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PubMed2005

The economic burden of lung cancer and the associated costs of treatment failure in the United States.

The economic burden of lung cancer was examined with a retrospective case-control cohort study on a database containing inpatient, outpatient and drug claims for employees, dependents and retirees of multiple large US employers with wide geographic distribution. Patients were followed for maximum of 2 years from first cancer diagnosis until death, health benefits dis-enrollment or study end (31 December 2000). Compared with controls (subjects without any cancer), patients with lung cancer (n = 2040) had greater health care service utilization and costs for hospitalization, emergency room visits, outpatient office visits, radiology procedures, laboratory procedures and pharmacy-dispensed drugs (all P < 0.05). Regression-adjusted mean monthly total costs were US dollar 6520 for patients versus US dollar 339 for controls (P < 0.0001), and overall costs across the study period (from diagnosis to death or maximum of 2 years) were US dollar 45,897 for patients and US dollar 2907 for controls (P < 0.0001). The main cost drivers were hospitalization (49.0% of costs) and outpatient office visits (35.2% of costs). Monthly initial treatment phase costs (US dollar 11,496 per patient) were higher than costs during the secondary treatment phase (US dollar 3733) or terminal care phase (US dollar 9399). Failure of initial treatment was associated with markedly increased costs. Compared with patients requiring only initial treatment, patients experiencing treatment failure accrued an additional US dollar 10,370 per month in initial treatment phase costs and US dollar 8779 more per month after starting the secondary and/or terminal care phase. Over the course of the study period, these patients had total costs of US dollar 120,650, compared with US dollar 45,953 for those receiving initial treatment only. Thus, the incremental costs associated with treatment failure were US dollar 19,149 per month and US dollar 74,697 across the study period. Other types of clinical and epidemiological analysis are needed to identify risks for treatment failure. The economic burden of lung cancer on the US health care system is significant and increased prevention, new therapies or adjuvant chemotherapy may reduce both resource use and healthcare costs. New strategies for lung cancer that reduce hospitalizations and/or prevent or delay treatment failure could offset some of the economic burden associated with the disease.

Adolescent↗

PubMed2004

Variation in the distribution of patient-reported outcomes based on different definitions of defining asthma severity.

OBJECTIVES: The purpose of this study was to observe the variation in the distribution of health-related quality of life and work performance scale scores based on using different methods of determining asthma severity. METHODOLOGY: Five methods of determining asthma severity were used, including three patient-derived measures (patient perceived severity or PPS; overall symptom-derived severity or OSS; and nocturnal symptom-severity or NSS); and 2 methods using retrospective pharmacy claims (reliever/oral steroid use or ROSU and multi-drug use or MDU). Three levels of severity were examined: mild, moderate, and severe, requiring condensing some severity categories of several methods. Data were obtained from a cross-sectional mail survey of 603 adults with asthma in a US managed care organization linked to pharmaceutical/medical claims data. Patient-reported outcomes included the Physical Component Summary Score (PCS) and the Mental Component Summary Score (MCS) of the SF-36, the summary score (AQLQ) of the Asthma Quality of Life Questionnaire, and the Work Performance Scale score (WPS) of the perceived work performance scale of the Functional Status Questionnaire. Analysis of variance (ANOVA) was used to examine each method's ability to distinguish between severity levels. Descriptive statistics were used to observe differences in scale scores between methods. RESULTS: Within each method, significant severity effects (except MDU) were found for PCS, AQLQ, and WPS. In post-hoc analyses, mild-moderate and mild-severe comparisons were consistently significant (p < 0.05). In the cross-method analyses, method effects were found at all levels of severity for most scale scores with ranges increasing with increases in severity level. Within-method results were consistent with previous studies demonstrating a significant relationship between severity, health-related quality of life (HRQL) and work performance (WP). However, HRQL and WP scale scores varied by the method used to define severity. CONCLUSION: This variation should be considered when performing cross-study comparisons of burden of illness and treatment effects.

Adult↗

PubMed2006

Construction of a safety management system for drug use by using an RFID tag.

We constructed a safety management system for narcotic drug use by using an RFID tag with barcode. In this system, RFID tags are mainly used for postscript of information, while barcodes, especially standardized unit drug codes for distribution, are used for drug identification. The outline of the system is described in the present paper.

Electronic Data Processing↗

PubMedDate not supplied

[Pharmacokinetics of antibiotics in burn patients].

