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Biomedical subjects

K K Knapp

Publications and source records attributed to K K Knapp.

At least 19 recordsLinked to original sources
PubMed2001

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--2001.

The results of a 2001 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of similar surveys conducted in 1997 and 1999. Three hundred and seventy-six MCOs and integrated health systems participated in the telephone survey. The surveyelicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey respondents were asked about 24 specific ambulatory care pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary care teams, automated dispensing systems, integrated electronic medical records, very supportive medical staff, and very supportive senior management. Twenty previously measured functions decreased since 1999. Decreases were greatest in negotiating pharmaceutical contracts (-28%), administering immunizations (-27%), and immunization screening (-24%). Enabling factors supported continued expansion. Two clusters of functions, patient-related and population-related activities, were identified and supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the broadest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of functions, with an emphasis on population-focused functions. Ambulatory care functions of pharmacists have expanded to new areas and have decreased in more traditional areas, perhaps because of the current pharmacist shortage and the increase in the number of prescriptions and patients.

Ambulatory Care↗
PubMed2000

The availability and distribution of dentists in rural ZIP codes and primary care health professional shortage areas (PC-HPSA) ZIP codes: comparison with primary care providers.

OBJECTIVE: This paper maps dentists, primary care physicians, physician assistants, nurse practitioners, and nurse midwives in rural areas and rural areas meeting criteria as underserved for primary health care. METHODS: Computer-based mapping was used to localize health care provider groups by five-digit ZIP code. For each rural and each rural primary care health professional shortage area (PC-HPSA) ZIP code, the number of providers in each group was determined. The different combinations of providers were determined. RESULTS: All providers in rural areas were present at levels substantially lower than national averages, particularly in PC-HPSA areas. Dentists were approximately equal in number to primary care physicians in rural areas and the largest group in PC-HPSAs. Approximately 75 percent of rural residents lived in ZIP code areas with dentists available. Over 5.8 million rural residents and over 50 percent of rural PC-HPSA residents had no providers available in their ZIP code areas. CONCLUSIONS: Rural areas continue to have a short supply of primary care providers and dentists. Dentists were present in many areas where primary care provider presence was absent or very low. These data, including those relating to provider co-presence, can be used to develop strategies to overcome health care access problems due to provider shortages.

Dentists↗
PubMed1999

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--1999.

The results of a 1999 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of a similar survey conducted in 1997. Four hundred MCOs and integrated health systems participated in the telephone survey. The survey elicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey recipients were asked about 24 specific ambulatory pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary teams, automated dispensing systems, integrated electronic medical records, and "very supportive" medical staff and senior management. Thirteen functions were reported to be routine activities for more than 50% of the respondents, compared with nine functions in 1997. The top four functions-using pharmacoeconomic data to make formulary decisions, conducting medication management programs, tracking adverse drug reactions, and providing written information with each new prescription-were performed in 75% or more of organizations. Some 15-18% of respondents indicated they would add specialized pharmacy-managed clinics, services to determine patient use of herbal products and dietary supplements, and Internet prescription services within 12 months, suggesting this expansion is likely to continue. Enabling factors supported expansion. Two clusters of functions were identified that related to either population-focused or patient-focused activities, and these were supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the greatest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of pharmacist functions, with an emphasis on population-focused functions, suggesting that a second model of ambulatory care pharmacist activity may be emerging. Ambulatory care functions of pharmacists in integrated health-system settings have expanded broadly since 1997.

Ambulatory Care↗
PubMed1999

Charting the demand for pharmacists in the managed care era.

The demand for pharmacists in the changing health care market is discussed. The Pharmacy Manpower Project (PMP) evolved out of concerns raised in the late 1980s, when the demand for pharmacists exceeded the supply. PMP collects, analyzes, and disseminates data on pharmacy work force variables. PMP's Subcommittee to Study Demand Issues was formed after the publication in 1995 of the Pew Health Professions Commission report projecting dramatic surpluses of pharmacists. In 1996-97, the PMP subcommittee held a series of sessions to discuss the future demand for pharmacists and their services. The panel identified a wide range of work force projections, but it concluded that medication management problems in the context of increasing prescription numbers and the emergence of data-driven health care support a scenario of a steadily increasing demand for pharmacists and pharmaceutical services. The data did not show that higher penetration by managed care is associated with smaller pharmacy staffs or job loss in institutions. There is little reason to expect the dramatic downsizing of the pharmacy work force predicted by the third report of the Pew Commission. However, retaining pharmacy roles that are useful to the system and satisfying to pharmacists will require a continuation of current proactive measures by the profession.

Drug Prescriptions↗
PubMed1998

Community pharmacist interventions in a capitated pharmacy benefit contract.

