-effective benefits to those groups' members. PBMs vary in their organization and services because they originate from different types of businesses. Many PBMs have been formed by publicly traded companies that have combined traditional ways of controlling cost and use, such as formularies, with new elements to form organizations whose primary function is managing the pharmacy benefit. Often, the PBM is paid a fixed amount for which it must provide all contracted services. PBMs may provide pharmacy services themselves (e.g., mail order prescription service is offered by Medco, one of the largest PBMs); more often, they subcontract with others to provide certain services. Full-service PBMs have the following functions: establishing networks of pharmacies for use by plan members; processing claims electronically at the time a prescription is filled and thus maintaining a database on drug use and cost; using these data to generate various reports; encouraging the use of generic products; managing existing formularies, helping to establish customized formularies, or providing a national formulary; providing information to support formulary guidelines (counter-detailing); offering programs in which prescriptions for maintenance medications are filled less frequently with larger amounts, often by mail order; negotiating volume-based rebates from manufacturers; performing drug-use review; developing disease management programs based on clinical practice guidelines and measurements of patient outcome; and evaluating outcomes by combining data on drug therapy with information about other parts of the patient's care.(ABSTRACT TRUNCATED AT 250 WORDS)

Contract Services↗
PubMed1996

Harvey A. K. Whitney Lecture. Searching for the soul of pharmacy.

This lecture explores the theme that the soul (character) of individual pharmacists must be nourished in order to save pharmacy as a health profession. Health care is being drastically altered by a private sector that says it wants to lower health care costs but in fact desires huge profits. Pharmacy leaders have shown nimbleness in dealing with corporate demands, but many are becoming too preoccupied with the business of health care. Pharmacists need to discipline themselves lest the lure of the new order blind them to their primary obligations to patients. Pharmacists should act as a counterforce to the marketing of prescription drug products directly to consumers. Pharmacy is an occupation psychically bound to the act of providing medications to patients, but which knows it must find a new reason for being. There is hope for the profession in this realization--it led to the philosophy of pharmaceutical care--but no guarantees. Pharmacists must declare that their interests may differ from their employers' whenever patient welfare is in question. Suggestions are offered on how to nourish the soul of pharmacy.

Drug Industry↗
PubMed1996

Pharmacy-based skin-testing program in a community hospital.

The establishment of a pharmacy-based skin-testing program at a community hospital is described. Problems with existing skin testing were brought to the attention of the pharmacy and therapeutics committee, which decided that one group of caregivers within the hospital should be chosen and trained to perform skin testing. A problem-solving team identified specific problems and developed solutions. The top four causes of the skin-testing problems were failure to follow procedure, inaccurate reading of tests, failure to report positive results, and failure to document results. Groups within the hospital who might perform skin testing were assessed according to several criteria; the pharmacy staff was selected because of ease of notification, availability, and ability to conduct follow-through (reading, documenting, and reporting results). Other improvements were step-by-step instructions for all phases of skin testing, a portable skin-test supply kit, and a skin-test record form to be placed in the physician progress notes. Pharmacists were trained by the employee health nurse. Pharmacist skin testing began in March 1995. Pharmacists administered tests to 93 inpatients and about 250 employees during the first 13 months of the program, and no problems were reported. Establishment of a pharmacy-based skin-testing program improved the quality of inpatient skin testing and enabled pharmacists to increase their role in patient care.

Hospital-Patient Relations↗
PubMed1999

Transitions in pharmacy practice, part 2: who does what and why.

The competencies required by the five practice models that constitute the total pharmacy care (TPC) model are discussed. Understanding the differences among the competencies required by the five practice models can help pharmacy's leaders estimate the extent of change that may be necessary whenever a change in practice is contemplated. Professional competence in any of the practice models is defined as the sum of skills, professional socialization, and judgment rooted in experience pertinent to the model. Possibilities for practice change are ideational and do not necessarily follow a straight line from other practice models to pharmaceutical care. The key competencies for each of the five practice models--drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution--demonstrate a clear distinction among the five models. The models draw on different knowledge and skills, are characterized by different attitudes and values about the work of pharmacy, and are grounded in different practice experience. While sharing a common underpinning of theory and practice, professional competence within each of the five models that make up TPC requires distinctly different knowledge and skills, professional attitudes, and values, as well as judgment that is developed through experience.

