On-site Pharmacy Research Articles

Reaching out in Richmond

Reaching out in Richmond

Know Your Audience

To identify the chief complaints and demographics at Clinica Esperanza, a student-run free clinic for an underserved Hispanic population. A retrospective chart review of patient files from 2005 through 2010 was undertaken, as approved by the University of Tennessee Health Science Center's Institutional Review Board. From 2005 through 2010, Clinica Esperanza fielded 2551 patient visits, consisting of 951 unique patients, 609 females and 342 males. Mean age was 34 years, and 60% of patients presented once, while 13% followed up for 1 year, 9% for 2 years, 6% for 3, 6% for 4, and 4% for 5. "Pap smear," "abdominal pain," and "follow-up lab results" ranked, in order, as the 3 top chief complaints. Resulting data have led to several improvements. The clinic has remained open weekly to improve patient continuity. With the top 10 chief complaints identified, they are better addressed. More funding is allocated for speculums and proper training of Pap smear technique. Systematic reporting of lab results is being implemented. Physical therapists and pharmacists now participate to address musculoskeletal and medication-based needs, respectively. A volunteer gastroenterologist has been recruited to provide specialized care for abdominal pain. An electrocardiogram machine is now used to evaluate chest pain. To improve student-patient communication, online language learning modules have been created. Based on these data, improvements in health care services have been made, including better continuity, emphasis on top chief complaints, and provider education in medical Spanish. Future plans include on-site pharmacy, smoother referrals, and similar clinics on the University of Tennessee Health Science Center's other campuses.

Impact of Pharmacists and Student Pharmacists in Educating and Screening Low-Income Women for Cardiovascular Disease

Objectives: To evaluate the effectiveness of an educational intervention on knowledge of cardiovascular disease (CVD) and to increase awareness of risk factors among female patients of a community health center with an on-site 340B pharmacy.
 Methods: The program consisted of a 10-minute educational intervention and brief pre-test, post-test, and participant satisfaction survey. Adult female patients at the clinic for any provider visit or prescription fill were eligible to participate. Participants met individually with a student pharmacist or faculty member and verbally completed the pre-test. The participant received education regarding CVD, risk factors, and symptoms of myocardial infarction and were screened for hypertension and/or hyperlipidemia. The post-test was then verbally administered. Participants answered the satisfaction survey privately. Based on individual needs, educational materials and information on available pharmacy clinical services were provided. The university IRB deemed the study exempt.
 Results:Eighty-four individuals received educational materials and/or a screening test. Of those, 30 women (mean age 46.9 years) completed the educational intervention. Thirteen (43%) reported smoking; 22 (73%) identified themselves as overweight. Fourteen (47%) indicated a preexisting diagnosis of hypertension. Correct responses for 6 of 8 knowledge-based questions were statistically significantly improved from pre-test to post-test (p
 Conclusion: CVD is the leading cause of death in U.S. women. Data from this program indicate that through screening and education, pharmacists and student pharmacists can impact female patients' knowledge of CVD risk factors. Continued efforts in this area may help to reduce the public health burden of CVD.
 
 Type: Student Project

Medical care delivery at the Inaugural Youth Olympic Games Singapore 2010

ContextMass gatherings such as the Youth Olympic Games require medical services for large populations with special needs specific to elite competitive youth athletes. The location of the Games in a...

Prescription Drug Abuse & Diversion: Role of the Pain Clinic

The goal of this research is to better understand the role that South Florida pain management clinics may be playing in the abuse and diversion of prescription drugs. This study explores 1) the characteristics and practices of pain clinics that may be facilitating the drug-seeking endeavors of prescription drug abusers and 2) the drug-seeking behaviors of prescription drug abusers who use pain clinics as a primary source for drugs. Thirty in-depth interviews were conducted with prescription drug abusers in South Florida. Interviews were transcribed verbatim and codes were generated based on thematic analyses of the data. Using grounded theory strategies, the analysis revealed six main themes: "pill mills", on-site pharmacies, liberal prescribing habits, "sponsoring" drug diversion, pain doctor/pharmacy shopping, and faking symptoms/documentation. These findings should provide insights for law enforcement, regulatory agencies, and industry as they attempt to develop appropriate policy initiatives and recommendations for best practices.

