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Results for “Pharmacy Distribution”

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PubMed1987

The pharmacist as a trauma team member.

Mission Community Hospital in a 220-bed medical center. The pharmacy department is involved with services for the trauma center, neonatal ICU, oncology, nursery, critical care, pediatric, and medical/surgical patients. The role of the pharmacist in both the acute phase and the follow-up care of the trauma patient is described. The purpose of this article is to show contributions pharmacists can make in the care of trauma patients. Areas such as drug distribution, patient monitoring, and cost containment will be discussed.

California↗

PubMed2003

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2002.

Results of the 2002 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1101 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 46.7%. During 2002, both inpatient and outpatient hours of service increased compared with 2001. Paradoxically, there was an 8.5% decrease in pharmacy staffing and a 7% vacancy rate, suggesting that pharmacists are busier. Most hospitals (80%) had a centralized inpatient dispensing system, but 44% were planning to become more decentralized. Automated dispensing cabinets were used by 58% of hospitals with decentralized drug distribution systems. Most hospitals (81.4%) dispensed more than three quarters of oral doses as unit doses and 63.3% of injectable doses to non-critical care patients, increases from 1999. A large percentage of hospitals (89%) repackaged both oral and injectable medications. More hospitals were repackaging medications than three years ago, primarily because of lack of commercial availability. Approximately 20% of pharmacies either partially or completely outsourced drug preparation activities. Nurses administered medications in virtually all hospitals (99.7%). Despite widespread recommendations to use bar-code technology to check and document doses administered, only 1.5% of hospitals used this technology, an increase from 1.1% in 1999. Nearly two thirds of hospitals used computer-generated medication administration records. While pharmaceutical services are expanding, workforce issues continue to challenge pharmacists trying to maintain and enhance safe medication systems. Safe systems continue to be in place in most hospitals, but the adoption of new technology to improve safety is slow.

Documentation↗

PubMed2006

Effect of a clinical pharmacy service on lipid control in patients with peripheral arterial disease.

OBJECTIVE: Our group and others have previously established that patients with peripheral artery disease (PAD) are significantly undertreated with respect to overall cardiovascular risk factor management, despite national guidelines to the contrary. In an effort to maximize risk factor control in our patients with PAD, we established a pharmacist-managed, physician-monitored algorithmic approach to the outpatient management of lipids in patients with PAD. The purpose of this study was to determine the effect of this service on lipid screening and control in patients with PAD. METHODS: We analyzed the records of patients treated at a large, group-model, not-for-profit regional managed care system serving approximately 405,000 members. An electronic medical record provided full examination, laboratory, and pharmacy data for all patients. Pharmacy data were analyzed to determine prescriptions for lipid-lowering agents. Lipid control was assessed through fasting lipid data. Patients with validated PAD and the absence of clinical coronary artery disease (CAD) were offered the service between May 2003 and September 2004 and followed up for a minimum of 6 months. RESULTS: We administratively identified 5159 active patients with a diagnosis of PAD. Of these, 1075 could be validated with a noninvasive arterial study. The exclusion of 384 patients with a diagnosis of CAD resulted in a cohort of 691 patients. Of these, 90 patients were enrolled in the lipid service (study group), and 601 received standard care. Mean follow-up was 17.1 months. Screening fasting lipid profiles were found in 95.6% (86/90) of patients in the study group and only 66.9% (402/601) of the standard care patients (P < .0001). Low-density lipoprotein cholesterol (LDL-C) control was improved in the pharmacist-managed group, with 79.1% (68/86) achieving an LDL-C of less than 100 mg/dL in comparison to the standard care group (54.8% [219/400]; P < .0001). An LDL-C value of more than 130 mg/dL was noted in 1.2% and 14.0% (56/400) in the treatment and control groups, respectively (P < .001). Statin use was present in 51.9% (312/601) of the control group patients and 84.4% (76/90) of the pharmacist-managed group (P < .001). CONCLUSIONS: Despite national consensus of PAD as a CAD equivalent, patients are currently undertreated with regard to atherosclerotic risk factor modification. Initiation of a pharmacist-managed, physician-monitored lipid service provides improved compliance with national guidelines.

