Biomedical subjects

Cynthia L Raehl

Publications and source records attributed to Cynthia L Raehl.

4 recordsLinked to original sources

PubMed2002

Individualized drug use assessment in the elderly.

STUDY OBJECTIVE: To quantify how seniors' ability to take oral prescription drugs safely may correlate with age, sex, socioeconomic status, education, cognitive impairment, depression, and drug self-management. DESIGN: Cross-sectional study SETTING: Three retirement communities and an adult day care center. PATIENTS: Fifty-seven elderly individuals (mean age 79.49 +/- 7.26 yrs; mean education 11.33 +/- 3.8 yrs; 72% women). INTERVENTION: After completing a comprehensive medical history, and with drug vials and pillboxes available for consultation, each subject described how he or she was taking prescribed oral drugs. MEASUREMENTS AND MAIN RESULTS: The MedTake test evaluated dosage, indication, food or water coingestion, and regimen. For each agent, the test was scored as percentage of correct actions, equally weighted, and compared with label directions or self-expressed physician changes. A composite MedTake test score (0-100%) summarized a subject's overall ability to take their drug(s) safely A follow-up qualitative assessment by a single pharmacist assigned each agent to one of four potential risk categories: correct use, partial correct use without potential clinical significance, partial correct use with potential clinical significance, or incorrect use with high potential of clinical significance. Most subjects (80%) managed their own drug therapy; 70% used reminder systems (calendar, pillbox). The number of medical conditions and prescription drugs was 6.11 +/- 4.2 and 5.88 +/- 3.44, respectively. Of 325 agents, correct dosage was reported for 94% (306), correct indication for 95% (309), correct coingestion with food or water for 97% (314), and correct regimen for 89% (288). The composite MedTake test score was 88.5 +/- 21.3%. The multivariate model, with that score as the dependent variable, adjusted for age and sex, used Mini-Mental State Examination (p = 0.002) and Medicaid assistance within 10 years (p = 0.021) as significant factors. The most frequent problem was underdosing of cardiovascular drugs. CONCLUSION: Seniors' ability to take oral prescription drugs safely was affected by cognitive function and socioeconomic status. Although the MedTake test helped identify some problems with therapy adherence, a pharmacist's follow-up evaluation of comprehensive medical and drug histories identified additional potentially clinically significant problems in 20% of subjects.

Administration, Oral↗

PubMed2002

Clinical pharmacist staffing in United States hospitals.

We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownership, hospital pharmacy director's degree, pharmacist location within the hospital) and clinical pharmacist staffing/occupied bed in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Simple statistical tests and multiple regression analysis were employed. The study population consisted of 1391 hospitals that reported information on clinical pharmacist staffing. The mean number of clinical pharmacists/100 occupied beds was 0.51 +/- 0.18. Factors associated with increased clinical pharmacist staffing were west north central region (slope = 0.0029439, p = 0.002), Pacific region (slope = 0.0032089, p = 0.004), affiliation with pharmacy teaching hospitals (slope = 0.0025330, p = 0.0001), teaching hospitals (slope = 0.0028122, p = 0.001), federal government ownership (slope = 0.0029697, p = 0.012), directors with Pharm.D. degrees (slope = 0.0335020, p = 0.002), directors with M.S. Pharmacy degrees (slope = 0.0028622, p = 0.003), pharmacists in a decentralized location (slope = 0.0035393, p = 0.0001), and pharmacy technician staffing (slope = 0.0517713, p = 0.0001). Statistically significant associations between demographic variables and decreased clinical pharmacist staffing/occupied bed were mid-Atlantic region (slope = -0.0028237, p = 0.002), small size (slope = -0.0028894, p = 0.001), pharmacy directors with B.S. degrees (slope = -0.0019271, p = 0.023), and pharmacy administrator staffing (slope = -0.0184513, p = 0.042). The R2 for this multiple regression analysis was 28.31% and adjusted R2 was 24.83%. Increased pharmacy technician staffing had the greatest association (slope = 0.0517713) with increased clinical pharmacist staffing. Significant differences were observed between clinical pharmacist staffing and hospital demographic factors. It appears that one of the most effective ways to increase clinical pharmacist staffing is to increase pharmacy technician staffing (slope). These findings will help future researchers determine specific reasons why some types of hospitals have higher and some lower levels of clinical pharmacist staffing.

Analysis of Variance↗

PubMed2002

Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals.

The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.

Adverse Drug Reaction Reporting Systems↗

PubMed2002

Changes in pharmacy practice faculty 1995-2001: implications for junior faculty development.

OBJECTIVE: To compare changes in United States pharmacy practice faculty demographics from 1995-2001 and to discuss the implications for junior faculty development. METHODS: Demographic data were extracted from the American Association of Colleges of Pharmacy institutional research system for academic years 1995-1996 and 2000-2001. RESULTS: In 2000-2001, pharmacy practice was the largest faculty discipline, 3.8 times larger than the next three disciplines. Junior pharmacy practice faculty occupied 65% of all junior full-time pharmacy faculty positions. Tenure track assistant professors decreased 4% from 283 to 271, and nontenure track assistant professors increased 58% from 427 to 677 (chi2 = 20.0, p<0.05). In 2000-2001, 72% of all pharmacy practice assistant professors were nontenure track, up from 59% in 1995-1996. Women assistant professors in pharmacy practice outnumbered men by 2:1. Challenges faced by new faculty include balancing teaching, practice, and research demands; selecting a nontenure or tenure track and understanding its expectations; limiting teaching preparation time; developing productive writing habits; setting performance goals; managing time; and handling the mental and physical stress of academic life. Senior faculty must actively help new members appreciate the many positive aspects of academic life by sharing their strategies and success stories. CONCLUSION: Schools and colleges of pharmacy relied heavily on increasing the number of nontenure track junior pharmacy practice faculty to meet increased clinical education demands.

Chi-Square Distribution↗