Ethics and the Latest LTC Pharmacy Issues

Ethics and the Latest LTC Pharmacy Issues

Jousting with windmills? The quest to achieve our quality aspirations in pharmacy practice

2focuses on the principles of continuous quality improvement (CQI) using measures of quality to improve patient care and describes a model to implement a CQI program in your pharmacy or institution. He explores the purposes of measuring quality and speculates on how performance indicators might be used to shape the evolution of pharmacy practice through the use of pay-for-performance incentives, benchmarking, and report cards. Kelly and Clancy 3 from the Agency for Healthcare Research and Quality share the twin goals of the agency: improving quality of care and enhancing patient safety. They urge pharmacy professionals to defend the helpless by aiding older Americans to make better health care decisions. The experience of one supermarket chain shows how this might be done—by integrating onsite pharmacy resources with a local statewide managed care organization to conduct health risk appraisals of the supermarket’s employees. 4

Joint-Effort Clinical Pharmacy Services in Rural Hospitals

Studies in the literature support the practice of having clinical pharmacists work in direct patient care and the value of these services within the health care system.1,2 Although most pharmacists want to provide pharmaceutical care in collaboration with other health care professionals, some hospitals lack the staff that would be necessary. In Canada, the burden of a recently documented shortage of pharmacists3 has been felt across the country, but it has also prompted the innovative use of pharmacy technicians and expansion of their role.4-6 For example, some rural hospitals have empowered pharmacy technicians to fulfill medication dispensing requirements in rural settings, without on-site pharmacists. A clinical pharmacy technician has been described as a technician who takes on the clerical responsibilities of the pharmacist7 (including medication historytaking, 6 drug-use evaluation, investigational drug services,4 and clinical management tasks5), thereby allowing the pharmacist to provide more clinical services. Most experiences with this practice model have been in larger centres where pharmacists are on site.4-6 Rural centres present a unique opportunity to enhance patient care at sites where a pharmacy technician is present but clinical pharmacy services would not otherwise be possible. This model may free up pharmacist time for other tasks, enhance patient care, increase the number of proactive interventions by an off-site pharmacist, and increase utilization of pharmacy technicians’ skills at a time when pharmacists are in short supply. With direction and training, technicians would be able to alert nurses to potential pharmaceutical problems and triage problems for the clinical pharmacist (i.e., assign values to problems and alert the pharmacist according to their severity and urgency). Technicians would also be able to collect information more efficiently, giving off-site pharmacists more time to review patients at their own sites. A project was conceived whereby an off-site pharmacist would work with on-site pharmacy technicians to provide clinical pharmacy services intended to optimize patient care. The purpose of the project was to increase and assist with pharmacists’ clinical interventions by educating pharmacy technicians to identify clinical pharmacy problems and collect patient information.

Establishing an on-site pharmacy in a community health center to help indigent patients access medications and to improve care.

To describe the establishment of an on-site pharmacy in a community health center (CHC) to improve access to medications for indigent patients, the implementation of pharmaceutical care programs and clinical pharmacy services to improve patient care and therapeutic outcomes, and the development of an ambulatory care site for training pharmacy students. Partnership Health Center (PHC), a federally funded CHC in Missoula, Mont. Establishment of an on-site pharmacy and strategies for accessing medications for indigent patients, including participation in the U.S. Public Health Service pricing program, pharmaceutical manufacturers' assistance programs, and drug sampling, are described. The clinical pharmacy, disease management, and pharmaceutical care programs developed at the site to improve medication use and therapeutic outcomes are discussed. Development of an ambulatory care clerkship site at the CHC for training University of Montana pharmacy students is reviewed. Partnership between PHC and the University of Montana School of Pharmacy and Allied Health Sciences (SPAHS) to establish an on-site pharmacy to help medically indigent patients access medications and to improve care. Programs to help indigent patients access, adhere, and appropriately use needed medications while decreasing clinic expenditures for medications. Number of prescriptions dispensed per month, clinic expenditures on medications per month, and number of clinical services and pharmaceutical care programs developed. Between November 1, 1999, and April 30, 2000, the average number of prescriptions filled for PHC clients increased from 219/month to 838/month and the average expenditure per prescription decreased from $16.55/month to $0.51/month. A pharmacist-assisted refill program was implemented. Programs in diabetes, hypertension, dyslipidemia, asthma, anticoagulation, and peptic ulcer disease were developed. Establishing an on-site pharmacy in a CHC in collaboration with a school of pharmacy significantly improved indigent patients' access to medications while decreasing clinic expenditures. Pharmaceutical care programs improved therapeutic outcomes, and clinical pharmacy services complemented the clinical activities of other health care providers in managing chronic diseases and resolving drug-related problems. The CHC provided an excellent setting for training pharmacy students in ambulatory care.

