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PharmaTrend as a management tool: capturing workload data.

Several methods of collecting workload data for use in PharmaTrend, a computerized pharmacy management information system, are described. Although the number of indicators produced by PharmaTrend is limited by the input of the user, the integrity of the indicators that are produced is not compromised; this allows the user to implement PharmaTrend on a limited scale, such as for workload only. Workload data that can be used in PharmaTrend are collected routinely by most pharmacies. Many activities are already recorded in logs and other noncomputerized sources. The aid of members of the pharmacy department and other departments may be enlisted in collecting these data. Self-reporting through time sheets and cards can also be used to obtain data on the distribution of work hours. Recording is simplified if employees are told to record only exceptions to their usual job responsibilities. The PharmaTrend manual contains detailed definitions of the workload categories, but simpler and more practical definitions may have to be used. A computer spreadsheet program should probably be used for compiling data if they are collected from several sources; this will facilitate entry into PharmaTrend. Simple methods are available for capturing workload data for input into the PharmaTrend program.

Database Management Systems↗

Developing a DSS for a distribution facility: an application in the healthcare industry.

This article details a successful project in the design and implementation of a decision support system for practical use in a hospital setting. The approach used, the steps followed, the problems encountered, and the lessons learned are described and discussed with special emphasis on the managerial issues and management involvement during the decision support system life cycle.

Decision Support Systems, Management↗

[Evaluation of a programme to monitor drug therapy in type-2 diabetics].

OBJECTIVES: To evaluate the results of pharmaceutical intervention in a programme to monitor the drug therapy of type-2 diabetics; and to assess the improvement of the indicators, glycosylated haemoglobin, basal glycaemia, lipid profile, albumin/creatinine, blood pressure, BMI, medication-related problems and adherence. DESIGN: Randomised clinical trial. SETTING: 14 local pharmacies in the province of Pontevedra (Galicia), Spain. SUBJECTS: 126 type-2 diabetics, over 18 years old and who joined voluntarily a monitoring programme, distributed 50-50 into intervention and control groups. VARIABLES: The main variable was HbA1c. Other variables were: clinical indicators of metabolic control (mean basal glycaemia, lipid profile), blood pressure, BMI, medication-related problems, understanding of the illness and its complications, adherence to medical treatment and to changes in life-style, and incidence of complications. METHODS: Introduction and randomisation of patients. Recording of the initial status of the research variables, study and assessment stage, pharmaceutical interventions to detect and resolve any passing medication-related problems and educational activities. Referral to family doctor if his/her intervention required. Follow-up lasted 12 months with monthly scheduled visits and on-demand visits, after which the variables were assessed once more. The stages of study, evaluation, intervention and education did not occur in the control group. DISCUSSION: The study will enable the role of the chemist in achieving the objectives of controlling type-2 diabetes patients to be achieved through educational intervention and assistance in drug therapy monitoring.

Blood Glucose↗

Analysis of grocery chain pharmacists' work-related behaviors.

OBJECTIVE: To measure grocery chain pharmacists' work-related behaviors to assess the impact of a Pharmaceutical Care Certificate Program (PCCP) and other future interventions intended to alter pharmacists' practice behaviors. DESIGN: This study used multidimensional work sampling (MWS), a work measurement methodology that breaks "work" into three components: activity (what was done), contact (with whom the activity was performed), and function (the purpose or objective of the activity). Pharmacists were signaled at random intervals during the workday by a random signal generator. A selection was made from a list of items in each of the three dimensions of work to form an activity-contact-function combination code that described the work-related behavior at that point in time. SETTING AND PARTICIPANTS: Pharmacists in 15 grocery chain stores in the Indianapolis area; 20 pharmacists were enrolled in Purdue University's PCCP and 10 served as controls. Data were collected for a period of six weeks during April through June 1997 before the beginning of the PCCP program. MAIN OUTCOME MEASURES: Pharmacists' work-related behaviors. RESULTS: Writing/keyboarding was the most frequently recorded activity (22%), followed by one-to-one meetings (21.6%), and drug preparation (18%). Pharmacists spent most of their time working alone (62.9%), while a smaller but still substantial proportion of time was spent interacting with patients (17.9%). The most frequently recorded purpose (i.e., function) of pharmacists' activities was drug distribution (23.9%), followed by personal time (12.4%), receiving or transferring a medication order (10.2%), and patient counseling (6.6%). Out of a possible, 1,760 activity-contact-function combinations, 10 accounted for 46.3% of all reported observations, with "Prepare drug-Self-Drug distribution" representing the most frequently recorded activity-contact-function combination (15.7%). CONCLUSION: MWS is useful in helping grocery chain management better understand how pharmacy personnel are currently being utilized. This study provides a baseline for evaluating the impact of training programs or other alterations in the practice environment on pharmacists' work-related behaviors.

