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Biomedical subjects

M E Pitterle

Publications and source records attributed to M E Pitterle.

35 records · Page 2Linked to original sources
PubMed1990

Hospital pharmacy services in the Great Lakes region.

The results of a spring 1987 survey of hospital pharmacy services in seven states of the Great Lakes region are reported. The study group (n = 1087) comprised all hospitals in seven states that employed at least one full-time or part-time pharmacist and that had 50 or more licensed beds. The survey had a 63% response rate (681 usable responses). Seventy percent of the hospitals were small (average daily census, less than 200), 20% were medium sized (200-399), and 11% were large (greater than or equal to 400). Some 33% of the hospitals were affiliated with a college of pharmacy. Pharmacy directors who held an advanced degree (master of science or doctor of pharmacy) were more likely to work in larger hospitals and in those affiliated with educational institutions. The extent of unit dose services differed based on hospital teaching affiliation and pharmacy director's education. Provision of i.v. admixture services differed based on hospital teaching affiliation and pharmacy director's education but not hospital size. Pharmacy preparation of six specialty i.v. products differed according to pharmacy director's education and hospital teaching affiliation; however, pharmacy preparation of only three of the specialty products differed based on hospital size. Larger hospitals that were affiliated with an educational institution were more likely to employ a clinical coordinator, drug information specialist, or clinical pharmacist. Home health-care services involving pharmacists were provided by 26% of the hospitals; the most common programs were antimicrobial therapy and total parenteral nutrition therapy. Pharmacists provided services in ambulatory-care clinics in 24% of the hospitals, with the most common services being patient education, pharmacokinetics consultation, and dosage regimen adjustment. Provision of 10 of 12 inpatient clinical pharmacy services differed based on hospital size and teaching affiliation; 11 of the 12 services differed based on education of the pharmacy director. Workload and pharmacist staffing data for the inpatient clinical pharmacy services varied widely. Eleven of these services were expected to undergo a positive net growth, while one service, provision of admission medication histories, was expected to decline. An extensive survey of hospital pharmacy services in the Great Lakes region showed that the provision and scope of many services were related to hospital size, hospital teaching affiliation, and the education of the pharmacy director.

Drug Information Services↗
PubMed1990

A comprehensive measure of pharmaceutical services: the pharmaceutical-care index.

The construction, validation, and use of a numerical index for measuring the provision of pharmaceutical care are described. The 681 respondents to the 1987 Great Lakes Pharmacy Services Survey were randomly divided into two equal groups of hospitals. Data for the first group (n = 341) were used to construct and validate the pharmaceutical-care index (PCI); data for the second group were used for index analysis. Bivariate analysis of 14 major inpatient pharmaceutical services resulted in one service, admission medication histories, being dropped from the index. Multivariate analysis showed that the remaining services contributed equally to the PCI; they were therefore retained. The possible range of PCI scores was -11.166 to 26.518, with a high score indicating greater provision of service. Analysis of data for the second randomly selected group of hospitals (n = 340) showed that PCI scores differed significantly on the basis of hospital size, hospital teaching affiliation, and pharmacy director's education. The correlation between average daily census and PCI score was fair. Higher scores were associated with the presence of a clinical coordinator or a clinical pharmacist. There were weak associations between PCI score and numbers of pharmacists, pharmacy managers, drug distribution pharmacists, and clinical pharmacists. However, the number of decentralized pharmacists and the number of technicians both showed a fair association with PCI score. Hospitals that had pharmacist participation in ambulatory-care clinics or a staff development program had higher PCI scores than hospitals that did not. The provision of inpatient pharmaceutical services, as assessed by the PCI, may be influenced by hospital size, teaching affiliation, the education of the pharmacy director, and other factors. Further research is needed to extend these findings to other hospitals, expose interactions among the factors that affect pharmaceutical care, and refine the PCI.

Abstracting and Indexing↗
PubMed1986

Home blood pressure readings in clinical hypertension research.