Patterns of service use in a continuing care retirement community.

The authors analyzed the use of 16 onsite services reported by 91 residents of a new continuing care retirement community (CCRC). The most frequently used services appear to be those of convenience to the residents, including an onsite pharmacy, insurance billing, and a bank, as well as health and fitness services. Perceived health and multiple illnesses were associated with greater use of health and auxiliary health/fitness services, whereas age and marital status were not. In addition, respondent reports of spouse service use predicted respondent service use, whereas measures of social connectedness and friendship did not. Community service use before relocation to the CCRC was predictive of total CCRC service use only in unmarried respondents, demonstrating the complex nature of the relationship between informal support and the use of formal services. The behavioral model appears to be applicable to the study of CCRCs.

Clinical pharmacy--a hospital perspective.

All large acute hospitals have an on-site pharmacy department which has the key purpose of ensuring that patients can receive the right medicine at the right time by an efficient and economical system. Today most pharmacists would agree that they have a wider responsibility in ensuring that they apply pharmaceutical expertise to help maximise drug efficacy and minimise drug toxicity [1]. This concern of pharmacists for the outcome of treatment in an individual patient, which has developed in the UK over the last thirty years, characterises the practice of clinical pharmacy and has led to the concept of pharmaceutical care [2] as the description of the role of the pharmacist in patient care. Clinical pharmacy is not practised in a uniform manner in UK hospitals, a reflection of the diversity of pharmacy practice in general found amongst our hospitals. The input to patient care for example does vary, in some hospitals there are ward based pharmacists who practice as key members of the clinical team whilst in others a pharmacist may visit the wards on an irregular basis [3] to review medicine charts and promote formulary policies. This lack of consistency applies not just to clinical pharmacy, but is true of pharmaceutical services such as intravenous additive services, discharge planning services and almost all aspects of pharmacy services. The absence of central direction by the profession and by the Department of Health has enabled this diversity to flourish. Each major hospital’s service has developed in a way favoured by its pharmacy staff. Strong leaders have developed their own style of service varying from a supply orientated to a patient orientated service. They have frequently been more concerned with promotion of pharmacy within the hospital as opposed to disseminating information on service improvements to their colleagues. A result of this is that any benefits to patients from a new approach to service provision developed in one hospital, may not be realised by other pharmacy departments without a long lag time. Implementation of evidence based improvements in pharmacy practice could be accelerated if a more open approach to dissemination and promotion of developments was adopted by pharmacists.

Formulary Management by an On-Site School of Pharmacy Faculty Member in a Medicaid Managed Care Organization

The value of medication formularies and the use of restrictions to generate cost savings in the pharmacy budget have created controversy in pharmacy. Managed care organizations (MCOs) often use pharmacy benefits managers to manage pharmacy claims and provide clinical pharmacy services. For the Medicaid population, a drug formulary designed for commercial insurance plans may not be the optimal mechanism to decrease drug costs while maintaining quality care. This Medicaid MCO utilized an onsite pharmacy faculty member with support from experts from the Department of Clinical Pharmacy to manage the medication formulary. The faculty member developed the formulary utilizing the most cost-effective drugs within each drug class to coincide with drug usage guidelines developed from the medical literature and based on the expertise of the clinical pharmacist. The purpose of this study was to evaluate the effectiveness of this method of formulary management in regard to drug costs and effects on utilization in other areas such as emergency room visits and hospital discharges. Over the evaluation period of 12 months, an on-site faculty member of the Department of Clinical Pharmacy of the School of Pharmacy, University of California at San Francisco, managed the medication formulary and provided clinical pharmacy services for this Medicaid MCO, a county-organized health system in California with approximately 36,000 members with pharmacy benefits. A measure of formulary restrictiveness was used to compare the formulary before and after changes made by the faculty member. Overall drug costs were compared for the fiscal year before the faculty member started (1995-1996) and the fiscal year after the faculty member started (1996-1997). As a measure of the potential impact of formulary changes on the quality of care within the MCO, the total number of emergency room visits and hospital discharges for all reasons also were examined. Formulary restrictiveness, as measured by two commonly prescribed drug classes, increased as a result of changes made to the formulary by the pharmacy faculty member. Drug costs per member per month (PM PM) for the MCO remained constant from the fiscal year before the faculty member started (1995-96) to after (1996-97), an estimated $65,000 per month below the projected budget and despite inflation in the costs of pharmaceuticals. Utilization in other areas as measured by the per member per year (PMPY) rates for emergency room visits and inpatient hospital discharges were not affected by increased restrictiveness in the medication formulary. Using an on-site pharmacy faculty member to manage the drug formulary and provide clinical services for an MCO has resulted in no increase in drug costs, with stable utilization in areas such as emergency room visits and hospital discharges. The medication PMPM costs remained essentially unchanged from fiscal years 1995-96 to 1996-97 despite inflation and the utilization of a more restrictive formulary. A pharmacy faculty member was able to effect these changes not. Only without dependence upon pharmaceutical manufacturer rebates and contract restrictions, but also while utilizing the most cost-effective medications as determined by evidence-based pharmaceutical protocols substantiated by the current medical literature.

