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Biomedical subjects

C H Knowlton

Publications and source records attributed to C H Knowlton.

17 recordsLinked to original sources
PubMed2000

Palliative pharmaceutical care: a randomized, prospective study of telephone-based prescription and medication counseling services for treating chronic pain.

OBJECTIVE: To evaluate the effects of providing a unique telephone-based pharmaceutical care program to a sample of patients enrolled at a university pain clinic in Philadelphia, Pa. We hypothesized that in comparison to routine pharmaceutical care, the telephone-based pharmaceutical care program would have a positive impact on delivery of medication, quality of life, and overall satisfaction with the pain clinic program. PATIENTS: One hundred seven pain clinic patients were randomly assigned to the control and intervention groups. Seventy-four patients (control group, n = 36; intervention group, n = 38) met inclusion criteria. METHOD: The control group continued to receive care and prescription services through the same means as prior to the study. There were 2 components to the pharmaceutical care program offered to the intervention group. The first component consisted of a palliative care pharmacy company, PainRxperts, providing specialized prescription services tailored to the needs of a pain medicine clinical practice. The second component involved the palliative-trained pharmacist's proactive monitoring of patient pharmacotherapy for potential or actual drug related problems (DRPs). RESULTS: Intervention patients perceived that they had better access to medication, more efficient processing of prescriptions, and fewer stigmatizing experiences. They also endorsed pharmacists' behavioral interventions such as medication counseling, availability to answer medication-related questions, and non-judgmental attitudes when managing opioid prescriptions. CONCLUSION: This study suggests that the palliative-trained pharmacist can play an important collaborative role in managing chronic pain. Application of the pharmaceutical care model in pain medicine centers can improve satisfaction and remove some of the barriers to good pharmaceutical care facing patients with chronic pain disorders

Clinical Trial↗
PubMed1997

Consensus guidelines for coordinated outpatient oral anticoagulation therapy management. Anticoagulation Guidelines Task Force.

OBJECTIVE: To provide primary and referring healthcare practitioners with guidelines for the provision of safe and effective anticoagulation management in any venue to standardize and improve quality of care and to permit negotiation for reimbursement from third-party payers. DATA EXTRACTION AND SYNTHESIS: Data on the current practice of anticoagulation providers and outcomes related to anticoagulation clinic care were obtained through the literature, interviews with anticoagulation providers, and a focus group meeting of anticoagulation clinic stakeholders. This information collation process revealed that an anticoagulation service consists of three separate areas for which guidelines should be developed. Based on the consensus opinions of the committee members, the literature review, and the current practice of anticoagulation services providers, a draft guideline was developed and reviewed by an independent multidisciplinary panel of anticoagulation services providers whose comments were incorporated into the final guideline. CONCLUSIONS: Systematic outpatient anticoagulation services are systems of care designed to coordinate and optimize the delivery of anticoagulation therapy by (1) evaluating patient-specific risks and benefits to determine the appropriateness of therapy; (2) facilitating the management of anticoagulation dosages and prescription pick up or delivery; (3) providing ongoing education of the patient and other caregivers about warfarin and the importance of self-care behavior leading to optimal outcomes; (4) providing continuous systematic monitoring of patients, international normalized ratio results, diet, concomitant drug therapy, and disease states; and (5) communicating with other healthcare practitioners involved in the care of the patient. To create a reproducible framework for the provision of these services, guidelines for structure, process, and outcomes of coordinated outpatient anticoagulation management services were developed. Guidelines for organization and management include (1) qualifications for personnel, (2) supervision, (3) care management and coordination, (4) communication and documentation, and (5) laboratory monitoring. Guidelines for the process of patient care include (6) patient selection and assessment, (7) initiation of therapy, (8) maintenance and management of therapy, (9) patient education, and (10) management and triage of therapy-related and unrelated problems. Guidelines for the evaluation of patient outcomes include (11) organizational components and (12) patient outcomes. The impact of these 12 guidelines on patient care and reimbursement procurement will depend on their implementation and the perceived value of their use.

Ambulatory Care↗
PubMed1996

Dynamic competition as an exploratory model of healthcare policy for the antihypertensive market.

