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Pharmaceutical care management: a modern approach to providing seamless and integrated health care.

Institutional pharmaceutical services have widely evolved over the past 20-30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualized patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients' hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today's health-care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health-care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Continuity of Patient Care↗

Measuring moral distress in pharmacy and clinical practice.

This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings.

Adaptation, Psychological↗

The practice of pharmacy in England.

The practice of pharmacy in England is described. Community pharmacies have a contract with the Department of Health and Social Security to fill National Health Service prescriptions. A large proportion of the general public obtain their prescriptions free. Funding for the health service comes from taxes and automatic contributions from employers and employees. Aspects of hospital pharmacy practice and salaries are discussed, e.g., a junior pharmacist may expect to earn between $9000 and $12,000. There is very little unit-dose dispensing, and many hospitals are unable to provide 24-hour services. Hospital pharmacies function with fewer pharmacists than their U.S. counterparts, utilizing larger numbers of technicians. Clinical pharmacy practice centers around drug monitoring (ward pharmacy). Pharmacokinetic services are provided in a few places. Master of science degrees in clinical pharmacy are available. However, the future of clinical pharmacy practice in England depends on staffing levels and competition between and acceptance from other health disciplines.

Community Pharmacy Services↗

Job satisfaction in the practice of clinical pharmacy.

Two groups of pharmacists (n = 69) assigned to 35 US Army Medical Treatment Facilities were surveyed to assess job satisfaction. Pharmacists providing patient care were significantly more satisfied on intrinsic job satisfaction measures than pharmacists not providing patient care. On the other hand, no significant difference in satisfaction was found between pharmacy groups on extrinsic job satisfaction measures. The results are discussed relative to intrinsic and extrinsic sources of job satisfaction and patient care.

Job Satisfaction↗

The changing role of pharmacy practice--a clinical perspective.

Professor Carmichael and Dr. Cichowlas argue for the reexamination of the pharmacist's role in the current health care system. Reexamination is necessitated due to changing complexities of the health care system as evidenced by increased economic demands and pharmaceutical surpluses. The authors advocate for Collaborative Drug Therapy Management, in which physicians and pharmacists maximize patient care by pooling their areas of expertise together.

Cooperative Behavior↗

Student perspectives on pharmacy curriculum and instruction in Egyptian schools.

OBJECTIVES: To determine student attitudes and opinions towards pharmacy education in Egyptian universities to provide information for designing delivery of a revised pharmacy curriculum. METHODS: Students were recruited from the pharmacy faculties at a government-sponsored university and a privately funded university. Data were gathered using a structured questionnaire and statistically analyzed. Responses from open questions were subjected to thematic analysis. RESULTS: Students spent widely differing amounts of time on non-classroom study, little of which was self-directed. This was reflected in the low frequency of use of library facilities and the preference of students for passively acquired information. Themes that emerged on how students would improve the curriculum were to increase the use of computers and the Internet; make the course more relevant to pharmacy practice and/or clinical pharmacy; improve and expand the practical components of the course; increase their own involvement in learning; and increase their understanding of subjects as well as their knowledge. For many of the questions, there was a significant different between the responses of students at the 2 universities. CONCLUSIONS: Students relied on classroom teaching and devoted little time to self-directed study. However, students were aware of international developments in pharmacy education and practice and are receptive to change.

Attitude↗

Advancing patient care through innovative practice: the Clinical Partners Program.

