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PubMed2006

Advocacy coalitions and pharmacy policy in Denmark--solid cores with fuzzy edges.

This paper presents the results from a qualitative study in which the Advocacy Coalition Framework (ACF) was used to analyze deregulation of the distribution of medicine in Denmark in October 2001. The study is based on qualitative methods, and it examines the policy process between 1996 and 2001. Data sources were documents and qualitative interviews. The results show that minor modifications of the ACF are needed to make it fully applicable to the case of pharmacy policy, especially when the policy process proceeds in a predominantly corporatist state. We found that the policy process was framed by two coalitions advocating different belief systems. One coalition wanted the pharmacy sector to be controlled by the state, the other wanted a full-scale liberalization. Throughout the process there was a general shift in policy core beliefs among the actors involved--moving from positively disposed towards a market-oriented reform to being more negatively disposed towards such a reform. We argue that two factors contributed to this. First, as the discussions about a reform became more specific, technical matters began to influence the actors. Second, the legitimacy of a solution which did not alter the regulation of the pharmacy sector radically, was reinforced by institutionalized norms that made politicians take onboard pharmacy professionals' concerns.

Attitude to Health↗
PubMed2003

Development of a computer algorithm for defining an active drug list using an automated pharmacy database.

BACKGROUND AND OBJECTIVE: Increasingly, pharmacy databases are being used to assist in evaluating the appropriateness of drug therapy. Such determinations often require the creation of a drug regimen at a particular point in time. The objective of this study was to develop a computer algorithm for defining a cross-sectional active drug list. METHODS: Electronic pharmacy data were obtained as part of the Iowa Medicaid Pharmaceutical Case Management Program. The active drug lists generated by the computer algorithm were compared with active drug lists generated by independent pharmacist review of the pharmacy refill data. RESULTS: In a sample of 25 patients who received 379 potentially active medications, the interrater reliability between pharmacist reviewers was excellent (kappa=0.94). In a second sample of 100 patients who received 1476 potentially active medications, the computer algorithm had a sensitivity of 93.8% and specificity of 91.7%, using pharmacist review as the comparison standard. CONCLUSION: The computer algorithm was found to be a valid method of processing electronic pharmacy data to yield a characterization of drug exposure at a point in time. The potential benefits and limitations of using this approach are discussed.

Adult↗
PubMedDate not supplied

"One voice-one vision" for Wisconsin pharmacy.

OBJECTIVE: To describe how a new organization, reflecting a new vision and unifying the pharmacists of Wisconsin, was created by bringing together organizationally the resources and memberships of the Wisconsin Pharmacists Association and the Wisconsin Society of health-System Pharmacists. SETTING: State of Wisconsin. DESCRIPTION: The boards of directors of the two precursor organizations initiated an exploration of the desirability and feasibility of creating a single, new organization to represent, with a unified voice, all of Wisconsin's pharmacists. This two-year effort resulted in the creation of the Pharmacy Society of Wisconsin (PSW) on January 1, 1998. INNOVATION: The new organization builds on the strengths and resources of two pharmacy organizations that previously represented divergent views and practice settings. PSW offers a new vision and level of service to its members and to pharmacy students. It presents a single voice to patients, other health care providers, and governmental agencies. RESULTS: The creation of the Society was supported unanimously by the two boards of directors and by 98% of the voting membership of the two previous organizations. CONCLUSION: Through a deliberate and extensive planning and organizational process, two vigorous professional organizations were able to recognize the importance of combining their resources into a new single organization. The pharmacists of Wisconsin responded to a call for a new vision and a unified voice. The opportunity exists for American pharmacy to examine how it will be best served by its professional organizations.

Humans↗
PubMed1999

The Role of the Practice of Nuclear Pharmacy in Positron Emission Tomography.

