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At least 649 records · Page 36Linked to original sources
PubMed1999

Cost analysis of laparoscopy versus laparotomy for early endometrial cancer.

OBJECTIVE: The purpose of this study was to determine whether the cost associated with treatment of early stage endometrial cancer differs on the basis of the surgical approach. METHODS: A retrospective analysis was performed on a series of women with presumed early stage endometrial cancer treated between 5/96 and 1/99 at a single institution. The patients were grouped according to the surgical approach utilized. The first group consisted of 19 patients who underwent laparoscopic assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and laparoscopic pelvic and paraaortic lymph node dissection. The second group consisted of 17 patients who underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node dissection. The two groups were compared with a two-tailed Student t test. Variables analyzed included age, Quetelet index (QI), surgical stage, number of lymph nodes, surgical time, estimated blood loss, postoperative complications, number of days in the hospital, and costs. The cost analysis was divided into room and board, pharmacy, ancillary services, operating room equipment, operating room services, and anesthesia. RESULTS: Both groups were similar in age, QI, and distribution of stage. The laparoscopic group required more OR time (237 vs 157 min, P < 0.001); however, the number of lymph nodes, estimated blood loss, and postoperative complications were not significantly different between the groups. The laparoscopic group required significantly shorter hospitalization than the laparotomy group (3.7 vs 5.2 days, P < 0.001) resulting in less room and board ($299 vs $454, P < 0.001) as well as pharmacy costs ($443 vs $625, P < 0.02). The cost of anesthesia was higher in the laparoscopic group ($696 vs $444, P < 0.001) but the costs of OR equipment, OR services, and total costs were not statistically different between the groups. CONCLUSION: Laparoscopic surgical management of early stage endometrial cancer is feasible with minimal morbidity. The cost savings of early hospital discharge is offset by longer surgical time and higher anesthetic costs. The total costs for each surgical approach are not statistically different. The presumed advantages of less pain, early resumption of normal activities, and overall improvement of quality of life await further investigation.

Aged↗
PubMed2006

Customers' expectations and satisfaction with a pharmacy not providing advanced cognitive services.

OBJECTIVE: To assess customers' expectations and satisfaction with a community pharmacy which does not provide advanced professional cognitive services (APCS). METHOD: A non-validated questionnaire was designed; the questionnaire included items on expectations with pharmacy services and on satisfaction with the existing services. An independent interviewer was appointed to survey people leaving the pharmacy; the questionnaire was administered on two randomly chosen days. RESULTS: The mean age of respondents (n=61) was 46 years. Expectations: The most highly ranked item was "Drug available in the pharmacy" (4.97 on a 5-point Likert scale), followed by "Having queries and questions about health problems answered" (4.84). People found it easy "To seek advice on health problems or about medicines from the pharmacist at the counter" (4.48). The lowest ranked item was "reduced waiting time" (3.13). The overall Satisfaction with pharmacy services was high (4.89). CONCLUSIONS: Customers reported a high level of satisfaction in a pharmacy where advanced cognitive services were not available. However, this should not discourage pharmacists from implementing APCS, because patients' expectations are based only on experiences with current distributive services, which fulfill their perceived needs.

Community Pharmacy Services↗
PubMed2000

Self-medication with vaginal antifungal drugs: physicians' experiences and women's utilization patterns.

BACKGROUND: In many countries, vaginal antifungal drugs have been released on over-the-counter (OTC) markets, yet little is known about women's management of their symptoms. OBJECTIVES: The aim of this study was to judge the appropriateness of self-medication with vaginal antifungal drugs by examining utilization patterns and physicians' experiences of women's self-medication. METHODS: An anonymous questionnaire survey was carried out in 20 pharmacies in Finland of women buying OTC vaginal antifungal drugs in 1997. Out of the 453 questionnaires distributed, 299 (66%) were returned. A survey of a random sample of gynaecologists (n = 169) and specialists in general practice (n = 288) was carried out in 1996. The response rate was 77%. RESULTS: Nearly all women had used vaginal antifungal drugs previously, 49% during the previous 6 months. Most women did not report any difficulties with treatment, but 44% of women used the drug against recommendations. Half of the women had symptoms that are more likely to be related to infections other than Candida. Physicians had observed several disadvantages of self-treatment, with unnecessary use and use for the wrong indications being the most often reported. In all, 31% of gynaecologists and 16% of GPs reported that these adverse events had been clinically significant, with delay in the treatment of other infections being the most common problem. CONCLUSION: The results raise concerns about inappropriate use and women's ability to self-diagnose correctly. Because vaginal antifungal drugs are likely to remain on OTC markets, two ways to address these concerns are for physicians and pharmacy personnel to provide spontaneous information and to have more informative advertisements on vaginal antifungal drugs.

Adolescent↗
PubMed2004

Pharmacist computer skills and needs assessment survey.

