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PubMedDate not supplied

Pharmacist-managed tobacco cessation program in Veterans Health Administration community-based outpatient clinic.

OBJECTIVE: To describe an ongoing pharmacist-managed tobacco cessation clinic and assess the long-term effectiveness of the program. SETTING: Veterans Health Administration (VHA) community-based outpatient clinic in Missoula, Montana. PARTICIPANTS: Pharmacy professor/clinical pharmacy specialist, advanced pharmacy practice experience students, and tobacco cessation participants. PRACTICE DESCRIPTION: Ongoing, pharmacist-managed tobacco cessation program offered to veterans. PRACTICE INNOVATION: With use of the "Vets without Cigarettes" program developed by the Montana VHA and the most current strategies reported in the literature, the clinical pharmacy specialist and pharmacy students provide tobacco cessation services for Missoula Veterans Affairs Primary Care Center veterans. Activities include a three-session program using the Transtheoretical Model of Change, tobacco cessation pharmacotherapy, behavioral strategies, cognitive techniques, documentation, and follow-up survey. MAIN OUTCOME MEASURE: Percentage of veterans contacted reporting tobacco abstinence. RESULTS: Follow-up survey results were obtained for 130 (87.8%) of 148 veterans attending one or more sessions of the tobacco cessation class between November 1999 and December 2003. Of the 130 veterans contacted, 54 (41.5%) continued to be tobacco free. CONCLUSION: This program demonstrates that pharmacists are effective providers of tobacco cessation services. Furthermore, a comprehensive tobacco cessation program is provided that can serve as a model to guide pharmacists in assisting more patients to become tobacco free and live healthier lifestyles.

Ambulatory Care Facilities↗

PubMedDate not supplied

Integration of a clinical community pharmacist position: emphasis on workflow design.

OBJECTIVE: To design and implement a scope of practice for a clinical pharmacist position and assess the clinical and economic impact of a Diabetes Medication Management Program in a community pharmacy setting. SETTING: Independent community pharmacy in an urban area. PRACTICE DESCRIPTION: Standard dispensing and consultative services and durable medical equipment supplies and services were offered in the pharmacy. Approximately 260 prescriptions were dispensed per 10-hour workday. PRACTICE INNOVATION: Pharmacy workflow was redesigned with workstations in which each position was occupied at all times by pharmacy technicians or pharmacists. Clinical pharmacy interventions were delivered while normal dispensing processes continued. INTERVENTIONS: A Clinical Community Pharmacist provided education and counseling to patients newly diagnosed with diabetes as well as services to patients with other chronic diseases. RESULTS: During the first 6 months of the project, 221 clinical interventions were made; 16 patients with diabetes (who had received 67 of the interventions) were enrolled in a medication management program. CONCLUSION: A Clinical Community Pharmacist in an urban setting can deliver clinical services during the normal dispensing process using an efficient workflow design.

Community Pharmacy Services↗

PubMed2000

Impact of pharmacists providing a prescription review and monitoring service in ambulatory care or community practice.

OBJECTIVE: To systematically review the impact, on patient outcomes and costs to the healthcare system, of pharmacists reviewing and monitoring prescribing in ambulatory care or community practice. DATA SOURCES: We conducted a systematic search of published literature, up to and including 1998, on outcomes of prescription monitoring and review by pharmacists. Thirteen electronic databases were reviewed, along with a hand search of 11 journals known to publish pharmacy practice research. Fifty-five articles describing 50 comparative studies were identified. DATA EXTRACTION: Data were extracted including study design, clinical site, and results. A qualitative synthesis of the findings was conducted and methodological quality was appraised. DATA SYNTHESIS: Pharmacist-run services may be accompanied by improvements in clinical outcomes. Inconsistent definitions used in the research evaluated meant that an overall interpretation of a change in the incidence of compliance and adverse drug reactions was impossible. Other outcomes such as knowledge and satisfaction showed equivocal results overall. There was little or no change in quality of life where this was assessed. Savings in drug acquisition costs may have accrued, but it was impossible to calculate the magnitude. Pharmacist involvement produced a positive impact on cost-benefit and cost-effectiveness. CONCLUSIONS: The heterogeneity of the studies found and the variety in quality of much of the research design prevent the rigorous assessment of the direction and magnitude of any changes reviewed. Further studies are required, which must be rigorously designed, with blind and independent assessment of clearly defined outcomes. In particular, there is a need to investigate the effect of such services on the incidence of adverse drug reactions and quality of life and to conduct robust cost-benefit analyses.