Documented interventions associated with processing prescriptions in a managed care environment were analyzed, and a bench-mark for interventions was proposed. A retrospective analysis of documented interventions by 31 pharmacies contracted by a managed care organization to serve 22,000 Medi-Cal patients was undertaken. An intervention consisted of identifying any problem related to a prescription, taking action, and recording the problem, action, and outcome on a form. Problems were categorized as drug selection issues, clinical issues, errors in prescription writing, and patient education issues. A similar process was followed for describing actions and outcomes. The data were used as an indicator of prescription-related problems in contemporary pharmacies in a managed care environment; data from another study were used as an indicator of "ideal" pharmacist performance in detecting and resolving problems. The estimated intervention rate when pharmacists meeting ideal performance expectations worked in a managed care environment was set as a benchmark. The economic impact of drug selection interventions was determined as well. Data were retrieved and compiled from 595 (93.4%) of 637 interventions performed in 1995, when 93,483 contract-related prescriptions were processed by the 31 pharmacies. Fifty percent of problems related to drug selection issues. The most frequent action was contacting the presciber (56.1%). The overall intervention rate was 0.7% (range, 0-4.1%). It was estimated that 4% of prescriptions would require an intervention; two pharmacies met this level. Interventions resulting in prescription change realized an average decrease in cost of 65.8%. Community pharmacies under contract with a managed care organization intervened on 0.7% of prescriptions, but the rate of intervention across pharmacies was inconsistent, ranging from 0% to 4.1%; a benchmark of 4% would be reasonable.

California↗
PubMed1995

Factors motivating pharmacy students to pursue residency and fellowship training.

Factors that influence pharmacy students to pursue residency and fellowship training were studied. Directors of 514 residency or fellowship programs were asked to distribute to their residents or fellows a survey concerning factors that influenced their decision to enter a residency or fellowship. Deans of the 75 U.S. pharmacy schools were sent a related survey and asked to forward it to the faculty or staff member who was most involved in promoting residencies and fellowships to students. This survey asked about methods for promoting the programs and the faculty member's opinion on why students chose to become residents and fellows. Residents and fellows cited "to gain knowledge and experience," "recognition of new and challenging roles," and "desire for specialized training" as their leading reasons for entering their programs. The pharmacy school representatives also cited "to gain knowledge and experience" and "desire for specialized training" as leading reasons. The residents and fellows thought instruction on residencies and fellowships should occur earlier in the pharmacy degree programs than it was being provided. The pharmacy school respondents considered the largest barriers to entering such programs "financial" and "a job was available upon graduation from pharmacy school." The pharmacy school survey results were broken into two groups: the 9 schools that produced the most students who went on to residencies and fellowships, and the rest of the schools. The former group was more likely to offer the Pharm.D. degree and to involve preceptors, residents, and fellows in didactic and clerkship teaching. Two factors--"to gain knowledge and experience" and "desire for specialized training"--were cited most frequently by survey respondents as important factors in students' decisions to pursue residencies and fellowships, and schools that produce more residents and fellows tended to involve preceptors, residents, and fellows in didactic and clerkship training.

Adult↗
PubMed1994

Pharmacy manpower: implications for pharmaceutical care and health care reform.

Our understanding of the pharmacy work force has improved substantially over the past five years. Research efforts have described the existing work force and projected for the next decade the effect that changes in educational programs, increasing numbers of female pharmacists, and increasing numbers of employee pharmacists will have on the effective work force size. Projections about the effect of pharmacy technicians and automation are less certain. Continued research is needed to document the changing nature of the pharmacy work force, to provide work force data that are essential to representing pharmacy in health care policy decisions, and to help confirm the value of pharmacy services.

Adult↗
PubMed1994

Pharmacist-managed medication review in a managed care system.

A medication-review service at a managed care facility was studied. The service, developed in 1991, provides in-depth analysis of medication use and patient consultation by a pharmacist. Patients are seen by referral. During a visit, the pharmacist reviews each medication for patterns of use, clinical response, and adverse effects and if necessary teaches the patient how to use the drugs more appropriately. The pharmacist may change some aspect of the prescription and may schedule follow-up visits. The investigators reviewed data on (1) medication-related problems for all new patients seen by the pharmacist during the first 12 months of the service, (2) patient demographics for the first 23 months, (3) utilization of the service and pharmacist productivity for the first 23 months, (4) utilization of medications and health care services in a representative subset of patients 12 months before and after they used the service, and (5) costs. A total of 2720 medications were reviewed during months 1-12. On average, 64.9% of the drugs reviewed each month were problematic. A total of 836 patients were seen during the first 23 months; most of the referrals were from physicians. The patients averaged 2.6 diagnoses and 4.7 drugs each and were not dominated by any one age group, gender, diagnosis, or drug therapy. A representative subgroup showed reductions in the number of unscheduled physician visits, urgent care visits, emergency room visits, and hospital days; a savings of $644 per patient per year was calculated. Patients used fewer health services during the year after they began participating in a pharmacist-managed medication-review program.

