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PubMed1977

Skilled nursing facilities--a clinical opportunity for pharmacists.

It is suggested that nursing homes, as opposed to hospitals, provide the pharmacist with one of the best opportunities to practice clinical pharmacy. Restraining forces to clinical pharmacy include the reluctance of other health professionals to accept the pharmacist in clinical roles, and inadequate reimbursement for monitoring services. These restraining forces are less prevalent in nursing homes. Further, the great reliance on drug therapy in nursing homes, coupled with regulations requiring the pharmacist to assume a drug monitoring role, create a favorable atmosphere for clinical pharmacy practice. The importance of documenting the benefits of clinical pharmacy service is discussed.

Communication↗
PubMed1976

Clinical pharmacy: the past, present and future.

Clinical pharmacy is discussed in terms of its historical basis, current status and future trends. Topics covered include the origins and current scope of clinical pharmacy practice, controversial issues in clinical pharmacy practice and education, and the quest for quality in clinical pharmacy practice.

Education, Pharmacy↗
PubMed1985

Definition of clinical pharmacy as a specialty in clinical practice. Committee on Clinical Pharmacy as a Specialty. American Pharmacy Association.

Specialty credentialing has been discussed extensively and debated within pharmacy for more than ten years. Within the profession, there now appears to be a consensus on the need for and appropriateness of acknowledging professional practice areas as unique, defined entities. However, there remain substantive differences on how the definition of specialty practice should be constructed. One approach is to identify practice areas by functional activity (e.g., nuclear pharmacy, drug information) and/or therapeutic focus (e.g., psychopharmacy, clinical pharmacokinetics). A second approach is to define clinical pharmacy as a specialty practice that would, at least initially, coalesce clinical practitioners with the common denominator of an active role in the therapeutic decision-making process. The following document was developed by the Committee on Clinical Pharmacy as a Specialty (CCPS). The CCPS is independent of any formal organizational affiliations. It will serve as the preface to a petition that will be submitted to the Board of Pharmaceutical Specialties requesting recognition of clinical pharmacy as a specialty. The intention of the committee is to resolve the question of specialty status for clinical pharmacy through the Board of Pharmaceutical Specialties' review process. It is then hoped that pharmacy can move forward on the important issue of specialty credentialing.

Certification↗
PubMed1997

Guidelines for hospital pharmacy practice.

Clinical practice guidelines may take a variety of forms, and their role in contemporary health care continues to be debated. Practice guidelines may provide assistance for health-care workers in optimizing the quality of patient care. The complexity and diversity of contemporary pharmacy practice has necessitated the development of practice guidelines which will assist pharmacy departments in providing high quality, customer-focussed pharmaceutical services.

Accreditation↗
PubMed1981

Profile of a unique community-based clinical pharmacy family practice program.

The provision of clinical pharmaceutical services in family practice offices has aroused considerable national interest among both pharmacists and physicians. Many of these clinical pharmaceutical services and educational programs have been university-funded and/or rely on colleges of pharmacy for fiscal support. Few examples of community-funded, ambulatory care clinical pharmaceutical programs have been reported. Community Health Care, Inc., and Davenport Medical Education Foundation, Inc., are two health care programs which sponsor an innovative ambulatory care clinical pharmacy program. Community Health Care is a nonprofit corporation which utilizes a multidisciplinary team concept to provide comprehensive ambulatory care services to patients. Davenport Medical Education Foundation is a nonprofit corporation that provides a community-based family practice residency program. Because the two separate parent organizations have distinct goals requiring individualized clinical pharmaceutical services, the responsibilities of the clinical pharmacist have evolved to be comprehensive in scope.

Family Practice↗
PubMed1987

Changes in pharmacy practice due to a clinical pharmacy training programme for a group of community hospitals.

Education for and the practice of Clinical Pharmacy in South Africa have been neglected. This paper describes one attempt to improve matters. An initial survey of pharmacies, pharmacists and other staff in a small group of private hospitals determined the level of Clinical Pharmacy organization and services. The results were used to design a Clinical Pharmacy (training) Programme for selected pharmacists in the group. The programme consisted of six units, each of which was presented in at least a full-day session, with strong audiovisual support, small group discussion and rigorous exercises. During and after each session, implementation and application in the respective hospitals were monitored, as were participants' reactions. Clinical Pharmacy services increased markedly as a result of the programme, as did job satisfaction and motivation among most of the participating pharmacists.

Curriculum↗
PubMed1987

Developing and implementing standards of practice for clinical pharmacy services.

The authors' department has attempted to bring more order to the provision and evaluation of clinical services through the development of "Clinical Standards of Practice." A pilot project was initially conducted on one satellite. Pharmacists were asked to prepare a list of minimum standards that could be agreed upon and that everyone believed were achievable even on the busiest days. After standards were developed and implemented, a procedure was established to evaluate compliance through review of pharmacy records and patient materials. Staff received feedback concerning the results of the review. As a result of the success with the pilot, Clinical Standards of Practice have been developed by staff and are in use throughout the department. Plans for the future include continuous revision of the standards to reflect changing departmental goals and directions and a change to a "pharmacist specific" rather than a current "nursing unit specific" monthly review format to facilitate performance review and staff development. Eleven standards are shown in the appendices.

Clinical Competence↗
PubMed1987

Why we seek treatment here: retail pharmacy and clinical practice in Maiduguri, Nigeria.