Ambulatory Care Facilities↗

PubMed2003

Pharmacist intervention enhances adherence to orlistat therapy.

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with orlistat. METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean +/- SD age of 43.8 +/- 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

Adult↗

PubMed1996

Relationships between ambient sounds and the accuracy of pharmacists' prescription-filling performance.

Associations between ambient sounds and accuracy of pharmacists' prescription-filling performance in a pharmacy was studied. Pharmacists were videotaped as they filled prescriptions each workday for 23 days. Each filled prescription was inspected by the investigator. Deviations from the physician's written order were considered errors. Videotape analysis was used to detect unpredictable, predictable, uncontrollable, and controllable sounds. A within-subjects case control study design was employed to determine whether the frequency of ambient sounds was significantly different when prescriptions with errors, compared with those without errors, were filled. Loudness, in terms of equivalent sound levels (Leq) for each half hour, was analyzed for a relationship to dispensing error rate. A mean dispensing error rate of 3.23% was found. Unpredictable sounds, controllable sounds, and noise had a significant effect on pharmacists which resulted in a decreased dispensing error rate. These results suggest that the quality of pharmacists' performance is not adversely affected by ambient sound. As equivalent sound levels increased, the error rate increased to a point, then decreased.

Case-Control Studies↗

PubMed1999

Clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals.

We evaluated direct relationships and associations among clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Multiple regression analysis, controlling for severity of illness, was employed to determine the associations. The study population consisted of 934 hospitals. Four clinical pharmacy services were associated with lower drug costs: in-service education, $77,879.19+/-$56,203.42 (a total of $48,518,735.37 for the 623 hospitals offering this service, p=0.016); drug information, $430,579.84+/-$299,232.76 ($90,852,346.24 for the 211 hospitals offering this service, p=0.015); drug protocol management, $137,333.67+/-$98,617.83 ($45,045,443.76 for the 328 hospitals offering this service, p=0.049); and admission drug histories, $213,388.21+/-$201,537.85 ($5,548,093.46 for the 26 hospitals offering this service, p=0.011). As staffing increased for hospital pharmacy administrators (p<0.0001), dispensing pharmacists (p<0.0001), and pharmacy technicians (p<0.0001), drug costs increased. As staffing increased for clinical pharmacists, drug costs decreased (p=0.018). The results of this study show that increased staff levels of clinical pharmacists and some clinical pharmacy services are associated with reduced hospital drug costs.

Data Collection↗

PubMed2000

Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension.

This prospective, randomized, controlled study evaluated the impact of pharmacist-initiated home blood pressure monitoring and intervention on blood pressure control, therapy compliance, and quality of life (QOL). Subjects were 36 patients with uncontrolled stage 1 or 2 hypertension. Eighteen subjects received home blood pressure monitors, a diary, and instructions to measure blood pressure twice every morning. Home measurements were evaluated by a clinical pharmacist by telephone, and the patient's family physician was contacted with recommendations if mean monthly values were 140/90 mm Hg or higher. Eighteen control patients did not receive home monitors or pharmacist intervention. Office blood pressure measurements and QOL surveys (SF-36) were obtained at baseline and after 6 months. Mean absolute reductions in systolic and diastolic pressures were significantly reduced from baseline in intervention subjects (17.0 and 10.5 mm Hg, both p < 0.0001) but not in controls (7.0 and 3.8 mm Hg, p = 0.12 and p = 0.09). More intervention subjects (8) had blood pressure values below 140/90 at 6 months compared with controls (4). During the study 83.3% (15) of intervention subjects had drug therapy changes versus 33% (6) of controls (p < 0.01). Compliance and QOL were not significantly affected. Our data suggest that the combination of pharmacist intervention with home monitoring can improve blood pressure control in patients with uncontrolled hypertension. This may be related to increased modifications of drug regimens.

