Acceptance Of Pharmacists Research Articles

Opportunities and Responsibilities for the Academy in the Medical Home

Opportunities and Responsibilities for the Academy in the Medical Home

Acceptance of pharmacists’ recommendations and outcomes and distance versus local learning

1 concluded that pharmacy case managers were underused and the low acceptance rate may have reduced the potential to avoid readmissions. The study involved a subsample of patients (n = 192) from a randomized prospec- tive study 2 on a number of areas that might be further investigated, includ- ing the of specialist versus nonspecialist care, the number of medications at discharge versus at admission, and reasons for declin- ing recommendations. Moreover, the of the study design on the outcome should be explored, includ- ing reasons for a conclusion of no impact for the composite measure of adverse outcomes versus indi- vidual events (e.g., urgent care visit) or the shortcomings of descriptive/ bivariate explanations versus mul- tivariate explanations. Health care practitioners, including family phy- sicians, specialists, and hospitalists, should guard against the unintended consequences of acting on a noncriti- cal acceptance of this study's conclu- sion of no difference. Distance versus local learning

CPC-082 Measuring Effectivity: Pharmaceutical Interventions Through Computerised Physician Order Entry Versus Direct Phone Calls

BackgroundComputerized physician order entry (CPOE) implementation in hospitals has become an important tool for interactive validation of medical orders as well as a facilitator for pharmacist interventions. However several studies...

Assessing the impact of the presence of pharmacists in a clinical department of a Lebanese hospital

Clinical pharmacy services are still in their very early implementation stages in Lebanon. The objective of this pilot study was to evaluate the impact of clinical pharmacist's presence at the infectious diseases department of Hôtel-Dieu de France University Hospital of Beirut (HDF) and to evaluate the acceptance of pharmacist's interventions by healthcare providers. A 21-month prospective analysis was conducted, including 240 hospitalized patients in the infectious diseases department of HDF and 475 interventions performed by the pharmacist. A clinical pharmacist and pharmacy residents were present for 1 to 2hours/day in the ward. A pharmaceutical care plan was established and used to document patients' problems and pharmacist's interventions. Main criteria analyzed were: types and frequencies of pharmaceutical problems detected, types of pharmaceutical interventions performed, their acceptance by the prescribers and/or nurses, and factors affecting the interventions and their acceptance. The most frequent pharmaceutical problem detected was incorrect dosage and the three most frequent interventions performed by the pharmacist were stop/start/substitute a drug, change drug dosage/or daily distribution, and change administration time. The acceptance was the highest for I.TIM (change drug administration time) and the lowest for I.FOL (request a lab test/exam/clinical follow-up). Even a short daily pharmacist's presence is an added value in inpatient care at the infectious diseases department of Hôtel-Dieu de France University Hospital. Areas of improvement are a better communication between the pharmacist and the prescribers, a direct contact between pharmacist and patient and a longer presence of the clinical pharmacist in the clinical department.

Comprehensive medication reviews for elderly patients: Findings and recommendations to physicians

To assess drug-related problems (DRPs) documented by specially trained community pharmacists during the Finnish comprehensive medication review (CMR) procedure and to describe the resulting interventions for home-dwelling and assisted-living primary care patients 65 years or older. Retrospective analysis of applicable written CMR case reports for primary care patients 65 years or older by 26 community pharmacists attending a 1.5-year CMR accreditation training (174 patients recruited; 121 included in the analysis). The main outcome measures were DRPs and physicians' acceptance of pharmacists' recommendations. The pharmacists reported a total of 785 DRPs (average of 6.5/patient). DRPs were more common among home-dwelling patients (7.2) than those in the assisted-living setting (5.5; P = 0.014) but were similar in nature. Inappropriate drug choices were the most common DRPs (17% of DRPs), involving most often hypnotics and sedatives. Also, indications with no treatment were common (16%), particularly those associated with cardiovascular diseases and osteoporosis. Pharmacists made 649 recommendations, 55% (n = 360) of which were accepted by physicians without revision. In 51% of DRPs (n = 403), CMRs resulted in change of drug therapy; stopping a drug was the most common change. Specially trained pharmacists were able to identify DRPs among elderly primary care patients by using a CMR procedure, and more than one-half of the identified DRPs led to medication changes. The pharmacists' special knowledge of geriatric pharmacotherapy and access to clinical patient data were crucial for recognizing DRPs.

Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial.

BackgroundDespite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/DesignWe will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.DiscussionAs the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000452998

Physician perceptions of pharmacist roles in a primary care setting in Qatar

PurposePharmacists are uniquely trained to provide guidance to patients in the selection of appropriate non-prescription therapy. Physicians in Qatar may not always recognize how pharmacists function in assuring safe medication use. Both these health professional groups come from heterogeneous training and experiences before migrating to the country and these backgrounds could influence collaborative patient care. Qatar Petroleum (QP), the largest private employer in the country, has developed a pharmacist-guided medication consulting service at their primary care clinics, but physician comfort with pharmacists recommending drug therapy is currently unknown. The objective of this study is to characterize physician perceptions of pharmacists and their roles in a primary care patient setting in Qatar.MethodsThis cross-sectional survey was developed following a comprehensive literature review and administered in English and Arabic. Consenting QP physicians were asked questions to assess experiences, comfort and expectations of pharmacist roles and abilities to provide medication-related advice and recommend and monitor therapies.ResultsThe median age of the 62 (77.5%) physicians who responded was between 40 and 50 years old and almost two-third were men (64.5%). Fourteen different nationalities were represented. Physicians were more comfortable with pharmacist activities closely linked to drug products than responsibilities associated with monitoring and optimization of patient outcomes. Medication education (96.6%) and drug knowledge (90%) were practically unanimously recognized as abilities expected of pharmacists, but consultative roles, such as assisting in drug regimen design were less acknowledged. They proposed pharmacist spend more time with physicians attending joint meetings or education events to help advance acceptance of pharmacists in patient-centered care at this site.ConclusionsPhysicians had low comfort and expectations of patient-oriented pharmacist roles but were not threatened to learn more about these capabilities or explore enhanced collaboration in patient care.

Evaluating and classifying pharmacists’ quality interventions in the emergency department

The results of an evaluation of the impact of pharmacists' medication-related interventions on quality of care in the emergency department (ED) setting are reported. Using data from a previously published observational study of medication errors intercepted by ED pharmacists at four academic medical centers, trained reviewers retrospectively analyzed 130 additional pharmacist interventions (those not categorized as medication errors in the primary study) over a specified four-month period to identify "quality interventions" (QIs), defined as those that (1) prevented misuse, underuse, or overuse of medications or (2) improved adherence to quality standards or evidence-based medicine (EBM) standards. The study included an evaluation of the medication classes associated with QIs and the acceptance of pharmacist-recommended QIs. The reviewers identified a total of 91 pharmacist QIs at the four sites during the study period (2.3 QIs per 100 patients or about 1 QI per 100 medication orders). About 45% of the identified QIs improved adherence with EBM or national quality standards; other QIs prevented medication underuse (34%), misuse (14%), or overuse (6%). Pharmacists' QIs most often pertained to antiinfective agents (39%), cardiovascular agents (13%), and anticoagulants and thrombolytics (12%). The overall rate of acceptance of pharmacists' QIs was 93.4%. A secondary analysis of data from a previously published study at four medical centers indicated that ED pharmacists often recommend interventions that improve the quality of medication use and adherence to EBM and national quality standards.

