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At least 991 records · Page 55Linked to original sources

PubMed1999

Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs.

BACKGROUND: It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice. AIM: To determine whether intervention practices made savings relative to controls. METHOD: An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to take part and received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of 163,000 Pounds. Changes in prescribing patterns were investigated by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. Prescribing data (PACTLINE) were used to assess these changes. The measures used to take account of differences in the populations of the practices included the ASTRO-PU for overall prescribing and the STAR-PU for prescribing in specific therapeutic areas. Differences between intervention and control practices were subjected to Wilcoxon matched-pairs, signed-ranks tests. RESULTS: The median (minimum to maximum) rise in prescribing costs per ASTRO-PU was 0.85 Pound (-1.95 Pounds to 2.05 Pounds) in the intervention practices compared with 2.55 Pounds (1.74 Pounds to 4.65 Pounds) in controls (P = 0.025). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around 347,000 Pounds higher. CONCLUSION: This study suggests that the use of pharmacists did control prescribing expenditure sufficiently to offset their employment costs.

Community Pharmacy Services↗

PubMed1979

Pharmacist monitoring of parenteral nutrition: clinical and cost effectiveness.

The effect of pharmacist involvement in total parenteral nutrient (TPN) therapy on patient outcome and cost of therapy was studied. Data from 26 patients who received standard TPN solutions without pharmacist monitoring (Group 1) were compared with those from 26 patients whose TPN therapy was individualized (by use of a minicomputer) and monitored by a pharmacist (Group 2). Six patients from each group who were 35 days of age or younger and who received TPN as the only caloric source for 8 to 20 days were compared for clinical response. Mean duration of TPN therapy increased form 12.3 +/- 9 days for Group 1 to 14.8 +/- 12 days for Group 2, and the TPN use rate for Group 2 was 31% above that for group 1. The mean daily charge for TPN was greater for Group 1 ($72.00) than for Group 2 ($50.18). The pharmacy's mean cost per course of TPN for Group 2 was $44.10 less than that for Group 1. The mean weight gain in Group 1 was significantly less (4 g/day) than that in Group 2 (17 g/day) (p less than 0.05) (for the six patients per group compared). Pharmacist monitoring of TPN reduced the pharmacy's costs and patient charges for TPN and improved the patients' clinical responses to TPN.

Child, Preschool↗

PubMed1994

[The proposal for community pharmacist activity from a viewpoint of science history].

Community pharmacists have many kinds of problems for demonstrating their ability and activity. One of them is to realize the professional activity. At present, I am afraid that such community professional activities might be for now confined to legal extension. I would therefore like to discuss the aspect of professional centrifugal practice in community health care system under the pharmaceutical law system. Secondly, the role of pharmacists in drug sale comprises advising and controlling medication that we call "Application Pharmacy" in which individual pharmacokinetics and susceptivities have to be considered. The Application Pharmacy will be established in the community medical health care system for new pharmacist's activity. The Application Pharmacy should be a requirement for community pharmacists and lead to a notion of "Community Pharmacy Therapeutics."].

Community Pharmacy Services↗

PubMed1999

The historical study of an ethics for American pharmacists.

The Code of Ethics for pharmacists clarifies the standards of professional conduct. The code should be positively enforced in every country, and must play its role as the conduct standard for pharmacists at all times. American pharmacists did not suddenly become ethical in the 1980s. An appreciation of the importance of professional ethics has a long history starting when the Philadelphia College of Pharmacy adopted a Code of Ethics in 1848. Since the first legislation of the American Pharmacy Code of Ethics as far back as 1852, the code has been revised in 1922, 1952, 1969, 1981 and 1994. The term of between revisions has gotten shorter over the years, reflecting the change in the status and the proficiency of pharmacists in 146 years. Its historical meaning is quite significant.

Ethics, Pharmacy↗

PubMed1998

[The punishment of a pharmacist in Istanbul in 1853].