Dynamic competition based on innovation, rather than classical competition based on price, may better explain the research-intensive pharmaceutical market. In an exploratory comparison of these models, economic indicators of annual change in price and price elasticity of demand were tested in a repeated-measures design by analysis of variance. Between 1990 and 1992, updated US prescribing guidelines for hypertension provided a framework in which the contrast between 2 newer classes and 2 older classes of first-line therapies served as a marker for innovation. The principal hypothesis was that newer classes would be less elastic than older classes, but with such innovation-based differences eroding over time. Although temporarily greater inelasticities for newer classes supported dynamic competition, initially extreme inelasticities for newer classes indicated a market distortion or a shifting demand curve. These exploratory results, although requiring substantiation, point toward using dynamic competition in crafting healthcare policy for the pharmaceutical market.

Analysis of Variance↗
PubMed1994

Community pharmacists help HMO cut drug costs.

Twenty-seven independent community pharmacies that were preferred providers for a health maintenance organization (HMO) were enrolled in a study to determine the effect of increased intervention activities on the cost of a drug benefit in a managed care environment. Pharmacists from nine pharmacies were trained to initiate changes in medication prescriptions to contain costs, to enhance communication with patients and prescribers, and to intervene in drug-related problems. Their intervention activities during the nine-month study period were compared with activities of nine pharmacies assigned to a control group and nine pharmacies assigned to a comparison group. Patients who visited the intervention pharmacies had a 6.5% lower prescription mean ingredient cost; a 6.0% higher generic substitution rate; an 8.3% lower average patient drug cost per month; and no difference in the days supply, the average number of prescriptions per patient, or the aggregate hospital admission rate. The pharmacists in the intervention group spent more time with patients before preparing prescriptions (2.4-fold increase); initiated more requests for prescribers to change prescriptions (2.5-fold increase); intervened more often to reduce the cost of drug therapy (3.7-fold increase); and suggested medication changes more often for better quality of care (1.9-fold increase). In this study, community pharmacists altered their practice procedures and settings to foster communication with patients and prescribers. Also, the prospective drug regimen review changed prescribing patterns: physicians permitted increased use of generic medications, which reduced monthly prescription expenditures.

Drug Costs↗
PubMedDate not supplied

Establishing community pharmacy-based anticoagulation education and monitoring programs.

OBJECTIVE: To determine the process for establishing community pharmacy-based anticoagulation education and monitoring programs using fingerstick capillary whole blood testing. DESIGN: Pilot community-based intervention study using convenience sample of patients. SETTING: Three community pharmacies with pre-established health education centers and laboratories certified for moderate complexity. PARTICIPANTS: 26 patients were referred to the clinics by 2 primary care physicians for each pharmacy, most with a diagnosis of atrial fibrillation. INTERVENTION: Patient assessment, including adherence to prescribed regimens; changes in medication use, including prescription and nonprescription medications, vitamins, health foods, and nutrition supplements; changes in diet and ethanol consumption; assessment of adverse experiences; and needed changes in warfarin dosage. MAIN OUTCOME MEASURES: Percentage of international normalized ratio (INR) values within therapeutic range, major bleeding events, and thrombotic events. RESULTS: A total of 21 patient charts were available for analysis. More than 80% of patients had INR values within their targeted range (+/- 0.2) 60% or more of the time, comparable with values reported for anticoagulation clinics. Of the 235 INR values obtained during the study, 75% were within the individualized targeted therapeutic range (e.g., 2 to 3 +/- 0.2). One patient experienced a major bleeding event related to an underlying cancer. None of the patients experienced a thrombotic event. CONCLUSION: Community pharmacies can effectively implement an anticoagulation education and monitoring program.

Adult↗
PubMedDate not supplied

Cross-sectional study of the ethics of pharmacy students.

The importance of ethics in pharmacy education and practice has recently received increased attention. Previous studies have addressed occupational orientation and personality traits as well as the nature of attitudes and values. Many unanswered questions remain. This cross-sectional study was designed to compare the attitudes and value priorities of pharmacy students in preprofessional and professional years of study and to evaluate a modified questionnaire. The 495 students who completed the questionnaire were representative of the 835 pharmacy students enrolled in this "0/5" undergraduate pharmacy program. The survey results indicated that honesty and full disclosure are preferences held by preprofessional students, whereas what may be described as professional judgment predominates in students during their final two professional years. Most students felt they had an idealistic or humanistic orientation. The differences among the classes may be due to any of a number of factors including curricula, normal maturation, or chance differences in the students within each class.

Cross-Sectional Studies↗