Drug benefits in managed care: seeking ethical guidance from the formulary?
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Advisory Committees↗
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Results for “ETHICS, PHARMACY”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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A teaching guide for electroconvulsive therapy.
Concern has been raised regarding the erratic and sometimes less than adequate teaching of electroconvulsive therapy (ECT) to health professionals. The development of standardized curricula will ultimately improve the quality of care for patients receiving ECT and help to minimize the myths and misinformation clinicians have regarding ECT. An outline for teaching ECT is presented that covers the following areas: preconceptions, history, patient selection, conditions of increased risk, medical and neurological side effects, memory issues, technical aspects, electrode placement, clinical problems, management of the post-ECT course, legal and ethical issues, mechanisms of action, and educational issues. This outline can be expanded to encompass up to a 6-hour course for psychiatric residents, or compressed to provide the basics to nursing, medical, or pharmacy students.
Curriculum↗
[Strife between the dispensing physician and the pharmacist--a historical overview IV. 1979-1987].
In 1981 a liaison committee established between the Medical Association of South Africa (MASA) and the Pharmaceutical Society of South Africa (PSSA) to probe the dispensing-doctor issue, published a joint declaration of co-operation. After a brief truce, however, relationships deteriorated again. Pharmacists claimed that the numbers of dispensing doctors were rapidly increasing and each profession accused the other of breaking the agreement. According to the PSSA many doctors were transgressing the MASA's guidelines and the Medical Council's ethical rule 28 by trading in medicines. Subsequent legislation approved by the Council and designed to obviate this problem brought unexpected complications, and led to a joint effort by the Medical Council and the Pharmacy Council to reach an acceptable compromise. In 1984 a tentative agreement was reached but not endorsed by the full Medical Council, largely because of pending recommendations from the Competition Board which would profoundly affect dispensing by pharmacists and doctors. These recommendations were made public in November 1986, and the Government's response to them is still being awaited. The author finally summarises the status quo of the age-old feud as he perceives it.
Association↗
Pharmacy conscience clause statutes: constitutional religious "accommodations" or unconstitutional "substantial burdens" on women?
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Attitude of Health Personnel↗
Onset of illegal use of mind-altering or potentially addictive prescription drugs among pharmacists.
OBJECTIVES: To determine the temporal and descriptive aspects of pharmacists' decision-making processes regarding illegal use of mind-altering or potentially addictive prescription drugs (PAPDs) and to measure the effects of social factors associated with being and becoming a pharmacist on pharmacists' decisions to use PAPDs illegally. DESIGN: One-time, written, mailed survey. SETTING: United States. PARTICIPANTS: Random sample of licensed practicing pharmacists who were members of the American Pharmaceutical Association in fall 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responses to items on the survey. RESULTS: Nearly 40% of respondents indicated that they had used a form of PAPD without first obtaining a physician's authorizing prescription. A significant portion of the sample showed signs of repeated use-20% of the respondents reported 5 or more lifetime PAPD-use episodes, and 6% reported more than 10 such episodes. Almost 6% of the respondents identified themselves as being drug abusers at some point during their pharmacy careers. Moreover, a full 88% of these pharmacists began such illegal PAPD use after entering college, 51% used more than one type or class of PAPD, and 69% directly violated their professional code of ethics and state and/or federal laws by either stealing PAPDs from their place of employment (61%) or forging prescriptions (8%) to obtain them. CONCLUSION: A considerable percentage (40%) of the pharmacists surveyed had, on at least one occasion, used some form of PAPD without first obtaining a physician's authorizing prescription, and about one-fifth of respondents reported repeated use. The onset of such illegal PAPD use by pharmacists almost always occurred after the individuals had entered college. Interpersonal factors, such as positive reinforcement of self-medication practices from peers and increased levels of one's own approval for self-medication, appear to increase the likelihood that a pharmacist will engage in such illegal PAPD use.
Adult↗
Legal limitations for nurse prescribers in primary health care.
The nurse plays an important role in the delivery of primary health care services in South Africa. The primary purpose is to provide the public with access to safe competent basic health care and to achieve this, the nurse should be empowered to practice within legal and ethical boundaries. This paper explores and describes the limitations imposed by legislation on the nurse's ability to prescribe treatment in the primary health care field. The focus is mainly on the Nursing Act, the Pharmacy Act and the Medicines and Related Substances Control Act which highlights a number of limitations. It is concluded that empowerment of the nurse should not only include addressing the legal boundaries for practice, but also education and training opportunities to equip them with the expert knowledge and skills that they need to render a quality health care service.
Clinical Competence↗
Informed consent for emergency contraception: variability in hospital care of rape victims.
There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 58 large urban hospitals, including 28 Catholic hospitals, from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim's right to information about her treatment options and jeopardize physicians' fiduciary responsibility to act in their patients' best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requiring hospitals to meet the standard of care for treatment of rape victims is appropriate.
