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PubMedDate not supplied

Charting the demand for pharmacists in the managed care era.

OBJECTIVE: To discuss the future demand for pharmacists and pharmaceutical services in the managed care area. DATA SOURCES: Published reports about the future demand for health professionals and data relating to managed care and the institutional pharmacy work force. DATA SYNTHESIS: A panel from the Pharmacy Manpower Project's Subcommittee to Study Demand Issues examined a broad range of pharmacy-related work-force projections and found widely differing predictions. The panel reviewed recent health care trends related to managed care and data about staff size and changing job numbers in institutional pharmacies to determine which of the predictions were most likely. Medication management problems in the context of increasing prescription numbers and the emergence of data-driven health care support a scenario of a steadily increasing demand for pharmacists and pharmaceutical services. Higher penetration by managed care was not associated with job loss or reduced pharmacy staff size in institutions. CONCLUSION: There is little reason to expect the dramatic downsizing of the pharmacy work force predicted by the third report of the Pew Commission. However, retaining pharmacy roles that are useful to the system and satisfying to pharmacists will require a continuation of current proactive measures by the profession.

Data Collection↗

PubMedDate not supplied

Quality-of-life assessment in acute, chronic, and cancer pain: a pharmacist's guide.

OBJECTIVE: To describe instrumentation, or measures, available for use in assessing the impact of pain on the quality of life (QOL) of patients, and methods to evaluate the appropriateness of these QOL measures. DATA SOURCES: MEDLINE, PSYCHLit, and CANCERLit were searched from 1980 through 1997 to identify QOL instruments that included a pain subscale or pain-related items. DATA SYNTHESIS: Given the high prevalence of chronic diseases or conditions that include pain as a primary or secondary symptom, pharmacists should understand how pain affects the QOL of patients. Over the past two decades, emphasis has increased on developing instruments that assess health-related QOL concerns, including pain. Scores of measures--including utility measures--are available to measure general QOL in patients with conditions involving pain. Condition-specific instruments have also been developed to measure the impact of specific conditions, such as arthritis, on QOL. Guidelines are presented for evaluating QOL instrumentation, and existing measures used to evaluate the QOL of patients with acute and chronic pain are described. Pharmacists can use these guidelines to evaluate the usefulness of existing instruments for assessing the QOL of patients with pain. CONCLUSION: Using QOL measures in everyday practice may assist pharmacists in gaining insight into the effects of pain on their patients' QOL. This information may be useful in developing treatment programs that minimize pain and its associated side effects while maximizing patients' well-being.

Acute Disease↗

PubMedDate not supplied

[Drug-related clinical research--a practical opportunity for the hospital pharmacist].

OBJECTIVE: To describe a pharmacist s field of activity in drug-related clinical trials. METHOD: A non-systematic assessment of available scientific literature in international databases queried during the period of May 05 to 31, 2005. RESULTS: In all, 36 papers were obtained regarding the role of hospital pharmacists in the development of drug-related clinical trials. Most common activities included dispensation, storage, and inventory. Participation in ethics committees and study coordination represent an expanding area. CONCLUSIONS: Drug-related clinical research is an excellent practical setting for the hospital pharmacist. Activities related to investigational drug control, including dispensation, randomization scheme management, and patient follow-up, are an example. This is a novel though rapidly expanding scenario in Brazil.

Biomedical Research↗

PubMed2000

Development of a method for clinical medication review by a pharmacist in general practice.

Medication review of patients on long-term treatment in general practice in the UK has been reported to be inadequate. Proposals followed suggesting that pharmacists could use their expertise to lead such a medication review in conjunction with the general practitioner. This paper describes the concept of clinical medication review by a pharmacist based in general practice. We describe the development of a method for a structured and systematic process for undertaking such a review in clinics conducted by a pharmacist. The method was developed for a nationally funded study in the UK. We provide a definition of clinical medication review and suggests a structure for the process through data gathering, evaluation and implementation.

Communication↗

PubMed2001

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes.

INTRODUCTION: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study. METHOD: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out. RESULTS: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of short-acting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening. CONCLUSION: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.

Aged↗

PubMed1999

When should pharmacists visit their wards? An application of simulation to planning hospital pharmacy services.

