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New York State pharmacists' attitudes toward needle and syringe sales to injection drug users before implementation of syringe deregulation.

In May 2000, New York State passed legislation permitting the sale, purchase, and possession of up to 10 needles and syringes without a prescription. The law is intended to reduce the transmission of human immunodeficiency virus (HIV) and hepatitis among injection drug users (IDUs), their sexual partners, and their children. To obtain baseline information about the attitudes and likely practices of New York State pharmacists, we distributed a self-administered questionnaire to attendees of the state pharmacy association meeting in June 2000. Of 48 usable responses, 19% were from New York City and the rest from New York State. Of the 48, 42% were unaware of the new law before the day of the survey, and 60% were somewhat or very willing to sell needles and syringes to an IDU. Of those who were not willing to sell to an IDU, 82% cited familiarity of the customer as a very important consideration in their decision making. Those who were not willing to sell to an IDU were more concerned about the detrimental impact of syringe sales on the community, were less likely to be aware of the new law, and were more likely to be concerned about legal liability for syringe sales. Over 80% of all pharmacists believed that syringe sales to IDUs are an important preventive health measure. The majority also favored learning more about the law. Compared to other state surveys of pharmacists, these preliminary data show a similar level of interest in becoming involved with syringe availability programs.

Attitude of Health Personnel↗

Implementation of a pharmacist-led clinic for hypertensive patients in primary care--a pilot study.

OBJECTIVES: To implement a pharmacist-led Hypertension Management Clinic in one general medical practice. To evaluate the impact of the clinic on blood pressure (BP) control and prevention of coronary heart disease (CHD). METHOD: A total of 242 patients attended the pharmacist-led hypertension clinic over a 10-month period. Lifestyle and drug therapy alterations were implemented to achieve British Hypertension Society (BHS) target level BP. A sub-group of 160 patients were used to compare BP control in the clinic setting against that with the general practitioner (GP). Assessment was made of 10-year CHD risk in patients with no artherosclerotic disease. Patients with underlying artherosclerotic disease were prescribed statins, and antiplatelet drugs where indicated. MAIN OUTCOME MEASURES: Changes in numbers of hypertensive patients meeting the BHS target level BP. Changes in prescribing of antiplatelet agents and statins for primary and secondary prevention of artherosclerosis. RESULTS: In 206 patients with established hypertension, the number achieving target level BPs increased from 74 (36%) pre-clinic to 174 (85%) post-clinic; P < 0.001 chi-squared test. After attending the clinic, for 5 months 74 patients (80%) achieved target level BP in the clinic compared with 27 (40%) with standard GP care; P < 0.001 chi-squared test. Of 188 patients assessed for primary prevention therapy, 126 (67%) required treatment with aspirin and 37 (20%) with a statin. Post-clinic 101 (80%) received aspirin compared with 17 (13%) pre-clinic and 34 (92%) received a statin in comparison with 4 (11%) pre-clinic; both P < 0.001 chi-squared test.A total of 52 (96%) of 54 patients received an antiplatelet agent for secondary prevention of artherosclerosis compared with 40 patients (74%) pre-clinic. Thirty six of 54 patients required a statin for secondary prevention. Thirty five patients (97%) received a statin compared with 23 (64%) pre-clinic; both P < 0.01 chi-squared test. CONCLUSION: Implementation of a pharmacist-led clinic improved blood pressure control and appropriate prescribing of antiplatelet agents and statins for primary prevention of CHD and secondary prevention of artherosclerosis.

Aged↗

Identification of potential drug-related problems in the elderly: the role of the community pharmacist.