The feasibility and reliability of home blood pressure measurement in clinical research were determined as part of a study to document the safety and efficacy of two captopril dosage regimens. Twenty patients were studied. Patients were instructed to record blood pressures twice daily (before morning and evening doses of captopril) for 24 weeks. All patients were instructed in blood pressure measurement and were required to demonstrate the accuracy of their techniques. Supine and standing blood pressures were measured every two weeks in the clinic. The mean of all home blood pressures recorded in the two-week period before each clinic visit was compared with the measurement obtained at that clinic visit for each patient. Blood pressure data could be evaluated for 17 patients. Each patient recorded 330-380 readings, and the mean home blood pressure measurement for each two-week period was calculated from 26-32 separate readings. Home blood pressures were consistently lower than clinic measurements but showed similar trends in response to treatment. There was good correlation between values obtained at home and in the clinic. Morning and evening blood pressures obtained by patients were not significantly different. Home blood pressure monitoring is a useful tool in hypertension research.

Adult↗
PubMed1986

Low-dose weekly oral methotrexate therapy for inflammatory arthritis.

The efficacy and toxicity of low-dose, weekly oral methotrexate (MTX) therapy for inflammatory arthritis was evaluated. Fifty-nine patients with a diagnosis of inflammatory arthritis who had failed to respond to or developed toxicity to gold, penicillamine, or hydroxychloroquine therapy were treated with MTX 10-20 mg administered orally or intravenously once a week in divided doses. Various tests to assess arthritis were performed upon each patient's entrance into the study and at specified intervals throughout the 24-month study period. The mean duration of methotrexate therapy was 15.5 months. Patients showed significant improvement in number of swollen joints, duration of morning stiffness, amount of pain, and amount of activity during the study period. Of the 35 patients who had had roentgenographic studies of their hands performed initially and after one year of MTX therapy, 23 had no evidence of new joint erosions after one year. Biopsies of hepatic tissue from 20 patients showed no progressive changes when compared with pretreatment biopsies. Gastrointestinal symptoms, mucocutaneous lesions, or small increases in liver enzyme concentrations were observed in 31 patients; three patients developed pulmonary toxicity and had to be withdrawn from the study. MTX is an effective agent for the treatment of inflammatory arthritis in patients who do not respond to therapy with nonsteroidal anti-inflammatory drugs or slow-acting antirheumatic drugs. Short-term weekly oral MTX therapy does not appear to result in clinically important liver disease.

Administration, Oral↗
PubMed1985

Use of serum drug concentrations in outpatient clinics.

A four-month retrospective study was conducted to analyze the use of serum drug concentrations (SDCs) in the outpatient clinics of a teaching hospital. The general internal medicine, asthma and allergy, cardiology, and neurology clinics were selected as frequent users of SDCs. Serum theophylline, digoxin, quinidine, procainamide, carbamazepine, phenytoin, and phenobarbital concentrations obtained during patient clinic visits were audited by trained pharmacy students using medical records and computer-generated laboratory data. The SDCs were evaluated for (1) the appropriateness of how they were obtained, (2) the appropriateness of the actions taken on the results, (3) the reasons they were ordered, and (4) the patient charges secondary to obtaining SDCs incorrectly or taking inappropriate actions on the results. Overall, the SDCs from all the clinics combined were obtained appropriately 251 (61.4%) of 409 times. Appropriate actions were taken on the SDC results 82.4% of the time. A change in therapy was made after an SDC was ordered 24.4% of the time. A total of $4975 of patient charges was associated with incorrectly obtained SDCs or inappropriate actions taken on SDC results. The asthma and allergy clinic, which was staffed by a clinical pharmacist, used SDCs more appropriately than the other clinics. Pharmacists or other professionals should be used to obtain accurate SDC information and to follow-up on SDC results to maximize drug therapy and reduce costs.

Carbamazepine↗
PubMed1979

Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate.

The pharmacokinetics of erythromycin and erythromycin 2'-propanoate were studied in healthy male volunteers following single and repeated doses of erythromycin stearate tablets, erythromycin estolate capsules, and a suspension. Estolate dosages gave rise to higher plasma levels of total drug than the stearate. However, the stearate yielded higher plasma levels of erythromycin base. Absorption of all dosage forms, except the suspension, was delayed, and pharmacokinetic interpretation of both single- and multiple-dose data required incorporation of an absorption lag time. The absorption of erythromycin stearate was inhibited by food and also by low fluid volumes in fasted subjects. Absorption of erythromycin estolate was increased in the presence of food and was not greatly affected by fluid volume. Although single-dose data poorly predicted circulating levels of erythromycin following repeated doses, trends observed after single doses were maintained during chronic treatment.