Implementation of a Community Pharmacy–Based Falls Prevention Program

Background Falls are the leading cause of fatal and nonfatal unintentional injury among older adults in the United States. Multifaceted falls prevention programs, which have been reported to reduce the risk for falls among older adults, usually include a medication review and modification component. Based on a literature search, no randomized trials that have examined the effectiveness of this component have been published. Objective The aim of this article was to report on a retrospective process evaluation of data from a randomized, controlled trial conducted to examine the effectiveness of a medication review intervention, delivered through community pharmacies, on the rate of falls among community-dwelling older adults. Methods Patients were recruited through 32 pharmacies in North Carolina. Participants were community-dwelling older adults at high risk for falls based on age (≥65 years), number of concurrent medications (≥4), and medication classes (emphasis on CNS-active agents). The process evaluation measured the recruitment of patients into the study, the process through which the intervention was delivered, the extent to which patients implemented the recommendations for intervention, and the acceptance of pharmacists' recommendations by prescribing physicians. Results Of the 7793 patients contacted for study participation, 981 (12.6%) responded to the initial inquiry. A total of 801 (81.7%) participated in an eligibility interview, of whom 342 (42.7%) were eligible. Baseline data collection was completed in 186 of eligible patients (54.4%), who were randomly assigned to the intervention group (n = 93) or the control group (n = 93). Pharmacists delivered a medication review to 73 of the patients (78.5%) in the intervention group, with 41 recommendations for changes in medication, of which 10 (24.4%) were implemented. Of the 31 prescribing physicians contacted with pharmacists' recommendations, 14 (45.2%) responded, and 10 (32.3%) authorized the changes. Conclusions Based on the findings from the present study, coordination of care between community pharmacists and prescribers needs to be improved for the realization of potential beneficial effects of medication management on falls prevention.

The impact of a pharmacist assisted clinic upon medication adherence and quality of life in mental health patients

To determine if a pharmacist assisted psychiatric clinic would improve adherence to medications and quality of life over 6 months. The primary study endpoints were the change from baseline in Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life - BREF (WHOQOL-BREF) scales as well as hospitalizations and emergency room visits. Secondary endpoints included metabolic and physiologic parameters. A prospective, single-center study conducted at an outpatient psychiatric clinic. Subjects were required to attend 3 clinic visits (baseline, 3 and 6 months) with the pharmacist. Subject and medication histories were obtained at each visit. Subjects' records within the local health system were reviewed for emergency room visits and hospitalizations. Metabolic parameters were assessed at each visit. Twenty-seven subjects enrolled and twenty subjects completed. Total MARS score at baseline and study end were 7.90 and 8.65, respectively. At baseline, 10 (50%) were nonadherent based on the BEMIB and 9 (45%) were nonadherent at 6 months. Statistically significant improvements were seen in 2 domains of the WHOQOL-BREF. Reductions in both ER visits and hospitalizations were achieved. There were significant improvements in total cholesterol and LDL. Improvements were seen in two domains of the WHOQOL-BREF - physical capacity and psychological well-being over the 6 month period. While improvements were seen in various rating scales, due to small sample sizes, these were insignificant improvements. Reductions in hospitalizations and ER visits were also seen during the study and up to 6 months post study. Statistically significant improvements were also seen in both total cholesterol and LDL. The lack of improvement in many of the study outcomes reflects the difficulty of the mental health population to adhere to treatment recommendations; but also underscores the need for continued research in this area. This pilot demonstrates the pharmacist's ability to provide comprehensive medication management services to the psychiatric outpatient.

A retrospective study of drug‐related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners

Drug-related problems (DRPs) in Australian aged care homes have been studied previously. However, little is known about the acceptance and implementation of pharmacists' recommendations by general practitioners (GPs) to resolve DRPs. The primary objective of this study was to investigate the number and nature of DRPs identified by accredited clinical pharmacists. The secondary objective was to study the GP acceptance and implementation of pharmacist recommendations to resolve DRPs. This was a retrospective study of 500 randomly selected, de-identified medication reviews performed by 10 accredited clinical pharmacists over 6 months across 62 aged care homes. The DRPs identified by pharmacists were subsequently classified by the drugs involved, types of problem (indication, effectiveness and safety) and medical diagnoses of the patient. GP written feedback on the medication review reports determined implementation of pharmacists' recommendations to resolve the DRPs. A total of 1433 DRPs were identified in 480 of the 500 residents. Potential DRPs were frequently classified as risk of adverse drug reactions, need for additional monitoring and inappropriate choice of a drug. Alimentary, cardiovascular, central nervous system and respiratory drugs were most frequently implicated, accounting for more than 75% of the DRPs. GPs' acceptance and implementation of pharmacists recommendations were 72.5% (95% CI; 70.2, 74.8) and 58.1% (95% CI; 55.5, 60.6), respectively. Over 96% of the residents had potential DRPs identified by pharmacists. GP acceptance of pharmacists' recommendations was independent of the drug category, but not independent of the disease category.