As nuclear medicine evolved from an obscure research tool to a mainstream clinical diagnostic and therapeutic modality, so has the role of the practice of pharmacy in nuclear medicine also evolved. A similar evolution is unfolding today in the practice of positron emission tomography (PET). The skills of many diverse professionals, including pharmacists, are essential for the safe and efficient operation of a modern PET facility. The importance of the role of pharmacists in PET has been increasing as the use of PET radiopharmaceuticals has matured from research to clinical to commercial arenas. While it is clear that pharmacists can contribute clinical and technical skills to the operation of a PET center, perhaps one of the most important factors influencing the increased role of pharmacists in PET is their expertise and experience in the drug regulatory process. The commercial distribution of PET radiopharmaceuticals, primarily [18F]2-fluorodeoxyglucose (FDG), is currently being performed by a variety of corporate and institutional facility partnerships, with the likelihood of several new players entering the marketplace in the near future. This factor has served to dramatically increase the role for nuclear pharmacy in PET. The practice of nuclear pharmacy is a well-established component of PET. The role of nuclear pharmacists in PET is complementary to the many other professionals currently practicing in this specialty. With the rapidly increasing clinical demand for FDG imaging, it is likely that the number of facilities and institutions entering into the commercial distribution of PET radiopharmaceuticals will also increase. Such growth will also serve to solidify and expand the role for the practice of nuclear pharmacy in PET.

Journal Article↗
PubMed2006

Pharmacy fill patterns in young urban children with persistent asthma.

BACKGROUND: Medication adherence impacts healthcare utilization. Pharmacy records are useful to establish fill patterns. OBJECTIVE: Use pharmacy records to establish medication patterns fill patterns for comparison to healthcare utilization. Methods. Pharmacy records of 175 children with persistent asthma were collected and compared to healthcare utilization. RESULTS: Majority of subjects had significant healthcare utilization, low numbers of rescue medications, and poor controller medication fill rates. Those with more rescue medications had more healthcare utilization and more controller medications. CONCLUSIONS: Pharmacy fill patterns demonstrate few rescue and/or controller medication fills. Those with more rescue medications reported increased healthcare utilization despite controller medications.

Administration, Oral↗
PubMed1995

Task analysis of Air Force pharmacy practice.

The frequency with which United States Air Force pharmacists perform specific professional tasks and the pharmacists' views as to the importance of those tasks were studied. A questionnaire was prepared that asked recipients to rate each of 36 tasks selected as representing the spectrum of practice activities. There were four categories of tasks: managerial tasks, dispensing tasks, drug information tasks, and patient care tasks. Recipients rated the tasks with respect to frequency of performance and importance on separate 6-point scales. The questionnaire was mailed in May 1991 to the 225 pharmacists then serving in the Air Force worldwide. Of the 225 questionnaires, 150 usable questionnaires were returned (response rate, 67%). All the tasks in the survey were performed by at least one Air Force pharmacy officer, although the frequency of task performance varied. In particular, the frequency of many patient care tasks was low. All the tasks were perceived to have some importance, but drug information tasks were rated as being significantly more important than tasks in the other categories; patient care tasks were rated lowest in importance. The results varied with the respondents' demographic characteristics. Pharmacy officers with more years of service, more senior positions, higher rank, or an advanced degree in a field other than pharmacy tended to give responses that diverged from those of the population. A 1991 survey showed an awareness among Air Force pharmacists of the need to orient practice around patient care; however, they were not spending substantial time on patient care and tended to view it as less important than more traditional pharmacy tasks.

Female↗
PubMed2004

Substance use by pharmacy and nursing practitioners and students in a northeastern state.

PURPOSE: The prevalence and predictors of substance use among pharmacists and nurses and pharmacy and nursing students were studied. METHODS: During summer 2002, pharmacists and nurses in a northeastern state were mailed an anonymous survey to determine their use of alcohol, tobacco, and commonly abused drugs; to determine their ease of access to controlled substances; and to measure their family history of alcohol and drug problems. A similar but not identical survey was distributed to pharmacy and nursing students during spring 2000. RESULTS: A total of 262 usable questionnaires were received from pharmacists and nurses (response rate, 72.8%), and 138 usable questionnaires were received from students (35.3%). Large majorities of nursing students, pharmacy students, and nurses were women. A higher percentage of pharmacists reported having used an opioid or an anxiolytic at least once in their lives (24.8% and 14.3%, respectively) than nurses (14.5% and 7.8%). Higher percentages of nursing students and nurses reported having ever used an unprescribed drug (74.5% of nursing students and 63.6% of nurses). CONCLUSION: A survey of pharmacy and nursing practitioners and students in a northeastern state provided important information on alcohol, tobacco, and illicit drug use among these groups and highlighted the need for prevention and intervention.

Humans↗
PubMed2000

Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women.