Antihypertensive Agents↗

PubMedDate not supplied

A pharmacist-based screening program of octogenarians starting new medications.

OBJECTIVE: To measure the impact of clinical pharmacists in primary care practices who closely monitor patients older than 80 years after initiation of new medications. METHODS: The study was an uncontrolled pilot trial performed at a group-model health maintenance organization in the Pacific Northwest between August and December 1999. Forty-eight patients who were older than 80 years and were prescribed at least one new medication in their primary care clinic were called at home 3 to 6 days after starting a new medication and asked questions focusing on compliance and potential adverse drug events. RESULTS: More than 20% of patients (10 of 48) had a clinically important change made as a result of the pharmacist telephone monitoring; 42% of patients (20 of 48) either experienced an undesired medication effect (14 of 48) or an inadequate effect (6 of 48). Pharmacists spent an average 11.3 minutes at an estimated cost of $6.40 per patient. CONCLUSION: A simple, inexpensive pharmacist-based program to screen for medication problems after initiation of new medicines may improve the care to a population older than 80 years.

Aged↗

PubMed2005

Pharmacist interventions in geriatric nursing facility NSAID therapy: a one-year follow-up study of costs and outcomes.

OBJECTIVES: To document costs and outcomes occurring with acceptance or rejection of ongoing pharmacists' interventions regarding therapy with a nonsteroidal anti-inflammatory drug (NSAID) versus acetaminophen (APAP) therapy in treating osteoarthritis in a long-term care facility in the sixth year of observation. DESIGN: A nonrandomized observational prospective cohort study with all patients resident for 30 or more days over the 12-month study period receiving NSAID or APAP therapy for osteoarthritis. SETTING: A skilled nursing facility with more than 100 beds. PATIENTS: All patients had a monthly drug regimen review, receiving full-dose NSAIDs (not low-dose aspirin alone) on a continuous basis, and were selected for intervention. A control group of patients receiving APAP on a continuous basis also was selected for comparison of outcomes. INTERVENTIONS: Patients receiving NSAIDs had (1) periodic hemoglobin and hematocrit determinations; (2) physical assessment of lower eyelid, nailbed, and stool color; (3) and a recommendation to replace NSAID with APAP or to add gastroprotective pharmacotherapy if the NSAID was continued. Patients not receiving an NSAID for osteoarthritis and continuously taking APAP served as a control group. MAIN OUTCOMES MEASURES: Cost-analysis calculations were performed for existing regimens versus cost savings that would be experienced with recommended pharmacotherapeutic interventions. RESULTS: Fourteen intervention subjects and sixteen control patients were identified. In the three patients for whom the pharmacist's recommendations were accepted within three months (11 NSAID-use months), there were three substitutions of APAP therapy observed over an additional 26 patient-months. Five of 11 patients in the NSAID group for whom pharmacists' recommendations were rejected developed gastrointestional (GI) bleeding, necessitating six hospitalizations. Two of these patients died over the study period. No group for whom APAP was accepted nor control-group patients experienced suspected GI bleeding. Total costs of the control group analgesic therapy was $756.74, or $47.30 per patient. Cost savings for APAP substitution in the intervention rejection group would exceed $91,000, while cost savings with the addition of hemoglobin and hematocrit determinations would exceed $84,200. Cost savings from addition of gastroprotectives to the NSAID would have been misoprostol, $73,000; omeprazole, $71,400. CONCLUSIONS: Refusal to accept pharmacists' intervention recommendations regarding alternatives to NSAID pharmacotherapy in this nursing facility population is associated with sustained and considerable costs, morbidity, and mortality.