Yakop who ran a pharmacy in Istanbul was accused of malpractice in 1853. The pharmacist had prepared a bottle of cod liver oil for a patient and a bottle of croton oil for another one. He had neglected to label the bottles which were administered by mistake to the patients by his apprentice. The patient who drank a spoonful of croton oil was intoxicated immediately and died. As soon as the event was reported, the police asked the deceased person's family if they intended to sue the pharmacist. They did not. However, the police forces started an investigation and asked the School of Medicine whether the pharmacist was guilty. The School answered that the pharmacist had neglected to label the bottles and was found guilty of causing the death. The Supreme Court took up the matter and sentenced Mr. Yakop to six months imprisonment and decided to close his pharmacy. The decision was published in Takvim-i Vekayi, the official newspaper of the State.

Drug Labeling↗

PubMed2003

Physician acceptance rate of pharmacist recommendations to reduce use of potentially inappropriate medications in the assisted living setting.

OBJECTIVE: To reduce the number of potentially inappropriate medication orders, based on the Beers' criteria, for an elderly population residing in assisted living facilities through consultant pharmacist medication review, interventions, and recommendations DESIGN: Prospective case series of consultant pharmacist recommendations. PATIENTS: Census of 456 residents of assisted living facilities who received a new or refill medication order during the preceding two months. INTERVENTIONS: Potentially inappropriate medications for the elderly were identified and recommendation letters faxed to the physician for consideration. MAIN OUTCOME MEASURES: Demographic characteristics, prevalence data for medications ordered and considered potentially inappropriate based on the Beers' criteria, and physician acceptance and return rate of recommendations. RESULTS: The data demonstrated that 31.6% of the residents in this study were receiving one or more routine or p.r.n. medications orders considered potentially inappropriate based on the Beers' criteria. The majority (82.9%) of the residents were female, and the average age of the residents was 85.4 +/- 7.34 SD years (range, 66-102 years). A total of 205 routine and p.r.n. medication orders were identified as potentially inappropriate. Of these orders, 16.7% were discontinued and 2.5% were changed to lower dosage regimens. The overall return rate of all recommendations faxed to physicians was 88.7%. CONCLUSIONS: Potentially inappropriate medications, according to the Beers' criteria for use in the elderly, are ordered at a high rate for residents of assisted living facilities. Though not mandated in all states, screening of these orders by a consultant pharmacist, with recommendations for alternative pharmacotherapy of less risk, would be appropriate. Physicians do address the recommendations in the majority of cases, but the physician acceptance rate of those recommendations is much lower. Consultant pharmacists have the opportunity to educate physicians of the risks of using medications considered potentially inappropriate for geriatric patients. Further studies are needed to determine barriers to physician acceptance of these recommendations.

Journal Article↗

PubMed1987

The clinical pharmacist in drug research and development. Pharmacodynamics.

Today, clinical pharmacists are involved in various types of pharmacodynamic research. Fellowship training programs encompassing research on pharmacodynamics, pharmacokinetics, and their relationships are becoming more prevalent. The training needs of future clinical pharmacist investigators require careful consideration, especially with regard to standards for fellowship programs and the evolving science of pharmacodynamic-pharmacokinetic modeling. Liability and legal issues as well as stable sources of funding for fellowships are current concerns of clinical pharmacist investigators. These issues notwithstanding, the prospect of continued growth and evolution of the clinical pharmacists' role in pharmacodynamic research looks bright.

Drug Therapy↗

PubMed1985

Improving patient-oriented pharmacy services: what the individual pharmacist can do.

How individual pharmacists can improve patient-oriented services is described. Pharmacists practicing on patient-care units should assess how they can, by meeting the needs of other health-care providers, contribute to better drug therapy. They should examine how changes in the drug distribution system can allow more flexibility for providing services on the patient-care unit. They should promote appropriate drug use by identifying problems and bringing these to the attention of the providers involved. Individual pharmacists can be assigned to patient-care units to coordinate drug therapy and patient education. They should document their activities. Individual pharmacists can take responsibility not only for their own actions but also for the actions of other health-care professionals associated with drug therapy.

Humans↗

PubMed1979

Pharmacist management of anticoagulant therapy in ambulant patients.

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.

Anticoagulants↗

PubMed1983

Hospital pharmacists' evaluation of drug wholesaler services.

