PubMed Health⌕ Search

Biomedical subjects

P W Abramowitz

Publications and source records attributed to P W Abramowitz.

15 recordsLinked to original sources
PubMed1992

Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic.

The effects of pharmaceutical care on medication cost and quality of care in a university-based family-practice clinic were studied. Prognostic indicators were used to target patients who should receive pharmaceutical care. Those patients who received care. Those patients who received pharmaceutical care over a 14-month period during 1988-89 were included in the study. A pharmacist interviewed each targeted patient, obtained the patient's medication history, made therapeutic recommendations to the patient's physician, and counseled the patient on his or her therapy. The pharmacist's recommendations were noted, and the outcome of each recommendation was documented on subsequent patient visits. For each recommendation, drug cost avoidance was calculated and patient outcome was analyzed. For quality assessment, a panel of three health-care professionals reviewed the pharmacist's recommendations for 25% of the study patients (randomly selected) and noted their agreement or disagreement with the pharmacist's actions. Over the study period, 184 targeted patients received pharmaceutical care. Clinic physicians accepted 297 (82.5%) of 360 pharmacist recommendations. Annual extrapolated cost avoidance associated with the pharmacist's recommendations was $19,076. For 213 (80.4%) of the 265 accepted recommendations for which outcome data were available, improvement or resolution of the patient's disease state occurred. For 8 (16%) of 50 unaccepted recommendations, the patient's status declined. The peer review panel agreed with 86% of the pharmacist's recommendations. The provision of comprehensive pharmaceutical care in an ambulatory-care clinic can both reduce medication costs and improve quality of care.

Cost Control↗
PubMed1991

Effect of computer software on time required to prepare parenteral nutrient solutions.

Pharmacist and technician times required for the preparation of parenteral nutrient (PN) solutions were studied before and after the introduction of a software package that is used with an automated compounder. At a 580-bed teaching hospital, work sampling was used to collect data on how time was spent by personnel in the i.v. admixture pharmacy during six-week periods before and after the introduction of software that calculates the quantities of PN solution ingredients on a computer-generated work sheet and prints labels. The second data-collection period began when the software had been in use for four months. In the second study period, there was a significant decrease (28%) in total pharmacist time spent per PN solution; the mean +/- S.D. pharmacist times per PN solution per day for the two study periods were 14.03 +/- 3.24 minutes and 10.12 +/- 1.61 minutes, respectively. There were also significant decreases in pharmacist time spent performing calculations, checking calculations, and typing labels. After introduction of the software, technicians spent significantly less time typing labels and pumping base solutions. Overall, technicians spent significantly less time per PN solution in the second study period (20.15 +/- 3.50 versus 17.82 +/- 1.94 minutes). Use of the software allowed pharmacist staffing in the i.v. admixture pharmacy to be reduced, and the pharmacy resources were reallocated toward the provision of clinical services. The generation of PN labels and calculation worksheets by computer software reduced pharmacist and technician time requirements for PN solution preparation.

Data Collection↗
PubMed1990

Comparison of automated and manual methods of syringe filling.

A study to measure the time and cost associated with an automated and a manual method of syringe filling is reported. A stopwatch was used to measure the time needed by an experienced pharmacy technician to prepare batches of 200 syringes of each of seven drugs by a manual method and an automated method, the Multi-Ad Fluid Dispensing System. For each drug and method, time-and-motion data were collected during the preparation of four batches. The accuracy of each method was determined by dividing the actual by the expected number of syringes filled per batch. Material costs were calculated by summing the contract costs of the necessary equipment. The total cost of each method was determined by adding the labor and material costs. For all the drugs, the mean total time required to prepare one batch of syringes by the automated method was significantly less than that for the manual method. There was no significant difference in accuracy between methods for any of the drugs. The annual labor costs of the automated and manual methods were $4056 and $5761, respectively, and the annual material costs were $3364 and $2260, respectively. The total annual cost of the automated method was $7419, compared with $8021 for the manual method. The Multi-Ad system was significantly faster and somewhat less costly overall than a manual method for batch preparation of syringes of seven drugs.

Automation↗
PubMed1989

Indicators for the selection of ambulatory patients who warrant pharmacist monitoring.

The development of indicators to identify ambulatory patients who might benefit from pharmacist monitoring is described. With the assistance of an eight-member panel of ambulatory-care pharmacists, six prognostic indicators were identified: (1) five or more medications in present drug regimen, (2) 12 or more medication doses per day, (3) medication regimen changed four or more times during the past 12 months, (4) more than three concurrent disease states present, (5) history of noncompliance, and (6) presence of drugs that require therapeutic drug monitoring. The charts of patients who had visited the internal medicine, general surgery, pediatric, and obstetric/gynecology clinics during five randomly selected weeks in 1985 and 1986 were reviewed to determine the presence or absence of the six prognostic indicators and their adverse outcomes. Evidence of drug-therapy-related adverse outcomes was present in 79 (33.1%) of 239 charts. Charts of patients with a documented history of noncompliance were most likely to show evidence of an adverse outcome. The likelihood that a patient chart would show evidence of an adverse outcome increased as the number of prognostic indicators present increased. The presence of individual or multiple prognostic indicators in the charts of ambulatory-care patients should enable pharmacists to identify patients at greatest risk of experiencing drug-therapy-related adverse outcomes.