Community Pharmacy Services↗

Simulation of robotic courier deliveries in hospital distribution services.

Flexible automation in the form of robotic couriers holds the potential for decreasing operating costs while improving delivery performance in hospital delivery systems. This paper discusses the use of simulation modeling to analyze the costs, benefits, and performance tradeoffs related to the installation and use of a fleet of robotic couriers within hospital facilities. The results of this study enable a better understanding of the delivery and transportation requirements of hospitals. Specifically, we examine how a fleet of robotic couriers can meet the performance requirements of the system while maintaining cost efficiency. We show that for clinical laboratory and pharmaceutical deliveries a fleet of six robotic couriers can achieve significant performance gains in terms of turn-around time and delivery variability over the current system of three human couriers per shift or 13 FTEs. Specifically, the simulation results indicate that using robotic couriers to perform both clinical laboratory and pharmaceutical deliveries would result in a 34% decrease in turn-around time, and a 38% decrease in delivery variability. In addition, a break-even analysis indicated that a positive net present value occurs if nine or more FTEs are eliminated with a resulting ROI of 12%. This analysis demonstrates that simulation can be a valuable tool for examining health care distribution services and indicates that a robotic courier system may yield significant benefits over a traditional courier system in this application.

Computer Simulation↗

[Good drug distribution practice and its implementation in drug distribution companies].

Good Distribution Practice is based on the Directive of the Board of the European Community 92/25/EEC regarding the wholesale distribution of drugs for human consumption. It is stated in the Directive that the whole drug distribution channel is to be controlled from the point of drug production or import down to the supplies to the end user. In order to reach the goal, the drug distribution company must create the quality assurance system and facilitate its correct functioning. This aim requires development of the rules of the Good Distribution Practice. Those rules set the general requirements of the Good Distribution Practice for distribution companies that they must conduct. The article explains main requirements postulated in the rules of the Good Distribution Practice and implementation of the Good Distribution Practice requirements in drug distribution companies.

Drug Industry↗

[Estimation of the cost in the farmacologic treatment of chronic renal failure].

The prevalence and incidence of end stage renal disease has increased considerably in the past years. We know that the cost of treatment of these patients is high. Limited information exists on care resource utilization for maintenance of patients before the initiation of replacement therapy. The purpose of this study is determine the cost of pharmaceutic treatment during the predialysis phase. Pharmacy cost was analyzed for 200 patients controlled on outpatient nephrology department. The mean age was 72.4 years, 59% were males, and the comorbidity distribution was: hypertension 87%, hyperlipidemia 56% and diabetes 35%. The per-patient-per-month charges were 215.45 Euro, with a continous increase from 84.64 Euro on stage 1 to 352.59 Euro on stage 5 of chronic kidney disease. Erythropoiesis stimulants were reponsible of 46.5% of these cost. The most frequent prescribed medications were antihypertensive drugs, statins and iron preparations. Patients with end stage renal disease generate significant cost during the predialysis period. The limited resources, and the growth of health care expeditures, particulary the spending for prescriptions drugs, are two of the major problems for Health Care Systems. A better knowledge of the associated costs to the treatment of these patients will help us to increase our efficiency.

Aged↗

Costs, resource utilisation and financing of public and private hospitals in Uganda.