Adolescent↗
PubMed1992

Work patterns of male and female pharmacists. A longitudinal analysis 1959-1989.

A demand for better data about pharmacists as working health professionals led the authors to study the work patterns of 1,146 pharmacists over a 30-year period from 1959 to 1989. Work history data were used to determine gender-specific participation rates as a function of age, years in the work force, and date. Percent full-time (as opposed to part-time) work as a gender-specific function of age was also determined. Participation rates for males and females, widely disparate in the 1960s, have converged and are not significantly different. Graduates of the 1980s, both male and female, are remaining with pharmacy as an occupation at a significantly higher rate than earlier graduates. Percent full-time rates for women pharmacists are significantly lower than those for male pharmacists, although women have registered significant increases in percent full-time work in each decade from the 1960s to the 1980s. An unexpected finding was the overall reduced participation by graduates of the years 1970 to 1979. The findings of the study are helpful in explaining recent controversies about the adequacy of the supply of pharmacists. The form of the data bases constructed for this study could be used as a model for the study of other health professionals.

Adult↗
PubMed1991

Promoting residencies to pharmacy students.

A program for promoting pharmacy residency training to pharmacy students at the University of the Pacific (UOP) is described. A residency club was started in 1982 to increase UOP students' interest in residency training and to provide them with relevant information. Some students needed to be convinced that residencies were primarily educational rather than staffing experiences. Students were made aware of pharmacists' practice in specialty areas, for which residency training is needed, and were taught how to prepare themselves for selection for residencies. The club was formed to encourage mutual support among the students, which would be less likely to occur if residencies were promoted only through work with individual students. Club meetings provide information about available residencies, the application process, and the value of residency training to a career in pharmacy. Students are taught how to prepare curricula vitae, how to interview, and how to select programs to which to apply. Applications for residencies increased. Although the rate of acceptance was low at first, it was expected to increase as more UOP students demonstrated their interest in and qualification for residency training. The promotion of residencies as part of a balanced career planning and placement program for pharmacy students is encouraged.

California↗
PubMed1990

Models for the supply of pharmacists.

The BHPr (formerly Bureau of Health Professions) Supply Model for pharmacists is presented and analyzed. Recommendations are made for improvement of the supply model. Included are considerations of additional variables and improvement of tables of separation rates to more accurately reflect working patterns of male and female pharmacists. The supply model shares many features of supply models for other health professions such as nursing and medicine. The variables suggested for improvement of supply determinations parallel supply measures of other health professions also. The adoption of suggestions for improvement of the pharmacy supply model to other health professions' supply models is suggested.

Age Factors↗
PubMed1989

Educational differentiation of the pharmacy work force.

A model of the pharmacy work force in which pharmacists are differentiated and quantified on the basis of their professional education is described, and the model is used to analyze work force data for 1978 and 1987. The educational differentiation of the pharmacy work force was represented by a three-tiered pyramid in which the base, second, and third levels comprised pharmacists with a B.S. degree, a Pharm.D. degree, and residency or fellowship training, respectively. The number of pharmacists at each level was tabulated for 1978 and 1987 by using data from the National Center for Health Statistics, the American Association of Colleges of Pharmacy, ASHP, and other sources. In 1987, as in 1978, more than 90% of pharmacists had no formal training beyond the B.S. degree. However, the proportion of pharmacists with Pharm.D. degrees did increase from 1 in 30 to 1 in 16, and proportionately more pharmacists were receiving post-Pharm.D. training. Large state and regional differences were seen in the number and educational level of pharmacists. Differentiation in the physician and nursing work forces was examined; the physician work force was highly specialized, but nurses showed a more balanced differentiation. An increase in the demand for postgraduate training of pharmacists was projected. The educational differentiation model shows that the pharmacy work force is highly undifferentiated and that education at the Pharm.D. level should be emphasized. Such emphasis will increase the demand for residency and fellowship programs and improve the image of pharmacy as a profession.

Education, Medical↗
PubMed1988

Pharmacy manpower: the need for an improved database.

There are many indications that there is currently a shortfall in the supply of pharmacists. Pharmacy manpower studies available today did not predict this event and fail to adequately describe the pharmacy workforce. This paper examines the major, recent pharmacy manpower studies comparing their scope, methods and results to each other and to selected manpower studies of other health professions. The paper attempts to point out areas where pharmacy manpower date are lacking, outdated or inappropriate.

Evaluation Studies as Topic↗