OBJECTIVE: The high prevalence of multiple drug use combined with age-related changes in pharmacokinetics and pharmacodynamics makes older adults more vulnerable to drug-related problems (DRPs). This pharmacy-based study was performed to identify potential DRPs from prescription records of the elderly and the role of the pharmacist in this process. METHOD: The study was performed from June 2002 to February 2003 in 16 community pharmacies in the Netherlands. Medication assessment of elderly patients aged 65 and over using six or more drugs concomitantly took place on the date of inclusion. Ten types of potential DRPs, grouped into three categories, were determined. The three groups were patient-related, prescriber-related or drug-related potential DRPs. We looked at the occurrence, nature and determinants of differential potential DRPs. RESULTS: The mean number of prescriptions per patient was 8.7. In total 3.9 potential DRPs per elderly person were identified. The distribution of the potential DRPs over the three categories was: patient related 4.7%, prescriber related 55.7% and drug related 39.6%. Use of NSAIDs (OR 29.9; 95% CI 4.1-219) and digoxin (OR 15.7; 95% CI 4.9-50.5) were associated with the highest risk for potential DRPs. CONCLUSION: In this vulnerable group of elderly patients potential DRPs frequently occur. Community pharmacists can play an important role in the identification, assessment and prevention of potential DRPs in the elderly. It is useful to investigate which part of potential DRPs can be avoided by the intervention of the community pharmacist in collaboration with the prescriber and the patient.

Aged↗

The physician and pharmacist team. An effective approach to cholesterol reduction.

OBJECTIVE: To assess the effect of a program that encourages teamwork between physicians and pharmacists on attempts to lower total cholesterol levels and to meet recommended goals proposed by the National Cholesterol Education Program (NCEP). DESIGN: A single-blind, randomized, controlled trial lasting 6 months. SETTING: An ambulatory primary care center. PATIENTS: A sample of 94 patients with total cholesterol levels of 240 mg/dL (6.2 mmol/L) or higher. INTERVENTION: Equal numbers of patients were randomly assigned to a control arm in which standard medical care was received and an intervention arm which implemented close interaction between physicians and pharmacists. MEASUREMENTS AND MAIN RESULTS: Absolute change in total cholesterol levels from baseline values and the percentage of patients who achieved an NCEP goal after 6 months of intervention were determined. The rate of success in achieving NCEP goals in the intervention arm was double the rate in the control arm (43% vs 21%, P < .05). Total cholesterol levels in the intervention arm declined 44 +/- 47 mg/dL (1.1 +/- 1.2 mmol/L) versus 13 +/- 51 mg/dL (0.3 +/- 1.3 mmol/L) in the control arm (p < .01). The effect of intervention on reducing total cholesterol levels was similar for men and women and did not appeared to be altered by age. The effect of intervention was greatest in patients with coronary heart disease (p < .01) followed by those without disease but with two or more coronary heart disease risk factors (p < .05). An effect of intervention was absent in patients without coronary heart disease and with fewer than two risk factors. CONCLUSIONS: Attempts to lower total cholesterol levels and achieve NCEP goals are likely to be more successful when combined with programs that include teamwork between physicians and pharmacists. Some programs, however, may be more successful for high-risk patients, for whom it is often easier to provide more aggressive therapies. Although altering adverse lipid profiles in lower-risk patients may be difficult, achieving optimal cholesterol levels could have an important impact on preventing movement to higher risk strata.

Aged↗

Reported and actual prescription of oral rehydration therapy for childhood diarrhoeas by retail pharmacists in Nigeria.

This study documented what retail pharmacists and operators of patent medicine shops prescribe for childhood diarrhoeas in Borno State in the northeastern part of Nigeria. Data was generated by a combination of open and confederates survey of 135 pharmacies and patent medicine shops in the state. The study found that retail pharmacies and patent medicine shop operators, in the overwhelming majority routinely prescribe drugs, particularly, antibiotics, for both watery and bloody diarrhoea. Very few of the pharmacists and almost none of the patent medicine shop operators prescribed any form of oral rehydration therapy (ORT) for watery diarrhoea. There was very high discrepancy between what respondents told interviewers they usually prescribe and what was actually prescribed to confederates in their facilities. It is suggested that the non-prescription of ORT by the majority of facilities could be accounted for by pharmacists' permissive attitude to the norms. This permissive attitude was generated by the profit motive and reinforced by mothers' expectations. The study conclude that more operators can be made to prescribe ORT by instituting incentives for those who prescribe and overt sanctions for those who do not.

Developing Countries↗

Pharmacist provided education and counseling for managing pediatric asthma.

