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Biomedical subjects

D E Miller

Publications and source records attributed to D E Miller.

At least 55 records · Page 3Linked to original sources
PubMed1982

Obtaining reimbursement for clinical pharmacokinetic monitoring.

A method of obtaining reimbursement for clinical pharmacokinetic monitoring is described. The process included reviewing the existing literature, observing the practices of others providing similar services, collecting workload and expense data, selecting an equitable fee, and presenting third party payers with evidence of the service's need, documentation, and effectiveness. The average patient was monitored by the pharmacokinetic service for 8.4 days and had 5.1 serum samples drawn. The physician received 3.1 dosing recommendations. An average of 4.3 hours was spent monitoring each patient with an average cost of $86. Of the several alternatives for charging considered, an inclusive charge of $10 per patient day was chosen. Blue Cross reimbursement criteria for pharmacokinetic monitoring stipulated that (1) the service must be physician initiated; (2) documentation of services provided must appear as a permanent part of the patient's record; (3) service provided must be identified with a specific group of patients rather than applied equally to all patients in the institution; and (4) evidence of reduced morbidity, mortality, or length of hospital stay would help. During 1981, $37,470 in charges was generated for pharmacokinetic monitoring services with reimbursement being received from third party programs, insurance companies, and private patients.

Humans↗
PubMed1981

Establishing an aminoglycoside pharmacokinetic monitoring service in a community hospital.

A pharmacy-based aminoglycoside pharmacokinetic monitoring service is described, including the use of serum gentamicin levels before and after the service. A retrospective drug and serum level use review for i.v. gentamicin treatment of 80 patients during an 11-month period was conducted. It established a need for a pharmacokinetic monitoring service, which was first instituted as a six-month pilot program. Twenty patients in the retrospective review had 43 serum levels obtained for an average of 2.2 levels per patient. In comparison, 39 patients in the pilot program had 243 serum levels drawn for an average of 6.2 levels per patient. Only six (14%) of the serum levels were obtained correctly and used appropriately in the review, compared with 231 (95%) in the pilot program (p less than 0.0001). It is concluded that the method used in establishing this service is a satisfactory approach for pharmacists who wish to convince administrators and medical staff of the need for pharmacokinetic consultation.

Aminoglycosides↗
PubMed1981

Pharmacist involvement in institutional review of clinical trials.

The establishment of an institutional review committee (IRC) for investigational clinical trials in a large community hospital is reported. After the need for an IRC was identified, the pharmacy and therapeutics committee charged the director of pharmacy with drafting a protocol for establishing an IRC. Following a literature review, guidelines were written for the IRC in the form of a committee manual. These guidelines were approved, and composition of the nine-member committee was set as follows: three members of the trustee medical education and research committee, three members of the medical staff, one member each of the clergy staff and the pharmacy staff, and one nonaffiliated community representative. The IRC reviews, approves or denies, and supervises all proposed clinical investigations. Risk/benefit ratios, purpose, recruitment and selection procedures, financial support, and informed consent documents of the proposed study are among the factors considered in the approval process. Guidelines for written policies and procedures governing IRC structure and activities are presented. The involvement of the pharmacist in the establishment and subsequent functions of the committee is described. IRC membership is an opportunity for the pharmacist to work with other professionals in protecting the rights and welfare of human research subjects.

Clinical Trials as Topic↗
PubMed1975

Drug usage review in a community hospital.

A simple and effective manual drug usage review program in a community hospital is described. Fifteen randomly selected charts are screened each month by a drug information pharmacist. Charts demonstrating questionable drug therapy are forwarded to a physician member of the pharmacy and therapeutics committee; those showing questionable drug administration practices are referred to the nurse member of the committee. These committee members screen the questionable charts and refer to the entire committee those cases which require further follow-up. The committee categorizes the problems and communicates its recommendations to the individual practitioners involved. Recommendations focus on the legal ramifications of FDA-unapproved drug usage. During the first two years of the program, 341 charts were screened for drug usage; 62 of these were referred to the pharmacy and therapeutics committee for further review. In 20 cases, the committee sent a letter to the prescribing physician or his department chairman; in 16 cases, letters were sent to nursing administration.

Drug Utilization↗