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Carotid baroreflex pressor responses at rest and during exercise: cardiac output vs. regional vasoconstriction.

The arterial baroreflex mediates changes in arterial pressure via reflex changes in cardiac output (CO) and regional vascular conductance, and the relative roles may change between rest and exercise and across workloads. Therefore, we quantified the contribution of CO and regional vascular conductances to carotid baroreflex-mediated increases in mean arterial pressure (MAP) at rest and during mild to heavy treadmill exercise (3.2 kph; 6.4 kph, 10% grade; and 8 kph, 15% grade). Dogs (n = 8) were chronically instrumented to measure changes in MAP, CO, hindlimb vascular conductance, and renal vascular conductance in response to bilateral carotid occlusion (BCO). At rest and at each workload, BCO caused similar increases in MAP (average 35 +/- 2 mmHg). In response to BCO, neither at rest nor at any workload were there significant increases in CO; therefore, the pressor response occurred via peripheral vasoconstriction. At rest, 10.7 +/- 1.4% of the rise in MAP was due to vasoconstriction in the hindlimb, whereas 4.0 +/- 0.7% was due to renal vasoconstriction. Linear regression analysis revealed that, with increasing workloads, relative contributions of the hindlimb increased and those of the kidney decreased. At the highest workload, the decrease in hindlimb vascular conductance contributed 24.3 +/- 3.4% to the pressor response, whereas the renal contribution decreased to only 1.6 +/- 0.3%. We conclude that the pressor response during BCO was mediated solely by peripheral vasoconstriction. As workload increases, a progressively larger fraction of the pressor response is mediated via vasoconstriction in active skeletal muscle and the contribution of vasoconstriction in inactive beds (e.g., renal) becomes progressively smaller.

Animals↗

Alteration of humoral and peripheral vascular responses during graded exercise in heart failure.

We hypothesized that performance of exercise during heart failure (HF) would lead to hypoperfusion of active skeletal muscles, causing sympathoactivation at lower workloads and alteration of the normal hemodynamic and hormonal responses. We measured cardiac output, mean aortic and right atrial pressures, hindlimb and renal blood flow (RBF), arterial plasma norepinephrine (NE), plasma renin activity (PRA), and plasma arginine vasopressin (AVP) in seven dogs during graded treadmill exercises and at rest. In control experiments, sympathetic activation at the higher workloads resulted in increased cardiac performance that matched the increased muscle vascular conductance. There were also increases in NE, PRA, and AVP. Renal vascular conductance decreased during exercise, such that RBF remained at resting levels. After control experiments, HF was induced by rapid ventricular pacing, and the exercise protocols were repeated. At rest in HF, cardiac performance was significantly depressed and caused lower mean arterial pressure, despite increased HR. Neurohumoral activation was evidenced by renal and hindlimb vasoconstriction and by elevated NE, PRA, and AVP levels, but it did not increase at the mildest workload. Beyond mild exercise, sympathoactivation increased, accompanied by progressive renal vasoconstriction, a fall in RBF, and very large increases of NE, PRA, and AVP. As exercise intensity increased, peripheral vasoconstriction increased, causing arterial pressure to rise to near normal levels, despite depressed cardiac output. However, combined with redirection of RBF, this did not correct the perfusion deficit to the hindlimbs. We conclude that, in dogs with HF, the elevated sympathetic activity observed at rest is not exacerbated by mild exercise. However, with heavier workloads, sympathoactivation begins at lower workloads and becomes progressively exaggerated at higher workloads, thus altering distribution of blood flow.

Animals↗

Origin of oscillatory kinetics of respiratory gas exchange in chronic heart failure.