Aged↗

PubMed1992

[Fat and oil consumption in a university student population in Buenos Aires].

The purpose of this study was to evaluate the fat and oil intake and their distribution according to the dietary origin in students of the University of Buenos Aires. A 7 day dietary record of students (49 males and 127 females) attendant to the 1989 Course of Nutrition, School of Pharmacy and Biochemistry, to obtain in Pharmacy and Biochemistry was collected. This information was processed in a PC Computer (VAN Program, Lujan University, Argentina) to obtain the energy and fat daily intake, according to the Dietary Composition Tables compiled by INCAP; missing data were completed t with the German, Italian or Argentine Tables. The results obtained were (average daily intake +/- SD) for females and males, respectively: Energy (Kcal): 1805 +/- 5431 and 2551 +/- 712; total fat (g): 65.6 +/- 21.8 and 87.8 +/- 28.7; percentage of energy provided by fat: 33.0 and 31.1. The distribution of fat intake according to its dietary source was (g/100 g): meat: 33.3; oils: 15.5; diary products: 19.3; cakes and pasta: 11.6; cereals (bread, crackers, etc.): 8.3; separate animal fat: 5.1; legumes and oil seeds: 1.4; eggs: 2.9; poultry: 1.5; margarines: 0.6; fish: 0.3; viscera: 0.3. These data show that the fat intake is not excessive, about 30% of the energy intake; but the high percentage of animal fat might be one of the risk factors responsible for the high incidence of cardiovascular diseases in the population of Buenos Aires.

Adult↗

PubMed1988

Pharmacy component of a hospital end-product cost-accounting system.

Determination of pharmacy department standard costs for providing drug products to patients at Thomas Jefferson University Hospital in Philadelphia is described. The hospital is implementing a cost-accounting system (CAS) that uses software developed at the New England Medical Center, Boston. The pharmacy identified nine categories of intermediate products on the basis of labor consumption. Standard labor times for each product category are based on measurement or estimation of time for each task in the preparation and distribution of a dose. Variable-labor standard time was determined by adjusting the cumulative time for the tasks to account for nonproductive time and nonroutine activities, and a variable-labor standard cost for each category was calculated. The standard cost per dose included the costs of labor and supplies (variable and fixed) and equipment; this standard cost plus the acquisition cost of a drug line item is the total intermediate product cost. Because the CAS is based on the hospital's patient charges, clinical pharmacy services are excluded. Intermediate products that substantially affect end-product costs (costs per patient case) will be identified for inclusion in CAS reports. The CAS will give a more accurate picture of resource consumption, enabling managers to focus their efforts to improve efficiency and productivity and reduce supply use; it could also improve the accuracy of the budgeting process. The CAS will support hospital administration decisions about marketing end products and department managers' decisions about controlling intermediate-product costs.

Accounting↗

PubMed2006

Social context of needle selling in Baltimore, Maryland.

Although much of the debate surrounding the distribution of sterile syringes to injection drug users (IDUs) has focused on needle exchange programs (NEPs), IDUs acquire their syringes from three major sources: NEPs, pharmacies, and secondary exchangers or needle sellers. The purpose of the present study is to examine types and frequencies of social interactions among drug injectors who sell needles, most of which come from NEPs, compared with individuals who do not sell needles. Specifically, we compared engagement in drug-related behaviors, roles in the drug economy, and social network membership. Data were collected as part of the SHIELD study, an HIV prevention intervention targeted at drug users and their social networks (n=910) from February 2001 through September 2003 in Baltimore, Maryland (USA). In this sample, 56 participants reported selling needles. Needle sellers had higher levels of engagement in drug-related social interactions, including using drugs with others, giving or receiving drugs from others, and buying drugs with other users. Participants who sold needles had a significantly higher number of roles in the drug economy. Also, they had more social network members who were injectors, with whom they talked about risky drug behaviors, gave needles to, and shared cookers and bleach with. Compared with nonselling injectors, needle sellers engage in HIV risk-related behaviors, such as injecting daily and sharing injection equipment, more frequently. The study's findings may be useful to determine whether secondary exchangers should be targeted for HIV prevention activities both to reduce their own risk and to diffuse risk reduction information throughout the drug using community.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Harm reduction interventions, behaviours and associated health outcomes in France, 1996-2003.

