Drug Regimen Review Research Articles

Effect of initiation, termination, and reinitiation of consultant clinical pharmacist services in a geriatric long-term care facility.

The effect of initiation, termination, and reinitiation of consultant clinical pharmacist services of drug regimen review and physician communication on patient drug use in a 72-bed geriatric long-term care facility was assessed at five points in time: initiation, termination, reinitiation, then 3 months and 3 years after reinitiation of services. Both times when the consultant was retained, drug use was cut almost in half (46.1% and 42.7%, respectively), with essentially the same number of established diagnoses per patient at each point in time. Conversely, before the consultant services were initiated, and when the consultants services were terminated, drug use was twice as great as when consultant pharmacist was retained. Regularly scheduled drugs increased 59%, and pro re nata (prn) drug increased 200% during the period between the termination and reinitiation of consultant services. There was also a lower admission, discharge, and death rate as well as higher hospitalization rate when the consultant was retained. It appears that the consultant clinical pharmacist has an impact on drug cost in long-term care facilities that is reversed when drug regimen review is removed and renewed when services are reinitiated.

Pharmaceutical services in hospital-based home health-care agencies–1982

A survey of Medicare-certified hospital-based home health-care agencies was conducted in May 1982 to determine the type and extent of pharmaceutical services provided. A 12-page questionnaire was mailed to 243 directors of U.S. agencies that were identified from a 1976 directory. The questions elicited information about the characteristics of the director and agency, personnel, reimbursement, and scope of services. The overall response rate was 73.7%. Ninety-five percent of the agency directors were nurses. The median patient census of the agencies was 110. All agencies reported offering visiting-nurse services, 92% provided home health-aide services, and 46% offered home hospice services. Ninety-nine percent and 91% reported receiving reimbursement from Medicare and Medicaid, respectively. One fourth of the agencies provided home services that traditionally involve hospital pharmacists, including intravenous therapy (29%), home chemotherapy (18%), and total parenteral nutrition (18%). Although 85% of the agency directors reported using the services of a pharmacist, only 4% actually employed a pharmacist on their staff. The directors viewed educational programs, drug regimen review, and drug information services as the most important functions of pharmacists in home health-care agencies. Although these agencies provided an array of pharmaceutical services in 1982, very few pharmacists were actually employed. Additional studies are needed to re-evaluate the current status of pharmacy involvement in home health care.

Application of federal indicators in nursing-home drug-regimen review

Numbers of medications per patient and rate of drug administration errors were compared in Wisconsin long-term care facilities that used federal indicators in conducting drug-regimen review versus facilities that did not use the indicators. Data were collected from 1132 charts in 24 facilities randomly selected from a state survey schedule for June-October 1982. Both prescription and nonprescription drugs that patients received during the 30-day period preceding the survey were counted. Medication use was compared by facility type--skilled-nursing facility (SNF), intermediate-care facility (ICF), or ICF for the mentally retarded. The federal indicators were used in 10 facilities. Mean number of medications used per patient where indicators were applied (5.4 versus 6.6 for SNFs and 3.4 versus 5.8 for ICFs ) was not significantly different. In SNFs using the indicators, patients received 5.6 medications where the consultant pharmacist was also the provider and 5.2 where the consultant was not the provider. Medication use was not significantly different by facility type. The number of drug administration irregularities per 100 residents was significantly greater where indicators were not applied. Further study is needed to determine whether use of federal indicators encourages more efficient and appropriate drug therapy for patients in long-term care facilities.

Drug Regimen Review Indicators for Skilled Nursing and Intermediate Care Facilities

Drug Regimen Review Indicators for Skilled Nursing and Intermediate Care Facilities

Abrams Emphasizes Steps to Improve Drug Regimen Review in Long-Term Care Facilities

Abrams Emphasizes Steps to Improve Drug Regimen Review in Long-Term Care Facilities

Drug Regimen Review in Skilled Nursing Facilities by Consulting Clinical Pharmacists

The organization and operational methods of clinical pharmacists providing contractual pharmaceutical services in skilled nursing facilities (SNFs) are described, and the use of a model toidentify drug therapy problems is analysed. A group of clinical pharmacists incorporated as Clinical Pharmacy Consultants (CPC) provided consultative services through contractual agreements with pharmacy vendors or SNF administrators. Using a drug regimen review model designed by CPC, the consulting pharmacists reviewed 13,081 medical charts at 10 SNFs. Of the reviews, 928 (7.1%) indicated potential or real drug therapy problems; on an annual basis this corresponds to approximately eight drug therapy problems per 10 beds per year in an SNF. About 60% of the problems could be attributed either to prescribing of medication with no documented indication (23.9%) or to lack of objective data for monitoring drug therapy effectiveness (34.6%). Because these problems are related to disease state management, it was concluded that consulting clinical pharmacists could help to improve patient care in SNFs, primarily through drug therapy review and staff consultation.

Saving Cost, Quality and People: Drug Reviews in Long-Term Care

Monthly drug regimen reviews by pharmacists can save patients from medication errors and can save taxpayers money.