BACKGROUND: Respiratory gas exchange measurements in patients with chronic heart failure (CHF) at rest and during exercise commonly reveal prominent slow oscillations in ventilation (V(E)), measured oxygen uptake (VO(2)), and carbon dioxide production (VCO(2)), whose origin is not clear. Voluntary simulation of periodic breathing (PB) in normals has been reported to generate a different pattern of oscillations in gas exchange from that seen in spontaneous PB. This necessitates hypothesizing that PB is caused by a primary oscillation in tissue metabolism or in cardiac output. METHODS AND RESULTS: We developed an automated method by which normal controls could be guided to breathe according to a PB pattern. The resultant metabolic oscillations closely matched those seen in spontaneous PB and had several interesting properties. At low workloads (including rest), the oscillations in VO(2) were as prominent as those in V(E) in both spontaneous PB (alpha(VO2)/alpha(VE)=0.92+/-0.04) and voluntary PB (0.93+/-0.07). However, at increased workload, the oscillations in VO(2) because less prominent than those in V(E) in spontaneous PB (intermediate workload 0.63+/-0.05, high workload 0.57+/-0.04; P<0.001) and voluntary PB (intermediate 0.66+/-0.03, high 0.48+/-0.03; P<0.001). There was no difference in the relative size of metabolic oscillations between voluntary and spontaneous PB at matched workloads (P>0.05 at low, intermediate, and high workloads). Furthermore, VO(2) peaked before V(E) in both spontaneous and voluntary PB. This time delay varied from 6.4+/-0.4 s at low ventilation, to 11.3+/-0.9 s at high ventilation (P<0.0001). CONCLUSIONS: The magnitude and phase pattern of oscillations in gas exchange of spontaneous PB can be obtained by adequately matched voluntary PB. Therefore, the gas exchange features of PB are explicable by primary ventilatory oscillation.

Adult↗

Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD).

We investigated whether 12 weeks of rehabilitation at home in patients with chronic obstructive pulmonary disease (COPD) had a beneficial effect on lactate production, metabolic gas exchange data, workload of the inspiratory muscles, and dyspnoea during a maximal bicycle ergometer test. A second aim was to assess whether a change in dyspnoea was related to a change of inspiratory muscle workload. Forty three COPD patients with severe airways obstruction were included in the study: mean forced expiratory volume in one second (FEV1) 1.3 +/- 0.4 L (44% predicted), mean FEV1/inspiratory vital capacity (IVC) 37 +/- 8%. Twenty eight patients started a rehabilitation programme, whilst 15 patients received no rehabilitation. Rehabilitation was carried out at home; patients were supervised by a general practitioner, a physiotherapist and a nurse. Exercise tolerance was measured by means of a 6 min walking distance test (6MWD) and maximal workload (Wmax) during an incremental symptom-limited cycle ergometer test. Inspiratory muscle workload at Wmax was assessed with the Tension Time Index (TTI), and dyspnoea at Wmax with the Borg scale. After 12 weeks, the rehabilitation group showed a significantly larger increase in 6MWD (from 438 to 447 m) and in Wmax (from 70 to 78 W) compared with the control group. A significant improvement in oxygen consumption (V1O2) (from 1.0 to 1.1 L), lactate level (from 3.7 to 3.1 mEq.L(-1)), dyspnoea (from 6.0 to 4.5) and TTI (from 0.10 to 0.08) at Wmax occurred in the rehabilitation group during the programme. The reduction in TTI was not significantly correlated with the fall in dyspnoea, as assessed by the Borg scale. We conclude that 12 weeks of rehabilitation at home in COPD patients increases symptom-limited V1O2 in combination with an increased Wmax. At this significantly higher Wmax, there was a reduction in dyspnoea, lactate level and inspiratory muscle workload. The reduction in dyspnoea was not related to a decreased inspiratory muscle workload. This study shows that rehabilitation at home can produce beneficial physiological improvements during exercise in patients with chronic obstructive pulmonary disease.

Aged↗

Comparison of the end-tidal arterial PCO2 gradient during exercise in normal subjects and in patients with severe COPD.

We undertook the present study with the following objectives: (1) to compare the difference between the end-tidal and the arterial carbondioxide concentration (P[ETa] CO2) gradients at rest and during exercise in normal subjects and patients with COPD; and (2) to analyze the factors contributing to this gradient. We studied seven normal subjects and seven patients with COPD using a symptom-limited exercise test on a cycle ergometer. Our results show that the P(ET-a)CO2 increased progressively as the individuals went from rest to higher workloads in both the normal group and in the COPD group. The P(ET-a)CO2 in patients with COPD both at rest (-3.24 +/- 2.78 mm Hg) and during exercise (1.03 +/- 2.23 mm Hg) is significantly lower than that in normal individuals at rest (1.84 +/- 3.68 mm Hg) and during exercise (10.3 +/- 6.5 mm Hg) (p < 0.01). However, the slope for the relationship between the P(ET-a)CO2 and the workload is actually significantly steeper in the patients with COPD. Although the P(ET-a)CO2 correlated significantly with the workload in both normal subjects (r = 0.63, p < 0.001) and patients (r = 0.55, p < 0.005), the P(ET-a)CO2 was much more closely correlated with the ratio of dead space to tidal volume (VD/VT) (r values of -0.86 and -0.77, respectively). Moreover, when multiple regression analysis was performed, addition of any other physiologic measure (eg, oxygen consumption [VO2], carbon dioxide production [VCO2], minute ventilation [VE], or workload) as a second independent variable after the VD/VT did not improve the correlation. This indicates that the correlation between the P(ET-a)CO2 and the workload is probably related to the dependence of the VD/VT on the workload. The PaCO2 in normal subjects and in the COPD group correlated significantly with the partial pressure of end-tidal carbon dioxide (PETCO2). Using multiple regression analysis, with the PaCO2 as the dependent variable and the PETCO2 (along with other physiologic measures) as the independent variables, we found that the standard error of the estimate was still above 2.1 mm Hg in normal subjects and in patients with COPD. We conclude that (1) during exercise, the P(ET-a)CO2 in normal subjects and in patients with COPD increases significantly, (2) the P(ET-a)CO2 gradient is more closely correlated with the VD/VT than any other physiologic variable, and (3) changes in the PETCO2 during exercise are not correlated closely with changes in the PaCO2.