The pathophysiology associated with major burns is complex and subject to a state of flux (coexistence of pain, infectious diseases, multiple trauma, disturbances of metabolism and acid-base status, etc) which could affect the disposition and the pharmacokinetic behaviour of drugs. In current clinical practice, practitioners often use powerful antimicrobial agents; however, few pharmacokinetic studies are available in burns patients (of the order of 30 studies). Furthermore, the methods used are sometimes questionable. After dealing with the ethical and physiological context in which such research is undertaken, the authors report a review of the pharmacokinetic studies done during the last 15 years. Concerning both aminoglycosides and glycopeptides, no therapeutic recommendations are available (therapeutic schedules). However, in this case, therapeutic monitoring is available and represents a suitable tool to better master their use. In the case of beta-lactam antibiotics and quinolones, more data are available. Some investigations have shown the possibility of translesional diffusion of certain agents in burns (such as gentamicin, piperacillin/tazobactam combination, or fosfomycin). This phenomenon could be a co-factor of success in treatment. Considering the relatively meager pharmacokinetic and pharmacodynamic data available in burns, it is important in the future to refine our knowledge of the distribution and metabolism of drugs in burns patients in order to better master their use. Finally, ethical and methodological considerations need to be taken in account.

Aminoglycosides↗

PubMed1991

Health Level 7: an application standard for electronic medical data exchange.

The development of the HL7 is proceeding along two lines. Much effort is being spent on solving the ambiguities of version 2.1 and in extending the standard to areas that are not yet well defined. For example, at a recent working group meeting new messages were defined for dealing with pharmacy records, specifically those relating to IVs. As the number of vendors implementing the standard and as the number of organizations using the standard increase, the standard will continue to be refined and expanded along current formats. As often as possible, these efforts will be "backwards compatible" and may be implemented by vendor choice as the need arises. These changes will be distributed as chapter updates to the current release. A parallel effort is underway that will add formality to the development of the standard. These efforts incorporate a number of case tools, including data modeling. The biggest advantage of this approach will be to reduce significantly the ambiguity in data element definitions. Completeness and correctness of data relations will be enhanced as well. New approaches to documentation, including an object-oriented specification of the data model, will increase understandability. There are still a number of domain-specific areas in which the standard needs to be defined and examples generated to show how the standard applies. Forms of data transfer other than text must be accommodated. HL7 again will take advantage of existing work in these areas, such as the work of American College of Radiology/National Equipment Manufacturers Association (ACR/NEMA) in standards relating to image transfer. HL7 will continue to move toward OSI-compatibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstracting and Indexing↗

PubMed1993

[The characteristics of medical supplies under current conditions].

The present situation requires that medical supply system could make it possible to assure an adequate ratio in distribution of the resources, using stable economic links between all the subjects on the basis of objective economic laws. As the world experience shows the best form for this matter is wholesale trade of medications and medical technique. Nevertheless, it is impossible to implement this form of supply without detailed and complex researches in the field of economics for military medicine and pharmacy, and reconstructing on this basis the system of training of commanding officers for military medical supply.

Equipment and Supplies↗

PubMed2002

Historical risks of tuberculin skin test conversion among non-physician staff at a large urban hospital.

BACKGROUND: Nosocomial transmission of Mycobacterium tuberculosis among workers at a 1000-bed inner-city hospital led to an extensive evaluation of this risk among workers with potential exposure to TB patients or laboratory specimens. METHODS: Retrospective cohort study to determine the incidence and risk of tuberculin skin test (TST) conversions among workers employed 1/1/90 to 9/30/92. RESULTS: Personal, community, and occupational risk factors were evaluated in 2,362 workers with potential M. tuberculosis exposure and 886 workers with no known exposure. The 33-month cumulative rate of TST conversion was 5.8% for potentially exposed workers and 2.0% for controls (RR 3.6; 95% CI; 2.2-5.8). Among workers with potential M. tuberculosis exposure, statistically significantly elevated risks were found for nurses, laboratory technicians, pharmacy workers, phlebotomists, housekeepers, clerks, emergency room workers, and emergency responders. CONCLUSIONS: Workers with patient contact and those employed in certain occupational groups were at increased risk for occupational M. tuberculosis infection.

Adolescent↗

PubMedDate not supplied

A survey of selected Internet pharmacies in the United States.