Pharmacy-Physician Communications: Potential To Reduce Medication Errors

Pharmacist—physician communication is a vital component of quality health care. Enhanced communication can reduce costs, promote patient safety, and prevent medical errors. 1. Dobie III., R.L. Rascati K.L. Documenting the value of pharmacist interventions. Am Pharm. 1994; NS34: 50-54 PubMed Google Scholar , 2. Schenkel S. Promoting patient safety and preventing medical error in emergency departments. Acad Emerg Med. 2000; 7: 1204-1222 Crossref PubMed Scopus (111) Google Scholar , 3. Torchinsky A. Landry D. An analysis of pharmacist interventions. Can J Hosp Pharm. 1991; 44 (270): 245-248 Google Scholar , 4. Klopfer J.D. Einarson T.R. Acceptance of pharmacists' suggestions by prescribers: a literature review. Hosp Pharm. 1990; 25: 834-836 Google Scholar , 5. Monane M. Matthias D.M. Nagle B.A. Kelly M.A. Improving prescribing patterns for the elderly through an online drug utilization review intervention: a system linking the physician, pharmacist, and computer. JAMA. 1998; 280: 1249-1252 Crossref PubMed Scopus (181) Google Scholar , 6. McNally D.L. Wertheimer D. Strategies to reduce the high cost of patient noncompliance. Md Med J. 1992; 41: 223-225 Google Scholar , 7. Klotz R.S. Pharmacist-physician link: keys to effective outcomes management. Am Pharm. 1994; NS34: 46-57 Google Scholar , 8. Sardinha C. Physician groups embrace pharmacists: collaborations that work. J Manag Care Pharm. 1997; 3 (530): 526-528 Google Scholar Kallail and colleagues 9. Kallail K.J. Ngong L.B. Kellerman R. Pharmacy to physician communication. 2002 Google Scholar found that 3% of pharmacist communications to a family practice clinic involved a prescription error or potential error. Nonspecific directions on prescriptions influence a patient's ability to adhere to treatment plans and may not allow the pharmacist to reinforce the importance of proper medication use. 6. McNally D.L. Wertheimer D. Strategies to reduce the high cost of patient noncompliance. Md Med J. 1992; 41: 223-225 Google Scholar

Characterization of errors detected during central order review.

Characterization of prescribing errors detected by dispensary pharmacists in a tertiary-care teaching hospital is described. During the 25 week study period, 1330 prescribing errors were identified from a total of 237,798 medication orders processed by the pharmacy, representing a rate of 5.6 errors per 1000 orders. Resident physicians wrote more errant medication orders than any other physician class. Errors most often occurred on the general medicine teaching wards. The most common drug classes implicated were non-formulary medications and antibiotics. Approximately 11% of errors were defined as potentially fatal or severe (Type A) errors, 7% were potentially serious (Type B), 21% were potentially significant (Type C) and 61% were problem orders (Type D) based on a classification system of severity. The most common error types were inappropriate dosing of antibiotics and the prescribing of medications for patients who had a potential conflicting allergy history. The acceptance of pharmacists' suggestions was 67%. The study identified three major areas where future educational and corrective measures could be aimed: adherence to the formulary, antibiotic prescribing and allergy validation.

Inconsistencies in the Drug Use Process

Rational drug therapy has historically been viewed as the right drug, in the right dose, at the right time, for the right patient. Today, the emphasis on cost containment has added an extra dimension: cost-effective therapeutic regimens. Most stages of the DUP have not been extensively studied. Evidence presented to date reflects duplication of efforts and suboptimal decisions, with little concerted effort to identify means for improvements that may have a favorable impact on cost and patient outcome. The increasing use of drugs as the primary mode to treat diseases, the reduction in the number of hospital employees at a time increased severity of patient illness, the nursing shortage, and the increasing cost and complexity of drugs, along with the inconsistencies that exist in drug use, demonstrate a need for a complete review of the DUP. The DUP, as it currently operates, is not conducive to the provision of a systematic approach to therapy. The stages in this process are often independent of each other and poorly performed by a variety of health professionals. The subsequent development of strategies for improving the chance for optimal drug therapy through the use of pharmacists as drug therapy experts is needed. The pharmacy profession is in a prime position where expanded patient care services and supervision of the entire DUP may actually decrease the total cost of health care. This expansion represents the key to increasing acceptance of pharmacists' clinical role and for ensuring long-term survival of the profession.

