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PubMed2006

Participation of the general gynecologist in surgical staging of endometrial cancer: analysis of cost and perioperative outcomes.

OBJECTIVE: To compare the cost and perioperative outcomes of endometrial cancer staging when the procedure is performed by a gynecologic oncologist alone or when a general gynecologist participates in the procedure. METHODS: A retrospective analysis was performed on a series of women with clinical stage I endometrial cancer treated at a single institution between 1/98 and 12/00. The patients were grouped according to the participation of a general gynecologist in their surgery. The 48 patients in Group 1 underwent surgery with a general gynecologist who consulted a gynecologic oncologist intraoperatively. Group 2 included 77 patients whose procedure was performed completely by a gynecologic oncologist. The two groups were compared with the chi-square, Fisher's exact, and Wilcoxon rank sum tests. Cost analysis included total hospital costs (room, pharmacy, and ancillary services) and total surgical costs (anesthesia, operating room, procedure, and perioperative physician evaluation costs). RESULTS: The groups did not differ in age, type of surgeries performed, distribution of surgical stage, proportion of patients undergoing lymph node sampling (LNS), and length of follow-up. When LNS was performed, Group 2 had a significantly shorter median operative time (170 vs. 180 min; P=0.05) and shorter total time in the operating room (204 vs. 224 min; P=0.02). This group had a lower procedure cost when considered both in terms of payor's cost ($1,414 vs. $2,134; P<0.0001) and physician charge ($7,106 vs. $11,116; P<0.0001). Perioperative physician evaluation was reduced by almost half ($685 vs. $424; P<0.0001) in Group 2. Group 2 had a savings in total surgical cost by payor's cost ($9,142 vs. 10,294; P=0.005) or physician's charge ($14,546 vs. $19,276; P<0.0001), and in combined hospital and surgical cost by payor's cost ($15,664 vs. $17,346; P=0.004) or physician charge ($21,311 vs. $26,328; P<0.0001). Total hospital costs, however, did not differ between groups. CONCLUSION: Operative time and costs increase when general gynecologists participate in the surgical procedure of patients with clinical stage I endometrial cancer. Although perioperative outcomes are similar, the involvement of two surgeons increases the length of the procedure as well as the cost of operating room time and physician reimbursement. The efficient use of limited health care resources must be considered as we plan the surgical approach to endometrial cancer.

Adult↗
PubMed2000

Cost containment of pharmaceutical use in Iceland: the impact of liberalization and user charges.

OBJECTIVES: Iceland was the first Nordic country to liberalise its drug distribution system, in March 1996. Subsequent regulation in January 1997 increased patients' share of drug costs. The objectives of this study were to test the assumptions that liberalizing community pharmacy ownership would lower reimbursement costs for the state's Social Security Institute and that increasing patient charges would reduce use and, therefore, lower the cost to the Institute. METHODS: Based on the assumptions, we built and tested two models using interrupted time series designs that contrast the monthly reimbursement costs before and after the legislation and regulation took effect. A control variable (the number of office visits to general practitioners) was tested to assess other events in the health care arena. Monthly data on these variables were provided by the Icelandic State Social Security Institute for January 1993 to August 1998 for reimbursement costs and to December 1998 for office visits to general practitioners. RESULTS: Reimbursement costs have risen steadily throughout the period under study. The interrupted time series analysis did not show a substantial effect from the legislative change in March 1996 or from the regulatory intervention in January 1997. CONCLUSIONS: The main argument used for liberalizing community pharmacy ownership in Iceland was built on false assumptions regarding the effect on drug reimbursement costs to the state. It will be necessary to find more promising interventions to halt the rapidly increasing cost of drugs.

Cost Control↗
PubMed1984

Users' perspectives of hospital pharmacy computer systems.