A program to promote and assess the provision of family directed counseling by pharmacists on the understanding of pediatric asthma is discussed. The program consisted of two questionnaires separated by an educational intervention program. The initial questionnaire was developed to evaluate participants' understanding of asthma and its management. The aim of the intervention program was to improve this understanding through counseling, demonstration, and sharing of families' experiences with asthma. The second questionnaire assessed post-intervention knowledge including short-term retention of information. Before the intervention, few participants (14%) indicated that they were counseled by a pharmacist about the safe and effective use of asthma medications. Seventy-nine percent indicated that more information would aid them in better understanding asthma and possibly better controlling their child's illness. After the intervention, participants were able to correctly answer questions about asthma and medications used to manage the disease 78% of the time. This program offers one method for pharmacists to become involved in patient care through the provision of education and counseling. It also provides an avenue to encourage patients and their families to gain a deeper understanding of asthma and its management.

Adolescent↗

Statewide impact of pharmacist-delivered adult influenza vaccinations.

BACKGROUND: Oregon law has allowed pharmacists to provide adult immunizations since 2000. Every vaccination delivered must be reported to the state health department. Previous reports indicate that pharmacists vaccinate individuals unlikely to receive vaccinations elsewhere. METHODS: Administration reports were analyzed in 2005 for the first three influenza seasons (2000 to 2003). The number of pharmacies participating, type and quantity of vaccinations, and county where provided were analyzed. RESULTS: A total of 13,116 adult patients received influenza vaccinations during 2000-2001 at 56 pharmacies. The number of pharmacies participating increased to 88 and 132, and vaccinations provided to 25,785 and 30,218 in the next two seasons, respectively. The mean number of vaccinations per pharmacy was 250 (standard deviation 236) for the 3-year period. Rural counties accounted for 28.4% of influenza vaccinations. CONCLUSIONS: Pharmacists provided a substantial number of influenza vaccinations during this 3-year period. More than one quarter of the vaccinations were provided in rural counties.

Adult↗

[Characteristics of clinical trials in oncology: pharmacist's implication].

French hospital pharmacists have been officially involved in the organization of clinical trials since 1988. New responsibilities included reception of clinical treatment units and nominative dispensation of these drugs. For quality assurance, they organized all the procedures to secure drugs utilization according to good clinical practices and ICH guidelines. The pharmacists can be participate in ethical counselling and training in methodology. For oncology trials, only a few pharmacies are involved because clinical trials for evaluation of cytotoxic drugs have been regulated by very strict standardized procedures since 1960 in accordance with international rules. Using these rules, Phase I studies determine the useful dose for human administration with tolerable toxicities. Phase II studies determine the efficacy in specific cancer localizations. Good response in a particular indication is usually followed by drug approval for Phase III. New clinical and biological end points are arising especially for new non-cytotoxic therapeutic agents. This activity is at the present time limited to inpatient treatments, but with the growing development of outpatient care networks, dispensary pharmacists will come to be more involved in the necessary research and development of new anticancer agents.

Antineoplastic Agents↗

Why aren't more pharmacists counseling?

Clearly, the answers to the question "Why aren't more pharmacists counseling patients?" are complex. Factors affecting counseling vary by practice site, geographical region, and pharmacists' attitudes. Advocates of patient counseling may label many factors mentioned by workshop participants as "just excuses not to change" or may question their validity. However, our experiences have shown that these are real problems with logical explanations and relatively simple solutions. By focusing this column on the steps for overcoming these common barriers to counseling, we hope to help pharmacists expand their role in patient care.

Communication Barriers↗

Pharmacist involvement in needle exchange programs.

The use of injecting drugs with contaminated syringes and needles is a major factor in the spread of acquired immunodeficiency syndrome (AIDS). The Centers for Disease Control and Prevention has recommended that clean syringes and needles be made more easily available. This study surveyed 102 executives of state pharmacy boards and state pharmacist associations to determine their stands on repealing laws that preclude easy access to syringes and needles and on encouraging pharmacist participation in needle exchange programs. The 63 respondents to the survey moderately supported repeal measures, but they were somewhat less supportive of encouraging pharmacists to participate in needle exchange programs.

Attitude of Health Personnel↗

Monitoring diabetes mellitus: the pharmacist's role.