Adult↗

The treadmill test--where to stop and what does it mean?

The prognostic utility of an exercise ECG test depends upon having an adequate workload to stress the cardiac system. A negative stress test, in which there are no adverse clinical or ECG findings, and in which an adequate workload is achieved, stratifies patients into a low-risk group. The 1997 American Heart Association guidelines imply that any index of workload--heart rate, rate-pressure product, or exercise duration in multiples of resting O2 consumption (METS)--could be used to indicate that adequate stress was achieved. However, while there is considerable evidence supporting the use of METS as a strong independent prognostic variable, there is less support for the use of rate-pressure product or heart rate. Indeed, there is evidence that a high heart rate at a low workload carries an adverse prognosis. Further research is needed to identify the number of METS achieved that would define an adequate workload. In the meantime, a review of the literature suggests that 7 to 10 METS is a reasonable ballpark figure of the minimum workload in patients with a negative stress test that would imply a favorable outcome.

Coronary Disease↗

[Experiment on validity of skin resistance level as an index of arousal level].

It is important in establishing and improving work management and work planning to estimate the arousal level of workers during operation and monitoring tasks. This paper proposes a technique based on experimental results to estimate the arousal level during job execution. In this experiment, both a monotonous low workload task which degrades the arousal level and a high workload task which has an awakening action were alternately applied to five subjects for three hours. Skin resistance level (SRL) as an index of arousal level of the autonous nervous system was measured with subjective drowsiness and task performance, that is, signal omission probability for low workload task and both reaction time and error probability for high workload task, as indexes of arousal level of the central nervous system. The following results were obtained. (1) The results suggested that SRL as an index of arousal level of the autonous nervous system is significantly related and correlated with subjective drowsiness and signal omission probability as indexes of arousal level of the central nervous system. (2) The average reaction time and the error probability tended to increase by the application of high workload when the arousal level was degraded. The influence of degraded arousal continued for a short time and showed an unfavorable effect on task execution. The degree of this influence, however, differed between subjects. (3) SRL can be used as an index of arousal level of the autonous nervous system because the measurement is comparatively easy and is little influenced by artifacts due to body movements. (4) Using SRL at initial high workload period as the standard value, it is possible to quantify the SRL value at arbitrary time by estimating how many times the standard value goes into the SRL value. Based on this quantified value as an index of arousal level, comparison with task performance can be made. The proposed index of arousal level of the autonous nervous system showed a significant correlation with indexes of the central nervous system. This technique can be applied to various kinds of estimation on human characteristics accompanied with changes in arousal level.

Adult↗

[Hypotensive effects of telmisartan on blood pressure during rest and exercise in patients with mild and moderate arterial hypertension].