AIMS: To track the effect of the French harm reduction programme targeted at intravenous drug users (IDUs) and associated health outcomes. MATERIAL: Since 1996, we have collected monthly sales of sterile syringes and substitution treatments (buprenorphine high dosage and methadone) sold to IDUs in the 23 000 pharmacies in France and collated these figures in a single data base (SIAMOIS). To this data base we have also added the number of syringes distributed through community associations, as well as methadone treatments prescribed in public drug dependence clinics. METHODS: For the period 1996-2003 we analysed syringe sales and prescribed substitution treatments as indicators of access to harm reduction services. We compared variations of these figures over time with trends in health outcome indicators [annual number of fatal overdoses, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) prevalence among intravenous drug users], risk behaviour indicators (rate of syringe sharing or rate of syringe re-use) and legal indicators (heroin and cocaine use-related arrests). FINDINGS: The number of sterile syringes sold or distributed to IDUs increased from 1996 to 1999 (+ 21%) and then decreased dramatically from 1999 to 2003 (-40%). In 2003, we estimated that more than 100,000 drug users used substitution treatments. Between 1996 and 2003, a decrease in syringe sharing and syringe re-use was observed, HIV prevalence among IDUs decreased from 40% to 20% and HCV prevalence remained high (60-70%). From 1996 to 2003, arrests due to heroin use declined (from 17 328 to 4025) and deaths due to overdoses also decreased (from 465 to 89), whereas arrests for cocaine use increased from 1184 to 2511. CONCLUSION: Our results indicate that, since 1996 in France, IDUs have had greatly improved access to sterile syringes and substitution treatments. The decrease in syringe sharing and re-use practices and of HIV prevalence during the same time period indicates that the harm reduction policy implemented in France has had a positive impact. However, because of the persistent sharing and re-use of syringes and a remaining high HCV prevalence in IDUs, efforts to facilitate access to sterile syringes must continue, and targeting of at-risk groups must be improved. Behavioural surveys associated with HIV and HCV seroprevalence data are needed to further assess prevention of blood-borne infections among IDUs in France.

France↗

PubMed1990

Turbulence and tranquility in the new decade: pharmacy leader--managers in patient care.

Management challenges that face pharmacy in the 1990s are described. Tichy's rope metaphor--intertwined cultural, technical, and political strands of an organization--is applied to problems faced by pharmacy managers; effective managers keep the organization strong by preventing the strands from working at cross-purposes to unravel the rope. Pharmacy's culture--its shared beliefs and values--is changing as "altruistic" institutional pharmacists form home care businesses, pharmacists identify more strongly with the profession than with their institutions, clinical pharmacists identify more strongly with the medical team, and cost control becomes more important. Institutional pharmacy must identify its desired outcomes and apply technology to achieve them. The patient's bedside is the best place for pharmacists to influence prescribing and monitor drug therapy; technology could be used to process patient information at the bedside and to dispense medications there. Current unit dose distribution systems isolate the functions of physician, pharmacist, and nurse, which must be integrated to make the system efficient and responsive. Standardized doses and dosage forms could be developed that are consistent with patient-care protocols; use of protocols allows the effectiveness of treatment methods to be evaluated and eliminates unnecessary therapy. Pharmacy can further its patient-care goals through political success with the medical staff; a pharmacy practice plan developed for a specific clinical area and presented to the medical staff is an example. Collaboration of pharmacists and physicians in a unified institutional strategy for drug use helps ensure appropriate decisions about therapy and prevents manufacturers from attempting to isolate an institution's pharmacists from its medical staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Industry↗

PubMed1963