The pharmacist is in a unique position to monitor and counsel the patient with diabetes mellitus. Providing these services requires familiarity with both the disease and its contemporary management. Pharmacists can provide the necessary counseling and guidance regarding the myriad products and devices available to the patient and can serve as a resource to the physician and other health care professionals. Pharmacists with a special interest in diabetes are encouraged to develop services that are compatible with their practice resources. This shared-care approach to treatment will help contribute to the goal of a normal lifestyle for the person with diabetes mellitus.

Blood Glucose Self-Monitoring↗

Sequential antimicrobial therapy: comparison of the views of microbiologists and pharmacists.

Sequential antimicrobial therapy (SAT) is arousing keen interest in microbiologists and pharmacists. In an attempt to obtain information from these groups regarding the use of SAT in hospitals, an anonymized postal survey was carried out. A SAT questionnaire was circulated to consultant medical microbiologists, clinical microbiologists, and heads of pharmacy departments within the British Isles. Four hundred and forty-seven microbiologists and pharmacists returned completed questionnaires, giving a response rate of 29%. Just over half of medical microbiologists (MM) and pharmacists (PH) indicated that SAT was used in their institution in respiratory medicine, geriatrics, surgery and, significantly, to a lesser degree in paediatrics. The most common infections treated were pneumonia, bronchitis and wound infection. However, there were significant differences between MM and PH, with MM favouring greater use of SAT in peritonitis (P=0.03), septicaemia (P<0.01), bone infection (P<0.01), pyelonephritis (UTI) (P<0.01), and PH favouring use in bronchitis (P<0.01). The ability to take oral fluids or a recognition of no potential absorption problems were key criteria in the decision process leading to the institution of SAT by MM and PH. Significantly more MM favoured employing criteria such as temperature <38 degrees C (P<0.01), no requirement for high tissue concentrations (P=0.02) and evidence of response to i.v. antimicrobial therapy (P<0.01) than PH. The most frequently "switched" antimicrobials were metronidazole, ciprofloxacin and co-amoxiclav. There were more than five times as many MM reporting the use of clindamycin than PH (P<0.01), whereas nearly twice as many PH cited use of cefuroxime (P<0.01). Of those hospitals not employing SAT, most MM and PH concurred that the commonest reason to institute SAT was financial, followed by convenience to patients and staff. However, more PH than MM indicated that protocols (P<0.01) and a reduction in i.v. complications (P<0.01) were important to them. In promoting SAT, MM and PH felt they had the major role. Significantly, each profession felt that the other had a lesser role to play; MM as judged by the PH (P<0.01) and PH as judged by MM (P<0.01). When promoting SAT, both MM and PH felt that "education for clinicians" followed by regular audit was the best way to ensure implementation. However, significant differences arose with PH regarding nurse education (P<0.01), SAT posters (P=0.02), regular review of patients (P=0.04) and patient's notes SAT stickers (P<0.01) as more important to them than MM. Significantly, less MM than PH (P<0.01) insisted that either the i.v. and PO antimicrobials were identical or were from the same group or class when "switching". This survey highlights interesting comparisons between the approaches of MM and PH towards SAT and may indicate ways in which both groups may work together to bring about change.

Administration, Oral↗

Dispensing doctors and prescribing pharmacists: a South African perspective.

Adopting an historical and international perspective, this article explores and analyses the relationship and controversy between pharmacists and dispensing doctors in South Africa. In order to gain a better insight into this troublesome relationship, a combination of qualitative and quantitative methods has been employed. The findings reveal a deep ongoing sense of competition, which is manifest in the form of public debate and continuous attempts to protect professional task domains. Most of the pharmacists interviewed in this study mentioned the "dispensing doctor" as the main problem facing the community pharmacist in South Africa. Meanwhile, the medical profession, as a united front, is fiercely protecting its "inherent" right to dispense medicines. Using the South African scenario, issues such as occupational task boundaries, "business" versus "professional" systems as well as the role of the state are discussed in relation to professional dominance, jurisdiction and autonomy.

Attitude of Health Personnel↗

Using attitudes and subjective norms to predict pharmacist counselling behaviors.