UNLABELLED: The aim of the study was to evaluate an antihypertensive effect of AT1-receptor blocker telmisartan on the rest and exercise blood pressure (BP) in patients suffering from mild and moderate arterial hypertension. Twenty males (mean age 50.9 +/- 6.9) following a 3-week placebo run-in phase were treated by telmisartan 80 mg q.d. Bicycle exercise test and echocardiography was performed at the end of placebo run-in phase and following 12 weeks of treatment. The workload on the bicycle exercise test has been increased by 25 watts every 2 min and stopped at systolic BP (SDP) 240 or diastolic BP (DBP) 130 mmHg. The maximal workload was the same, prior and after 12 weeks of the treatment. Antihypertensive therapy with telmisartan had a favorable effect, i.e. significantly decreased the rest BP--both SBP (152.5 +/- 11.4 mmHg vs. 139.2 +/- 12.3 mmHg, p < 0.001) and DBP (100.0 +/- 4.6 mmHg vs. 88.7 +/- 6.2 mmHg, p < 0.001). There were no significant changes in the heart rate (HR) at rest prior and after telmisartan treatment (71.4 +/- 9.1 b/min vs. 72.2 +/- 10.4 b/min). When repeating the exercise test after 12 weeks of telmisartan treatment we detected the significant decrease of BP at maximal workload, i.e. SBP decreased from 230.9 +/- 11.4 mmHg to 211.3 +/- 12.7 mmHg, p < 0.05 and DBP decreased from 124.6 +/- 7.5 mmHg to 109.7 +/- 9.7 mmHg, p < 0.05. There was a significant decrease in HR (140.6 +/- 13.2 b/min vs. 130.1 +/- 14.2 b/min, p < 0.05) and significant increase in JT interval at maximal workload after telmisartan treatment (0.193 +/- 0.014 sec vs. 0.201 +/- 0.014 sec, p < 0.05). Telmisartan decreased the double product at rest and maximal workload (diff. of 16 x 10(2) mmHg x b/min and 48 mmHg x 10(2) b/min, respectively, p < 0.05). CONCLUSIONS: Twelve weeks of the telmisartan treatment showed a significant decrease of blood pressure at rest and exercise with no effect on the heart rate at rest in patients with mild and moderate arterial hypertension. There was statistically significant decrease in HR at maximal workload after the treatment by telmisartan.

Adult↗

[Walk-through phenomenon by gradual recruitment of collateral circulation].

The present study was performed to investigate whether coronary collateral vessels open immediately after occurrence of myocardial ischemia. Multistage bicycle exercise was performed to determine the maximum tolerable workload until the onset of angina and significant ST segment depression in 10 patients with well-developed collateral circulation. On a different day, exercise using the maximum tolerable workload was repeated for comparable exercise durations. In two of the 10 patients, anginal pain was gradually alleviated despite the continuation of exercise using the fixed workloads. The extent of ST segment depression during three min exercise with the fixed workload was 0.20 +/- 0.10 (SD) mV, which was significantly (p less than 0.05) greater than 0.16 +/- 0.08 mV at the end of exercise with fixed workload. By contrast, the pressure-rate product was smaller at three min than at the end of exercise using the fixed workload (20,900 +/- 5,500 vs 22,700 +/- 5,700 mmHg-beats/min; p less than 0.05). It was concluded that delayed collateral openings play a critical role in the pathogenesis of the walk-through phenomenon.

Adult↗

Adjustments of distributive and clinical pharmacy services to financial constraints.

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System. Hospitalwide staff reductions occurred in 1985, eliminating most clinical pharmacy services. From 1985 to 1986, drug costs increased more than expected; also, turnaround time for medication orders increased. In 1986, 1.4 full-time-equivalent positions were added, and the pharmacy instituted use of decentralized carts and a pharmacist on the patient-care units to provide first doses. The hospital's management engineering department had selected patient days as the single indicator for pharmacy workload, but pharmacy used the ASHP Pharma Trend monitoring system to present data that convinced management engineering that patient days was an inadequate indicator of pharmacy workload. Also, drug costs decreased after the drug distribution changes and the reinstitution of patient drug therapy monitoring. Pharmacy managers need workload monitoring systems that are responsive to changes and include departmental expense information; these systems should be able to interrelate to hospital cost-accounting systems.

Cost Control↗

Effect of physical training on hemodynamic performance following myocardial infarction: a controlled study.

The effect of physical training on hemodynamic performance was evaluated in a group of patients who had had a myocardial infarction and a group of healthy, age-matched controls. Before training, the patients' mean ventilatory equivalent was significantly less than that of the controls at the lowest workload (300 kpm/min), the mean stroke volume was significantly increased at the highest workload then achieved (600 kpm/min), and the mean arteriovenous oxygen content difference was significantly smaller at the highest workload. The patients had a relative bradycardia before training and there was no significant reduction in mean resting or submaximal heart rate after training. Their mean oxygen uptake was significantly reduced at the lowest exercise workload after training and this response was significantly different from that of the controls after 8 weeks of training. Mean cardiac output during exercise was significantly reduced in the patients after training, but only at the 600-kpm/min workload, the response being blunted at 900 kpm/min; mean stroke volume was also significantly reduced at this workload after training; both these responses were significantly different from those of the controls Mean arteriovenous oxygen content difference at 6oo kpm/min was significantly increased in the patients after training, though the response was not significantly different from that of the controls. Mean ventilatory equivalent was also significantly increased in patients after training, becoming similar to that of the controls.