OBJECTIVE: To determine whether differences in the provision of pharmacy services exist among different types of Internet pharmacies. DESIGN: Survey of selected pharmacies with a presence on the Internet. Data were abstracted onto a data collection form for further analysis. Data collection was limited to 3 weeks. SETTING: U.S.-based Internet pharmacies that allow patients to purchase prescription medications online. Pharmacies were identified using a metasearch engine with the search terms "Internet pharmacy" and "Internet pharmacist." INTERVENTION: Survey. MAIN OUTCOME MEASURES: Comparisons of availability of 10 commonly used products representing a variety of product categories, prescription verification methods, and privacy issues; and determinations of site navigability, drug information and provider access, and payment methods. Sites were categorized as "chain pharmacy extensions," "mail order pharmacies," "independent pharmacy extensions," and "online pharmacies." RESULTS: Thirty-three sites were reviewed. There was significant variation among the four types of pharmacies selling prescriptions over the Internet. Most pharmacies provided all of the drugs in the survey. Patients were required to provide their own prescription at 88% of the sites, and 75% of sites used mail or fax to verify prescription integrity. More than 50% of sites had privacy policies posted, and 64% used cookies. Chain pharmacy extensions required completion of an average of 10.2 pages to order drugs versus 2.4 to 4 pages for all other site types. Drug information was written at an eighth-grade reading level at 36% of the sites. More than two-thirds of the sites provided a toll-free telephone for a health care professional. Nearly 80% of the sites accepted health insurance, and 95% accepted credit cards; however, only 40% used a secure transmission mechanism for patient or payment information. CONCLUSION: Internet pharmacies provide varying levels of service. Policies regarding the use of the Internet for obtaining medications should focus on improving the privacy of consumer information and ensuring the secure transmission of financial information.

Analysis of Variance↗

PubMed1995

Prime vendor purchasing of pharmaceuticals in the Veterans Affairs health care system.

The development of a prime vendor system of pharmaceutical procurement and distribution in the Department of Veterans Affairs (VA) is described. The traditional system of pharmaceutical procurement and distribution in the VA required large stockpiles of the pharmaceuticals that had been needed the previous year, a system that was inefficient and full of hidden markups and other unnecessary fees. In late 1991, the VA began a pilot test of a prime vendor system, in which three wholesalers were selected to provide pharmaceuticals to 33 VA medical centers. Under the new system, pharmacies placed orders electronically, directly with the prime vendor, and payments were taken from funds obligated in advance. The benefits of the new system included reduced costs, faster turnaround of orders, higher fill rates, and higher satisfaction among users. In 1994, the VA ceased operation of its traditional depot system for pharmaceuticals. The implementation of a prime vendor procurement system for pharmaceuticals within the VA improved system responsiveness, increased satisfaction of system users, and reduced expenses.

Drug Industry↗

PubMed1995

Comparison of medication errors in an American and a British hospital.

Medication errors in a hospital in the United States and a hospital in the United Kingdom were compared. The study was conducted in wards with a high oral-drug-related workload in two large university hospitals. The U.S. hospital was studied in August 1993 and the U.K. hospital in May and June 1993. The U.S. hospital had a typical unit dose drug distribution system, and the U.K. hospital had the ward-based system commonly used in that country, in which a pharmacist visits each ward several times daily and reviews each patient's medication chart. The medication chart is used by the physician to order drugs and obviates the need for transcription of orders. A disguised-observation technique was used to determine frequencies and types of medication errors. Medication errors were identified retrospectively in the U.S. hospital by comparing the observer's notes with the original drug orders made in the patient's chart by the physician. In the U.K. hospital, identification of errors took place concurrently; as doses were administered, they were compared with the orders on the medication chart. In the U.S. and U.K. hospitals, 919 and 2756 opportunities for error were observed, respectively. The medication error rate in the U.S. hospital was 6.9% (95% confidence interval [CI], 5.2% to 8.5%), significantly higher than the 3.0% rate observed in the U.K. hospital (95% CI, 2.4% to 3.7%) (95% CI for the difference, 2.1% to 5.7%). Omitted doses and incorrect doses were the most common types of errors in the U.K. hospital; incorrect doses and unordered doses were the most common types in the U.S. hospital. An American hospital with a unit dose distribution system had a significantly higher medication error rate than a British hospital with a ward-based supply system.

Hospitals, University↗

PubMed2000

How resource allocation decisions are made in the health care market.

This paper describes how economists view resource allocation decisions in health care markets. The basic economic decisions that must be made in any economic system and the resource allocation decisions in a perfectly competitive market are described. An idealized market can achieve an efficient allocation of resources and is contrasted with a more realistic description of the numerous ways in which health care markets depart from the perfectly competitive ideal. The implications of these departures for health care policy are discussed, along with key controversies concerning reliance upon markets for resource allocation in health care. In particular, the failure of competitive markets to achieve what many consider an equitable distribution of health care is emphasized. The paper concludes with some practical observations on how pharmacists can use the increasing emphasis on economic efficiency to the advantage of their profession.

