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Biomedical subjects

Dale B Christensen

Publications and source records attributed to Dale B Christensen.

At least 19 recordsLinked to original sources
PubMed2006

Second-generation antidepressant discontinuation and depressive relapse in adult patients with bipolar depression: results of a retrospective database analysis.

BACKGROUND: To date, few postmarketing studies have addressed whether long-term prophylactic treatment with second-generation antidepressants (ADs) delays depressive episodes in patients with bipolar disorder. OBJECTIVE: The aim of this study was to compare the risk of depressive relapse between patients with bipolar disorder who took second-generation ADs>-6 months after depressive remission with those who discontinued AD use early. METHODS: Using a large US managed-care claims database, continuously enrolled bipolar subjects who took second-generation ADs after a depressive remission were identified between January 1, 1998, and December 31, 2002. Duration of AD and concurrent mood stabilizer use were based on coded diagnoses and pharmacy records. A Cox proportional hazards model was developed to predict time from depressive remission to next depressive relapse with continuous AD use, categorized as either >or=6 months or <6 months. Propensity scoring with greedy matching was used to help balance the observed background covariates and baseline disease severity between groups. RESULTS: Five hundred eighty-nine subjects met the inclusion criteria. A Kaplan-Meer estimate found that the median depressive relapse times for the continuous (ie, >or=6 months) and early discontinuation (ie, <6 months) AD treatment groups were 16.5 and 6.8 months, respectively (P<0.05). The Cox proportional hazards model with propensity score matching identified a significantly lower risk of depressive relapse over a 2-year period among those who continued AD treatment>or=6 months after remission, compared with those who discontinued treatment within 6 months (hazard ratio, 0.61 [95% CI, 0.42-0.88]; continuous vs early discontinuation, P<0.01). CONCLUSIONS: Continuous second-generation AD therapy for >or=6 months after depressive remission was associated with a lower risk of depressive relapse over a 2-year period in patients with bipolar depression. Given concerns regarding the risk of AD users with bipolar disorder switching to mania, an optimal prophylactic treatment after depressive remission should balance the risks between manic switching and depressive relapse.

Adolescent↗
PubMed2005

Accessing a new medication in Germany: a novel approach to assess a health insurance-related barrier.

PURPOSE: Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies. METHODS: The authors developed a novel three-dimensional person-time-related hurdle model and followed a cohort of 7358 statutorily (SHI) and 457 privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second to fourth year of the HealthCare Structural Reform Act in Germany. RESULTS: For SHI compared with PHI migraine patients, there was a hurdle to receiving sumatriptan at all (2.4-fold lower hazard, 95% confidence interval, 1.8-3.2). Among patients who received sumatriptan, frequency and intensity of use differed only minimally between SHI and PHI patients. CONCLUSIONS: These findings have implications for healthcare researchers and healthcare policies. The framework extends traditional hurdle models and can serve as a model for quantifying barriers to receipt of services under different funding policies.

Adolescent↗
PubMed2004

Quantifying delay in access to new medical treatment: an application of risk advancement period methodology.

BACKGROUND: We present a novel application of the concept of risk or rate advancement to compute the extent of delay in adoption of an effective new drug in 2 German health insurance systems. METHODS: We identified individuals with migraines, age 18 to 65 years, in 371 primary care practices in Germany in 1994 (MediPlus, IMS Health database). These included 8173 persons covered under the statutory health insurance system and 503 persons covered by private health insurance. We derived risk and population risk advancement periods for sumatriptan compared with nonserotoninergic acute migraine therapy using multiplicative risk regression and generalized estimating equations, adjusted for patient, physician, and practice cofactors. RESULTS: For patients at the mean age of the cohort, 43 years of age, sumatriptan was prescribed 1.2 (95% confidence interval [CI] = 0.3-2.0) years later among those in the statutory health insurance system compared with those who had private insurance. The lag increased by 0.6 (-0.1 to 1.3) years for every 10 years of patient age. In the age-mix of our sample, access to the health benefits of sumatriptan therapy lagged nearly 1.5 years behind in the statutory health insurance system and for Germany as a whole. CONCLUSIONS: Migraine patients' access to sumatriptan therapy lagged substantially in the statutory health insurance system and in the country as a whole. Risk advancement periods provide a useful methodology for communicating major healthcare issues in a meaningful way to society and policymakers.

Adult↗
PubMed2004

The disparity in access to new medication by type of health insurance: lessons from Germany.

