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National survey of hospital-based pharmacokinetic services.

The status of pharmacokinetic services in the nation's hospitals was studied. A questionnaire was mailed in February 1995 to all 252 respondents to ASHP's 1994 national survey of hospital-based pharmaceutical services who indicated the provision of pharmacokinetic services in their institution. Ninety-eight completed questionnaires were returned (40.2% response rate). The pharmacokinetic services provided required an average of 19.1 person-hours per week, tended to be provided by staff pharmacists, were managed by the pharmacy department, tended to be most focused on aminoglycosides and vancomycin, required an average of 60 notes in patient charts per month, and relied on both computers and calculators for deriving values. There was little contact with patients during the consultation process. Drug concentration measurements tended to be scheduled by service providers, but confidence in the accuracy of the timing of dose administration and blood sampling was limited. Respondents believed that the services tended to be supported by other hospital personnel and that they were successful. There was very little expectation that the workload for providing pharmacokinetic services would increase in the near future. A national survey of hospital-based pharmacokinetic services showed that it took 19 hours per week on average to provide the services, that the focus was on aminoglycosides and vancomycin, and that the services were perceived to be supported by other departments.

Drug Monitoring↗

A comprehensive measure of pharmaceutical services: the pharmaceutical-care index.

The construction, validation, and use of a numerical index for measuring the provision of pharmaceutical care are described. The 681 respondents to the 1987 Great Lakes Pharmacy Services Survey were randomly divided into two equal groups of hospitals. Data for the first group (n = 341) were used to construct and validate the pharmaceutical-care index (PCI); data for the second group were used for index analysis. Bivariate analysis of 14 major inpatient pharmaceutical services resulted in one service, admission medication histories, being dropped from the index. Multivariate analysis showed that the remaining services contributed equally to the PCI; they were therefore retained. The possible range of PCI scores was -11.166 to 26.518, with a high score indicating greater provision of service. Analysis of data for the second randomly selected group of hospitals (n = 340) showed that PCI scores differed significantly on the basis of hospital size, hospital teaching affiliation, and pharmacy director's education. The correlation between average daily census and PCI score was fair. Higher scores were associated with the presence of a clinical coordinator or a clinical pharmacist. There were weak associations between PCI score and numbers of pharmacists, pharmacy managers, drug distribution pharmacists, and clinical pharmacists. However, the number of decentralized pharmacists and the number of technicians both showed a fair association with PCI score. Hospitals that had pharmacist participation in ambulatory-care clinics or a staff development program had higher PCI scores than hospitals that did not. The provision of inpatient pharmaceutical services, as assessed by the PCI, may be influenced by hospital size, teaching affiliation, the education of the pharmacy director, and other factors. Further research is needed to extend these findings to other hospitals, expose interactions among the factors that affect pharmaceutical care, and refine the PCI.

Abstracting and Indexing↗

[Logistics in the pharmaceutical service].

The conception of the field of pharmaceutical service defines pharmaceutical service as the basic part of pharmacy, the principal task of which is to provide pharmaceutical care as an inseparable part of providing health care. It represents a set of professional activities of the pharmacist oriented to securing human and veterinary pharmaceutical products and health care products and to optimising effective, safe and quality pharmacotherapy. Technically, pharmaceutical service is an applied discipline, as it makes use of knowledge gained in other pharmaceutical, medical, psychological, social, and economic sciences. Because of its interdisciplinary character it is necessary to extend the theory of pharmaceutical service in such a way so that it may reflect all aspects of its sphere of activity. One of the possibilities is to define the pharmacy premises as an independent functional unit which operates on the basis of valid legal standards in such a way that on the one hand it secures the provision of health (pharmaceutical) care, and on the other hand it maintains its cost-effectiveness. To keep the quality of care of the patient and the economic aspect in balance, it is necessary to define the term pharmaceutical logistics also under the conditions of Slovak (Czech) pharmacy as early satisfaction of the requirements of the patient (client) in the pharmacy premises, which means that the appropriate pharmaceutical product or health care product and the appropriate information must be at the right time in the required amount and required quality in the right place.

Pharmaceutical Services↗

Decrease in emergency room or urgent care visits due to management of bronchial asthma inpatients and outpatients with pharmaceutical services.