A description of a pharmacotherapy curriculum in a university-based family medicine program.

To describe the methods by which a family medicine residency program implements a pharmacotherapy curriculum. The goal of the curriculum is to teach family medicine residents the principles of rational drug therapy. A university-based family medicine residency program. TEACHING STRATEGIES: Specific learning objectives are discussed and the following teaching strategies are expanded upon: (1) monthly noon conferences; (2) a printed formulary and pharmacotherapy handbook; (3) a pharmacy and therapeutics committee; (4) policy statements for drug representatives and use of samples; (5) an on-site pharmacy; (6) quarterly newsletter; and (7) inpatient consultation coverage. PHARMACIST ROLE: The role and responsibilities of the pharmacy faculty and pharmacist(s) who implement this curriculum and the methods used to evaluate its effectiveness are also described. The availability and funding of the pharmacy faculty member can sometimes be arranged with local schools of pharmacy seeking clerkship sites. Interaction with pharmacy students also serves to enhance the educational experience of the family medicine residents. The family medicine program implements a comprehensive curriculum designed to teach family medicine residents the principles of rational drug therapy. The curriculum may be expanded upon as necessary, or, if the entire program is not feasible, certain elements may be extracted and applied in other institutions.

Otrech health service for street youth

A voluntary health agency operated a clinic at a drop-in center for street youth. Six hundred nine youths were seen, with an average age of 16 years, 9 months. There were 2,086 diagnoses made during 1,895 visits. Respiratory, dermatologic, and gynecologic problems represented 56% of all diagnoses. Pregnancy tests accounted for 38% of all procedures, 50% of all medications dispensed were either oral antibiotics or decongestants, and 17% of the visits resulted in referrals. This chart review revealed that street youth seen at a drop-in center sought care for common medical problems. Problems related to substance abuse and sexually transmitted diseases were seen much less frequently than anticipated. Elements critical to the success of this clinic included its on-site location, hours of operation when teenagers were using other services, close working relationships between clinic and center staffs, the capability to perform a few simple laboratory procedures, and an on-site pharmacy.

In Reply: Office-Based Medication Dispensing: Another Consideration

It would appear that the use of manpower resources of a local school of pharmacy to staff an on-site office pharmacy is a creative solution to an area of inadequate patient services. This model might be considered by others to be an excellent alternative to dispensing vs no provision of convenient medication services to patients.

Documenting Outpatient Problem Intervention Activities of Pharmacists in an HMO

The outpatient drug use review experiences by pharmacists at a large health maintenance organization with on-site pharmacies were investigated. Pharmacists were asked to document the nature of potential drug therapy problems encountered, drug involved, review activities undertaken, and process-outcomes. Patterns of pharmacists intervention were observed over 1 year. Results indicated that the number of problems detected increased substantially during the months immediately following the introduction of problem recording and feedback procedures. During the latter months, the number of prescriptions with problems approximated 4 per 100 dispensed prescriptions. Drug interactions of a moderate nature and drug underuse were the most frequent problem types encountered. Most were not serious and usually resulted in a cautionary or counseling message given to patients by pharmacists. The next most frequently occurring type was drug overuse problems, and, after that, problems concerning some aspect of the prescribing decision. In 9 per cent of all problem interventions and in 44 per cent of prescribing-problem interventions, the outcome of the pharmacist intervention was a change in drug, strength or directions for use. The average amount of pharmacist time per problem intervention varied from 6.0 to 7.8 minutes across problem types. This approximate a pharmacist labor cost of $0.06 per dispensed prescription, given a problem encounter rate of 4 per 100 dispensed prescriptions.