Journal Article↗

PubMed2005

Involvement of neuropsychiatric pharmacists in a memory disorder clinic.

OBJECTIVE: Dementia is a progressive, degenerative brain disease characterized by an increasing loss of memory and other cognitive functions. Early diagnosis and intervention is important to enhance quality of life, as well as prevent costly nursing home admissions. Pharmacists can be used to assist in the selection and management of medications. SETTING: In the state of Florida, Memory Disorder Clinics are one approach to assist in the diagnostic process not only of Alzheimer's disease (AD), but also other causes of dementia. These clinics also provide community resources for caregivers and families. PRACTICE DESCRIPTION: The clinics provide services such as memory screenings, caregiver education, workshops for health professionals, and training for students in the allied health professions. PRACTICE INNOVATION: The clinic at Tallahassee Memorial Hospital utilizes clinical pharmacists to provide medication evaluations and education as a part of their services. MAIN OUTCOME MEASUREMENTS: The pharmacists' involvement has allowed an opportunity for interdisciplinary collaboration on the management and education of AD, other dementias, and the associated behavioral, psychiatric, and medical disorders. RESULTS: In the first six years of the clinic's existence, 408 evaluations were performed, with recommendations concerning medications. Almost 2,000 individuals have received medication evaluations through screenings. CONCLUSIONS: Pharmacists have valuable skills to assist in the management of diagnosis and management of dementia.

Journal Article↗

PubMed2002

Pharmacist scope of practice.

This paper explores the increased scope of practice of U.S. pharmacists. It presents background information on the pharmacy profession and outlines how the medical profession can work with pharmacists to enhance patient safety and quality of care. The paper calls for further research on the effects of pharmacy automation and the move to the Doctor of Pharmacy degree on pharmacy practice. Other positions include support for patient education and hospital rounds, opposition to independent pharmacist prescriptive privileges and initiation of drug therapy, increased use of the pharmacist as immunizer (as allowed by state law), and continued support for the American College of Physicians-American Society of Internal Medicine 1990 therapeutic substitution position.

Certification↗

PubMed1990

Physician assessment of pharmacists' interventions--a method of estimating cost avoidance and determining quality assurance.

The impact and quality of select pharmacists' interventions were assessed by four physicians with pharmacology experience. Each physician was sent 30 interventions and asked to indicate if the intervention by the pharmacist was of a positive nature and would prevent morbidity and/or mortality. They were also questioned regarding effect of the intervention on hospital stay. Each physician received 15 interventions which were, and 15 interventions which were not assessed by three other physicians. Of the 15 interventions assessed by all four physicians there was favourable agreement among the physicians with respect to the impact of the intervention with 86.7 percent (52 of 60) of the judgements indicating that the pharmacists' intervention had a positive effect on therapy. There was less agreement with regard to whether hospital stay would, and the extent to which it would, have been prolonged. Using consensus it was estimated that eight of 15 interventions would have prolonged stays approximately 3.7 days each. The use of physicians was helpful in assessing the impact of pharmacists' interventions.

Adolescent↗

PubMed1990

Acceptance of pharmacists' suggestions by prescribers: a literature review.

Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services that is often overlooked. A literature search was performed to review the information on this topic. Acceptance was defined as a measure of a prescriber's compliance with a pharmacist's recommendation regarding drug therapy. In order for the pharmacist to impact upon the quality of patient care or drug costs, the prescriber must accept the suggestions. A total of 23 studies was found that addressed the topic. The average rate of acceptance was 85.5%. Factors affecting acceptance included time, communication, solicited versus unsolicited recommendations, type of prescriber, and type of pharmacist. Factors leading to non-acceptance included lack of physician awareness of pharmacokinetic parameters, quality of suggestions, prescribers' exercise of caution with respect to patient safety and well-being, and negative attitude toward clinical pharmacy. More research needs to be done in order to evaluate the importance of these factors.