OBJECTIVE: To evaluate pharmaceutical care of bronchial asthma over a 1-year period and to investigate whether such care is effective. METHODS: 79 male and 97 female asthma patients who were treated with theophylline and other drugs between June 1994 and September 1996 were studied. The 15 subjects received pharmaceutical care (group 1) and were all inpatient asthmatics who had been admitted to the hospital for treatment. The other patients acted as controls. RESULTS: In 1994, the average medication cost of asthma patients without pharmaceutical care was $199/month and $295/month when such care was provided in the outpatient clinic. The drug treatments which patients received generally included inhaled anti-inflammatory agents and theophylline, but the 161 non-pharmaceutical services patients (group 2) received fewer inhaled anti-inflammatory agents than group 1 patients. The number of visits to the emergency room and hospital admissions were significantly lower in patients after receiving pharmaceutical services than inpatients before receiving pharmaceutical services during our observation period. The serum theophylline concentrations of group 1 patients generally attained levels sufficient for favourable therapeutic effect after patients received pharmaceutical care. CONCLUSION: Pharmaceutical care offered at the hospital is effective in the management of asthma patients.

Algorithms↗

Pharmaceutical services in the United States Public Health Service.

The status of pharmaceutical services in the United States Public Health Service (PHS) is described. The PHS has been the principal health agency of the United States for nearly 200 years, directing its resources to meeting the nation's changing health needs. Pharmacists are assigned to all eight operating divisions of the PHS (a major component of the Department of Health and Human Services), as well as other federal agencies and programs. Pharmacists assigned to the Indian Health Service, the National Institutes of Health, the United States Coast Guard, the Immigration and Naturalization Service, the Federal Bureau of Prisons, and Saint Elizabeths Hospital provide pharmaceutical services to a broad range of patients and settings. Some PHS pharmacists are involved in bringing new drugs to market in the Food and Drug Administration, participating in research protocols at the National Institutes of Health, and helping the underserved populations through the programs of the Health Resources and Services Administration. Still other PHS pharmacists provide leadership and program management at the Agency for Health Care Policy and Research, the Agency for Toxic Substances and Disease Registry, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Health Care Financing Administration. Pharmacists in the PHS work in a broad array of settings, in many cases providing care for the underserved.

Centers for Disease Control and Prevention, U.S.↗

On accreditation of healthcare organizations. Determining eligibility for Accreditation of Home Pharmaceutical Services.

Many misperceptions exist in the health care community about the Joint Commission's accreditation of home pharmaceutical services, primarily related to when pharmacy services are considered home care and which patients or services are eligible for survey. This article concentrates on eligibility for survey and accreditation of just one of the six eligible home care services-home pharmaceutical services. The concept of home care and pharmaceutical services is difficult for most people to understand. Unlike other home care services, pharmacy services cannot be provided directly in the patient's home. Pharmacy laws prohibit pharmacists from compounding and dispensing directly in the patient's home. The pharmacists must do these activities in a licensed pharmacy. Also, most patients who receive medications from pharmacies take their own medications in their homes. So the differences between home care pharmacy and ambulatory or retail pharmacy are much less clear-cut than the delivery of more traditional home care services such as nursing or home health aide services.

Eligibility Determination↗

Reimbursement for clinical pharmaceutical services.

Reimbursement for four clinical pharmaceutical services (growth hormone home instruction, patient consultation, patient visit and pharmacokinetic consultation), separate from other drug-related fees, is discussed. Included are descriptions of the clinical services, how they were provided, how charges were determined and documented, and how the proposal was submitted which initiated the charges. During a four-month observation period, from May to August 1977, 27 physicians requested a total of 71 clinical pharmaceutical services. Pharmacy charges generated by these requests totaled $4,492. Patients' and physicians' comments concerning the services have been positive, and pharmacy charges generated continue to average $1,100/month.

Fees, Pharmaceutical↗

Nurses' attitudes toward pharmaceutical services before and after decentralization.

Nurses' attitudes toward the quality of pharmaceutical services were assessed before and after the implementation of decentralized pharmaceutical services at a tertiary-care teaching hospital complex. The same multiple-choice questionnaire was distributed to nurses at the University of Michigan Hospitals 18 months before decentralized services were implemented (November 1982) and again after two satellite pharmacies had been established and a clinical pharmacist had begun providing first-dose dispensing services using a movable medication cart (March 1985). The questionnaire measured nurses' satisfaction with aspects of pharmaceutical services most likely to be affected by decentralization of services (e.g., number of missing medications, accessibility of pharmacists). Nurses' overall satisfaction with pharmaceutical services increased only slightly after services were decentralized. Significant positive changes in nurses' satisfaction occurred in areas served by the satellite pharmacies and the clinical pharmacist; no significant change s in satisfaction occurred in the other areas. Nurses' perceptions of increased helpfulness of pharmacy personnel were a better predictor of increased satisfaction than were changes in the number of missing medications, waiting time for medication delivery, or number of incorrectly dispensed medications. Respondents remained anonymous; therefore, changes in personnel, rather than changed opinions of nurses, may account for the differences in responses between 1982 and 1985. Nurses' attitudes toward pharmaceutical services improved in areas of the hospital served by satellite pharmacies or by a clinical pharmacist using a movable medication cart.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

Pharmaceutical services in a United States Army field hospital.