Catholicism↗
Interfacing managed care and long-term care: understanding the issues.
Both marketplace forces and legislative initiatives are forcing the traditional fee-for-service long-term health care sector into the managed care arena. To identify and address the issues surrounding quality and cost-effective pharmaceutical use at the interface between managed care and long-term care, the Philadelphia College of Pharmacy and Science convened a day-long conference between managed care and long-term care medical and pharmacy directors. This paper outlines the discussion and recommendations in respect to these issues.
Continuity of Patient Care↗
A comparison of health professions student attitudes regarding tobacco curricula and interventionist roles.
Health care providers who feel prepared are more apt to assume tobacco interventionist roles; therefore, educational preparation is critical. A nonprobability sample of health professions students at an urban academic health center were asked to respond to a twenty-two-item survey eliciting demographic, behavioral, and tobacco-related attitudinal information. Frequency distributions were assessed with Pearson chi-square statistics. The overall response rate was 76.7 percent, and final sample size was 319. Current use of spit tobacco (ST) was 2.5 percent and current smoking 5.6 percent. In comparing current smokers to nonsmokers and current ST users to nonusers, we found that no differences in proportion agreeing with any of the five questions about attitudes and opinions were statistically significant at p-value 0.05. At least 70 percent of students from each of six health professions programs agreed it was their professional responsibility to help smokers quit, and at least 65 percent agreed to the same responsibility for helping ST users quit. The proportion agreeing that their programs had course content describing their role in helping patients quit tobacco use varied widely by program from 100 percent agreement among dental hygiene and pharmacy students to 14.6 percent of physical therapy students (p-value <0.001). When asked whether their program adequately prepared them to help smokers quit, agreement ranged from 100 percent among dental hygiene students to only 5.5 percent among physical therapy students (p-value <0.001). Almost 90 percent of dental hygiene students agreed that they were adequately trained to help ST users quit, but no other program had a percentage of agreement above 34 percent (p-value <0.001). Consistent and comprehensive multidisciplinary tobacco-related curricula could offer desirable standardization.
Adult↗
[Information about drugs from physicians and pharmacists].
Good quality information is essential for those who prescribe, deliver or use medications. This information should meet quality criteria: it should be evidence based, practice oriented, easy to find and topical. Pharmacists and physicians receive information from different sources and of valable quality. Initiatives should be taken to improve the quality. The authorities should stimulate these initiatives, and make sure that the information is evidence based. Medical schools and pharmacy schools should educate the students in these matters, and play a role in the continuing medical education thereabout. Opinion leaders should be aware of their responsibility. Existing initiatives should be expanded, and should be coordinated. Finally, there is the ethical obligation for health professionals to remain informed. One wonders in how far incentives (or even coercive measures) are necessary. There is a task there for the "Orders" of physicians and pharmacists, and the scientific and professional bodies.
Drug Prescriptions↗
Use of pharmacy computer prescription database to access hypertensive patients for mailed survey research.
OBJECTIVE: To evaluate the use of a pharmacy computer prescription database (PCPD) to identify and sample hypertensive patients outside of their treatment setting for mailed, self-administered survey research comparing the presence and lack of participation incentives and mailed follow-up reminders. SETTING: Two independent, privately owned, free-standing community pharmacies. PARTICIPANTS: A total of 735 individuals identified from a PCPD search who had been prescribed at least 1 of 130 PCPD medications potentially used in hypertensive therapy. METHODS: PCPD was searched by the pharmacist/owner per protocol; participants were sent an individually addressed cover letter on pharmacy letterhead signed by the pharmacist that requested voluntary anonymous completion of an enclosed self-administered, quality-of-life opinion survey; the first search used no incentive or follow-up; the second search used an incentive and mailed a follow-up reminder. Research protocol followed published ethics guidelines. RESULTS: There was a mean 84% return with incentive and follow-up strategies compared with a mean 25% return without strategies (p < 0.01) for all drug groups between searches; no statistical difference in response was shown between the same drug groups (alpha 1-blockers, calcium-channel blockers, and centrally acting alpha 2-agonists) within searches. CONCLUSIONS: Acceptable response rates (74-93% return) can be obtained with traditional follow-up mailed incentives, prescription issuance within 6 months, incentives to both hypertensive and nonhypertensive responders, and sampling strategies within potential drug groups. Methodology can be adapted to other populations by alternative drug sampling strategies.
Adult↗
Perceived importance and self-assessment of the skills of Canada's health-system pharmacy managers.
