Comprehensive Pharmaceutical Services Research Articles

An investigation of the determinants for community pharmacists' positive image and the needs for community pharmacists' services in Taiwan.

To examine the specific factors that the general public believes have an effect on the image of community pharmacists and also to identify community pharmacists' services that truly fulfill people's needs. A convenient sample of 401 community pharmacy customers completed the questionnaire. When asked about the factors that help establish a positive image for a community pharmacist, 98.3% of the respondents reported accurate dispensing as the most important factor, followed by cordial attitude (95.5%), and wearing clothes showing pharmacist's license with a photo (94.6%). Among the services provided by community pharmacies, most people think that the most needed service is a consultation explaining drug-drug interactions (93.8%). Furthermore, 312 (77.8%) respondents indicated that there is a need for comprehensive pharmaceutical services. As for the amount that the respondents were willing to pay for such service, many (42.9%) chose 100 NT dollars (≈ 3USD). The results of this study showed that correct dispensing is the most important factor that helps establish a positive image of community pharmacists and that the most needed services were those that required pharmacists' professional competence. Moreover, nearly 80% of the respondents reported that they needed comprehensive pharmaceutical services and were willing to pay for it.

Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial

BackgroundElderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients.MethodsA randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis.ResultsSixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors ‘age’ or ‘length of stay on the ward’ were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward).ConclusionsOur findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial.Trial registrationClinicaltrials.gov identifier: NCT01578525, prospectively registered April 13, 2012.

Developing a Business Plan for Critical Care Pharmacy Services.

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

Exploring the gap: community pharmacists' perceptions of their current role compared with their aspirations

Abstract Objective To investigate community pharmacy managers' perceptions of their role in providing health care to patients and to compare these with their aspirations for the future. Method Fourteen pharmacist managers from one regional area of a UK national multiple pharmacy chain participated in two focus groups. Key findings Participants voiced a shared vision of wanting to play a more integral part in the health care of patients. Strategies put forward to embrace a more participative role included delegation of health screening and minor illness clinics from the prescriber to the pharmacist, having more formalised and open channels of communication with prescribers and moving away from performing technical duties, such as the physical assembly of medicines. Participants in both groups showed awareness that apathy and inaction would result in potential opportunities for pharmacy to be lost or passed over to another profession within the primary health care team (PHCT). Two key external obstacles that currently prevented attainment of desired roles were identified: first, a lack of awareness among other health care professionals and the general public about the pharmacist's skills and attributes and, secondly, current UK legislation that limits the potential for community pharmacists to expand their role away from the pharmacy premises. Conclusions Participants believed that they could provide a more comprehensive pharmaceutical service if given the chance. However, they believed that implementation of change would be difficult considering the obstacles that needed to be surmounted for change to occur.

Facilitating equity and efficiency in Malaysian primary health care through the application of the ACG® case mix system

Malaysian health care is a parallel system with both public and private sectors. The MOH (Ministry of Health) is the main provider of health services in the country, delivering comprehensive medical, health, dental and pharmaceutical services at primary, secondary and tertiary levels of care. The public health services are heavily subsidized by the government. The practice of financial distribution within the Ministry of Health of Malaysia has traditionally been dependent on historical information, i.e., looking at past performance. Any additional increment has been based on arbitrary predictions of the consumer index or inflation. A more appropriate distribution would be based not only on the volume of patients, but also on the morbidity profiles of these populations. Because of the development of the TPC (Tele-Primary Care) electronic system, considerable data is now collected, and there exists a vast potential for data-mining. One potential area of study is to account for the differences in the health status of populations and their anticipated need for healthcare services. An earlier project demonstrated that the TPC dataset provides viable data that can be used for understanding differences in case mix and resource need by various population sub-groups. This was the first step in a multi-stage process to demonstrate the benefits of integrating case mix into the Malaysian healthcare system. As a result of the first project, an increased understanding of the TPC database was gained, which is providing usable data. However, to make full and effective use of TPC, a resource-use measure based on micro-costing information needed to be developed and validated. This project evaluated the plausibility of recently developed cost measures. This new resource-use measure would enable a clearer understanding of the resource consumption based on the morbidity profile of populations across regions, as well as individual clinics.