Pharmaceutical services in a United States Army field hospital are described. The field hospital was deployed to Honduras to support United States troops during military exercises. Pharmaceutical services were provided from a large tent near the hospital, which consisted of an emergency treatment facility, two operating rooms, and a small medical-surgical ward. One pharmacist and four technicians provided outpatient pharmaceutical services 10 hours per day, seven days per week; pharmacy personnel were on call at other times. The majority of pharmacy time was spent prepackaging and labeling medications for use by medical teams visiting local villages to provide health care to Honduran natives. The pharmacy's drug distribution, inventory control, and intravenous admixture activities in light of limited personnel and storage space, long supply lines, and lack of an aseptic working area are described. Pharmacist-physician interactions regarding drug therapy and common ailments of United States troops and Honduran natives are also discussed. During a two-month period, the field hospital pharmacy dispensed approximately 24,000 prescriptions. Pharmaceutical services played an important role in the success of the field hospital's mission and provided aid to the population of an impoverished country that might not otherwise have received it.

Drug Prescriptions↗

Decentralization of pharmaceutical services in a large hospital complex.

The decentralization of pharmaceutical services to two patient-care areas remote from the central pharmacy in a large hospital complex is described. The addition of a fifth building to a large hospital complex led to problems with drug distribution and interprofessional communication, since the pharmacy that provided services to the 120 beds in the new building was located in a building some distance away. Decentralization of pharmaceutical services to a 24-bed surgical intensive-care unit and a 48-bed surgical patient-care unit in the new building was accomplished through a satellite pharmacy located on the intensive-care unit with support from a mobile medication cart located on the surgical unit. The satellite is staffed from 0700 to 2200 each day by one pharmacist and one technician per eight-hour shift. Evaluations of medication turnaround time, number of interactions with nurses and physicians, efficiency of the drug distribution system, quantity of floor stock maintained on the units, and productivity performed before and after the implementation of decentralized services indicated improvements in all areas. A survey of the nursing staff indicated that nurses were very satisfied with the improvements in pharmaceutical services. The implementation of decentralized pharmaceutical services in two patient-care areas remote from the central pharmacy was successful in improving services to these areas.

Centralized Hospital Services↗

Joint Commission on Accreditation of Hospitals' 1977 standards for pharmaceutical services.

New standards for pharmaceutical services in hospitals, recently approved by the Board of Commissioners of the Joint Commision of Accreditation of Hospitals (JCAH), are presented and compared with the previous standards. The efforts of the American Society of Hospital Pharmacists in working with JCAH to upgrade the pharmacy standards are reviewed. The new standards reflect progressive hospital pharmacy practice and focus of the hospital pharmacist's patient-care activities.

Accreditation↗

Effect of technical and functional quality on patient perceptions of pharmaceutical service quality.

PURPOSE: To evaluate the relative importance of functional quality (how services were provided) and technical quality (what was received for those services) on patient perceptions of pharmaceutical service quality. METHODS: A scenario-based experimental design was chosen to manipulate functional (FQ) and technical quality (TQ). Subjects were asked to read one of four scenarios describing a pharmacy service experience and imagine that he or she were in the situation described. High and low TQ were manipulated by describing the presence or absence of a prescription medication dispensing error made by the pharmacist in the scenario. Each subject completed a survey about their evaluations of the service provided in the scenario. An ANOVA using a 2 x 2 completely randomized factorial design was conducted to compare the effects of TQ, FQ, and their interaction on perceptions of service quality and behavioral intention. Effect sizes were measured with the calculation of omega-square. RESULTS: FQ had the greatest impact on patient perceptions of service quality and behavioral intentions. FQ explained 44% of the variance in service quality and 39% in intention to return. TQ and the interaction accounted for a significant but much lesser effect. The interaction showed that the effect of FQ was greatest under conditions of high TQ. There were no significant associations between any demographic characteristics and responses to service quality. CONCLUSIONS: The results suggest that FQ has the greatest impact on consumer perceptions of pharmaceutical service quality even under conditions of an obvious example of low TQ which respondents perceive as serious and possibly harmful. This study underscores the limitations of relying on patient perceptions in evaluating pharmaceutical services. Although patient evaluations are important, they can be inadequate for assessing the professional quality of services.

Adult↗