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The ethics of Pharmaceutical benefit management.

Efforts to limit pharmacy costs raise both ethical and economic considerations. Six values should inform pharmacy benefit management: (1) accepting resource constraints; (2) helping the sick; (3) protecting the worst off; (4) respecting autonomy; (5) sustaining trust; and (6) promoting inclusive decision making. Direct controls, such as formularies, step therapy, and prior authorization, can focus limited resources on the sick and worst off. However, direct controls limit autonomy and are administratively burdensome. Indirect controls, such as physician capitation, tiered copayments, and drug benefit caps, align physicians' and patients' interests with resource constraints, respect autonomy, and are administratively efficient. Unfortunately, they deter use based on cost, not medical need; they do not focus cuts on unnecessary or marginal drug use or focus resources on the sick. Budget caps are the least defensible, while tiered copays and physician capitation can be justified if implemented with safeguards. Formularies and step therapy are ethically justifiable if they can be efficiently instituted.

Capitation Fee↗
PubMed1999

The historical study of an ethics for American pharmacists.

The Code of Ethics for pharmacists clarifies the standards of professional conduct. The code should be positively enforced in every country, and must play its role as the conduct standard for pharmacists at all times. American pharmacists did not suddenly become ethical in the 1980s. An appreciation of the importance of professional ethics has a long history starting when the Philadelphia College of Pharmacy adopted a Code of Ethics in 1848. Since the first legislation of the American Pharmacy Code of Ethics as far back as 1852, the code has been revised in 1922, 1952, 1969, 1981 and 1994. The term of between revisions has gotten shorter over the years, reflecting the change in the status and the proficiency of pharmacists in 146 years. Its historical meaning is quite significant.

Ethics, Pharmacy↗
PubMed2006

U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review.

BACKGROUND: Although dietary supplements (DS) are widely sold in pharmacies, the legal, ethical, and practice responsibilities of pharmacists with respect to these products have not been well defined. This systematic review of pharmacists' attitudes, knowledge, and professional practice behaviours toward DS is intended to inform pharmacy regulators' and educators' decision making around this topic. METHODS: Eligible studies were identified through a systematic database search for all available years through to March 2006. Articles were analyzed for this review if they included survey data on U.S. or Canadian pharmacists' attitudes, knowledge, or professional practice behaviors toward DS published in 1990 or later. RESULTS: Due to the heterogeneity of the data, it was not possible to draw a conclusion with respect to pharmacists' general attitudes toward DS. Approximately equal numbers of pharmacists report positive as well as negative attitudes about the safety and efficacy of DS. There is strong agreement among pharmacists for the need to have additional training on DS, increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners. CONCLUSION: Further research is needed to explore the factors that influence pharmacists' beliefs and attitudes about DS, to accurately evaluate pharmacists' knowledge of DS, and to uncover the reasons why pharmacists do not routinely document, monitor, or inquire about patients' use of DS.

Canada↗
PubMed1977

1976 Harvey A.K. Whitney lecture: the peril of deprofessionalization.

It is argued that American pharmacy is in great peril of being deprofessionalized, and that hospital pharmacy practice offers the best hope for restoring public confidence in the profession. Pharmacists are criticized for a failing sense of mission and a waning dependence on knowledge. It is observed that pharmacy has diminished control over practitioner education. Various threats to the professional association of hospital pharmacists, and the need for ethical codes enforced by the profession are discussed. The concept of an American School of Hospital Pharmacy is supported. Hospital pharmacists are urged to become drug experts; it is suggested that pharmacists in hospitals be required to develop expertise in specific categories of drugs. It is concluded that pharmacy must use its drug knowledge effectively to avoid the peril of deprofessionalization.

Education, Pharmacy↗
PubMed2001

Ethical issues in a Brazilian hospital.

PURPOSE: The objective of this paper is to discuss ethical issues such as data protection, confidentiality, and patient freedom taking two ongoing studies as examples. METHODS: The two studies are being carried out at a public hospital in southern Brazil. Study 1 evaluates inadequate use of drugs (mainly vancomycin) and aims at reviewing criteria for drug use control. It includes records of 100 patients whose prescriptions are dispensed at the hospital's pharmacy. A major ethical concern in this study was to ensure data confidentiality. Study 2 evaluates treatment adherence by hypertension patients with a focus on hydrochlorothiazide. Here, in addition to data protection, a major ethical concern was the ability of patients to understand the informed consent form and therefore freely enter or refuse to enter the study. Both projects were approved by the Institutional Review Board at Hospital de Clínicas de Porto Alegre. RESULTS: In both studies, data confidentiality is ensured by the removal of all personal information from the forms used for data analysis. In Study 2, readability of the informed consent was considered adequate by the IRB for the population served by the clinic, and one-third of the patients who were contacted agreed to participate in the study. CONCLUSIONS: To obtain reliable results, basic ethical principles must be observed throughout the planning and execution of research projects, whether data are obtained from medical records or from actual interaction with patients. Thus, monitoring by an Institutional Review Board or equivalent is of paramount importance.

Bioethics↗