BACKGROUND: Antiretroviral treatment for HIV-infected women is standard during pregnancy to prevent vertical transmission, but data on postpartum therapy for the mother are lacking. OBJECTIVE: The objective of this study was to examine the impact of provider and patient characteristics on receipt of antiretroviral therapy and pharmacy-based measurement of adherence by postpartum HIV-infected women. RESEARCH DESIGN: This was a retrospective cohort study. SUBJECTS: The study included 2,648 New York State Medicaid-enrolled HIV-infected women who delivered from January 1993 through October 1996 and were followed up through September 1997. MEASURES: From Medicaid claims in the first postpartum year, the study examined any prescribed antiretroviral therapy and, among women treated >2 months, adherence, defined as > or =80% days covered by prescribed therapy from first to last antiretroviral prescription. RESULTS: Antiretroviral therapy was prescribed for 681 (26%) study women. Of 292 women treated >2 months, 28% were adherent on the basis of the pharmacy-based measure. The proportion of treated women was highest in 1996 (40%), and adherence was best in 1995 (44%) when most women took monotherapy. The adjusted odds ratios (AORs) of treatment were 1.67 (95% CI, 1.24 to 2.25) for women receiving HIV-focused services and 2.71 (95% CI, 1.99 to 3.69) for women with a provider in an HIV-related specialty. The AORs of adherence were greater for women with HIV-focused services (2.13; 95% CI, 1.05 to 4.30) and for former illicit drug users versus nonusers (2.40; 95% CI, 1.05 to 5.50). CONCLUSIONS: This population-based pharmacy analysis reveals improving antiretroviral use but continuing poor pharmacy-based adherence by postpartum HIV-infected women. Receipt of HIV-focused services appears to be particularly beneficial in increasing the likelihood of treatment and adherence.

Adult↗
PubMed2002

Quantifying the physician contribution to managed care pharmacy expenses: a random effects approach.

BACKGROUND: Despite the availability of more sophisticated techniques, few alternatives to ordinary least squares (OLS) regression have been utilized to profile physician prescribing in managed care. It is not known to what extent the modest R values derived from OLS models reflect incomplete risk adjustment or widely varying physician prescribing patterns. OBJECTIVES: To quantify the role of interphysician variability relative to overall variability in managed care pharmacy expenses, and to examine the extent to which different statistical approaches generate meaningful differences in profile results. RESEARCH DESIGN: Comparison of three basic statistical modeling approaches: OLS, fixed effects regression, and random effects (ie, hierarchical) regression models. SETTING: Two managed care populations that differed more than 2-fold in per member pharmacy expenditures in 1999, one from the Midwestern United States, the other from three Western States. MAIN OUTCOME MEASURES: The intraclass correlation coefficient (ICC, the proportion of variability in expenses attributable to differences among physicians) and the range of projected expenses attributed to each physician's prescribing style. RESULTS: The ICCs were small for aggregated pharmacy expenditures, 0.04 or less in both populations. As determined by OLS, the most costly physician contributed 94,399 U.S. dollars in excess expenses to the organization whereas the most parsimonious saved 89,940 U.S. dollars. When derived from random effects models, the range in performance was 63% of that derived from OLS. CONCLUSIONS: In the populations studied, systematic prescribing differences among physicians were small relative to the overall variability in pharmacy expenses, suggesting other factors were more likely driving these costs. Random effects models generated smaller estimates of the individual physicians' contribution to costs, sometimes considerably, relative to those derived from OLS and fixed effects approaches.

Adolescent↗
PubMed1992

Providing drug injectors with easier access to sterile injecting equipment: a description of a pharmacy based scheme.

In this short paper we describe the operation of a pharmacy-based scheme operating in Glasgow to provide injecting drug users with sterile injecting equipment. The operation of the scheme is described under a number of headings: its physical location, the policy of selling injecting equipment, the return of previously used equipment, counselling and referral, and, the style of working of pharmacy staff. It is shown that while retail pharmacies may be an important point of contact with injecting drug users it should not be assumed that pharmacy staff already possess the requisite skills for working in this area. There is a need for pharmacists' and their staff to be able to draw upon the experience of colleagues working in this area in order to benefit from a pool of common experience. In addition there is a need to provide staff with access to appropriate back-up and support services.

HIV Infections↗
PubMed1996

Pharmacy consultation and over-the-counter medication purchasing outcomes. Over-the-Counter Medication Intervention Project Team.