Decision Making↗

PubMed1995

Adherence screening and monitoring.

Patient adherence is an essential goal of pharmaceutical care and can be an initial focus for cognitive services in a traditional pharmacy. Pharmacists are well placed to manage adherence programs. Activities associated with adherence include screening or assessment, follow-up monitoring, and use of memory aids or refill reminders. Technology is available in many forms to assist pharmacists in this role. The pharmacist's role in adherence should focus on achieving desirable patient outcomes. Services associated with adherence programs need not be attached to distribution activities. Producing cost-effective drug therapy outcomes will continue to be of critical value to patients, health care systems, and third party providers.

Humans↗

PubMed2005

Effects of making emergency contraception available without a physician's prescription: a population-based study.

BACKGROUND: Timely access to emergency contraception has the potential to reduce the number of unwanted pregnancies and subsequent abortions. A public health policy initiative in British Columbia beginning in December 2000 allowed pharmacists to provide emergency contraceptives (ECs) without a prescription. We sought to determine changes in EC use after the policy was introduced and to analyze EC use with data generated by the policy. METHODS: All Ovral, Preven and Plan B EC prescriptions from Jan. 1, 1996, to Dec. 31, 2003, were identified through the BC PharmaNet and Medical Services Plan administrative databases and the data analyzed to determine changes between 1996 and 2002. Changes over time were determined in the frequency of EC provision, choice of EC agent, frequency of EC use by age group, repeat use and geographic distribution of EC prescription for the pre- and post-policy periods. Anonymized patient-specific data from treatment consent forms were used to describe the reason for EC use, interval between unprotected intercourse and EC prescription, proportion prescribed for immediate or future use, referrals for regular birth control and STD screening and concomitant antiemetic use. Consent data also provided the time in the menstrual cycle that the EC was requested. RESULTS: The number of EC prescriptions increased from a pre-policy mean of 8805 (99% confidence interval 7823-9787) in the years 1996 to 2000 to a post-policy total in 2002 of 17 794. Physicians prescribed the levonorgestrel regimen (Plan B) less frequently than did pharmacists. The frequency of EC use was highest among women aged 20-24 years across all study years, and all age groups demonstrated a post-policy increase in use. On average, 2.1% of the women received an EC 3 or more times a year over the period of the study. More women in urban regions received ECs than women in more rural areas of the province. Analysis of pharmacist treatment consent forms used in 2001 and 2002 showed that 56.2% of women receiving an EC reported using a method of birth control that had failed, 55.7% of pharmacist-provided ECs were obtained within 24 hours after unprotected intercourse, 1.1% of ECs were obtained for future use, antiemetics were provided to 57.7% of women receiving the Yuzpe regimen (Ovral, Preven) and to 20.5% of women receiving levonorgestrel, and women tended to seek ECs when unprotected intercourse occurred at the time of highest risk of pregnancy in their menstrual cycle. Women in greatest financial need obtained ECs more frequently from physicians than from pharmacists. INTERPRETATION: The policy change that granted pharmacists authority to provide ECs to women without a physician's prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province.

Adolescent↗

PubMed1977

[The control of medicines and related substances, Law 101 of 1965: a short review].

Act 101 of 1965, as amended by Act 65 of 1974, published on 21 February 1975, has far-reaching implications as regards the manufacture, distribution and use of medicines in South Africa. Some aspects in connection with the annexures to the Act relating to the pharmaceutical industry, doctors, pharmacists and the public, are discussed.

Drug Industry↗

PubMed2001

[Prophylactic prescription of low-molecular-weight heparin in the non-surgical setting: impact of recommendations].