BACKGROUND: Drug provision within the German statutory health insurance system has undergone several reforms, including the introduction of drug macrobudgets in 1993. OBJECTIVE: The objective of this study was to investigate the extent to which statutorily (SHI) and fully privately (PHI) health-insured patients were provided with new medication recommended by professional bodies in an equitable fashion using the example of migraine patients. RESEARCH DESIGN: We conducted a retrospective cohort study. SETTING: A total of 367 primary-care practices (MediPlus, IMS Health) in Germany in the second year of the HealthCare Structural Reform Act were studied. SUBJECTS: Subjected consisted of 7703 SHI and 470 PHI migraineurs (International Classification of Diseases, 10th edition G43) aged 18 to 65 years at their first migraine prescription visit in 1994. OUTCOME MEASURE: We compared prescription of oral or subcutaneous serotonin 5HT1B/1D receptor agonist sumatriptan with nonserotoninergic migraine therapy. RESULTS: In multiplicative risk regression with variance estimation accounting for clustering of patients within practices, PHI patients were 2.3 times (95% confidence interval [CI], 1.6-3.3) more likely to receive sumatriptan than their SHI counterparts at the mean age of the cohorts (43 years) adjusted for incident versus prevalent migraine treatment, the gender of the patient, the age, gender, and primary care specialist group of the physician, and the type and the community size class of the practice. This disparity widened by 38% (95% CI, 1-88%) every 10 years of patient age. CONCLUSION: Even though virtually everyone in Germany has health insurance and drug coverage, use of new and recommended migraine medicines was less common among those with SHI compared with their privately insured counterparts. Systematic studies of access to health care recommended by professional bodies will be critically important to ensure delivery of high-quality health care for all patients.

Adolescent↗
PubMed2004

Inappropriate medication use and health outcomes in the elderly.

Inappropriate medication use is a major problem for the elderly. Although increasing attention has been paid to inappropriate prescription medication use, most previous research has been limited to the investigation of prevalence and trends. Few studies provide the empirical evidence for the adverse effect of inappropriate medication use on health outcomes at the national level. This study is the first attempt to assess the relationship between inappropriate prescription use and health status for the elderly in the United States. Based on the 1996 Medical Expenditure Panel Survey, inappropriate medication use in a national representative elderly population was first identified using Beers criteria. A survey type of ordered probit model was then estimated to quantify the effect of inappropriate drug use on patient self-perceived health status measured using a five-point scale (poor, fair, good, very good, and excellent). After controlling for a set of possible confounding factors, it was found that individuals using inappropriate medications in Round 1 were more likely than those not using inappropriate medications to report poorer health status in Round 2. Other risk factors for poor health status include a higher number of prescriptions, being black, having low education, and having one or more chronic diseases. This study provides strong evidence of a significant adverse effect of inappropriate medication use on patient health status. These findings lend partial support to the use of Beers criteria in assessing the quality of prescribing and the appropriateness of medication use in the elderly population.

Aged↗
PubMed2004

Cost comparisons of olanzapine and risperidone in treating schizophrenia.

OBJECTIVE: To review the literature on the healthcare costs associated with olanzapine and risperidone in treating schizophrenia. DATA SOURCES: Published English-language pharmacoeconomic studies on olanzapine and risperidone obtained through a MEDLINE search (1990-May 2003) were selected. Additional studies were identified from a manual search of the references of retrieved articles. data extraction: Based on the identified studies, data were extracted on various treatment costs associated with the use of antipsychotic drugs, concomitant drugs from other classes, inpatient care, outpatient care, and emergency care. Emphasis was placed on studies directly comparing olanzapine and risperidone. DATA SYNTHESIS: Both olanzapine and risperidone were generally associated with a trend of decrease in total medical costs compared with typical antipsychotics. When directly comparing the drugs, some studies found significant cost savings in favor of olanzapine and some suggested risperidone to save total costs. Still others showed no significant difference in total costs between the 2 drug regimens. CONCLUSIONS: While both olanzapine and risperidone appear to be more cost saving than typical antipsychotics, the literature offers no conclusive evidence to determine the comparative advantage of one versus another in terms of total cost outcomes. Major factors that contribute to the inconclusive findings may include across-study variations in populations, design, outcome measures, dosage, severity of illness, inclusion criteria, and statistical methodologies.

Benzodiazepines↗
PubMed2002

Self-reported health status, prophylactic medication use, and healthcare costs in older adults with asthma.