Adult↗
PubMedDate not supplied

An assessment of recent pharmacy graduates' knowledge and competency, professional practice functions, and involvement in pharmacy teaching programs.

STUDY OBJECTIVES: To determine self-evaluated professional knowledge and competency, functions, demographic information, lifelong learning, degree and training status, practice sites, involvement in pharmacy teaching programs, and salary for recent pharmacy graduates. DESIGN: A survey of recent Bachelor of Science (B.S.) pharmacy graduates of the University of Wisconsin School of Pharmacy. MEASUREMENTS AND MAIN RESULTS: A total of 371 B.S. pharmacy graduates (55% response rate) provided information. Graduates who had an advanced degree or training (from many programs) after completing their B.S. pharmacy degree, and those who were teaching in pharmacy programs generally had higher self-rated levels of knowledge and competencies. Hospital pharmacists spent less of their work time in dispensing activities (33.82% +/- 30.39%) than community pharmacists (61.04% +/- 19.97%; t = 8.78, df = 288, p < 0.001); community pharmacists spent twice as much of their work time counseling and educating patients (16.65% +/- 10.47% vs 7.13% +/- 7.39%; t = 9.06, df = 288, p < 0.001). The amount of time pharmacists spent in dispensing functions had a negative association with knowledge and competencies in the sections on pharmacokinetic and disease process (r = -0.277, p < 0.01), patient communications (r = -0.272, p < 0.01), and administrative and economic aspects of practice (r = -0.210, p < 0.01) for all respondents. Pharmacists reported that they spent 13.78 +/- 14.06 hours per month outside work in professional lifelong learning. There was a negative association between the time pharmacists spent dispensing and the time they spent in professional lifelong learning (r = -0.239, p < 0.001), and a positive relationship between the time spent in such learning and the time providing information to prescribers and other health care professionals (r = 0.214, p < 0.001), monitoring patients (r = 0.216, p < 0.001), and performing primary care activities (r = 0.176, p < 0.001). Graduates reported a mean yearly salary of $46,879 +/- $8183. More hospital pharmacists were involved in teaching (48, 37%) than those practicing in a community setting (19, 12%). CONCLUSIONS: Practice site, advanced degree or training, lifelong learning, involvement in teaching programs, and time spent in various professional functions were associated with pharmacists' self-rated knowledge and competencies.

Community Pharmacy Services↗
PubMedDate not supplied

1992 National Clinical Pharmacy Services Study.

STUDY OBJECTIVE: To determine the extent of hospital-based clinical pharmacy services in 1992. DESIGN: National survey with trend comparison to 1989. SETTING: All 1597 United States acute care, general medical-surgical and pediatric hospitals with 50 or more licensed beds and one or more full-time pharmacists (43% of all U.S. hospitals). MEASUREMENTS AND MAIN RESULTS: Fourteen clinical pharmacy services, carefully defined to indicate pharmacist proactive or concurrent patient care provision, were assessed to determine pharmacists' specific patient care responsibilities. The percentage of hospitals offering each of the services increased from 1989 to 1992, with greatest growth in management of adverse drug reactions (22% increase), pharmacokinetic consultations (14%), and drug therapy protocols (12%). The mean percentage of patients actually receiving clinical pharmacy services ranged from 0.2% for pharmacist participation on the cardiac arrest team to 36.1% for daily monitoring of drug therapy. Pharmacists conducted clinical research in 13% of all hospitals, averaging 3.9 +/- 4.3 protocols per year with a total budget of $79,765 +/- $128,641. CONCLUSIONS: Clinical pharmacy services continue to expand; however, even the most common direct patient care service is provided to a small number of inpatients.

Drug Utilization Review↗
PubMedDate not supplied

Hospital and pharmacy characteristics associated with mortality rates in United States hospitals.