OBJECTIVE: Low-molecular-weight heparins (LMWH) had official approval for use for venous thromboembolism prophylaxis only for surgery patients when this survey was conducted, but were nevertheless often used in non-surgery patients. We conducted this "before and after" survey from May 1998 to April 1999 to assess the impact of the recommendations implemented in the beginning of 1999. METHODS: Data on the use of LMWH were collected on three different days within a three week interval in all non-surgery departments at the Tenon hospital before distribution of expert recommendations early in 1999. Published in La Presse Médicale in January 2000, these recommendations issued from an external panel of 43 experts who were contacted to establish a consensus opinion using the Delphi method. Data were again collected on three different days after implementation of the recommendations. Implementation was based on a patient-specific prescription order form requested by the hospital pharmacy for delivery to the department. RESULTS: Data were collected for 121 prescriptions prior to the recommendations and for 158 after. Sex-ratio, mean age and percentage of LMWH prescriptions did not differ significantly between the two periods. There was a lower number of non-appropriate prescriptions after implementation of the recommendations from 54.5% to 35.4% (p = 0.01) with better conformity for recommendation A (high-risk patients) (36% versus 43%, NS) and for recommendation B (= 2 risk situations or = 1 risk situation and = 2 aggravating factors) (10% versus 22%, p = 0.01). Better conformity of LMWH prescriptions in oncology and radiotherapy departments partially explained this general improvement, but the difference remained significant when excluding these two departments (p = 0.04). CONCLUSION: This study shows that physician compliance with recognized expert recommendations can improve their implementation. This procedure is now in general use in the Tenon hospital.

Aged↗

PubMedDate not supplied

Disaster modeling: medication resources required for disaster team response.

INTRODUCTION: Responses to disasters involve many factors beyond personnel, such as medical and non-medical equipment and supplies. When disaster teams respond, they must do so with sufficient amounts of medicine and supplies to manage all of the patients expected for several days before re-supply. In order for this process to be efficient and expedient, accurate and advanced planning for supplies needed by disaster workers is necessary. These supplies must provide for general medical care and for hazard-specific problems. OBJECTIVE: To develop a model that provides the framework for determining supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster teams in a civilian environment. METHODS: A community hospital was modeled to determine patient characteristics when presenting to an emergency department (ED), including patient demographics and chief complaint, medications administered during the ED visit and prescribed at discharge, and laboratory tests ordered to assess disaster team supply requirements. Data were downloaded from a patient tracking software package and abstracted from various hospital data information systems. Data from the community hospital were compared with data published from two hurricane disasters by members of the National Disaster Medical System. RESULTS: To the extent possible, the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients. CONCLUSION: This model offers a first step in preparing disaster medical teams for deployment.

Adolescent↗

PubMed2003

Opinion and behaviour of pharmacists towards the substitution of branded drugs by generic drugs: survey of 1,000 French community pharmacists.

OBJECTIVE: In 1999, a new law was introduced, giving French pharmacists the right to switch from branded to generic drugs, unless the prescriber had specified that substitution was not permitted. The purpose of this study was to assess the opinion and behaviour of community pharmacists toward substitution. DESIGN: Self-completion, postal close-ended questionnaires were filled out. SAMPLE AND SETTING: 1,000 French community pharmacists were included. RESULTS: 90% of the pharmacists were favourable to the implementation of the substitution right. 42.5% declared they systematically offered patients the generic drug, whereas 55% chose to target specific populations for substitution. The reluctance of pharmacists could be commercial ('How do I get paid for the time spent? Is it worth risking loosing a customer?'), or cultural ('How do I work this out? Who should I offer generic drugs to? What strategy should I use to offer them?'). CONCLUSION: Generic drug distribution is very recent in France and is not yet common practice. Pharmacists and patients must be informed and trained because substitution is a collaborative act. It does not depend solely on the will and experience of pharmacists.

Adult↗

PubMed2002

Is the prevention of genital chlamydial infections by community involvement possible?

This chapter presents different means by which community initiatives have been undertaken to reduce the prevalence and incidence of genital and allied infections caused by Chlamydia trachomatis. As most of these infections in the majority of infected individuals do not produce symptoms that are likely to urge them to attend any health care unit, screening programmes are mandatory to be able to influence the epidemic of infections with this agent. In many societies there has been a skewed gender distribution in the number of chlamydia-positive persons; this probably indicates that diagnostic service activities have been directed more against one gender than the other. The important role of partner notification, as in the case of other sexually transmitted infections, has been documented. Different means of community initiative have included counselling of school children and groups of persons more likely to be infected. Counselling by the pharmacy has an important role in many societies. Selected cohorts have been offered - via the mass media, Internet, radio and television programmes - sampling kits which can be mailed to a laboratory for testing. The establishment of youth clinics has been found effective for detecting teenagers harbouring C. trachomatis, similarly to screening at antenatal clinics. The offer of free consultations, aetiological tests and therapy has been a part of community initiatives, mimicking the services offered for some of the classic sexually transmitted infections. This chapter considers the usefulness of different test methods and stresses the need to retest those found to be positive. Barriers to the successful introduction of screening activities and diagnostic services are also considered.

Ambulatory Care Facilities↗