A survey was conducted to determine if user characteristics affected respondents' expectations of computer systems and to identify the most and least desirable features hospital pharmacists want in computer systems. A questionnaire was mailed to 200 hospital pharmacists selected randomly. The survey was designed to gather demographic data, general systems information, and information on system features in 10 major categories. A total of 111 surveys were returned. Of the respondents, 55% had some type of computer system. The leading type of system used by the respondents was a mainframe-shared system. The majority of respondents (87.4%) indicated that they had a "moderate" amount of experience with computer systems. The most commonly preferred hardware was the minicomputer. It appeared that user characteristics did not influence the pharmacists' expectations of computer systems. In ranking the categories, the hospital pharmacists indicated that the i.v. admixture area, inpatient drug distribution, and clinical functions were the most important for computer applications.

Attitude of Health Personnel↗
PubMedDate not supplied

[Study of access to health care and drugs in Cameroon: 1. Methods and validation].

During the 1980s, an economic depression and the concomitant decrease in the national health budget modified the population's health behavior. Improvement of the economy since the late 1990s makes it possible to renew the national health policy. To prepare the highly indebted and poor countries' program (HIPC), the Minister of Health and its partners commissioned a survey to measure the population's real access to health care and the factors that determine this accessibility and to propose concrete corrective actions. To fulfill these objectives, the steering committee decided to analyze health care demand, through a national population survey, and supply capacity, through a national survey of pharmacies and other drug dispensers. A survey of persons using medications will also be conducted (Fig.1). Focusing on this component of health care is justified by these findings: 95% of persons feeling ill buy drugs, whereas only 31% consult a physician or other healthcare provider, and half of the average household's health expenditures are for drugs. Financial, geographic, social and quality indicators were defined to measure accessibility and its determining factors (Table 1). The smallest administrative unit, the health area (HA), was chosen as the sampling unit, to enable us to survey together healthcare demand, supply and consumption according to different concentrations of supply and demand . It behaves as a cluster of sampling units of different populations: drug retailers of all sectors, drug users, households, and ill persons within the households. The HA samples include Yaounde and Douala, with urban and rural sub-samples, for which sampling ratios increase with the diversity of supply and demand, according to several pre-defined factors. The study includes 400 HAs, covering more than one third of the population (Table 2). Within these HAs, 900 pharmacies and other formal drug retailers, 709 street vendors, 4,505 households, 2,532 ill persons in these households, 4,121 pharmacy customers and 850 customers of street vendors were surveyed, i.e., more than 13,600 questionnaires. Assessment of data quality shows that the sample is representative of the national population for its socioeconomic characteristics. Its geographic distribution, even after correction, nonetheless favors urban areas, where both supply and demand are high. Generalizing the 3 sub-samples to the national level thus requires caution, especially for the geographic distribution. Other limitations and possible biases are described and evaluated. However, the retrospective demographic and statistic evaluation shows that the samples are representative of their population and that the data quality can be considered good. This article describes the background of this study and justifies its methodological choices. Future publications will analyze the data collected.

Adolescent↗
PubMed1989

The use of non-prescription salbutamol inhalers by asthmatic patients in the Hunter Valley, New South Wales. Newcastle Retail Pharmacy Research Group.

Because of concern over the unsupervised use of bronchodilator aerosols, we studied the characteristics of a group of asthmatic subjects who purchased their salbutamol inhalers and a group of asthmatic subjects who obtained their inhalers by prescription. Community pharmacists distributed 360 questionnaires to consecutive patients who requested salbutamol inhalers; 320 questionnaires were returned (response rate, 89%). Of these, 240 respondents described themselves as asthmatic and stated that they obtained their inhalers exclusively or predominantly by either purchase (120 subjects) or prescription (120 subjects). Purchasers were younger than were users of prescribed inhalers and were more likely to be in current employment. The "purchase" group perceived less disability from chest disease than did the "prescription" group but were not different from the prescription group with respect to more-objective measures of disease severity, such as the occurrence of wheeze every day, nocturnal wakening with wheezing, and admissions to hospital with asthma. The purchasers had a low rate of consultation with family practitioners and specialists and reported a low use of prescription-only medications, particularly of inhaled corticosteroid agents. This study highlights the possible disadvantages of providing bronchodilator aerosols without prescription, and emphasizes an important counselling role for community pharmacists in the management of bronchial asthma.

Administration, Inhalation↗
PubMed2004

[Examination of the stability of hydrogen peroxide solutions].