Adult↗

The academic radiologist's clinical productivity: an update.

RATIONALE AND OBJECTIVES: The purpose of this project was to further understand the academic radiologist's clinical workload with comparison to the prior studies in the past decade. This updated data is very important in determining faculty staffing requirements. MATERIALS AND METHODS: A survey performed by the Society of Chairmen of Academic Radiology Departments (SCARD) collected data in 2003 for radiologists in 23 departments. This data included Current Procedure Terminology (CPT) codes by radiologist. The CPT codes were converted into relative value units (RVUs) per full-time equivalent (FTE) faculty. By grouping the CPT codes into similar examination categories, adjustment factors were created for the RVU values for each CPT in order to compensate for workload variations. These adjustment factors are identical to the adjustments made in 2001 except for a new factor for nuclear medicine. RESULTS: Overall, the average clinical workload in 2003 was 5,872 RVU/FTE, a 32% increase compared to 4,458 RVU/FTE in 1998 and 55% increase compared to 3,790 RVU/FTE in 1996. The average number of examinations per FTE had a smaller (17%) increase since 1998. The adjustment factors remain very similar to those presented in 2001. The only change was a new adjustment factor of 1.3 for nuclear medicine. CONCLUSIONS: Clinical workload as measured by RVU/FTE and adjusted RVU/FTE are very useful for determining optimal staffing in subspecialty sections and in the department as a whole. The workload continues to increase, but more in examination complexity than in numbers of procedures overall.

Academic Medical Centers↗

Human information processing during physical exercise.

This study was designed to investigate how conditions of physical exercise affect human information processing. Sixteen subjects performed two information processing tasks (perception and decision) during two exercise conditions (endurance vs interval protocols) and during two control conditions (rest vs minimal load protocols). The control conditions required subjects either to perform the information processing tasks under resting conditions or while pedalling a bicycle ergometer at a minimal workload. Workload during the exercise protocols consisted of a fixed percentage of the subject's maximal workload. Each 40 min protocol consisted of five consecutive stages: practice, baseline, warming-up, exercise, and cooling-down, during which heart rate and ratings of perceived exertion were determined. In the perception task subjects had to identify a briefly presented row of three letters. In the decision task subjects had to indicate which of the outer numbers in a row of three digits was the larger. Results indicated that the two control protocols did not influence cognitive task performance; however, in the exercise protocols, increments in physical workload improved performance on the decision task and reduced performance on the perception task, while decrements in physical workload reduced performance on the decision task and improved performance on the perception task. Changes in mental task performance were not evident within protocol stages; only after stage transitions did changes in mental performance occur. We discussed possible theoretical approaches to explain these results and concluded that models advanced in the context of dual-task methodology seem most promising.

Adult↗

Influence of intermittency and static components of work on heat stress.

This paper summarizes the results of a series of experiments established to examine the effects of the composition and pattern of physical workload on human heat tolerance and to compare the predictive abilities of a selection of prominent heat stress indices. The experiments were carried out in a climatically controlled chamber and involved mixtures of dynamic (treadmill walking) and static (weight holding) activities as appropriate. The average physiological responses to intermittent dynamic workloads did not significantly differ from those to continuous dynamic work of the same average intensity. However, the average values masked periods of peak physiological loading. The inclusion of a static load component had a negligible effect on the average level of physiological thermal strain. As a consequence, the presence or absence of a static work component did not influence the predictive abilities of the five heat stress indices examined. It was concluded that, where peak loading was unlikely to be a problem, time weighted averaging of workload was a reasonable approach in assessing industrial thermal strain and that heat stress criteria, derived originally for continuous dynamic workloads, were likely to be equally appropriate for intermittent combined workloads. However, care should be taken to ensure that peak loading did not present a health risk to industrial populations carrying out intermittent work in hot environments.

Adult↗

Unfavourable working conditions for female GPs. A comparison between Swedish general practitioners and district nurses.