OBJECTIVES: To examine the relationship between self-reported health status, prophylactic medication use, and healthcare service use in older adults with asthma. DESIGN: A prospective longitudinal cohort study was conducted over a 2-year postenrollment period in a population of asthmatic older adults enrolled in managed care. Patients completed a comprehensive health-risk screen at time of enrollment in the plan. SETTING: A Medicare health maintenance organization (HMO) in the southeastern United States with prescription benefit. PARTICIPANTS: One hundred twenty-nine older adults with asthma using inhaled corticosteroid therapy as prophylaxis and enrolled in a Medicare HMO were available for complete follow-up. MEASUREMENTS: We measured self-reported health perception, falls, lifestyle, depressive symptomatology, and pre-enrollment healthcare service use using a comprehensive risk screen. We used the Med-Total index and total annual healthcare charges as measures of postenrollment inhaled corticosteroid and healthcare service use. RESULTS: After adjusting for the effects of other variables, we found that depressive symptomatology at baseline and increased comorbidity severity (using the Charlson comorbidity index) were associated with significant reductions in prophylactic medication possession (27% with depressive symptomatology and 6% with unit increase in Charlson's index, P <.05). Additionally, after adjusting for the effects of baseline health status, we found that a 10% increase in prophylactic medication possession was associated with a nearly 5% decrease in total annual healthcare charges in this population (P <.01). CONCLUSION: There are strong but not fully explained associations between depressive symptoms at time of enrollment, decreased postenrollment prophylactic medication use and increased postenrollment healthcare service use in older adults with asthma.

Administration, Inhalation↗
PubMed2002

Effect of high altitude on blood glucose meter performance.

Participation in high-altitude wilderness activities may expose persons to extreme environmental conditions, and for those with diabetes mellitus, euglycemia is important to ensure safe travel. We conducted a field assessment of the precision and accuracy of seven commonly used blood glucose meters while mountaineering on Mount Rainier, located in Washington State (elevation 14,410 ft). At various elevations each climber-subject used the randomly assigned device to measure the glucose level of capillary blood and three different concentrations of standardized control solutions, and a venous sample was also collected for later glucose analysis. Ordinary least squares regression was used to assess the effect of elevation and of other environmental potential covariates on the precision and accuracy of blood glucose meters. Elevation affects glucometer precision (p = 0.08), but becomes less significant (p = 0.21) when adjusted for temperature and relative humidity. The overall effect of elevation was to underestimate glucose levels by approximately 1-2% (unadjusted) for each 1,000 ft gain in elevation. Blood glucose meter accuracy was affected by elevation (p = 0.03), temperature (p < 0.01), and relative humidity (p = 0.04) after adjustment for the other variables. The interaction between elevation and relative humidity had a meaningful but not statistically significant effect on accuracy (p = 0.07). Thus, elevation, temperature, and relative humidity affect blood glucose meter performance, and elevated glucose levels are more greatly underestimated at higher elevations. Further research will help to identify which blood glucose meters are best suited for specific environments.

Adult↗
PubMedDate not supplied

How well have practices followed guidelines in prescribing antihypertensive drugs: the role of health insurance.

BACKGROUND: The US Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure issues guidelines on the optimal first-line drug therapy in treating hypertension. Despite broad dissemination of these guidelines, prescribing practices have long remained discrepant with recommendations. The purpose of this study was to examine the role of insurance type in the selection of drugs for hypertension treatment in light of the JNC guidelines. METHODS: Subjects were derived from the 1996 Medical Expenditures Panel Survey who had a diagnosis of essential hypertension and who were prescribed a diuretic, beta-blocker, calcium channel blocker (CCB), or ACE inhibitor (ACEI) as monotherapy. Using the nationally representative sample, this study presents the first estimates of the impact of insurance policies on the choice of antihypertensive drugs while controlling for predisposing, enabling, and need variables in the context of a logistic health-care utilization model. RESULTS: Nationally in 1996, more than twice as many subjects (7.3 million) were taking ACEIs or CCBs compared to diuretics or beta-blockers (3.1 million) as the first-line drug therapy, a sharp contrast to the JNC guidelines. Patients with health maintenance organization (HMO) insurance were much less likely than fee for service (FFS) patients to follow the JNC guidelines in this respect (odds ratio 0.50, P <.01), controlling for all other factors. Individuals with all other public insurance and no insurance were not statistically different from the FFS group in the use of the study drugs. Other significant factors in the regression model were being of African American descent, being unmarried, having higher out-of-pocket payment, being in excellent physical health, having diabetes, and being diagnosed with essential hypertension after 1988. Each was associated with a decreased likelihood of following the JNC recommendations for the use of diuretics or beta-blockers. CONCLUSIONS: After controlling for other predisposing, enabling, and need variables, patients who had HMO coverage were significantly more likely than FFS patients to receive ACEIs or CCBs. Given a popular public perception of HMOs being most cost conscious in providing health care, further research is needed to understand why prescribing patterns associated with HMOs have poorly followed the JNC recommendations.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence.

