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Measuring of impact of patient counseling in the outpatient pharmacy setting: development and implementation of the counseling models for the Kaiser Permanente/USC Patient Consultation Study.

The Southern California region Kaiser Permanente Medical Care Program, which serves 2.2 million patients, and the University of Southern California School of Pharmacy have designed and implemented a patient consultation study to determine the cost-effectiveness of three different approaches to providing pharmacist consultation to outpatients. This paper describes the development and implementation of these three models. A total of 107 pharmacies (approximately 600 pharmacists) participated in the study and were assigned to provide one of the models of patient consultation, designated the Kaiser Permanente (KP) model, the state model, and the control model. The KP model (20 pharmacies) provided targeted pharmaceutical care services to high-risk patients based on drug use. The state model (67 pharmacies) provided California-mandated patient consultation to patients with new or changed prescriptions, instructions for use, relevant warnings and precautions, storage requirements, and the importance of compliance. The control model (20 pharmacies) provided consultation when deemed necessary by the pharmacist and provided care similar to that provided before mandatory consultation in California. The KP and state models used the same pharmacist/technician/clerk resources, but the control pharmacies limited personnel resources to those existing before the mandatory consultation law was passed in California. The paper describes the KP model in detail and provides a literature-based rationale for targeting particular high-risk patients for expanded services. The paper also describes the training process, gives an example of a high-risk patient intervention, provides information on documenting pharmacist interventions in all models, and explains the method used for monitoring implementation of the models.

Ambulatory Care↗
PubMed1992

[Psychological counseling of the family of patients with craniocerebral injuries (psychological family counseling of severely ill patients)].

Relatives of 235 brain-injured (BI) patients were observed by trained (psychiatric) staff for psychological coping. This was practiced since 1984 in a BI-rehabilitation ward at a regional psychiatric hospital with 450 beds, serving a catchment area of 330,000. In semi-structured observations patterns of emotional behaviour were registered, which resemble those presented by Kübler-Ross for relatives of the dying. Nevertheless important differences were noted: 1. Unrealistic expectations on the relatives' side: caused by insufficient information on differences of physical and cerebral rehabilitation and unfounded belief, transfer from the intensive care section itself signifies the patient's restitution. 2. Unrealistic evaluations: individual consequences of BI may be underrated by relatives, more so if no additional injuries illustrate the patient's severe condition. 2.1. Coma--interpreted as "pseudosleep". Frequently the next of kin are uninformed on the aetiopathology or consequences of coma. Restitution of cerebral functions in various stages of impairment cause confusion, anxiety, resignation even rejection on the side of the relatives. 3. Personality changes: disruptions of personal traits or characteristics as outcome of severe BI are widely known and regarded as formidable consequence. 4. Fear of reintegration; therefore this fear is not infrequent in the next of kin. Additional factors caused by personal history or psychopathology may complicate the issue. Attitudes to rehabilitation are determined by psychological reactions of relatives and may be crucial for the outcome. Recognition of pathological traits and management of psychological attitudes ensures optimal effect of rehabilitation. We noticed several phases in the relatives' psychological changes: acute, initial, protracted and final stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