A Review on Specialization in Pharmacy—Part II: A Commentary on Postgraduate Training and Pharmaceutical Care

Many opportunities exist for pharmacists who desire to expand their role in providing comprehensive pharmaceutical care services to patients and other health care providers, who they serve and collaborate with on a daily basis. Consequently, there is a strong trend within pharmacy to specialize in areas of professional interest. In many respects, pharmacy has turned toward the medical model in addressing its needs and providing a framework for specialization in practice. With respect to generalist and specialized practitioners and varying initiatives relative to the medical model, the concept of specialization in pharmacy has recently developed some interesting tangents when issues of certification, credentialing, disease-state management, and added qualifications enter the discussion. The previous installment in this 2-part article focused on specialization in pharmacy and offered a review of the current initiatives by which a pharmacist can achieve specialty status. In this concluding installment, discussion is offered that addresses pharmaceutical care and postgraduate training in pharmacy relative to future professional and societal expectations for pharmacy.

A Review on Specialization in Pharmacy—Part I

Many opportunities exist for pharmacists who desire to expand their role in providing comprehensive pharmaceutical care services to patients and other health care providers whom they serve and collaborate with on a daily basis. Consequently, there is a strong trend within pharmacy to specialize in areas of professional interest. In many respects, pharmacy has turned towards the medical model in addressing its needs and providing a framework for specialization in practice. With respect to generalist and specialized practitioners and varying initiatives relative to the medical model, the concept of specialization in pharmacy has recently developed some interesting tangents when issues of certification, credentialing, disease-state management, and added-qualifications enter the discussion. In this, the first of a 2-part series (Part II in the upcoming issue) focusing on specialization in pharmacy, a review of the current initiatives by which a pharmacist can achieve specialty status will be addressed.

Pharmaceutical Care Research and Education Project: Patient Outcomes

To compare patients' adherence to therapy, expectations, satisfaction with pharmacy services, and health-related quality of life (HRQOL) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care. Randomized controlled cluster design. Sixteen community pharmacies in Alberta, Canada. Ambulatory elderly (> or = 65 years of age) patients covered under Alberta Health & Wellness's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles. Pharmacies were randomly assigned to either treatment (intervention) or control (traditional pharmacy care) groups. Patients at treatment pharmacies were recruited into the study, and pharmacists provided comprehensive pharmaceutical care services. Pharmacists at control pharmacies continued to provide traditional pharmacy care. Study participants' opinions, adherence to therapy, and scores on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Compared with those of patients receiving traditional care, treatment patients' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period. Treatment patients' satisfaction with the constructs "trust," "evaluation and goal setting," and "communicates with doctor" were also positively affected. HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions. Successful implementation of a pharmaceutical care practice model has the potential to increase patients' satisfaction with their pharmacists' activities and may increase patients' expectations that pharmacists will work on their behalf to assist them with their health care needs. If pharmaceutical care affects patients' HRQOL, instruments more specific than the SF-36 may be needed to detect the differences.

Patients' Willingness to Pay for Pharmaceutical Care

ObjectiveTo determine the level at which patients receive pharmaceutical care services and their willingness to pay for comprehensive pharmaceutical care services. DesignA mail survey was sent to 2,500 adults in the United States. SettingSurveys were mailed to subjects' homes. Patients or Other ParticipantsSubjects were randomly selected from a marketing database that included representation from each of the 50 states of the United States. Intervention(s)The survey provided a description of comprehensive pharmaceutical care, and survey items asked about the level of care subjects were receiving and their willingness to pay for these services. Main Outcome MeasuresLevel of various pharmacy services subjects reported receiving, and the dollar amount subjects were willing to pay for comprehensive pharmaceutical care. ResultsThe majority of the subjects were not receiving pharmaceutical care services. The average amount all respondents were willing to pay for these services was $13 for a one-time consultation and $28 for this plus 1 year of monitoring. Looking only at those respondents willing to pay (56%), the means rise to $23 and $50, respectively. ConclusionA majority of patients are willing to pay for pharmaceutical care services, even if they are not now receiving this level of care. Direct payment from patients who recognize the therapeutic benefits of pharmaceutical care may be a more viable option than is generally believed, at least until the profession can prove pharmaceutical care's utility and cost-effectiveness to third party payers.