The relationship between the perceived importance of managerial skills and self-assessed proficiency in each skill among health-system pharmacy managers in Canada was examined, and the demographic characteristics associated with pharmacy managers who lack these skills were analyzed. Surveys were mailed to 514 health-system pharmacy managers in Canada in July 2000. The survey listed 61 specific managerial skills, under seven general categories. The respondents were asked to rate the level of importance that each of the skills had in their job and rate their proficiency in each skill. Ratings were based on a five-point Likert scale ranging from very high importance or skill level to very low importance or skill level. The response rate was 52.7%. Of the 61 specific managerial skills considered, the majority of respondents identified "Demonstrating ethical conduct" as both the most important skill and their greatest strength. "Understand the operating principles of managed care" was viewed as the least important skill, while "Participating in the implementation of a marketing program" was respondents' greatest weakness. There were significant differences in the mean self-assessed skill levels of the respondents according to their educational background, size of the institution in which they work, and years of managerial experience. Health-system pharmacy managers with a master of business administration degree had a significantly higher overall mean perceived skill level than managers in all other "Education" categories. Managers with a bachelor of science degree in pharmacy had a significantly lower overall mean perceived skill level than those with a bachelor of science degree in pharmacy plus "other" degrees, while managers employed in institutions of 500 or more inpatient beds had a significantly higher overall self-rated mean skill level than managers employed in institutions of 51-100 inpatient beds. A national survey of health-system pharmacy managers in Canada revealed a pressing need for better training in managerial skills for these pharmacists.
Analysis of Variance↗
Defining excellence.
Excellence in the pharmacy profession, particularly pharmacy management, is defined. Several factors have a significant effect on the ability to reach a given level of excellence. The first is the economic and political climate in which pharmacists practice. Stricter controls, reduced resources, and the velocity of change all necessitate nurturing of values and a work ethic to maintain excellence. Excellence must be measured by the services provided with regard to the resources available; thus, the ability to achieve excellence is a true test of leadership and innovation. Excellence is also time dependent, and today's innovation becomes tomorrow's standard. Programs that raise the level of patient care, not those that aggrandize the profession, are the most important. In addition, basic services must be practiced at a level of excellence. Quality assessment is a way to improve care and bring medical treatment to a higher plane of excellence. For such assessment to be effective and not punitive, the philosophy of the program must be known, and the goal must be clear. Excellence in practice is dependent on factors such as political and social norms, standards of practice, available resources; perceptions, time, the motivation to progress to a higher level, and the continuous innovation required to reshape the profession to meet the needs of society.
Humans↗
[Nosocomial infectious: the realities of an endless fight].
Nosocomial infections (N.I.), contracted while patients are being cured, are the direct price of lightning progress in medicine in the course of the last fifty years. Absolute paradox of the end of century, the very place, where the most famous surgical and medical events are achieved, is also the same scene where a patient may contract infections that sometimes lead to a fatal outcome. With 10000 deaths per year and millions of additional hospitalization days, NI have become a real Public Health problem. They reach especially patients but also the staff, and they can be found everywhere a treatment is given (hospital, clinic, patient's home). Paradoxically, the first great myth of anti-NI struggle is the discovery of antibiotics, one of the hugest advancements for humanity. An excessive antibiotherapy prescription, added to a laxism in basic hygiene actions (individual or collective) increased for the last thirty years this phenomenon, which has now become so extensive that international and national authorities are managing this problem. The fight versus NI is an endless struggle because treatments will always exist. The rising emergence of antibiotics bacterial multiresistance has promoted this whole subject called Hospital Hygiene, a discipline which, little by little, regains a dominating place in our Health establishments. Bacteria are liable for 85% of NI, while virus and fungi are responsible for 15%. Omnipresent on a milliards scale, ubiquitous, the bacterial species will be thwarted only if the staff, who is taking care of patients, shows a constant vigilance. Immunosuppressive pathologies, age and nutritional conditions of the patient, new invasive diagnosis or assistance methods, antibiotics selection pressure, and at least a mismanagement of individual Hygiene and/or of the premises, are the main conditions leading to the outbreak of NI. The NI occurs basically within an early period of ten days after the patient's care. Catheter urinary infections, broncho-pneumonic infections with ventilation assistance, post-operative wounds and catheter bacteremia are the main nosocomial pathologies found in France, and in other european countries or in the United States. Staphylococci, Enterococci, Enterobacteria and Pseudomonas are the leaders of responsible bacteria but any kind of bacterium, can generate a NI, due to associated risk factors. Committees against nosocomial infections (Clin) have been organized in France in every public health establishment in 1988, then in every private health establishment in 1999. Since 1992 inter-aeras coordination committees and one national technical committee were instituted. In that way was the struggle officially set up. At last the Health National Agency of Accredidation and Valuation (ANAES), within the scope of an improvement policy concerning the security of and the quality of treatments in every health establishment, accepted about ten "standards" or "criterions" recommending supervision, education, written proceedings, informations diffusion modes, indicators definition in hospital hygiene. 85% of NI are in relation with direct or indirect hand transmission: that is the main point. So the first measure versus NI is just a fact: "HANDWASHING". It is the most effective method, the least expensive but unfortunately the least steady process. Beyond the struggle versus NI, all iatrogenic risks must be fought with a coherent control strategy. This "multivigilance" is a hard job for every health professional because it must be a daily, steady, rigorous and multidisciplinary task. The "Clin" is the privileged place for abilities round-up with an effective and permanent contribution between clinical structures, microbiology labs, pharmacy, administrative and technical sections. Every people belonging to a care unit must be equally involved in the rising of NI which activated a real mobilization of politicians and professionals who have become sensitive, on a socio-economic and an ethical basis. It is a collective and individual problem. Furthermore, the strict use of basic rules in hospital hygiene appears to be the KEYSTONE of the struggle.