BACKGROUND: To use technology effectively for the advancement of patient care, pharmacists must possess a variety of computer skills. We recently introduced a novel applied informatics program in this Canadian hospital clinical service unit to enhance the informatics skills of our members. OBJECTIVE: This study was conducted to gain a better understanding of the baseline computer skills and needs of our hospital pharmacists immediately prior to the implementation of an applied informatics program. METHODS: In May 2001, an 84-question written survey was distributed by mail to 106 practicing hospital pharmacists in our multi-site, 1500-bed, acute-adult-tertiary care Canadian teaching hospital in Vancouver, British Columbia. RESULTS: Fifty-eight surveys (55% of total) were returned within the two-week study period. The survey responses reflected the opinions of licensed BSc and PharmD hospital pharmacists with a broad range of pharmacy practice experience. Most respondents had home access to personal computers, and regularly used computers in the work environment for drug distribution, information management, and communication purposes. Few respondents reported experience with handheld computers. Software use experience varied according to application. Although patient-care information software and e-mail were commonly used, experience with spreadsheet, statistical, and presentation software was negligible. The respondents were familiar with Internet search engines, and these were reported to be the most common method of seeking clinical information online. Although many respondents rated themselves as being generally computer literate and not particularly anxious about using computers, the majority believed they required more training to reach their desired level of computer literacy. Lack of familiarity with computer-related terms was prevalent. Self-reported basic computer skill was typically at a moderate level, and varied depending on the task. Specifically, respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. CONCLUSIONS: Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness.

Adult↗
PubMedDate not supplied

[Pharmaceutical care in primary health care: the experience of 3 Brazilian States].

In the context of recent changes in the Brazilian drug supply system at the national level, mainly the deactivation of CEME (a government agency under the Ministry of Health that dealt with drug supply policy) and the increasing decentralization of activities under the Unified National Health System (SUS), three Brazilian States - Paraná, São Paulo, and Minas Gerais - have established programs for the distribution of essential drugs for primary health care. A nationwide program for the procurement and supply of 32 drugs for primary health care (the so-called "Basic Pharmacy Program") is currently being implemented by the Ministry of Health, to be decentralized subsequently. This article discusses the establishment of State-level drug policies for primary health care through the analysis of the three pioneering programs encompassing drug selection, procurement, storage, distribution, and use.

Brazil↗
PubMedDate not supplied

Pharmacist ambivalence about sale of syringes to injection drug users.

OBJECTIVE: To examine pharmacists' attitudes and practices surrounding human immunodeficiency virus (HIV) prevention among injection drug users. DESIGN: Focus groups. SETTING: Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. PATIENTS OR OTHER PARTICIPANTS: Eight focus groups, with 4 to 11 pharmacists participating in each group. INTERVENTIONS: Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of NUD*IST. MAIN OUTCOME MEASURES: Willingness to sell syringes to all customers, views on syringe exchange programs (SEPs), knowledge of laws governing syringe sales and racial, ethnic, or gender biases in syringe selling practices. RESULTS: Two pharmacists established their own policies of selling syringes to everyone, and three expressed a willingness to have their pharmacies serve as SEPs. A total of 20% of the pharmacists expressed an interest in learning more about the efficacy of SEPs and distribution of syringes by pharmacists, and were willing to change their views based on this information. Many also indicated a general willingness to work with SEPs or to participate in the effort to curb the spread of HIV. However, a majority of pharmacists opposed having SEPs in their pharmacies and reported selling syringes only within specific limits: to known diabetics, to individuals who looked reasonable, or to individuals who presented a logical explanation. No racial, ethnic, or gender bias was observed. CONCLUSION: Opinions among pharmacists varied across and within sites. While a majority of pharmacists would not establish SEPs in their own pharmacies, nearly all would participate in other HIV-prevention programs. Educational programs for pharmacists may be valuable in HIV-prevention efforts.

Attitude of Health Personnel↗
PubMed1997

Pharmacy and tobacco.

With the recognition that smoking begins in youth and that tobacco products are readily available to those under 18 years of age, new Food and Drug Administration (FDA) regulations restrict the sale, distribution, promotion, and advertising of cigarettes to minors. The objective is to decrease the use of tobacco by young people and consequently reduce the future morbidity and mortality from tobacco. Pharmacists currently have three choices with regard to the sale of tobacco in pharmacies: display and sell tobacco products, refuse to sell tobacco products, or make tobacco products available but counsel on smoking cessation. Each choice, as well as the impact of the new FDA regulations on pharmacy, is discussed.

Adolescent↗
PubMed1984

Capitation payment for pharmacy services. II. Impact on costs.

Four areas of cost were analyzed in the expanded capitation drug program: total program costs; drug costs, escrow account distribution, and administrative costs. Total program costs were, on average, 9% higher under capitation. Drug costs, however, were 3% lower than under fee-for-service (FFS) reimbursement. This discrepancy is probably because pharmacists were not at financial risk under the program, the capitation rates were higher than intended, there were many emergency claims, and other aspects of the research environment. Although administrative costs were large, almost two thirds of the development cost was for one-time work, which could be transferred to another state at little or no expense. One third of the total administrative costs can be attributed to complying with regulations of the Health Care Financing Administration. Significant refinement of the present capitation model may be necessary before this financing innovation is used elsewhere. Modifications might include limiting the system to nursing home patients, placing pharmacists at partial financial risk, restricting participation to pharmacies that service a large number of Medicaid eligibles, and basing capitation rates in part on the drug use behavior of cash-paying patients.

Capitation Fee↗