OBJECTIVES: To provide an updated review of the literature on the extent of and risk factors for inappropriate prescribing in the elderly. METHODS: A comprehensive review of the most recent publications in English assessing inappropriate prescriptions for elderly patients in the United States using the 1997 version of the Beers explicit criteria. The reviewed articles were obtained via an electronic search of the MEDLINE database for articles published between 1997 and 2001 and a manual search through major journals for articles referenced in those located through MEDLINE. Search terms were Beers, explicit criteria, inappropriate drug use, prescribing, prescriptions, medication use, elderly, and health outcomes. RESULTS: Using the updated explicit criteria, a total of 11 empirical studies were identified, all of which were conducted using observational surveys or claims databases. The reported prevalence of elderly patients using at least one inappropriately prescribed drug ranged from a high of 40% for a population of nursing home patients to 21.3% for community-dwelling patients over age 65. Propoxyphene, amitriptyline, long-acting benzodiazepines (e.g., chlordiazepoxide, diazepam, flurazepam), and dipyridamole are among the most commonly occurring inappropriate prescriptions. With a few exceptions, the most significant patient-related predictors of inappropriate prescribing include polypharmacy, poor health status, and female sex. Other potential risk factors include prescribing location, ethnicity, age, and referral status. Limited evidence was found of increased health care utilization and poorer quality of life resulting from inappropriate drug use in the elderly in Medicare health maintenance organization and emergency department settings. CONCLUSION: The prevalence of inappropriate prescribing remains alarmingly high for the elderly in general and for nursing home residents in particular. This review identified some attributes of the elderly groups most vulnerable to inappropriate prescribing. Future research should document more evidence regarding the adverse impact of inappropriate prescribing on total health care costs and patient health outcomes.

Aged↗
PubMedDate not supplied

Provision of pharmaceutical care services in North Carolina: a 1999 survey.

OBJECTIVE: To describe the extent of and factors associated with the provision of pharmaceutical care services (PCS) and value-added pharmaceutical services (PS) by pharmacists in North Carolina, the physical changes made in pharmacies to accommodate these services, the nature and extent of prior consent or collaborative practice arrangements between North Carolina pharmacists and prescribers, and the frequency of reimbursement for PCS. DESIGN: Descriptive study based on a mail survey. PARTICIPANTS: Pharmacist-managers at each of the 2,048 licensed pharmacy sites in North Carolina; a list of licensed pharmacies provided by the North Carolina Board of Pharmacy was used as the sampling frame. MAIN OUTCOME MEASURES: Pharmacists' reports of PCS and pharmacy demographics. RESULTS: Response rate was 40%. More than 30% of respondents provided PCS at their site, although only 20% met our more stringent definition of PCS (i.e., ensuring appropriate pharmacotherapy, ensuring patient understanding and adherence, and monitoring and reporting patient outcomes). Services were more frequently offered by university-affiliated (35%) or independent (32%) pharmacies. The median number of patients receiving PCS across all sites was 10 per week. Diabetes was the most common health problem for which PCS were offered. Three variables-weekly prescription volume (positive correlation); number of staff pharmacists with advanced training, specifically fellowship training; and medical clinic/health maintenance organization setting-were significant predictors of the numbers of patients provided PCS. Independent community pharmacies were most likely to have private counseling areas and to bill for and receive payment for PCS. CONCLUSION: In North Carolina, a substantial number of pharmacists provided PCS in 1999 or planned to do so in the near future. However, the number of patients receiving PCS was relatively low. Practice setting, pharmacist education level, and prescription volume were weakly predictive of the number of patients receiving PCS. Pharmacists commonly used prior consent arrangements with physicians in their practices, but primarily to facilitate generic substitution. Relatively few pharmacists billed for PS or PCS.