We attempted to determine hospital and pharmacy characteristics associated with mortality rates in 4864 United States hospitals. Data were obtained from the Health Care Financing Administration, the American Hospital Association, and the National Clinical Pharmacy Services survey. Univariate and multivariate regression models were used to determine which hospital characteristics were associated with mortality. A similar regression analysis was performed on 718 hospitals for which detailed pharmacy information was available. In a multivariate regression model, some characteristics of 4864 hospitals associated with reduced mortality rates were high-technology index (R2 = 0.09, p < 0.001), severity of illness (R2 = 0.048, p < 0.001), number of hospital beds (R2 = 0.016, p < 0.001), and medical personnel (R2 = 0.012, p < 0.001). This analysis accounted for 41% of the mortality rate variance. For the 718 hospitals and pharmacies, some of these characteristics were high-technology index (R2 = 0.157, p < 0.001), severity of illness (R2 = 0.07, p < 0.001), number of pharmacists/average daily census (R2 = 0.021, p < 0.001), and combined hospitalwide clinical pharmacy services (R2 = 0.016, p < 0.01). The results of this analysis were similar to those in the only other large study in this area, but that excluded pharmacy characteristics. This is the first study to show a statistically significant association between pharmacist and pharmacy variables and reduced hospital mortality rates.

Hospital Bed Capacity↗
PubMedDate not supplied

Ambulatory pharmacy services affiliated with acute care hospitals.

The extent to which hospital-based pharmacists provide ambulatory clinical pharmacy services in the United States is unknown. We evaluated pharmacists' activities in hospital-affiliated ambulatory clinics and home health services. A questionnaire was mailed to directors of pharmacy in one-half of the United States acute care general medical-surgical hospitals with 50 or more licensed beds. The survey response rate was 56% (n = 1174). In 19% of hospitals, pharmacists provided patient care (nondispensing activities) in ambulatory clinics. The most common clinics with pharmacist involvement were diabetes (10% of hospitals), oncology (9%), cardiology (6%), and geriatrics, infectious disease, and pain (4% each). Nondispensing roles varied by clinic type; prescribing by protocol was performed in 57% of anticoagulation clinics and 7% of diabetes clinics. Home health care services, with pharmacists' activity extending beyond providing drugs, were offered by 28% of the hospitals. Thirty-six percent of the hospitals operated one or more outpatient pharmacies. A statistically significant association was observed between hospitals' inpatient clinical pharmacy services (as assessed by the pharmaceutical care index) and the involvement of pharmacists in both ambulatory clinics and home health care services.

Ambulatory Care↗
PubMedDate not supplied

1995 National Clinical Pharmacy Services Study.

To determine the extent of hospital-based clinical pharmacy services in 1995, we surveyed 1109 United States acute care, general, medical-surgical, and pediatric hospitals with 50 or more licensed beds. Fifteen clinical pharmacy services were assessed to determine pharmacists' specific patient care responsibilities. The percentage of hospitals offering services grew between 1992 and 1995: pharmacokinetic consultations (16% increase), drug therapy protocol management (15%), drug therapy monitoring (8%), drug counseling (13%), and parenteral-enteral nutrition team (6%). All other services increased 0-5%. Pharmacists conducted clinical research in 14% of hospitals, averaging 6.3+/-22.1 protocols/department annually; total budget $96,219+/-$262,026. Patient-focused care predominated in 20% of hospitals, although most pharmacists reported to directors of pharmacy through traditional pharmacy department channels. Clinical pharmacy services continue to expand, with pharmacists providing higher-level direct patient care activities related to drug therapy management and monitoring.

Ambulatory Care↗
PubMedDate not supplied

Clinical pharmacy services in hospitals educating pharmacy students.

In 1995 we conducted a national survey of 1102 acute care hospitals in the United States to determine types of clinical pharmacy services, patient-focused care, and pharmaceutical care used to educate and train pharmacy students, and compared outcomes with surveys in 1989 and 1992. Clinical pharmacy services offered in 50% or more of Pharm.D.-affiliated hospitals (core services) were drug-use evaluation, in-service education, pharmacokinetic consultations, adverse drug reaction management, drug therapy monitoring, protocol management (most common for aminoglycosides, nutrition, antibiotics, heparin, warfarin, theophylline), nutrition team, and drug counseling. Comprehensive pharmaceutical care programs were established in 64%, 42%, and 33% of Pharm.D., B.S., and nonteaching hospitals, respectively. Patient-focused care programs were beginning or established in 77%, 71%, and 60%, respectively. Pharmacists served as care team leaders in 23% of hospitals affiliated with a college of pharmacy. Most common ambulatory care clinics were oncology, anticoagulation, diabetes, geriatrics, refill, and infectious diseases/HIV. For-profit hospitals rarely provided education for pharmacy students. Thus patient-focused and comprehensive pharmaceutical care programs exist according to a hospital's academic program affiliation with Pharm.D. or B.S. degree program.

Data Collection↗