This paper reports a pilot study of the use of simulation in planning hospital pharmacy services. The objectives were to create a simulation model of the hospital drug distribution system, to use the model to investigate a simple problem and to assess the potential for simulation to aid decision making in hospital pharmacy management. The problem chosen for investigation focused on the UK ward pharmacy system, where a pharmacist visits each ward daily to initiate the supply of newly prescribed non-stock medication. A simulation model was used to investigate how changing the time of the ward pharmacist's visit could affect the mean time delay between the prescription of a non-stock drug and the arrival of that drug on the ward. The simulation results suggest that the time of day at which pharmacists visit their wards can have a major impact on delay times, and that the relative benefit of different visit times is likely to vary between wards. Simulation was found to be a useful approach to investigating different service alternatives without the expense and disruption of assessing each in practice.

Computer Simulation↗

PubMed2002

Reliability, validity and ease of use of a portable point-of-care coagulation device in a pharmacist-managed anticoagulation clinic.

UNLABELLED: In a pharmacist-managed anticoagulation clinic, portable point-of-care coagulation devices may facilitate patient monitoring by providing rapid INR measurement. Few studies, however, have validated this type of device. OBJECTIVE: To evaluate the reliability, validity and ease of use of the CoaguChek S, a new portable coagulation device. METHODS: A total of 100 patients followed at a pharmacist-managed anticoagulation clinic attended two study visits. INRs were measured using the CoaguChek S and the standard laboratory technique. RESULTS: Reliability: The test-retest reliability (precision) of the CoaguChek S, estimated by the intraclass correlation coefficient (ICC) and a 95% confidence interval (95% CI), was high (0.98 (0.98-0.99)) and comparable to the standard laboratory technique (0.99 (0.98-0.99)). Interrater reliability was also high (0.97 (0.95-0.98)). Reliability coefficients did not vary with the test-strip lot number nor the CoaguChek S operator. VALIDITY: When compared with standard laboratory procedure, the ICC (95% CI) was equal to 0.93 (0.91-0.95). The mean difference (95% CI) between INR measured by the laboratory and the CoaguChek S was equal to -0.02 units (-0.06-0.03). The mean absolute and relative absolute differences (95% CI) were equal to 0.24 units (0.21-0.27) and 9% (8%-10%), respectively. Differences tended to increase for INRs greater than 3 units as seen by a mean difference (95% CI) of -0.17 units (-0.35-0.02). This represented a mean absolute difference (95% CI) of 0.44 units (0.33-0.55) and a mean relative absolute difference of 12% (9%-15%). Concordance between therapeutic decisions based on CoaguChek S and laboratory results was high (Kappa = 0.68). In 34 cases (18%), the therapeutic decision would have been different. However, in 15 of these discordant observations, the difference between the CoaguCheck S and laboratory INR was <or=0.25 units. Ease of use: In 3% of cases, no INR could be measured by the CoaguChek S. The percentage of extra finger pricks and extra test-strips were equal to 25.8% and 23.7%, respectively. CONCLUSIONS: When used by health professionals in a pharmacist-managed anticoagulation clinic, the CoaguChek S is reliable, valid and easy to use. However, its validity tends to decrease as the INR increases, possibly due to the low sensitivity of the thromboplastin. If the CoaguChek S INR is supratherapeutic, we would therefore recommend confirming the results with a standard laboratory measurement.

Adult↗

PubMed2000

Opium in 20th-century Britain: pharmacists, regulation and the people.

AIMS: To indicate how the system of pharmaceutical regulation of the sale and use of opium in Great Britain continued throughout the first half of the 20th century. DESIGN: An oral history investigation of community pharmacy in Great Britain (n = 50), together with an analysis of standard pharmaceutical texts. SETTING: Community pharmacies in Great Britain during the 20th century. PARTICIPANTS: Retired community pharmacists with experience of the sale and use of opium during the period. MEASUREMENTS: Oral testimony of retired community pharmacists about the use and sale of opium, and quantitative analysis of numbers of official preparations of opium available during the period. FINDINGS: The popular use of opium continued well after the First World War, and its use as an ingredient of prescribed medicines continued well beyond the introduction of the National Health Service in 1948. CONCLUSIONS: Although the role of pharmacy in the regulation of opiates and other drugs was displaced by medicine following the passage of dangerous drugs legislation in the 1920s, pharmacists continued to play an important part in this regulation, exercising considerable discretion in the process.