Reliable stabilization of the pharmaceutical preparation and the active ingredient remains one of the most important problems of world pharmacy because pharmaceutical preparations are not systems which are stable without limitation. The patient must receive a quality drug and that is why the question of stability is paid grest attention to not only in research and development, industrial manufacture, but also in distribution. The measure of stability is the expiration period. Diluted solution of hydrogen peroxide (3% solution) still belongs to the most widely used and at the same time the most easily accessible disinfectants. In practice it is common both in Slovakia and abroad. It is used in several concentrations. One of its most important disadvantages is its limited stability, which markedly decreases its expiration period. The present paper investigates the stability of hydrogen peroxide solutions of routinely used concentrations (3%, 6%, and 10%) without and with a stabilizing additive (phenacetin) prepared in the pharmacy and stored under different conditions for the period of their expected usability. The content of hydrogen peroxide was assayed by the pharmacopoeial method in 7-day time intervals. All concentrations of 3%, 6%, and 10% hydrogen peroxide were found to fulfil the conditions for stability in the period of time under study. Their concentration did not fall below the limit od 90% of the content of the active ingredient, and storage under decreased temperature proved to be more suitable. Storage of hydrogen peroxide in the light is inadmissible. When the conditions of storage are observed, the required therapeutic effect of hydrogen peroxide solution can be expected for the period of three months.

Drug Stability↗
PubMedDate not supplied

[In-hospital Radio-Pharmacy Unit: creation and development].

Regarding the creation of an In-Hospital Radio-Pharmacy Unit within Clínica Puerta de Hierro University Hospital, as well as the compliance with Real Decreto 479/1993 on the regulation of radio-drugs for human use, the steps to be taken to bring it service are laid out and discussed. An overall review of the differential characteristics of radio-drugs is undertaken. The adequate distribution of spaces and the Unit's functioning regulations are presented, and the responsibilities of the person in charge of the ionisation chamber are clearly placed on record. The professional responsible of the Unit should define performance and quality control protocols for each test. The responsibility for coordinating the Unit's operation is assigned to the Heads of Nuclear Medicine and Pharmacy Departments, within the Pharmacy and Therapeutics Committee and the Nuclear Medicine Quality Committee.

Drug Compounding↗
PubMed1982

Pharmaceutical services in a veterinary hospital and clinic.

The pharmaceutical services offered by hospital pharmacists to a veterinary hospital and clinic are described. At Washington State University, the Department of Veterinary Clinical Medicine and Surgery of the College of Veterinary Medicine approached the College of Pharmacy to evaluate the pharmaceutical services in terms of lost charges and to provide recommendations for needed changes. The records of 18 cases were surveyed, and an inventory was taken in two wards to determine outdated drug products, products without expiration dates, and product duplication. The survey and inventory revealed inefficiencies and waste in the billing and distribution systems. The findings indicated the feasibility and potential cost-effectiveness of employing hospital pharmacists to manage the drug distribution system. A combined floor stock and individual prescription order system was implemented under the direction of a pharmacist faculty member jointly appointed by the two colleges. The distribution system has been in successful operation for two years, and the relationship between the two colleges has prompted the development of shared academic positions and joint clinical research.

Animals↗
PubMed2006

Critical care pharmacy services in United States hospitals.

BACKGROUND: Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated. OBJECTIVE: To characterize the type and level of pharmacy services provided to intensive care units (ICUs). METHODS: A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal. RESULTS: Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 +/- 1.5 days/wk, mean +/- SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting in-services (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories. CONCLUSIONS: Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.

Clinical Pharmacy Information Systems↗
PubMed1986

Patient medication instruction and provider interactions: effects on knowledge and attitudes.

This prospective study examines whether a patient medication instruction sheet (PMI) given to clinic patients by their health care provider affects knowledge and/or attitudes with thiazide diuretic use as part of an antihypertensive regimen. Adult male patients (N = 285) in a general medicine clinic were assigned to groups receiving the American Medical Association PMI describing their diuretic. Patients getting the PMI obtained it either directly from their provider or at the pharmacy dispensing window. All patients were surveyed by phone 1 week following the clinic visit with regard to the PMI, knowledge of medication use, and attitudes toward drug use. Results indicate that a provider-dispensed PMI results in higher levels of drug knowledge and greater patient satisfaction with their knowledge than a pharmacy-dispensed PMI. In addition, the PMIs educational value may be lessened by an incomplete verbal consult. This study demonstrates that the AMA PMI is an effective educational tool when distributed by a provider and can promote better understanding and use of prescribed medications.