Implementing comprehensive pharmaceutical services at an academic tertiary care hospital

The implementation and impact of comprehensive pharmaceutical services at a hospital are described. Before 1992, pharmaceutical services at Detroit Receiving Hospital and University Health Center were comparable to those of many departments serving similar academic tertiary care institutions. A major conflict with the principles of pharmaceutical care existed in that specific tasks were assigned to pharmacists, so that up to four pharmacists may have been involved in one patient's drug therapy while other patients were ignored. Several steps were taken to solve this problem. The department's mission and vision statements were modified to embrace pharmaceutical care. The support of administration and department leaders was secured, pharmacist evaluations were adjusted to make pharmaceutical care skills baseline competencies, and staffing was reconfigured. A voluntary pharmaceutical care committee was formed to transform pharmaceutical services at the hospital. It was decided that all staff pharmacists would provide clinical and distributive services on a rotating basis. The drug distribution system was altered to free more pharmacist time for patient care, and two technician positions were added. The clinical program was made more patient focused. The program was implemented in a stepwise manner beginning in September 1992. Computerized systems for tracking workload and documenting clinical interventions and drug cost savings were established. Later changes included making pharmacists responsible for all patients on a medical service rather than for specific problems in a particular location and changing scheduling to enhance the continuity of care. The number of clinical interventions by pharmacists increased from 3,563 in 1993 to 15,476 (projected) in 1995, and drug cost savings and avoidance increased from $239,248 in 1992 to $562,402 (projected) in 1995. Major change was necessary to implement comprehensive pharmaceutical services at an academic tertiary care hospital.

Comprehensive Pharmaceutical Services for Pediatric Patients

The development of comprehensive pharmaceutical services for pediatric patients at a tertiary-care teaching hospital is described. A team of three staff pharmacists, a clinical specialist, and supportive personnel was formed. A pediatric pharmacy, operating from 0800 to 2100 daily, was created in a separate area of the central pharmacy to focus on potential problems with pediatric dosage calculations and drug administration. The team staffs the pediatric pharmacy for 75% of its day and evening shifts. The pharmacy prepares the 24-hour unit dose supply for each nursing unit, processes new orders, and provides drug information and problem-solving services. Clinical services are provided by the decentralized pharmacist, a rotating member of the team who makes rounds each day to the pediatric nursing units to review patient charts, provide medication information, and answer questions. The pediatric clinical specialist conducts educational programs, provides consultations, maintains reference materials, monitors pharmacokinetic evaluations, reviews medication communication forms, and assists in developing medication administration procedures. The creation of a pediatric pharmacy and a pediatric pharmacy team that coordinates both dispensing and clinical functions has made it possible to provide comprehensive pharmaceutical services to pediatric patients.

Pharmaceutical-care index for measuring comprehensive pharmaceutical services

Pharmaceutical-care index for measuring comprehensive pharmaceutical services

Pediatric Pharmacy Practice Guidelines. Pediatric Pharmacy Administrative Group Committee on Pediatric Pharmacy Practice

Pediatric patients are unique because of age-specific differences in metabolic capacity, disease processes that may make commercially available pharmaceutical preparations unacceptable for use, a lack of published information on the effects of many new pharmacotherapeutic agents in this population, and changes in population demographics caused by new diseases (e.g., AIDS) and new technologic applications. Comprehensive pharmaceutical services are essential for maximizing the benefits--while avoiding or minimizing adverse effects--of pharmacotherapy and new technologies. Comprehensive pharmaceutical services can help maximize the use of health-care resources in the pediatric population and assist in the development, implementation and evaluation of new methods of treatment that will benefit children everywhere.

Comprehensive pharmaceutical services in the outpatient surgery center of a health maintenance organization

The pharmaceutical services provided to the outpatient surgery center of a health maintenance organization (HMO) are described. The satellite pharmacy is managed by the nearby central pharmacy. The satellite pharmacist prepares and dispenses all needed medications and i.v. admixtures, maintains the inventory of all drugs and i.v. supplies, and supplies clinical and drug information. The pharmacist ensures that i.v. admixtures are made according to guidelines, that drug interactions and drug allergies are guarded against, and that each patient has access to oral pain medications and medication counseling while still in the recovery room. The tighter inventory control created by this arrangement helps to reduce costs, and the surgical nursing staff has been relieved of many medication-related activities. The presence of the pharmacist in the surgery center also allows for more accurate documentation of controlled-drug dispensing. The presence of a pharmacist in the surgery center has ensured strict control of drug use and enabled nurses to spend more time on direct patient care.

ASHP National Survey of Hospital Pharmaceutical Services—1987

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.