Services provided by drug wholesalers were evaluated by hospital pharmacists. A survey was mailed to 1500 randomly selected pharmacy directors. Respondents indicated availability and use of 26 customer services. Pharmacists rated the services that they used on the basis of importance of the service and satisfaction with the service. The 644 returned questionnaires indicated that most services were available to a large majority of respondents. Most services used were rated as important or essential. Most respondents were satisfied with wholesaler services; the service with which the most respondents were dissatisfied was stocking of pharmaceuticals in single-unit packaging. Of other services that were widely used and rated important, prompt crediting for delivery errors, few out-of-stock items, frequent pickup of return merchandise, and stocking of injectable pharmaceuticals received low satisfaction ratings. Same-day delivery service and emergency delivery of prescription items were unavailable to more than 40% of respondents. Hospital pharmacists were generally satisfied with services provided by drug wholesalers. Wholesalers should be aware of the particular service needs of hospital pharmacists, and further studies of these needs should be conducted.

Commerce↗

PubMed1983

Evaluation of a cardiopulmonary-resuscitation training manual for pharmacists.

The development and evaluation of a training manual for pharmacists participating in cardiopulmonary resuscitation (CPR) efforts at an institution encompassing ambulatory-care, acute-care, and emergency-trauma facilities are described. The manual was developed to familiarize pharmacists who had little or no experience in CPR procedures with the equipment and medications used and the pharmacist's role on the CPR team. To evaluate the effectiveness of the manual, a 29-question multiple-choice test was administered to 35 staff pharmacists who were randomly assigned to study and control groups. Training manuals were issued to members of the study group, who were asked to document time spent studying them. Three weeks after the pretest, the same test was administered to all subjects. There was no control on the number of CPR events attended during the three-week period. The study group spent less than two hours (mean +/- S.D. = 97.5 +/- 34.22 min) using the manual. For the study group, posttest scores were significantly higher than pretest scores. The difference in pretest scores for the study and control groups was not significant, but for the posttest the study group scores were significantly higher. Because use of the manual appeared to improve knowledge of drug therapy and procedures used in CPR, the pharmacy department incorporated it into its orientation procedure.

Education, Pharmacy, Continuing↗

PubMed1981

Concurrent pharmacist monitoring of gentamicin therapy.

The results of concurrent monitoring of gentamicin therapy by a clinical pharmacist are reported. All patients in a 332-bed teaching hospital who were started on gentamicin therapy during a 72-day period were monitored. Predetermined criteria concerning maximum daily gentamicin dose based on serum creatinine and acceptable precautions for avoiding toxicity (i.e., serum creatinine, gentamicin serum level determinations) were used. Deviations from these criteria resulted in contact with the patient's physician, and specific recommendations were made by the pharmacist at that time. During this period, 120 courses of gentamicin therapy were monitored in 101 patients. Major criteria deviations were found in 15 (12.5%) courses, resulting in the contact of 10 physicians. Physicians responded to the pharmacists' recommendations in 9 (60%) of the 15 courses. It is concluded that a clinical pharmacist can interact effectively with physicians in monitoring drug therapy in the hospital.

Boston↗

PubMed1980

The clinical pharmacist in a family practice residency program.

A project of interdisciplinary family medicine education was conducted in which a clinical pharmacist served as a drug therapy consultant-educator in a family practice residency program. The clinical pharmacist provided drug information, advised about drug therapy, taught in formal conferences, prepared and disseminated a drug information bulletin, made rounds with the physicians, provided drug blood level consultation, and conducted a drug utilization review project. The family physicians' attitudes about clinical pharmacy were assessed by interviews before and after the project and by a questionnaire administered after the project. The physicians and the pharmacist in this model were observed to have a greater understanding of the interdisciplinary team practice concept; and an active role for the clinical pharmacist as a teacher and consultant was reinforced.

Attitude of Health Personnel↗

PubMed1980

Drug regimen review in skilled nursing facilities by consulting clinical pharmacists.