Attitude of Health Personnel↗

PubMed1991

Documentation of pharmacist interventions in a decentralized unit dose system.

The purpose of this study was to justify the increased costs of providing decentralized pharmacy service by defining therapeutic interventions as they relate to improved patient care and by documenting cost savings generated by decentralized pharmacist interventions. Data were collected on a daily basis from information provided by the decentralized pharmacists using a daily worksheet. The various interventions were then categorized as cost-saving interventions and therapeutic interventions. Decentralized pharmacist interventions do provide important therapeutic interventions as well as cost-effective interventions. The total cost-saving interventions in 1989 was $126,509 and this included the automatic drug conversions. The pharmacists also provided 2506 therapeutic interventions.

Centralized Hospital Services↗

PubMed1993

A system for documentation of pharmacist interventions with incorporation into performance and quality improvement plans.

Budgetary constraints have compelled hospital administrators to take a more discerning look at the role of the pharmacist within the healthcare team. In 1991, financial difficulties and hospital-wide cutbacks at Northern Michigan Hospital resulted in the loss of pharmacy personnel. Consequently, the department has increasingly found it necessary to document the clinical activities of the pharmacists and their potential effect on patient care. To document therapeutic interventions, two forms specific to this activity were developed. These forms allowed evaluation of both the quantity and quality of interventions. The authors realize it is essential for pharmacists to not only maintain, but to continually update their knowledge base to be prepared for the future. A staff development program was developed to help meet the educational needs of the pharmacists. This article describes how therapeutic interventions were integrated into the quality improvement and performance plans to help motivate staff to continually improve their pharmacy practice skills at this institution.

Clinical Pharmacy Information Systems↗

PubMed1995

Nutrition support pharmacist board certification process.

Specialization is the logical outcome of the maturation of the profession of pharmacy, although its acceptance has been controversial. Specialization also meets a need created by the increasing complexity of the medical management of disease. Although the skills of the generalist pharmacist are still much in demand, the specialist pharmacist has the skills and knowledge to meet more in depth, or more focused, patient care needs. The current specialties within pharmacy that are recognized by the Board of Pharmaceutical Specialties (BPS) are nuclear pharmacy, pharmacotherapy, and nutrition support pharmacy practice. Psychiatric pharmacy practice has also been approved by BPS as a specialty, however, the process for attaining certification has not yet been established. This article will describe the process by which pharmacists, whose practice is concentrated in nutrition support, may become recognized as Board Certified Nutrition Support Pharmacists (BCNSPs).

Certification↗

PubMed1998

What's in there for me? The Internet for pharmacists.

Pharmacists and other professionals must develop a strategy to take the greatest advantage of information on the Internet. Healthcare providers must work effectively with increasingly demanding and well-educated consumers to survive the turbulent environment. We focus on describing Internet sites that can be of interest and assistance to individual pharmacists researching health and professional topics. It is important for health care practitioners to have an understanding of the content of Web sites so they may use their professional judgment to determine the authenticity of information. Utilizing the Internet to augment the pharmacist's knowledge base may solve the dilemma of the pharmacist's utility in the 21st century. The practicality of the Internet is underscored by its ability to link healthcare professionals worldwide in unique collaborative efforts unmatched by any individual's output, regardless of his singular genius.

Career Mobility↗

PubMed1986

Consulting pharmacist services: evaluation by long-term care facility administrators.

A questionnaire was distributed to 1,000 long-term care facility (LTCF) administrators in Texas to obtain their perspectives on consultant pharmacists. The administrators were asked to provide information on drug information and other services provided by consulting pharmacists at their institution and their opinions on those services. The results of the study are presented, and the views of LTCF administrators are discussed. Overall evaluation of the consultant pharmacists was good to excellent. Administrators believe drug information is appropriate and desirable, they are satisfied with the services, but they question pharmacist reimbursement.

Consultants↗