Ambulatory Care↗
PubMed1987

Changing use patterns of plasma volume expanders through educational intervention.

Use patterns of the plasma volume expanders albumin and hetastarch were evaluated before and after an educational program promoting the preferential use of hetastarch was implemented in a 700-bed teaching hospital. The high acquisition cost and periodic shortages of 5% albumin injection prompted the implementation in March 1985 of a target drug program that would encourage the use of 6% hetastarch injection in place of albumin whenever possible. Purchases of albumin and hetastarch were monitored from August 1984 to March 1985 and again from April to November 1985 to determine how much and where these agents were being used. Criteria and guidelines for the use of plasma volume expanders were developed by the pharmacy with physician input. Senior attending physicians who had been identified as primary decision makers in the clinical use of albumin were asked to abide by the guidelines; also, pharmacists conducted inservice educational programs on the use of hetastarch. Patterns of albumin and hetastarch use changed significantly (p less than 0.05) after the educational program was implemented. From August 1984 to March 1985, the mean number of units of albumin and hetastarch purchased monthly were 325.5 and 0.4, respectively. These numbers changed to 195.3 and 163.1 units, respectively, from April to November 1985. The monthly cost avoidance associated with this change was $5127, which extrapolates to $61,526 annually. An educational program can be effective in controlling hospital expenditures for plasma volume expanders. However, clinicians should be aware of the potential adverse effects of hetastarch and should avoid using it in excessive amounts or in patients with underlying coagulopathies.

Albumins↗
PubMed1985

Stability and cost analysis of clindamycin-gentamicin admixtures given every eight hours.

Stability and costs of a mixture of clindamycin and gentamicin in a single carrier solution for every-eight-hour i.v. administration were analyzed. Duplicate solutions containing clindamycin 900 mg (as the phosphate salt) and gentamicin 100 mg (as the sulfate salt) in 5% dextrose injection 150 mL in flexible plastic containers were prepared. Samples withdrawn at 0-24 hours were visually inspected and assayed for content of both drugs. Clindamycin concentrations were determined by high-performance liquid chromatography and gentamicin concentrations by fluorescence-polarization immunoassay. Preparation and administration times were measured in two trials to determine cost differences between every-eight-hour administration of the two-antibiotic mixture and separate administration of the two drugs (four daily doses of clindamycin and three of gentamicin). No precipitate was seen. Concentrations of both drugs after 24 hours were greater than 90% of initial concentrations. Total daily costs (per patient) for labor, drug, and carrier solution were $3.08 less when the two drugs were mixed and administered every eight hours. At the concentrations studied, clindamycin and gentamicin mixed together in 5% dextrose injection are stable for 24 hours. Administration of this drug mixture every eight hours is safe and less costly than separate administration of the two drugs.

Chromatography, High Pressure Liquid↗
PubMed1984

Controlling financial variables--changing prescribing patterns.

Techniques of formulary management, pharmacy and therapeutics committee intervention, and the use of clinical pharmacy services to change prescribing patterns and contain costs in hospital pharmacy departments are reviewed. Methods of using the formulary to contain costs include deletion of generic and therapeutic equivalents, inclusion of therapeutic categories and cost codes, and regular reviews and updates of its contents. Drug monographs for formulary evaluation prepared for the P & T committee should include a comparative review of other drugs in the therapeutic category and a cost impact statement. The P & T committee can help contain costs by developing policies for automatic stop orders and restricted drug use. Clinical pharmacy activities that can result in cost savings include physician education (focused on prescribing), target drug programs, target disease programs, pharmacist participation on TPN and i.v. therapy teams, and patient training programs for home care. A matrix for evaluating cost-containment activities is presented. By tailoring the described methods to departmental personnel resources and hospital needs, the pharmacy can be effective in controlling costs.

Drug Utilization↗
PubMed1984

Controlling financial variables--purchasing, inventory control, and waste reduction.

Purchasing, inventory control, and waste reduction techniques designed to minimize nonpersonnel expenditures are reviewed. Cost-saving purchasing mechanisms described include competitive bidding, contract negotiation, group purchasing, and primary wholesaler purchasing. The relative benefits of basic inventory management methods, including the ABC method, minimum and maximum levels, economic order quantity and value, and volume discount evaluation, are described. Waste and pilferage reducing methods discussed are unit dose drug distribution, i.v. admixture systems, and policies for use of i.v. sets and infusion pumps. Pharmacy departments in all institutions can reduce costs.