PURPOSE: The development, implementation, and outcomes assessment of an innovative pharmacist-managed ambulatory care and community pharmacy practice clinic are described. SUMMARY: The Clinical Partners Program at The Ohio State University (OSU) provides an active learning environment for students and residents, offers a patient-focused practice model based on pharmaceutical care principles, and serves as an arena for applied research in pharmacy practice. The program offers multiple services, including anticoagulation management, diabetes self-management, cholesterol management, hepatitis C education, herbal product and dietary supplement consultations, medication management, smoking cessation, and wellness. The practice is currently staffed by two faculty members from the college of pharmacy, with a 0.8 full-time-equivalent (FTE) pharmacist and a 0.65 FTE community pharmacy resident. It has served as a training site for 17 pharmacy residents, 28 bachelor of science (B.S.) in pharmacy students, 30 post-B.S. doctor of pharmacy (Pharm.D.) students, and 132 entry-level Pharm.D. students at various levels of training. The most successful methods of reimbursement for programs have been contracted services with OSU Managed Health Care Systems, Inc., which serves OSU faculty and staff and fee-for-service billing, charged directly to non-OSU patients. Numerous studies have shown that Clinical Partners has consistently demonstrated improved therapeutic outcomes over those achieved in traditional practice. Faculty are exploring outreach services, including the development of advanced practice community sites for the college, establishing patient care services within physician offices, and providing disease management services for self-insured employers. CONCLUSION: The Clinical Partners Program has improved patient care and provided education and training opportunities for pharmacy students and residents.

Ambulatory Care Facilities↗

Reforms in pharmacy education and opportunity to practise clinical pharmacy.

The impact on 357 newly licensed pharmacists, graduates of two colleges, of efforts to turn pharmacy into a clinical profession, was examined by way of a self-administered questionnaire. Perceptions and expectations about work, differences in consulting practices, relationship between practice and attitudes, and the presence or absence of an identifiable general value orientation (which could account for specific perceptions and attitudes), were examined. Results indicated that hospital practice was more likely to be associated with clinical pharmacy and clinical pharmacy practice was more likely to meet the expectations of recently graduated pharmacists. In addition, 52 per cent of the community-based pharmacists were found to engage in patient counseling, as compared with 39 per cent of hospital-based pharmacists. Newly licensed pharmacists are deepening the existing divisions in the profession, while moving toward a revision of their place in the health care delivery system.

Education, Pharmacy↗

Development and implementation of a smoking cessation clinic in community pharmacy practice.

OBJECTIVE: To describe a pharmacist-operated program to help people stop smoking. SETTING: Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION: Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerström Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.

Community Pharmacy Services↗

Model for cost-benefit analysis of clinical pharmacy in family practice.

A cost-benefit analysis (CBA) model that can be used to estimate the economic consequences expected from the inclusion of clinical pharmacy services in a family practice clinic was developed; use of the model was demonstrated by applying it to a hypothetical solo-physician practice. The effects that clinical pharmacy services would have on the medical practice were evaluated and classified as either costs or benefits. Equations were derived to quantify all direct effects. Semi-structured, open-ended interviews of 15 family practice physicians and five family practice clinical pharmacists were conducted to generate data describing a hypothetical solo-physician practice. Responses from these interviews were averaged to provide the numerical values called for by the equations in the CBA model. The difference between total costs and total benefits was the net benefit that could be expected by the hypothetical solo-physician practice for the first year after including a clinical pharmacist in that practice. The net benefit determined by these calculations was $2744 assuming a 5% increase in overall quality of care, or $25,658 assuming a 20% increase in overall quality of care. The net-benefit figure obtained by applying the CBA model to the hypothetical case should not be generalized to other practices. Rather, by applying the CBA model, practitioners and administrators can calculate the expected net benefit specific for their particular medical practice.

Cost-Benefit Analysis↗

Activity analysis and cost study of clinical pharmacists practicing in a university medical center: comparison with previously established criteria.

The activities of three staff clinical pharmacists practicing in a university medical center hospital were studied using work sampling direct observation techniques. The results of the activity analysis were compared with the functional criteria of the Task Force on the Pharmacist's Clinical Role. It was found that the clinical pharmcists devoted a large portion (72.36 percent) of their total practice time to accomplishing professional activities. A very low percentage (2.27) of time was observed to be spent in nonproductive idle time. The cost to provide clinical pharmacy services to the 165.23 average census of inpatients supported by the clinical pharmacists was calculated to be $1.18 per patient per day. It was concluded that the observed pharmacists were highly motivated and provided a wide variety and extensive amount of professional clinical pharmacy services. Recommendations were made calling for research of other clinical pharmacy practice models, standardization of pharmacy activity terminology, determination of clinical pharmacy outcomes and identification of motivational factors present in the study model environment.

Arizona↗