A descriptive cross-sectional, retrospective cost analysis was conducted in a public and private hospitals in Arua district, Uganda with the aim of assessing the resource use, costs, and financing of those hospitals. It employed the "full costing" approach to hospital costing. The results showed that most of the government recurrent expenditure on health facilities in the district went to the public hospital, while most of the revenues at the private hospital was from donations. The distribution of costs by category of inputs showed that materials and supplies costs were highest in both hospital, followed by employee costs. The administration, pharmacy and store had the highest cost at both hospitals. The cost of the kitchen was very high in the public hospital. The ratio of the unit costs of an out patient visit to an inpatient day and to the unit cost per case treated was 1:1:6 in the private and 1:7:46 in the public. This indicates the relative low cost of public hospital outpatient service and the relative high cost of the outpatient in the private hospital. The employee costs and the drug costs were the most important components of the unit costs in the OPD at both hospitals while in the inpatient wards, besides the above mentioned components, there were also the kitchen, blood bank (public) and theatre in both hospitals. It is concluded that hospitals should look for ways of increasing the level of recurrent funding available to them by increasing the efficiency of their operations and by mobilising additional resources from other sources other than government.

Costs and Cost Analysis↗

Stop the carts.

Nurses and pharmacists at the University of Utah Hospitals & Clinics successfully implement an automated medication distribution system to cut costs, and find they also create measurable process improvements.

Clinical Pharmacy Information Systems↗

Clinical pharmacy services in a rehabilitation facility.

Clinical pharmacy services provided by pharmacists to patients in a rehabilitation facility through a contracted arrangement with a local hospital are described. Two staff pharmacists from a community hospital oversee the drug-distribution process and provide clinical services at a 40-bed private rehabilitation facility. During alternate four-week periods, each pharmacist works at the rehabilitation facility; the other four-week period is spent in traditional drug-distribution activities at the hospital. The hospital is reimbursed for clinical services separately from drug-distribution services; by keeping records of the time spent in clinical activities at the facility, the pharmacists have obtained increased reimbursement for these services since initiation of this program. Clinical services provided by pharmacists at the institute include patient education, drug-therapy monitoring and consultation, drug information activities, and management of drug therapy in selected patients. In 1982, pharmacists provided 230 drug-therapy consultations to physicians and received referrals for drug-therapy management of 47 patients on warfarin sodium, 46 on antihypertensive drugs, and 27 on phenytoin sodium. The provision of a variety of clinical pharmacy services to patients in a rehabilitation facility offers a unique and professionally rewarding practice.

Contract Services↗

Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data.

OBJECTIVE: Electronic prescribing (e-prescribing) provides formulary information at the point of care. The objective of this study was to assess the effects of e-prescribing on formulary compliance and generic utilization. METHODS: This was a retrospective analysis of pharmacy claims data from a large national managed care organization. A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty. A total of 110,975 paid pharmacy claims, for the 12 months from August 1, 2001, through July 31, 2002, were analyzed to assess the effect of e-prescribing on formulary compliance and generic utilization. All paid pharmacy claims were examined for each group; for the e-prescriber group, this included all claims, not just those prescribed using an e-prescribing device. A written qualitative survey was distributed to physicians and office managers to assess e-prescribing usage, sources of formulary information, and effects of e-prescribing on office resources. RESULTS: Both predominantly e-prescribers and traditional prescribers demonstrated high levels of formulary compliance, 83.2% versus 82.8%, respectively (P=0.32). Formulary compliance for these groups did not differ from the overall prescriber population (82.0%). There was not a difference in generic drug utilization rates between e-prescribers and traditional prescribers (absolute rates 37.3% versus 36.9%, P=0.18). Qualitative survey responses supported previously reported research indicating reductions in calls both to and from pharmacies for prescription orders. CONCLUSIONS: An examination of paid pharmacy claims from a large, national managed care organization demonstrated no differences between predominantly e-prescribers and traditional prescribers in measures of formulary compliance or generic drug utilization. Future studies should examine keystroke data at the point of care to observe more detail about drug selection methods.

Ambulatory Care Information Systems↗