Drug and Narcotic Control↗

PubMed2004

Impact of pharmacist-conducted home visits on the outcomes of lipid-lowering drug therapy.

OBJECTIVE: To evaluate a pharmacist-conducted educational and monitoring programme, designed to promote dietary and lifestyle modification and compliance with lipid-lowering drug therapy, for patients with dyslipidaemia. METHODS: This was a prospective, randomized, controlled study. The participants were 94 adults, with 81 completing the study (intervention group: 39; control group: 42), with a cardiovascular-related diagnosis and discharged from hospital, between April and October 2001, on lipid-lowering drug therapy. Patients in the intervention group were visited at home monthly by a pharmacist, who educated the patients on the goals of lipid-lowering treatment and the importance of lifestyle issues in dyslipidaemia and compliance with therapy, assessed patients for drug-related problems, and measured total blood cholesterol levels using point-of-care testing. Patients in the control group received standard medical care. The main outcome measure was total blood cholesterol levels after 6 months, and an evaluation of patient and general practitioner satisfaction with the programme. RESULTS: There was no significant difference in baseline total blood cholesterol levels between the two groups. The reduction over the course of the study in cholesterol levels within the intervention group was statistically significant (4.9 +/- 0.7 to 4.4 +/- 0.6, P<0.005), whereas there was no change within the control group (P=0.26). At follow-up, 44% of the intervention group patients and 24% of the control group patients had cholesterol levels below 4.0 mmol/L (P=0.06). The reduction in total cholesterol in the intervention group should translate to an expected 21% reduction in cardiovascular mortality risk and a 16% reduction in total mortality risk--more than twice the risk reduction achieved in the control group. In addition, the programme was very well received by the patients and their general practitioners, by satisfaction questionnaire. CONCLUSION: A pharmacist-conducted educational and monitoring intervention improved the outcomes of lipid-lowering drug therapy.

Aged↗

PubMed2003

Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study.

BACKGROUND: Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure. Several studies have aimed to reduce rehospitalizations in heart failure patients through a comprehensive, multidisciplinary approach. Medication compliance was rarely measured in these studies or, when it was measured, the method employed was seldom valid. We aimed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure. METHODS: We conducted a randomized controlled trial into the effect of a pharmacist-led intervention on medication compliance in patients with heart failure (predominantly New York Heart Association [NYHA] II and III) treated with loop diuretics, presenting to a cardiology outpatient clinic or admitted to hospitals in The Netherlands. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period. Patients in the control group received usual care. Primary endpoint was medication compliance, assessed with a medication event monitoring system, an electronic pill bottle that registers time of opening. Secondary endpoints were the number of rehospitalizations, death, and quality of life. RESULTS: A total of 152 patients were randomized: 74 patients to the intervention arm and 78 patients to the usual care arm. Over the 6-month study period, patients in the intervention group had 140/7656 days without use of loop diuretics compared with 337/6196 days in the usual care group (relative risk 0.33 [confidence interval (CI) 95% 0.24-0.38]). Two consecutive days of nondosing occurred on 18/7656 days in the intervention group compared with 46/6196 days in the usual care group (relative risk 0.32 [CI 95% 0.19-0.55]). There were no significant differences in rehospitalizations, mortality, or disease-specific quality of life between groups. CONCLUSIONS: A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure, even in those with relatively high compliance. Future interventions should also focus at less compliant patients.

Aged↗

PubMed2001

The ability of the community pharmacist to learn the proper actuation techniques of inhaler devices.

Today, greater responsibility is placed on community pharmacists for the education of patients than ever before. Thus community pharmacists were recruited for this study and asked to demonstrate the proper steps in the actuation sequences of 3 inhaler devices. Baseline measurements were followed by an instructional session on the proper actuation technique, and then a posttest was conducted 4 to 6 weeks later. The mean changes between baseline and postinstruction percentage scores for the metered-dose inhaler device, the Turbuhaler, and the Diskus were (mean +/- SD) 17.1% +/- 15.4%, 22.6% +/- 18.7%, and 38.4% +/- 19.6%, respectively. This study demonstrates that a single instructional session can dramatically improve a community pharmacist's ability to demonstrate the correct method of actuation.