The organization and operational methods of clinical pharmacists providing contractual pharmaceutical services in skilled nursing facilities (SNFs) are described, and the use of a model toidentify drug therapy problems is analysed. A group of clinical pharmacists incorporated as Clinical Pharmacy Consultants (CPC) provided consultative services through contractual agreements with pharmacy vendors or SNF administrators. Using a drug regimen review model designed by CPC, the consulting pharmacists reviewed 13,081 medical charts at 10 SNFs. Of the reviews, 928 (7.1%) indicated potential or real drug therapy problems; on an annual basis this corresponds to approximately eight drug therapy problems per 10 beds per year in an SNF. About 60% of the problems could be attributed either to prescribing of medication with no documented indication (23.9%) or to lack of objective data for monitoring drug therapy effectiveness (34.6%). Because these problems are related to disease state management, it was concluded that consulting clinical pharmacists could help to improve patient care in SNFs, primarily through drug therapy review and staff consultation.

Consultants↗

PubMed1994

Pharmacists' views of patient counseling.

The goal of this study was to assess whether pharmacists rate eight elements of counseling of equal importance in different dispensing situations. A sample of 708 pharmacists was asked to complete a pretested questionnaire about patient counseling; 697 provided usable responses, for a response rate of 98%. Using multivariate analysis of variance and analysis of variance, we found significant differences (p < 0.01) in pharmacists' ratings of the importance of counseling patients in different situations. Pharmacists used patient familiarity with the medication and the perceived seriousness of potential consequences to the patient to determine the importance of each element of counseling.

Adult↗

PubMed1997

Analgesics: a comparison of therapeutic knowledge and inter-professional liaison between general practitioners and community pharmacists.

The aim of this study was to ascertain general practitioners' (GPs') and pharmacists' knowledge of analgesics, to establish professional opinion on their use, and to assess the extent of pharmacist input into the prescribing of analgesics. Pharmacists displayed a better knowledge of analgesics than their colleagues in general practice, but had little input into the prescribing decisions made by GPs. Pharmacists' knowledge is not being put to best use in contributing to the preparation of practice formularies, and links between these two health professional groups need to be developed further.

Analgesics↗

PubMed2001

Practice-based research: lessons from community pharmacist participants.

We designed this project to determine community pharmacists' opinions regarding the challenges and motivations of their recent participation in a pharmacy practice-based research study At the conclusion of a randomized, multicenter study, 87 community pharmacist-investigators were sent a questionnaire that explored four areas: motivating factors to participate, barriers to participation, communication tools used by study coordinators, and design issues for future studies. Fifty-eight (67%) completed questionnaires were returned. Key factors motivating participation in the study were desire to improve the profession and opportunity to learn. Time was the greatest barrier to participation. Pharmacy practice-based research has two distinct advantages. First, it translates clinical knowledge into direct application in the community. Second, it provides needed data to demonstrate the value of enhanced pharmacy practice. Thorough understanding of pharmacists' opinions is necessary to optimize the design of future studies.

Attitude of Health Personnel↗

PubMed1980

[A pharmacist's proposal for improved pharmacotherapy].

The pharmaceutical sciences have recently made great progresses towards a better knowledge of drug action. For the security of medication, it seems most important that said knowledge should be made available to specialists without delay. This means also that an adequate instruction in pharmacobiological branches is necessary. Cooperation of physicians and pharmacists should be intensified. The latter are in a position to give general information (i.e. critical evaluation of a new drug on the market) as well as specific information (required form of administration, mode of action, biopharmaceutical properties, adequate dosage, adverse effects and probable interactions, alternative medication in case of contraindications, etc.). The medical and pharmaceutical studies today do not sufficiently prepare both professions for such a cooperation. It is therefore highly advisable to coordinate in a better way the education in different sciences. For the time being, pharmacists already have at their disposals a good infrastructure, which comprises the scientific center of the national professional organization. The information of the patient himself should also be developed and intensified, especially with regard to the correct use of drugs, prescribed or OTC. Again, this specific activity needs the close cooperation of physicians and pharmacists. Steady relations between both health professions are thus to be deepened and reinforced for the benefit of the patient.

Drug Interactions↗