This field study examines the applicability of the central components of Fishbein and Ajzen's model for the prediction of behavior to the medication counselling activities of community pharmacists. The findings from a sample of 40 pharmacists provide support for the attitudes-subjective norms model. Both the attitude and subjective norm measures are significant predictors of behavior for verbal instruction provided and the length of encounter time. Each of the other behaviors examined--written instruction provided, monitoring activity, and pharmacist approachability--is weakly to moderately influenced by one of the two independent variables.

Attitude of Health Personnel↗

Opioids for managing patients with chronic pain: community pharmacists' perspectives and concerns.

Previous studies of pharmacists have suggested poor availability of opioids and apprehension about dispensing these drugs. This pilot study surveyed 52 randomly selected New Jersey community pharmacists (response rate = 69%). Reluctance to stock opioids was attributed to concerns about robbery by 14% and to concerns about federal or state investigation by 17%. No correlation was found between respondents who had a high degree of concern about robbery and those who had incurred previous robbery. Of the 20% of respondents who had incurred a prior federal or state investigation, none expressed more than minimal concern about opioid regulatory issues. Pharmacist confidence in the acceptability of opioids for chronic pain was 75% for malignant pain in patients with no history of opioid abuse and declined to 3% for nonmalignant pain in patients with a history of opioid abuse.

Adult↗

Effects of coaching by community pharmacists on psychological symptoms of antidepressant users; a randomised controlled trial.

BACKGROUND: Community pharmacists strive to deliver pharmaceutical care to patients. At the moment, coaching of depressive primary care patients on taking their antidepressants (ADs) is not yet part of their standard care package. AIMS: To investigate the effects of coaching by community pharmacists on psychological symptoms. METHOD: A randomised controlled trial with a 6-month follow-up. OUTCOMES: psychological symptoms with the Hopkins Symptom Checklist (SCL). Intention-to-treat (ITT) was performed with (1) last observation carried forward and (2) with group mean imputation (GMI). RESULTS: Analyses with LOCF and GMI resulted in different findings. The LOCF method revealed that at the 6-month follow-up, the intervention patients were less depressed and less anxious than the controls. The intervention was particularly effective in patients with lower levels of education who received pharmacist's coaching. However, ITT with the GMI method showed no differences in psychological symptoms. Differences between LOCF and GMI were explained by the selective attrition in the intervention arm (attrition intervention patients had lower initial SCL-item scores on depression and anxiety than the completers) and by the higher attrition rate in controls. CONCLUSIONS: Our study indicates that the interpretation of the effects of an intervention on psychological symptoms can differ substantially by the way missing values are imputed. If both LOCF and GMI produce significant differences, efficacy can be concluded. If not, the effects based on ITT analyses with LOCF are based on artefacts. We recommend that positive intervention effects should only be reported when findings with LOCF and GMI are in accordance.

Adult↗

What is the role of the pharmacist in home care?

Pharmacists provide a wide range of medications, along with health and convalescent aids, for patients at home. Traditionally community pharmacists have been viewed as providers of prescription and nonprescription medications administered orally. Today pharmacists in community and hospital pharmacies across the country have expanded their services for the homebound patient and provide a variety of sophisticated products and services in the patient's home.

Community Pharmacy Services↗

Role of the pharmacist in childhood immunizations.

OBJECTIVE: Fewer than half of the 2-year-old children in the United States are fully immunized. This article reviews the literature on barriers to immunization in children and examines how pharmacists can promote childhood immunizations by acting as an educational resource and providing increased access to vaccines. DATA SOURCES: Published data were collected from the literature. Anecdotal data were collected from unstructured interviews with parents and health care professionals at two childhood immunization clinics in Des Moines, Iowa. DATA SYNTHESIS: Data from the literature were compared with data informally collected in the clinics. Both the literature and interviews indicated a variety of structural and personal barriers that may prevent parents from having children vaccinated. CONCLUSION: By collecting and documenting adequate vaccination histories, pharmacists can be a resource for parents and health care professionals who are unsure of a child's immunization status. Pharmacists may wish to establish immunization clinics in their pharmacies as a method to increase access to vaccines.

Adolescent↗