Cross Infection↗
[Are acute toxicity testing and the three Rs rule reconcilable? Example of the lethal dose 50 determination].
Toxicity assessment and demonstration of innocuousness of chemical compounds have been part of the research studies conducted in the fields of pharmacy, agriculture and chemical industry for years. Acute systemic toxicity studies are an important element of the safety evaluation. They remain compulsory for regulatory purposes and important for the public opinion that does not accept the risk anymore. Evolutions of the ethics in animal experiments foster a necessary reduction of the number of animals involved in this type of experiments, following the well-known principle of the three Rs rule of Russell and Burch (1959) (Reduction, refinement and replacement). These two views seem in contradiction. Using the example of acute toxicity testing and focusing on the now very criticized parameter lethal dose 50, we will present approaches, including statistical ones, that a toxicologist can use, when free to choose, to keep on conducting the indispensable in vivo studies while abiding by ethical recommendations.
Animal Testing Alternatives↗
[Preparation of a "chronological table of main diseases in Japanese history" for pharmacy students of the 6-year program].
A chronological table of the main diseases that have appeared throughout Japanese history was prepared for pharmacy students, especially for students of clinical pharmacy in the new 6-year system. In ancient times (even in the 8th century), smallpox and measles prevailed in Japan. Japanese people prayed to gods and Buddha to cure the sick. New infectious diseases, like ruebella, pest, typhoid fever, dysentery, cholera, leprosy, etc., prevailed with the increasing exchange of culture from foreign countries. After the vaccines and the toxides were prepared, these infectious diseases were gradually stamped out in Japan early in the Meiji Era. While, public nuisances like the Minamata disease (CH3HgCl), Itaiitai disease (Cd), and atmospheric pollution with sulfurous acid gas, drug-induced suffering (Thalidomide, Sumon, AIDS, etc.) and toxin contaminations in foods have recently increased and produced new diseases. However, these diseases can be prevented if the workers in factories and government officers keep in mind the medical ethics and the ethics for pharmacists to protect the health of people from diseases. Today, cancer, diseases of cerebral vessels, heart diseases, and pneumonia are the four most important causes of death related to aging.
Chronology as Topic↗
Medicine and pharmacy: our once and future status as professions.
Pharmacists are challenged to fulfill in modern health care their historic role as professionals who, working with physicians, hold patients' well-being as their foremost concern. Advances in biomedical science and technology and drastic increases in the cost of care have changed the way medical care is organized, delivered, and paid for. The future of medical care depends on whether professionalism survives or succumbs to the profit motive and whether, faced with increased competition and restricted funding, care-givers will sustain the ethic of providing care to all who need it. The conflict between the medical care that is possible because of scientific advances and the care that will be paid for will be decided politically. Pharmacists can best improve the quality of care by dedicating themselves to rational drug therapy. Drug-use evaluation in hospitals must increasingly demonstrate patient benefit, not just cost savings. Pharmacists can improve the prevention of adverse drug reactions by more timely dissemination of drug information to physicians. Pharmacists should be assertive in identifying nonrational prescribing trends. Pharmacists' responsibility for therapy will expand as the use of biologic manipulation as an adjunct to or substitute for drugs increases. The future will require pharmacists to distinguish between efficiency in providing quality services and narrow economic motivations. Wise choices will help to ensure pharmacy a full partnership in patient care.
Cost Control↗
Pharmacist misconduct: the pitfalls of practice.
This article identifies the changing role of pharmacists in the provision of health care and analyses 78 complaints against pharmacists over a recent 12-year period in New South Wales, finding that the majority of complaints were in relation to the oversupply of particular medications, from which some pharmacists made significant financial gains. A number of other areas of complaint were identified, including issues in relation to the recording and labelling of medications and the roles and responsibilities of pharmacists, dispensing errors, fraud, and sexual misconduct. As the roles of pharmacists continue to expand, with the growth of "compounding chemists", and the suggestion that pharmacists are now performing basic medical tasks which were once the domain of a general practitioner, it is increasingly important that pharmacy take its place in any debates about the provision and regulation of health services.
Community Participation↗