OBJECTIVE: The aim was to analyse gender and occupational differences in the psychosocial working conditions of general practitioners (GPs) and district nurses (DNs) in Sweden. DESIGN: A stratified random sample of GPs (n = 566) and DNs (n = 554) from four county councils in Sweden. The overall participation rate was 83%. SETTING: Primary health care. MAIN OUTCOME MEASURES: A mailed questionnaire comprising 10 items providing demographic data and 36 items on psychosocial working conditions was used. The questionnaire had been tested for validity and reliability. A factor analysis included five items: strains and symptoms, professional content, social support at work, workload and job control. RESULTS: Professional content was the most positively rated aspect, whereas workload was the most negatively rated. GPs perceived a higher workload and lower social support than did the DNs. Female GPs scored significantly more negatively than both male GPs and female DNs did in four out of the five factors. Female GPs reported a high workload, low job control and low social support at work. Female DNs, too, reported a high workload, relatively low job control but fairly strong social support. CONCLUSION: Female GPs perceived more unfavourable psychosocial working conditions than both male GPs and female DNs did in the same organisational setting.

Adult↗

Development and validation of a scaled questionnaire for evaluation of residency programs.

As residency programs adapt to the need to promote primary care, the importance of quantitating qualitative issues increases. In this study, a questionnaire based on reported residency stressors was answered by 238 internal medicine residents. The Profile of Mood States (POMS) was also completed by 64. Factor analysis derived three scales reflecting emotional distress and satisfaction with the workload and learning environment. Emotional distress correlated positively with POMS scores indicating depression and dejection and was inversely related to workload. Workload satisfaction was significantly higher in programs with fewer admissions and lower in programs with greater patient loads. Responses did not differ by postgraduate year of training. Residents in different programs showed significant differences in emotional distress and workload but not learning environment. Residents in university programs indicated more stress and less satisfaction with workload than those in community programs. This study supports the validity of the three scales and provides insights into elements of the educational process that are difficult to quantitate.

Affect↗

Demographic and epidemiological aspects of plastic surgery: profile of a supradistrict specialty.

The workload of plastic surgery is often poorly understood by the public and those responsible for financing health care. The authors have used linked statistical data to analyse demographic and epidemiological profiles of workload in plastic surgery in Oxfordshire. The analyses were constructed for residents of the district and for patients treated from other districts. The former provides a profile of workload generated for plastic surgery from a geographically-defined population. The latter complements this by adding information about 'imported' workload. Admission rates for plastic surgery were higher for children and elderly people than for other age groups; higher for males than females; and they increased during the 11 years of the study. Most of the increase represented an increase in people treated by the service, rather than an increase in readmissions, although there was a modest increase in the latter too. Lengths of stay per admission and total time spent in hospital per person declined considerably. The bulk of the workload in plastic surgery is concerned with the treatment of trauma (including burns), cancer and congenital malformations. The main clinical conditions treated by the specialty are documented distinguishing, for each condition, the extent to which the patients came from outside the authority in which the provider unit is cited.

Adolescent↗

Community pharmacists' work environments: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe characteristics of community pharmacists' current practice environments and pharmacists perceptions' about aspects of their work environments. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies) in the United States. PARTICIPANTS: 1,564 actively practicing pharmacists. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Hours the pharmacy was open; staffing; workload, perceptions of workload, and impact of the current workload on them and their work; equipment and technology available and used; and impact of equipment and technology at the practice site. Responses were compared with those from the 2000 National Pharmacist Workforce Survey. RESULTS: Hours of operation varied across practice settings in 2004 and were similar to those reported in 2000. Pharmacist and technician staffing varied somewhat across settings, but overall pharmacists were working with more technicians in 2004 compared with 2000. The number of prescriptions personally dispensed daily (personal workload) increased for pharmacists in all practice settings from 2000 to 2004. When pharmacists reported the impact of their current workload, motivation to work at the pharmacy and job satisfaction were rated most positive, and opportunity to take adequate breaks were rated most negative. Equipment used for facilitating the dispensing process was more common in pharmacies than equipment related to patient care activities. More than one half of pharmacists reported that equipment and technology increased their level of productivity, quality of care, financial performance, and job satisfaction in the pharmacy. CONCLUSION: Pharmacists' work environments tend to be oriented toward traditional dispensing roles and activities. Staff, equipment, and information technology resources are available to facilitate both dispensing and patient care activities, and these resources have increased productivity, quality of care, and pharmacists' satisfaction.

Community Pharmacy Services↗