Moving toward the provision of comprehensive ambulatory-care pharmaceutical services

Moving toward the provision of comprehensive ambulatory-care pharmaceutical services

National survey of hospital pharmaceutical services—1985

The results of a 1985 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, and 1982. A sample of 809 hospitals was selected randomly from among the estimated 5480 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had an 84.6% response. Fewer than 10% of respondents did not have and were not planning for unit dose systems. The percentage of hospitals with complete or partial pharmacy-based i.v. admixture services increased since 1982 from 67.4% to 80.6%. More than half the respondents said floor-stock i.v. solutions were distributed by a department other than pharmacy. Only about half the respondents had both unit dose drug distribution and i.v. admixture services. Prime vendors were used by 87% of small hospitals, 75% of medium hospitals, and 51% of large hospitals. The percentage of pharmacies involved in patient monitoring increased from 27% in 1982 to 44% in 1985. The survey also collected data on other clinical services, computerization, inventory turnover, use of prime vendors, and selection of therapeutic alternates. Drug distribution services are improving, but the distribution of injectable drugs often is not under pharmacy control. Only 10% of respondents had comprehensive pharmaceutical services, defined as complete unit dose drug distribution and i.v. admixture services plus three or more clinical services.

Comprehensive pharmaceutical services in the surgical suite and recovery room

The operation of a pharmacy satellite located within the operating suite of a large university hospital is described. The satellite provides comprehensive services 24 hours a day, seven days a week to the staff of the operating room (OR), recovery room, and anesthesia department. Kits of anesthetic agents and other drugs used by the anesthetist and surgeon are prepared for each surgical procedure. The pharmacy staff also prepares i.v. admixtures, cardioplegic solutions, and specialized preparations as needed for surgery and provides drugs and i.v. admixture services to the recovery room for postoperative patients. Controlled substances are signed out to the anesthetist as needed in the particular kits and are issued as single doses upon request to the recovery room. All pharmacy charges to patients in the OR are done directly from the pharmacy satellite using a computer charging system. The decentralized pharmacy satellite has substantially reduced drug loss and waste, improved drug delivery to patients, increased revenue for the institution, reduced drug inventory, improved controlled-drug distribution and accountability, improved clinical services, and eased the nursing workload by reassigning drug-related responsibilities to the pharmacy department. The OR pharmacy satellite is a viable cost-effective operation.

Comprehensive pharmaceutical services in a medical intensive-care unit

The clinical and distributive services that have been provided by clinical pharmacists for the past 14 years in the medical intensive care unit (MICU) of a 1600-bed urban teaching hospital are described. The MICU pharmacy staff consists of 4.3 full-time equivalent pharmacists who provide daily 24-hour services. The pharmacists are actively involved in all pharmacological decisions with hands-on control of drug distribution from preparation through delivery and administration. They maintain up-to-date patient medication records and monitoring flow sheets for each patients. The pharmacists identify adverse reactions, formulate contingency plans, and promptly intervene to prevent crises. They provide comprehensive pharmacokinetic services, select drug administration times and routes, and prepare and deliver all medications. All i.v. medications are custom-made to meet the patients' fluid, sodium, or potassium restrictions. The pharmacists set up infusion pumps and select the proper infusion rates for i.v. and intra-arterial drugs. They also recommend and monitor the patients' nutritional support therapy. The program has been well accepted by nurses and physicians; however, only 20% of the inpatient clinical pharmacists desire to work in the MICU. The skills and educational requirements for managing patients in an MICU are discussed. Pharmacists have become an integral part of this MICU by optimal drug therapy, increasing productivity and efficiency, providing prompt and accurate services, and participating in research.

Comprehensive pharmaceutical services for a state correctional facility

A contractual model for comprehensive pharmaceutical services involving a major medical center pharmacy, a university, and a state department of corrections is described. Project goals and methods for the provision of services are described. These include areas of formulary development, inventory management, drug distribution, on-site placement of pharmacy operations, and educational development. Impact of the program was assessed over a 30-month period. Development of policies and procedures for drug use in a correctional setting enabled implementation of a strict patient population-specific drug formulary. Procedural changes resulted in an 83% decrease in on-site drug inventories and a 62% decrease in quarterly drug expenditures. A one-time saving of more than $26,500 resulted from the decrease in on-site inventory, and an annual saving of $44,000 is projected for decreased drug expenditures. All but five controlled substances were removed from the formulary, and only 13 nonprescription items remained in the formulary. An educational course on health care in correctional settings provided exposure for pharmacy students to this new area of institutional practice. The contractual model proved both cost-effective and functional for the department of corrections.