Community Pharmacy Services↗
PubMedDate not supplied

The Asheville Project: short-term outcomes of a community pharmacy diabetes care program.

OBJECTIVE: To assess short-term clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes in community pharmacies. DESIGN: Intention-to-treat, pre-post cohort-with-comparison group study. SETTING: Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS. INTERVENTIONS: Patients scheduled consultations with pharmacists over 7 to 9 months. Pharmacists provided education, self-monitored blood glucose (SMBG) meter training, clinical assessment, patient monitoring, follow-up, and referral. Group 1 patients began receiving PCS in March 1997, and group 2 patients began in March 1999. MAIN OUTCOME MEASURES: Change from baseline in the two employer groups in glycosylated hemoglobin (A1c) values, serum lipid concentrations, health-related quality of life (HRQOL), satisfaction with pharmacy services, and health care utilization and costs. RESULTS: Patients used SMBG meters at home, stored all readings, and brought their meters with them to 87% of the 317 PCS visits (3.7 visits per patient). Patients' A1c concentrations were significantly reduced, and their satisfaction with pharmacy services improved significantly. Patients experienced no change in HRQOL. From the payers' perspective, there was a significant dollars 52 per patient per month increase in diabetes costs for both groups, with PCS fees and diabetes prescriptions accounting for most of the increase. In contrast, both groups experienced a nonsignificant but economically important 29% decrease in nondiabetes costs and a 16% decrease in all-diagnosis costs. CONCLUSION: A clear temporal relationship was found between PCS and improved A1c, improved patient satisfaction with pharmacy services, and decreased all-diagnosis costs. Findings from this study demonstrate that pharmacists provided effective cognitive services and refute the idea that pharmacists must be certified diabetes educators to help patients with diabetes improve clinical outcomes.

Adolescent↗
PubMedDate not supplied

The Asheville Project: factors associated with outcomes of a community pharmacy diabetes care program.

OBJECTIVE: To assess the importance of environment, patient characteristics, and health behavior in explaining differences in clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes. DESIGN: Quasi-experimental, pre-post cohort-with-comparison group study using multivariate logistic regression. SETTING: Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS. INTERVENTIONS: Scheduled consultations with pharmacists involving education and training, assessment, monitoring, follow-up, and referral. MAIN OUTCOME MEASURES: Change in glycosylated hemoglobin (A1c) value, diabetes diagnosis and all-diagnosis utilization and cost of medical care, quality of life, and satisfaction with pharmacy services. RESULTS: The strongest predictors of improvement in A1c following PCS were the patient characteristics baseline glycemic control and type 1 diabetes. All patients with type 1 diabetes had reduced their A1c concentrations at follow-up. Patients in one employer group (an environmental characteristic) were significantly more likely to have a 10% reduction in diabetes diagnosis costs, compared with employees in the other group. They were also more likely to report improved satisfaction with pharmacy services. No other statistically significant relationships were found. CONCLUSION: The greatest improvement in A1c occurred among patients with type 1 diabetes and/or higher baseline A1c concentrations. When controlling for other factors, PCS did not emerge as a significant factor in lowering A1c, but it was imprecisely measured, and our proxy measure did not capture the full complement of PCS provided to patients. Success in terms of cost savings and patient satisfaction differed by employer group.

Adolescent↗
PubMedDate not supplied

The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program.

OBJECTIVE: To assess the persistence of outcomes for up to 5 years following the initiation of community-based pharmaceutical care services (PCS) for patients with diabetes. DESIGN: Quasi-experimental, longitudinal pre-post cohort study. SETTING: Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Patients with diabetes covered by self-insured employers' health plans. Community pharmacists trained in a diabetes certificate program and reimbursed for PCS. INTERVENTIONS: Education by certified diabetes educators, long-term community pharmacist follow-up using scheduled consultations, clinical assessment, goal setting, monitoring, and collaborative drug therapy management with physicians. MAIN OUTCOME MEASURES: Changes in glycosylated hemoglobin (A1c) and serum lipid concentrations and changes in diabetes-related and total medical utilization and costs over time. RESULTS: Mean A1c decreased at all follow-ups, with more than 50% of patients demonstrating improvements at each time. The number of patients with optimal A1c values (< 7%) also increased at each follow-up. More than 50% showed improvements in lipid levels at every measurement. Multivariate logistic regressions suggested that patients with higher baseline A1c values or higher baseline costs were most likely to improve or have lower costs, respectively. Costs shifted from inpatient and outpatient physician services to prescriptions, which increased significantly at every follow-up. Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline. Days of sick time decreased every year (1997-2001) for one employer group, with estimated increases in productivity estimated at $18,000 annually. CONCLUSION: Patients with diabetes who received ongoing PCS maintained improvement in A1c over time, and employers experienced a decline in mean total direct medical costs.

