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PubMed1995

University-based sports pharmacy program.

Ways for pharmacists to become involved in sports pharmacy are discussed, and a university-based sports pharmacy program is described. Sports pharmacy encompasses treating athletic injuries, distributing drugs and sports-related supplies, counseling patients, and monitoring therapeutic outcomes, along with educating athletes, trainers, and others about drug use and abuse. Pharmacists can contribute their expertise by presenting information at schools, health clubs, and other exercise-related organizations. They can serve on drug-testing crews at collegiate athletic events. Pharmacists can also provide supplies and services to schools or athletic facilities; ideally, this could be a contractual arrangement to provide comprehensive pharmaceutical care. A sports pharmacy program was implemented at the University of North Carolina at Chapel Hill in 1980. Pharmacists provide drug therapy monitoring and patient education to all patients at the school; patients' level of athletic activity is taken into consideration. Pharmacists also ensure proper use, storage, and distribution of drugs kept in clinics, training rooms, and sports medicine travel bags, as well as identifying and providing drugs and supplies that might be needed at an off-campus event. They provide inservice education to athletic trainers and physicians. The program has improved patient outcomes and helped to ensure adequate drug supplies and minimum waste. There are numerous opportunities for practitioners to become involved in sports pharmacy. A university-based sports pharmacy program improved the care of student athletes and helped contain drug costs.

Athletic Injuries↗
PubMed1995

Implementation of a criteria-based antimicrobial formulary system.

The development of a criteria-based antimicrobial formulary system for use in a 432-bed university-based tertiary-care hospital is described. A subcommittee of the hospital's pharmacy and therapeutics committee developed prescribing criteria for antimicrobials thought to have a specific place in the treatment of various infections. The criteria were based primarily on patient needs, but when two therapies were thought to have similar effectiveness and similar toxicity profiles, cost became the deciding factor in drug selection. Educational packets were designed to assist physicians in prescribing criteria-based antimicrobials. An antimicrobial order form was also developed. The program was implemented after an extensive orientation and education period; data on antimicrobial use were collected for the first year of the program. Hospitalwide compliance with the criteria was 89%, although compliance in certain departments was poorer. The database was formulated to be both service- and physician-specific for the purposes of reporting and education.

Anti-Infective Agents↗
PubMed1996

Benchmark analysis of strategies hospitals use to control antimicrobial expenditures.

Hospital expenditures on antimicrobial drugs, antimicrobial management practices, and the effects of these practices were studied. A survey on institutional budget, size, and staffing; intensive care unit drug costs and use evaluations; and pharmacy expenditures, including antimicrobial costs, for 1993 and 1994 was sent to 122 hospitals. The written survey was followed by telephoned questions regarding each institution's antimicrobial management and expenditures, and any perceived link between the two. Hospitals were grouped by size and type, data were normalized to costs per occupied bed and costs per occupied bed per case mix index, and averages for each size category were calculated for general institutional information and expenses per antimicrobial. Eighty-eight institutions (72%) responded. Although 61% to 74% of the respondents used an antimicrobial formulary to restrict drug choices and control costs, average total antimicrobial expenses increased by more than $300 per occupied bed between 1993 and 1994. Only 7% of the institutions saw decreased costs of $500 or more per occupied bed. The most common reasons for these decreases were restructuring of pricing contracts and implementation of educational programs. The replacement of one formulary alternative with another led to increases in the use of antimicrobials other than the replacement drug and often did not produce savings. The replacement of one formulary antimicrobial with another led more to costshifting than to overall savings.

Anti-Bacterial Agents↗
PubMed1996

Formularies in integrated health systems: Integris health.

Formulary management implications are described for an Oklahoma integrated health system that consists of 14 acute care facilities, numerous owned medical practices, and a fledgling HMO and has loose alliances with other rural facilities. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations manager for the Oklahoma City area has been created. A physician group has been formed that is expected to address systemwide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently, P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, which includes a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information systems. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Cost Savings↗