This study based on interviews with 418 persons treated for various health problems at two retail pharmacies in Maiduguri, Nigeria, sought to know why the population uses the retail pharmacies as outpatient clinics. The most frequent reasons given by the respondents for their use is 'expeditious action in consultation and treatment'. This is followed by 'efficacy of treatment given' and 'convenience' (nearest source). There was no significant relationship between the reasons given and demographic background factors except age. The single most important advantage of retail pharmacy treatment over hospital treatment cited by respondents is 'expeditious treatment'. This is followed by 'availability of unadulterated drugs at all times'. The majority of respondents were in the habit of using retail pharmacies whenever they have illness episodes. Relatives and friends constituted the social network of significant influence over the decision to seek treatment at the particular retail pharmacy. The range of health problems reported for treatment was very wide with malaria as the most frequently reported. But the most frequent treatment given is antibiotic chemotherapy by injection or orally.

Adolescent↗
PubMed1999

Re-engineering: an opportunity to advance clinical practice in a community hospital.

A hospital pharmacy's efforts to advance clinical pharmacy practice and reduce pharmacy costs as part of a hospitalwide re-engineering program are described. In 1995, a 321-bed community hospital in Wisconsin undertook a three-year re-engineering program aimed at reducing operating expenses, primarily labor costs. The pharmacy department focused its efforts within the program on improving the efficiency of product-related functions, mainly through automation, and redeploying staff to value-added clinical functions. This involved installation of a hospitalwide pneumatic-tube system, use of unit-based automated medication dispensing devices, and implementation of a dedicated clinical pharmacy services program. Implementation of this program was to occur incrementally, with the first 12 months to be used primarily in developing a service model, initiating a staff-development program, and hiring additional clinical staff. Services added under the program included i.v. to oral conversion, dosage adjustments for patients with renal impairment, advanced patient counseling, development of care plans, and rounds in all areas of the hospital. After the first full year of implementation of the program, a cost-benefit analysis was undertaken; costs were composed primarily of pharmacists' salaries and benefits, and benefits were composed primarily of drug cost savings. A benefit to cost ratio of 2.61:1 and a net saving of $217,551 were calculated. The introduction of clinical pharmacy services as part of a hospitalwide re-engineering program was associated with a positive benefit to cost ratio and a substantial net cost saving.

Cost-Benefit Analysis↗
PubMed2003

Development of a quality use of medicines coding system to rate clinical pharmacists' medication review recommendations.

OBJECTIVE: To develop a 'quality use of medicines' coding system for the assessment of pharmacists' medication reviews and to apply it to an appropriate cohort. METHOD: A 'quality use of medicines' coding system was developed based on findings in the literature. These codes were then applied to 216 (111 intervention, 105 control) veterans' medication profiles by an independent clinical pharmacist who was supported by a clinical pharmacologist with the aim to assess the appropriateness of pharmacy interventions. The profiles were provided for veterans participating in a randomised, controlled trial in private hospitals evaluating the effect of medication review and discharge counselling. The reliability of the coding was tested by two independent clinical pharmacists in a random sample of 23 veterans from the study population. MAIN OUTCOME MEASURE: Interrater reliability was assessed by applying Cohen's kappa score on aggregated codes. RESULTS: The coding system based on the literature consisted of 19 codes. The results from the three clinical pharmacists suggested that the original coding system had two major problems: (a) a lack of discrimination for certain recommendations e.g. adverse drug reactions, toxicity and mortality may be seen as variations in degree of a single effect and (b) certain codes e.g. essential therapy were in low prevalence. The interrater reliability for an aggregation of all codes into positive, negative and clinically non-significant codes ranged from 0.49-0.58 (good to fair). The interrater reliability increased to 0.72-0.79 (excellent) when all negative codes were excluded. Analysis of the sample of 216 profiles showed that the most prevalent recommendations from the clinical pharmacists were a positive impact in reducing adverse responses (31.9%), an improvement in good clinical pharmacy practice (25.5%) and a positive impact in reducing drug toxicity (11.1%). Most medications were assigned the clinically non-significant code (96.6%). In fact, the interventions led to a statistically significant difference in pharmacist recommendations in the categories; adverse response, toxicity and good clinical pharmacy practice measured by the quality use of medicine coding system. CONCLUSION: It was possible to use the quality use of medicine coding system to rate the quality and potential health impact of pharmacists' medication reviews, and the system did pick up differences between intervention and control patients. The interrater reliability for the summarised coding system was fair, but a larger sample of medication regimens is needed to assess the non-summarised quality use of medicines coding system.

Aged↗
PubMed1996

Initiation of clinical pharmacy in Greece.

INTRO: There was neither Clinical Pharmacy practice in Greece nor Hospital Formularies. Clinical Pharmacy (CP) services started experimentally during a 3-month period (February 1995-April 1995) at the 2nd surgical Department of "Apostle Paul-KAT" Hospital in Athens. Since then there has been a strategy plan for further CP development. Our aim is to give information about these first steps in introducing CP in Greece. METHOD: The work at the Department was based on the prescription monitoring of every patient, realizing the prescribing trends and giving priority to certain prescribing problems. Eventually there was a focus on antibiotics and respiratory system drugs. RESULTS: 250 patients 91 interventions for alternative drug treatment and the duration of antibiotic treatment 25 interventions for individualization of drug dosage. 15 cases of monitoring adverse effects. 12 discussions with patients consulting them about their drug treatment 4 educational presentations. High acceptance by the medical staff. Comparison of 2 months (pre and post CP services) revealed 50.7% reduction in antibiotics and respiratory system drugs. Total cost saving 1,034120 drs-->E 2,787 for one month. CONCLUSIONS: The results of the 1st experimental 3-month period are indicative for the consequences of CP services both for the quality of pharmaceutical care and pharmaco-economics. Implementation of CP services by organizing a CP dept or Unit will influence the pharmaceutical policy of the Hospital and lead to institutional changes, such as a Hospital Formulary.

Drug Monitoring↗