Adolescent↗
PubMedDate not supplied

Medication therapy management services in North Carolina community pharmacies: current practice patterns and projected demand.

OBJECTIVE: To evaluate the types of cognitive services offered and the number of patients being served in community pharmacies, determine the number of pharmacies that plan to offer medication therapy management (MTM) services under the Medicare Part D prescription drug benefit, and assess whether current and expected practices will meet the potential needs of enrollees. DESIGN: Cross-sectional study. SETTING: North Carolina in January 2005. PARTICIPANTS: 1,593 community pharmacy managers. INTERVENTIONS: Survey using a Web-based tool. MAIN OUTCOME MEASURES: Provision of cognitive services and number of patients for whom services are provided. RESULTS: A total of 262 (16%) pharmacy managers provided usable responses. Approximately 42% of respondents (n = 110) indicated that they provide some type of cognitive service. Comprehensive MTM services, or services consistent with the professionwide consensus definition, were provided by 31% of respondents (n = 81). Independent pharmacies were more likely to offer some type of service compared with chain pharmacies (58% versus 31%, respectively; P < .001). Pharmacy managers with a doctor of pharmacy degree were less likely than pharmacy managers with a bachelor's degree to offer services in their pharmacies (P = .02), and pharmacies with pharmacists on staff who had received certificate training were more likely to offer cognitive services (P = .03). Of all respondents, 28% (n = 73) indicated that they planned to offer MTM services under the Medicare Part D prescription drug benefit. CONCLUSION: Comparing these results with those of a 1999 survey of North Carolina pharmacists that used some of the same items, the percentage of community pharmacies that provide cognitive services has increased in the intervening years but remains low. Among the services being offered in 2005, most were focused on patient education and training, coordinating and integrating care, and medication regimen reviews. Implementation of MTM services under the Medicare Part D prescription drug benefit should hasten the development and offering of these services in community pharmacies.

Ambulatory Care↗
PubMedDate not supplied

Studying pharmaceutical care: difficult but necessary.

Research into the impact of pharmaceutical care need not be complex, but it is difficult in real-world settings. Pharmaceutical care projects need a committed project manager, dedicated pharmacists, an involved payer, and patients who believe they have a problem that needs to be addressed. Significant differences in outcomes are more likely with some chronic diseases than with others. Adequate funding of pharmaceutical care studies is needed to support identification of drug-related problems and outcomes in larger numbers of patients and over longer time periods. Demonstrating changes in patient satisfaction with providers and in health-related quality of life is difficult.

Health Services Research↗
PubMedDate not supplied

Impact of community pharmacy automation on workflow, workload, and patient interaction.

OBJECTIVE: To compare workload productivity, workflow efficiency, and pharmacist-patient interaction in automated and nonautomated community pharmacies. DESIGN: Observational study. SETTING: Four community pharmacy sites within a regional pharmacy chain. STUDY PARTICIPANTS: 173 patients and 11 pharmacists. INTERVENTIONS: Patient surveys, pharmacist surveys, and direct observation. MAIN OUTCOME MEASURES: Patient satisfaction, frequency of pharmacist-patient interactions, and prescription dispensing productivity and efficiency. RESULTS: Results from the three nonautomated pharmacies were averaged and compared with results from the automated pharmacy. Patient satisfaction was generally favorable for both automated and nonautomated pharmacies, but scores for the automated site were significantly better on items measuring one domain, technical competence of pharmacy staff. No association was found between patient counseling and prescription workload in automated or nonautomated sites. Personnel at the automated site made significantly more offers to counsel patients, but the number of patients who received counseling did not differ significantly. Automation was associated with a higher number of prescriptions dispensed per full-time equivalent pharmacist and fewer technical dispensing tasks performed by pharmacists. CONCLUSION: Patient satisfaction was not related to the presence of an automated dispensing system. Automation was associated with higher prescription productivity, but actual counseling rates were no different from those observed in nonautomated pharmacies. The likelihood that a patient would receive counseling was not related to staffing levels, automation, or workload. Whether counseling occurred appeared to depend on factors other than automation.

Automation↗