Community Pharmacy Services↗

PubMed1995

Role of the pharmacist in improving asthma care. National Asthma Education and Prevention Program.

Our current understanding of the pathophysiology of asthma and the availability of potent, effective therapies mean that asthma can be well controlled. However, to achieve this goal, optimal therapy must be prescribed, and the patient must be taught how and when to use it. Pharmacists, as part of the health care team, can help improve the pharmacologic management of asthma by teaching patients about their medications, how to use them, and the importance of using them as prescribed. Pharmacists' alerting physicians to suspected problems, such as underusing anti-inflammatory therapy or overusing inhaled bronchodilators, will provide an opportunity for the physician to consider changes in a patient's management plan when appropriate. Acting in these educational and information-sharing roles, pharmacists can contribute to improving the control of asthma and enabling patients to live full, active, and productive lives.

Administration, Inhalation↗

PubMed1996

Quality-assurance testing of staff pharmacists handling cytotoxic agents.

Competency-based simulation testing was used to improve staff pharmacists' handling of cytotoxic agents. Pharmacists were asked to prepare a simulated liquid cytotoxic agent (fluorescein sodium 0.5 mg/ml.) according to the pharmacy service standard operating procedures. Participants were observed throughout the preparation to assess proper safety and aseptic technique, waste disposal, and labeling. Ultraviolet light was used to assess surface contamination. After the test, errors were discussed with each participant. All participants then received scheduled annual training on preparation of cytotoxic agents, and they took the simulation test again three months later. Thirteen staff members completed all testing. Simulation test scores improved from 61% to 84%. Evidence of surface contamination was found for 92% of these pharmacists during the pretest and only 23% during the posttest. Written test scores improved, but not significantly, from 85% to 89%. Each simulation and feedback session took 30 minutes. Simulation testing significantly improved competence in preparation of cytotoxic agents.

Antineoplastic Agents↗

PubMed1998

Effect of pharmacist interventions on medication use and cost in hospitalized patients with or without HIV infection.

Pharmacotherapeutic interventions and drug acquisition costs in HIV-positive and HIV-negative patients on a hospital medical service were studied. In November and December 1995, HIV-positive and HIV-negative patients were randomly selected and matched on the basis of admission date. Pharmacotherapeutic interventions were recorded by a pharmacist until the time of discharge. Drug acquisition costs were obtained through records of medications ordered. The two patient groups were compared with respect to length of stay (LOS), number and cost of medications, and number of interventions. HIV-positive patients had significantly more medication orders and required more interventions than HIV-negative patients. Mean LOS was not significantly different. HIV status and number of medications were significantly associated with requiring five or more interventions. Drug acquisition costs were significantly higher in the HIV-positive group. The mean pharmacist-attributed cost saving per patient was $134 for HIV-positive patients and $27 for HIV-negative patients. HIV-positive patients required more interventions and consumed more medication resources than HIV-negative patients. Pharmacist interventions produced drug acquisition cost savings for both groups, with more savings being realized for positive patients.

Adult↗

PubMed2000

Economics of using pharmacists as advisers to physicians in risk-sharing contracts.

An educational program designed to help physicians control the overall cost of drugs and total health care is described, along with its effectiveness at one managed health care plan. Prime Therapeutics, Inc., developed and manages an ongoing physician education program designed to help primary care physicians control drug and total health care costs. Physician education initiatives in the program are developed by using peer-reviewed literature; selections of preferred drugs are based on evidence of their safety, efficacy, uniqueness, and cost-effectiveness. For a typical educational initiative, a pharmacist meets with the physicians identified as being among the top 20% of prescribers of high-cost drugs addressed by the initiative and delivers a 20-minute presentation. One-on-one meetings with the physicians are then held quarterly to review their prescribing. Each physician is shown comparisons with the prescribing patterns of other physicians in the organization. The clinic chooses to present the clinicwide data as either blinded or nonblinded data. The program was evaluated by comparing per member per month (PMPM) total health care and drug costs for 1996 and 1997 at 12 general medicine clinics in a managed health care plan. Five clinics received no interventions, three clinics allowed the initial presentation and the quarterly face-to-face meetings, and four clinics allowed only the presentation and barred ongoing meetings. In general, the clinics with more interaction between pharmacists and physicians had lower PMPM costs for total health care and drugs than the clinics with less interaction. Pharmacists acting as advisers to primary care physicians in general medicine clinics helped lower PMPM costs for drugs and total health care.