Humans↗
PubMed1999

ASHP national survey of pharmacy practice in acute care settings: prescribing and transcribing--1998. American Society of Health-System Pharmacists.

Results of the 1998 ASHP national survey of pharmacy practice in acute care settings that pertain to prescribing and transcribing practices are presented. Pharmacy directors at 1058 general and children's medical-surgical hospitals in the United States were surveyed by mail. Data on hospital characteristics were supplied by SMG Marketing Group, Inc.; the survey sample was drawn from SMG's hospital database. The response rate was 51.8%. Respondents reported that at least 90% of hospital and health-system pharmacy and therapeutics (P&T) committees are responsible for formulary development and management, drug policy development, medication-use evaluation, adverse-drug-reaction reporting, and medication error monitoring. More than 90% of the facilities use pharmacoeconomic, clinical and therapeutic, and cost information in formulary development; 83% have a medication-use-evaluation program designed to improve prescribing; more than 95% have P&T committees, infection control committees, and quality control committees; and more than 80% provide pharmacist consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. A majority of respondents reported that accurate transcription of medication orders is ensured by use of standardized physician order forms, clarification of illegible orders, reconciliation of medication administration records (MARs) and pharmacy profiles at least daily, and use of computer-generated MARs. The 1998 ASHP survey results suggest that pharmacists in acute care settings have positioned themselves well to improve the prescribing and transcription components of the medication-use process.

Ambulatory Care↗
PubMed2000

Development of a pharmacy residency program in home care.

A residency training program developed by a college of pharmacy in conjunction with a home care company is described. The 12-month program is based on the ASHP Residency Learning System and the goal statements and educational objectives of ASHP's accreditation standard for pharmacy practice residency training with emphasis in home care. Establishing the program involved identifying goals, objectives, and learning experiences consistent with the expected outcomes. Specific objectives for meeting goals in four categories--practice foundation skills, direct patient care, drug information and drug policy development, and practice management--were linked to expected program outcomes. Learning experiences that would lead to achievement of the program objectives and outcomes were selected and organized into one- to eight-week rotations (e.g., in acute care, care of pediatric patients, pain management, nutrition, patient education and counseling, and administration and practice management). Throughout the program, residents gain experience in pharmaceutical services and research. Skills in care planning and monitoring are emphasized, as is practicing pharmaceutical care in an interdisciplinary environment. Residents who have completed the program have found employment immediately as pharmacy managers of home infusion centers. Pharmacy residency training in home care provides the experience needed to function as a competent clinician and manager who can identify and solve problems to improve patient care.

Education, Pharmacy↗
PubMed2000

Enhancement of a pharmacy consultation program on a transitional care unit.

The revision and outcomes of a pharmacy consultation program on a transitional care unit (TCU) are described. In 1996, the pharmacy consultation program for the TCU at a 550-bed, tertiary care, community teaching hospital was revised. The changes included increasing the number and depth of medication reviews, mandating pharmacist attendance at interdisciplinary meetings, simplifying the medication review form, and expanding physician education. Data collected during the final two years of the original program (May 1994 to April 1996) and the first two years of the revised program (July 1996 to August 1998) were compared. The number of drug-related problems identified per admission was 0.80 for the revised program (versus 0.32 for the original program), the percentage of patients receiving at least one pharmacy medication review was 99% (versus 70%), the number of pharmacist recommendations made was 726 (versus 140), and the percentage of recommendations accepted was 82% (versus 55%). The program required up to 15 hours of pharmacist time per week. Cost savings were estimated at $15,000 for the first year of the revised program and $23,000 for the second year. Revision of the pharmacy consultation program for a TCU increased the identification of drug-related problems and the number of pharmacist recommendations, helped integrate pharmacists into the interdisciplinary care team, and produced a modest estimated cost savings.

Data Collection↗