Adult↗
PubMed1980

Pharmacist's role in projects for children and youth.

The establishment of clinical and distribute pharmaceutical services in an ambulatory care clinic serving primarily children and youth is discussed. In addition to assuring that drug therapy is appropriate and needed drugs are dispensed, the pharmacy staff administers the first dose of medications prescribed for pediatric patients. As part of the clinic's interdisciplinary health care team, pharmacists also provide therapeutic and pharmacokinetic consultations, drug monitoring, drug information, educational programs for patients, staff, pharmacy students and the community, and drug dependency and poison prevention services. Health professionals, patients, and the community have accepted the expanded role of the pharmacists.

Ambulatory Care Facilities↗
PubMed1993

Pharmacy technicians and computer technology to support clinical pharmacy services.

Use of pharmacy technicians, computer-assisted patient-selection algorithms, and bar-code technology to increase efficiency of clinical pharmacy staff is described. Workload assessment showed that clinical pharmacists at Henry Ford Hospital (Detroit) were spending two thirds of their time with data collection, patient selection, and documentation and only one third of their time intervening to improve drug therapy. To increase pharmacist efficiency, two technicians were hired to perform the clerical functions associated with clinical pharmacy services. Also, a bar-code data-collection system was implemented to help pharmacists document their clinical activity. Computerized algorithms helped pharmacists target patients whose therapy should be most carefully reviewed. Reports generated by the system summarized workload distribution and provided information about the types of problems identified and corrected. After these changes were implemented, the fraction of time that pharmacists spent intervening to improve drug therapy increased to one half. Use of technicians to perform clerical tasks, computerized algorithms to help identify patients in need of pharmacist assistance, and bar-code technology to facilitate data collection has helped clinical pharmacists improve their time management.

Algorithms↗
PubMed1988

Survey of pharmacy directors' experience with staff vacancies and recruitment.

Hospital pharmacy directors were surveyed in September 1987 about staff pharmacist turnover, recruitment, and retention. Questionnaires were mailed to pharmacy directors at 541 hospitals in the United States. Three hundred thirty-nine questionnaires were returned (62.7% usable response rate); more than 50% of the questionnaires sent to each geographic region were completed. Only 129 respondents reported difficulty filling vacant staff pharmacist positions within the past 12 months, although 320 believed there is a pharmacist shortage. Seventy-eight reported having positions that remained unfilled for three to six months. For more than 90% of the vacant positions, two-thirds of the duties were in drug distribution. Five hundred thirty-three pharmacists were reported to have left their positions in the past 12 months; the directors said salary and working hours were the reasons most often given, and that 47.5% left to work at other hospitals and 13.1% at chain community pharmacies. National advertisements and the use of professional recruitment agencies were the recruitment methods most frequently mentioned, and salary increases, recognition through feedback from management, and participation in management decisions were the methods most commonly mentioned for retaining pharmacists. Salary was the most frequently reported reason for hospital pharmacist turnover, and nearly half of the pharmacists leaving their positions went to other hospitals.

Attitude of Health Personnel↗
PubMed1987

Providing financial justification to support a stand-alone computer system in a large tertiary-care hospital.

An assessment of the pharmacy's needs and an evaluation of the pharmacy's batch-oriented data processing system supported the acquisition of a new computer system to meet the pharmacy's requirements in the areas of: Medication order entry Response time Capability to interface a materials management system Capability to interface to a patient billing program Development of an audit trail for patient charges Management reports Flexibility for future needs Conversion from a dated batch-oriented system to a medication on-line computerization system has provided enhanced benefits in the areas of fiscal accountability, inventory management, improved quality of pharmaceutical services (drug distribution and drug therapy monitoring), and employee productivity.

Capital Expenditures↗