A demonstration project was conducted within 23 community pharmacies located throughout the state of Washington to: (1) assess the effects of pharmacy consultation on over-the-counter (OTC) medication purchasing decisions and costs, (2) to identify factors influencing those intending to purchase a brand name medication to change to a generic or private label product, or to a different brand name product, and (3) to quantify prevented adverse medication outcomes. Pharmacy students in their final year of training provided consultation to 745 consumers intending to purchase an OTC product. The consultations averaged 4.6 min in length, and resulted in 42.6% of consumers changing their intended purchase. These changes reduced OTC expenditures by an average of US $1.53 per customer, primarily as a result of movement from brand name products to lower priced generic or private label equivalents. Nearly 8% of consumers made no purchase after consultation, and 4.3% were referred to a physician. Logistic regression analysis identified gender of the consultant being female (odds ratio = 3.87, 95% CI = 1.58-9.45), and an increasing length of consultation (odds ratio = 1.30, 95% CI = 1.08-1.57) as being significant factors influencing consumers to change their final purchase from a brand name OTC product to a generic or private label, or to a different brand name product. Potential adverse outcomes (disease-medication interaction; medication-medication interaction; additive side-effects; or duplication in therapeutic category) were prevented in 7.1% of the study population. This study documents consumer need for pharmacy consultation in order to optimize both the therapeutic appropriateness of, and pharmaceutical expenditures for OTC medication.

Adult↗
PubMed2005

Health-related quality of life in hypertension: impact of a pharmacy intervention programme.

BACKGROUND AND OBJECTIVE: In a previous study, we observed that a pharmacy-based intervention programme decreased the blood pressure of hypertensive patients. The objective of the present study was to assess the effect of this pharmacy programme on the health-related quality of life (HRQOL) of individuals treated for hypertension. METHODS: In a quasi-experimental cohort pilot study, we recruited 91 participants from nine pharmacies in the Quebec City area. We offered the intervention programme over a 9-month period to participants enrolled at four of the pharmacies. The other participants were not exposed to pharmaceutical services other than those usually given by their pharmacists. We used the SF-36 to evaluate HRQOL. Covariance analysis was used to test for significant differences of HRQOL scores between participants exposed and not exposed to the programme. RESULTS AND DISCUSSION: When compared with the non-exposed participants, those receiving the intervention and with high income had an improvement in vitality score (P=0.05). On the contrary, low-income exposed participants did not show this benefit and had a decline in mental health score (P=0.01). Improvement in vitality is likely due to increased physical activity and to a reduction in systolic blood pressure in the high-income exposed group. The negative effect of the programme on the mental health of those exposed in the low-income group might be due to the fact that the programme was not effective in reducing blood pressure and may therefore have caused anxiety. CONCLUSION: Pharmacists' interventions can have both a positive and negative impact on the HRQOL of individuals, treated with antihypertensive agents, depending on income level.

Aged↗
PubMed1999

Pharmacy benefit management companies: dimensions of performance.

Research on pharmacy benefit management companies focuses on descriptive accounts of the organizations and the scope of their services. This review provides a critical analysis of publicly available research on contemporary issues surrounding the operations and effects of pharmacy benefit management companies. There has been very little systematic, empirical research on these issues; major questions concerning the impact of pharmacy benefit management companies on quality, costs, and patient outcomes remain unanswered. We analyze what is known and what needs to be known, and we explore major research challenges that lie ahead in the assessment of the pharmacy benefit management company's role in the health care system and in improving the public's health.

Drug Industry↗
PubMed1995

Experience in the development of a postmarketing surveillance network: the pharmacy medication monitoring program.

OBJECTIVE: To describe the pilot and early implementation phase of a system for assembling and recruiting cohorts of patients taking selected prescription medications and prospectively monitoring them for new health events. DESIGN: Prospective observational study, based on telephone interviews, of 1475 patients filling prescriptions for a nonsteroidal antiinflammatory drug (NSAID). Patients were interviewed by telephone using trained interviewers at a central site. Hospitalizations and deaths were followed up and reviewed by an independently physician. SETTING: Community setting in a region of Hamilton, Ontario, Canada. PARTICIPANTS: All consenting patients filling new or repeat prescriptions for NSAIDs at participating pharmacies. MAIN OUTCOME MEASURES: The authors report on the development and assessment of systems for: (1) ongoing recruitment of patients through community pharmacies; (2) data transfer from pharmacies to the coordinating center; (3) surveying patients; (4) classifying, coding, and evaluating new health events; and (5) following up on new serious adverse events. RESULTS: Fifty-one percent of patients approached were recruited, and 83% of these provided completed interviews. For patients picking up their own medications, pharmacy workload varied from 4 to 10 minutes per patient approached. Nineteen percent of patients reported having a new health problem or unusual symptom at the initial telephone interview. Reported health-related events were similar to those described in other studies of NSAIDs. CONCLUSIONS: Most aspects of the monitoring system performed well. One limitation was the low recruitment rate for patients who did not directly drop off or pick up their own prescriptions. Even so, this method of patient accrual may complement alternative monitoring programs.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Implementation and evaluation of a lipid screening program in a large chain pharmacy.