Effect of chronic ethanol intake on lactase activity and active galactose absorption in rat small intestine.

The effects of feeding a nutritionally adequate liquid diet containing 5% ethanol to rats over a four week period on intestinal lactase activity and the kinetics of jejunal galactose absorption in vivo have been determined. Both lactase activity and the maximum capacity for active, saturable galactose absorption (Jmax) were increased significantly after chronic ethanol ingestion. In contrast, uptake of the sugar via the phlorhizin-insensitive (passive) route was unaffected by ethanol. Our results imply the presence of an increased maturity of the enterocyte population on the villus surface in response to ethanol. The relevance of this work to uptake studies in alcoholics is briefly discussed.

Effect of pharmacists' clinical interventions on nonformulary drug use

The effect on drug costs of pharmacists' interventions in reducing the use of nonformulary medications was studied in a private teaching hospital. During a four-month period, nonformulary medication request forms and pharmacist consultation logs were reviewed to determine physicians' actions taken on requests for nonformulary medications. Cost avoidance of interventions (nonformulary medication cost) and the cost of pharmacist cost) and the cost of pharmacist time for the interventions were determined. The pharmacist was able to contact The pharmacist was able to contact the physician in 388 of 394 instances in which the use of a nonformulary medication was considered. Of 230 recommendations by pharmacists to change a nonformulary drug order to one for a formulary alternative, 64.8% (149) were accepted by physicians. Of pharmacists' recommendations that were accepted, 75.8% (113/149) were from decentralized areas, which was a significantly higher acceptance rate than that for the centralized areas (24.7% or 36/149). Cost avoidance resulting from acceptance of pharmacists' recommendations during the four-month study was $2,645, or $13,573 per year; this was more than the cost of pharmacist time required to perform interventions. Pharmacist interventions to decrease use of nonformulary drugs can be cost-effective and appear to be more successful in decentralized pharmacy service areas than in areas served by a central pharmacy.

The role of the pharmacist in a geriatric nursing home: a literature review.

This review delineates the pharmacist's controversial clinical role in nursing homes as it has developed within the legal, social, and economic climate of the Medicaid and Medicare conditions of participation. Special problems of the geriatric institutionalized patient include polypharmacy, adverse reactions, the overuse of prn drugs, and inadequate physician contact. These problems are compounded by an impoverished scientific data-base for appropriate drug use in the aged. Studies that clarify the impact consultant pharmacists have on the number of drugs prescribed, adverse reactions, and cost containment are compiled and evaluated. It is shown that pharmacists can reduce the number and cost of drugs. Physician acceptance of pharmacists' recommendations was found to be at least 60 percent in these reports. Well-controlled studies are lacking in the literature.

Pharmacists' attitudes towards home-study lessons. Development of an assessment instrument

This study describes the development of an instrument for assessing pharmacist's acceptance of home-study continuing education lessons. The home-study lessons were distributed in booklet format, used a multiple-choice knowledge evaluation tool, and were issued as a group of six lessons per year or volume. The objectives of the study were to: 1) develop an attitude scale for use with specific home-study lessons; 2) determine the reliability of the attitude scale; and, 3) determine the validity of the attitude scale. The methodology was straightforward. An attitude scale was constructed with reference to the literature. This scale was pretested, revised, and used for the study. Over six hundred usable pieces of data were collected for each of two sets of lessons. These data were analyzed by estimating reliability (coefficient alpha) and by assessing construct validity using principle component factor analysis with varimax rotation. Factors with eigenvalue of less than 0.5 were rejected. These analyses indicated that the study objectives had been achieved. An attitude instrument of known psychometric properties was developed for use in assessing pharmacist acceptance of home-study continuing education lessons.