Contract Services↗
PubMed1983

The pharmacist as a member of the CPR team: evaluation by other health professionals.

Physician and nurse evaluation of the pharmacist's participation on the cardiopulmonary resuscitation (CPR) team was studied, in an attempt to justify the pharmacist's role. A pharmacist-evaluation questionnaire was prepared, based on the Likert Method. This questionnaire contained ten statements related to organizational and mechanical contributions, drug information contributions, and overall contribution and desire, by other health professionals, for continuance of this service. Pharmacists attended all CPRs during a six-month period and distributed a questionnaire to one physician and one nurse in attendance. Verification was obtained that these individuals had attended previous arrests where pharmacists were not in attendance. Only those evaluations that were completed and returned by the physician or the nurse, to the Department of Pharmaceutical Services, were evaluated. Results indicated that physicians and nurses are in agreement with the pharmacist's organizational and mechanical contribution. Both physicians and nurses tended toward agreement with the pharmacist's drug information contribution. Finally, physicians and nurses are in agreement with the pharmacist's overall contribution to the CPR team and desire continuance of this service.

Humans↗
PubMed1982

Hiring drug information personnel.

An analysis of the functions performed at a drug information center (DIC) is described as the basis for hiring personnel. A functional job analysis demonstrated a division in the duties of DIC personnel. The workload demanded a drug literature specialist (DLS) to access, store, and retrieve drug information, and a practitioner in drug information (PDI) to analyze this information and make the appropriate clinical judgements. The DIC hired a DLS with a background in library science and experience with computer searching techniques to work with the PDI. It is suggested that the combination of a qualified librarian and a drug information pharmacist can provide the DIC with the optimal personnel. The analysis was a valuable tool in selecting personnel who possess the appropriate skills, job understanding, attitude, and innovative abilities.

Computers↗
PubMed1982

Use of clinical pharmacists to reduce cefamandole, cefoxitin, and ticarcillin costs.

The financial impact of using cefamandole and cefoxitin rather than cefazolin and of using ticarcillin rather than carbenicillin in one institution was assessed; the effectiveness of clinical pharmacists in reducing the costs associated with these drugs also was determined. During Phase 1 (July 1, 1980-March 31, 1981), the numbers of intravenous piggyback cefazolin, cephalothin, cefamandole, cefoxitin, carbenicillin, and ticarcillin doses prepared were recorded. Quarterly purchase data for each drug were determined from invoice records. During Phase 2 (April 1, 1981-September 30, 1981), eight clinical pharmacists reviewed all patient charts for cefamandole, cefoxitin, and ticarcillin orders. If the indication for these orders was missing or considered inappropriate, the pharmacist contacted the prescriber and recommended substituting appropriate doses of cefazolin for cefamandole and cefoxitin and of carbenicillin for ticarcillin. The number of doses prepared and quarterly purchase data were collected as in Phase 1. The projected savings resulting from clinical pharmacist input relating to these drugs was calculated. Based on Phase 1 data, the total theoretical expense resulting from cefamandole and cefoxitin use instead of cefazolin and from ticarcillin use in place of carbenicillin was projected to be $233,448 annually. Cefamandole and cefoxitin accounted for 59.8 and 39.7% of total cephalosporin use in Phases 1 and 2, respectively. Ticarcillin accounted for 77.1% of the total ticarcillin and carbenicillin doses in Phase 1, and 16.6% in Phase 2. A projected annual savings of $156,756 was achieved because of clinical pharmacist input at a cost of $16,000 for time devoted to the effort. Clinical pharmacists were effective in reducing the use of cefamandole, cefoxitin, and ticarcillin in situations where cefazolin or carbenicillin could be substituted.

Anti-Bacterial Agents↗
PubMed1980

Effect of theophylline, terbutaline, and their combination on the immediate hypersensitivity skin-test reaction.

Methylxanthines and beta agonists can be expected to inhibit the antigen-induced hypersensitivity skin-test reaction by affecting cyclic 3', 5'-adenosine monophosphate (cyclic AMP) metabolism, yet in vivo studies produce conflicting results. The discontinuation of these drugs prior to skin testing may result in the exacerbation of asthmatic symptoms; however, if these drugs are maintained, the validity of the test remains in question. To determine the effect of these drugs on the skin-test response, 15 patients received theophylline, terbutaline, the combination, and placebo in a double-blind study. No statistically significant difference (p greater than 0.05) was found for the areas of wheal and flare in response to injected allergens or histamine, between placebo and theophylline, terbutaline, and their combination. A marginal decrease in wheal area in response to codeine following combination therapy was observed. Therapeutic theophylline and terbutaline serum concentrations were documented. There is no need to discontinue theophylline or terbutaline prior to skin testing.

Adult↗