Health Care Costs↗

PubMed2001

Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model.

The implementation and pharmacoeconomic analysis of a clinical staff pharmacist (CSP) practice model are described. Staff pharmacists at a large, tertiary care, academic medical center were selected and trained to perform clinical pharmacy services under the direction of clinical pharmacy specialist mentors. Clinical interventions by these CSP practitioners were evaluated in terms of direct cost savings (the difference in actual acquisition costs between therapies) and cost avoidance (the dollar value of adverse drug events [ADEs] avoided). The CSPs performed a total of 4959 interventions during a 12-month period. The interventions provided direct cost savings of $92,076 and an estimated cost avoidance of $488,436. Comparing cost savings and cost avoidance with the expenses of providing these services indicated a net economic benefit of $392,660. A new model of pharmacy practice that integrates staff pharmacists into existing clinical practice has the potential to minimize the risks, decrease the costs, and improve the outcomes associated with drug therapy.

Cost Savings↗

PubMed2004

Pharmacist-managed service providing penicillin allergy skin tests.

PURPOSE: A penicillin allergy skin-testing service run by pharmacists is described. SUMMARY: A board-certified allergist trained pharmacists at a tertiary care teaching hospital to administer penicillin allergy skin tests and interpret the results. A major objective of the service was to avoid unnecessary use of vancomycin and quinolones in patients claiming but not actually having a penicillin allergy. Patients with a severe type I reaction to penicillin during the preceding five years, patients with a confirmed history of a type II-IV reaction to penicillin, and severely immunosuppressed patients were not eligible for testing. As of July 2003, 26 patients had been enrolled in the service. A type I penicillin reaction was ruled out by the drug allergy history for 3 patients. The results were negative in 22 of the 23 patients who received skin testing, and in 1 the result was indeterminate. A penicillin or a beta-lactam antibiotic was administered to all 26 patients. No patient had a significant adverse reaction to skin testing or drug administration. CONCLUSION: A pharmacist-managed penicillin allergy skin-testing service was well received by physicians and showed potential to avoid unnecessary use of alternative antibiotics.

Academic Medical Centers↗

PubMed2004

Randomized trial of pharmacist interventions to improve depression care and outcomes in primary care.

PURPOSE: The impact of pharmacist interventions on the care and outcomes of patients with depression in a primary care setting was evaluated. METHODS: Patients diagnosed with a new episode of depression and started on anti-depressant medications were randomized to enhanced care (EC) or usual care (UC) for one year. EC consisted of a pharmacist collaborating with primary care providers to facilitate patient education, the initiation and adjustment of antidepressant dosages, the monitoring of patient adherence to the regimen, the management of adverse reactions, and the prevention of relapse. The patients in the UC group served as controls. Outcomes were measured by the Hopkins Symptom Checklist, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression, health-related quality of life, medication adherence, patient satisfaction, and use of depression-related health care services. An intent-to-treat analysis was used. RESULTS: Seventy-four patients were randomized to EC or UC. At baseline, the EC group included more patients diagnosed with major depression than did the UC group (p = 0.04). All analyses were adjusted for this difference. In both groups, mean scores significantly improved from baseline for symptoms of depression and quality of life at three months and were maintained for one year. There were no statistically significant differences between treatment groups in depression symptoms, quality of life, medication adherence, provider visits, or patient satisfaction. CONCLUSION: Frequent telephone contacts and interventions by pharmacists and UC in a primary care setting resulted in similar rates of adherence to antidepressant regimens and improvements in the outcomes of depression at one year.

Adult↗