OBJECTIVE: To evaluate the implementation of a lipid testing service across an entire market of a large chain pharmacy. DESIGN: Observational study using a validated satisfaction scale. SETTING: Nine Osco Drug pharmacies in Des Moines, Iowa. MAIN OUTCOME MEASURES: Number of patients choosing to participate in a fee-for-service lipid screening program, type of test chosen, effects of marketing on service volume, and patient satisfaction. RESULTS: A total of 159 screenings were performed in the 9 pharmacies. The majority of patients (79.7%) chose the more expensive fasting lipid profile, and service volume seemed to correspond to the number and intensity of marketing efforts. There was a trend toward increased patient satisfaction with the services represented by the Managing Therapy and Friendly Explanation dimensions addressed in the survey. CONCLUSION: Patients were willing to pay out-of-pocket for lipid screening. More efforts need to be devoted to marketing this service to create value for the customer and to establish it as a viable component of pharmacy business.

Humans↗
PubMed2006

Quality of medication records and use of pharmacy resources in community residential care facilities.

BACKGROUND: In community residential care (CRC) facilities, medication administration is often performed by unlicensed personnel with minimal knowledge in medication use. Medication management is one of the top 3 quality-of-care issues facing these facilities. OBJECTIVE: To examine the type of medication assistance residents received, determine the proportion of facilities that used pharmacy resources, and examine the quality of facility medication records in CRC facilities (eg, adult family homes, adult residential care, assisted living facilities). METHODS: Baseline in-person interviews were conducted with 349 residents and 299 facility providers in the Puget Sound region of Washington. Information was also obtained from facility medication records at enrollment and state databases. A pharmacist determined quality of the records using a standardized form. RESULTS: The average resident was a 78-year-old white female taking 7 drugs. Medication records that were computer generated were significantly less likely to have misspelled names of drugs and errors in or absence of dose, directions for use, and route of administration. Overall, 26.3% of facilities reported that a consultant pharmacist reviewed residents' medication lists, 52.0% reported the use of preprinted lists, and 75.6% received prepackaged medications from the pharmacy. Adult family homes, the smallest facility type, were the least likely to use pharmacy-related services. CONCLUSIONS: The quality of handwritten medication records was a concern in CRC facilities. These facilities may benefit from services offered by pharmacies that may enhance medication management, many of which were underutilized.

Adult↗
PubMedDate not supplied

The changing face of pharmacy benefit design.

Employers, health plans, and pharmacy benefit managers-seeking to reduce rapid growth in pharmacy spending-have embraced multi-tier pharmacy benefit packages that use differential copayments to steer beneficiaries toward low-cost drugs. The consensus of fifteen pharmacy benefit design experts whom we interviewed is that such plans will become more prevalent and that the techniques these plans use to promote low-cost drugs will intensify. The effect on health outcomes depends on whether the high-cost drugs whose use is being discouraged have close, low-cost substitutes.

Deductibles and Coinsurance↗
PubMed2000

[Intramuscular administration of drugs: skills of pharmacy personnel].

Complications from the incorrect administration of intramuscular injections can cause serious organic damages, infections and increase the patient's permanence in health institution or to harm the functions in the work. The previous study detected several cases of patients with local complications after administration of diclofenac in pharmacies and it concluded that the lack of knowledge of this technique can be the causes of these complications. This current study objectives to identify and evaluate the level of knowledge of the professional that administer medications in pharmacies of Ribeirão Preto--SP. The study constituted in a survey, from a questionnaire with 20 open and closed questions, applied to a population constituted for occupational working in pharmacies, selected through the method of the sampling, resulting in a total of 41 pharmacies. It was concluded that the population is receiving medications from occupationals, without a specific formation and with deficit of knowledge regarding the technique. The subjects referred not to receive training to exercise that procedure, learning it with other employee or observing somebody that accomplishes it. It results knowledge gaps that can cause complications in the population that uses the services of those institutions.

Clinical Competence↗