Pharmacist In Charge Research Articles

Health plan starts P4P program for community pharmacies

Health plan starts P4P program for community pharmacies

The pharmacist’s personal IMPACT

At all of the diverse Project IMPACT: Diabetes sites, pharmacists are having firsthand experience with the effectiveness of personal contact with patients. By encouraging patients to adhere to their medications, helping them navigate the tricky waters of the health care system, or simply listening to their concerns, pharmacists can make a difference just by their presence.

Adherence of Community Pharmacies in Riyadh, Saudi Arabia, to Optimal Conditions for Keeping and Selling Good-Quality Medicines

Exposure to excessive temperature during distribution or storage has unfavorable consequences on the quality of medicines, particularly in hot climates. This could be one of the possible reasons behind the existence of substandard amoxicillin in community pharmacies in Riyadh, Saudi Arabia. This study explored the conditions under which medicines were kept in a random sample of 181 community pharmacies in Riyadh. The pharmacist in charge in each pharmacy was interviewed and our observations about the quality of storage were recorded. The inspection revealed that in 9% of the sample the readings of the existing room thermometers were >25℃, and that 13% of the sample lacked thermometers. Also in 33% of the sample the readings of the refrigerator thermometers were outside the accepted range, and 7% of the sample lacked refrigerator thermometers. About 15% of pharmacists were not informed about the local regulations of community pharmacy practice, neither before nor after taking up their current positions. Surprisingly, incorrect answers to simple questions about the system were frequently given by the informed pharmacists. Certain aspects of substandard storage conditions existed, in varying degrees, in significant percentages of pharmacies regardless of the pharmacists’ qualifications, experience, or awareness about the local regulations of community pharmacy practice. Stricter monitoring by the authorities regarding the adherence of community pharmacies to optimal conditions of storing medicines is recommended. Continuing education of community pharmacists must also be improved.

SY8-5 - Patient-Reported Adverse Events

ABSTRACT Patient-reported outcome is recently regarded as an important matter in chemotherapy. Although evaluation of quality of life (QOL) is adapted to clinical trials, it is not applied to practical settings so far. Precise evaluation of adverse events, therefore, is necessary to continue chemotherapy effectively and safely, especially in outpatient clinic. Adverse event is commonly evaluated objectively by physicians, nurses or pharmacists using Common Terminology Criteria for Adverse Events (CTCAE). However, patient–physician agreement is reported to be difficult to get in evaluation of QOL, even if in evaluation of single symptom such as fatigue, nausea, appetite loss etc. We have developed the mark-sheet system to evaluate and record patients' adverse events by themselves. Evaluated items on the mark sheet are set according to the cancer site and chemotherapy regimen. Each item is graded into 4, and the text of each grade was created referred to the CTCAE by the members of the Chemotherapy Center in our hospital. It is handed to a patient on the first day of the cycle of chemotherapy, and he starts checking the items on the mark sheet every day in the cycle. Before the consultation on the first day of the next cycle, he scans his mark sheet at the Chemotherapy Center. It is printed out and is sent to the physician, the nurse and the pharmacist in charge. We think this system leads to the better compliance of the patients and the efficient consultation.

Taking over as ‘pharmacist in charge’

Taking over as ‘pharmacist in charge’

Quality of Life and Job Satisfaction of Dispensing Pharmacists Practicing in Tehran Private-sector Pharmacies.

As there is no evidence of previous studies on evaluating the level of job satisfaction and the major causes of dissatisfaction among the pharmacists in Iran, this study was designed. This study is a cross-sectional descriptive analysis of pharmacists practicing in Tehran private-sector pharmacies. We selected a stratified random sampling using number of prescriptions as a variable for stratification. The questionnaire was divided into three sections containing the demographic characteristics, general health perception and job satisfaction. Of all the participants, 62% were the owners of pharmacies and 38% were pharmacists in charge (non-owner). Seventy-eight percent of respondents reported satisfaction about their psychological and physical state. Just 11% of pharmacists were financially satisfied and 49% felt relaxed at the workplace. There was no correlation between the satisfaction and owning the pharmacy or sex of respondents. Spearman›s correlation showed that the income satisfaction correlated negatively with age (p ≤ 0.001) and years of experience (p < 0.05). Moreover, the average working hours was significantly higher among men compared to women (p < 0.01) and among owners relative to non-owners (p < 0.05). Overall, general health perception and quality of life among the respondents were at satisfactory level. However, work-related satisfaction was not high enough and most interviewed pharmacists were financially dissatisfied.

Access to multilingual prescription labels and verbal translation services in California

Background The number of patients with limited English proficiency is on the rise in the United States, and conveying medication information to these individuals in an effective manner is crucial to improve adherence and reduce medication errors. Objectives To examine (1) self-reported capability for and actual provision of prescription labels or verbal medication information in languages other than English by California pharmacies and (2) characteristics of pharmacies that provide such services. Methods In this cross-sectional, observational study, pharmacists in charge at 552 randomly selected retail pharmacies throughout California (US) were interviewed by phone. The main outcome measures of the study were number of pharmacies that could and did provide multilingual labels (MLs) and/or offer medication information verbally in the patient’s preferred language. Chi-square tests and multivariate logistic regression analysis were used to determine associations between availability of MLs and verbal translation services and the demographic characteristics of pharmacies. Results Approximately, 69% of the pharmacies surveyed could provide MLs, and 67.9% did provide MLs routinely on patient request. Verbal translation of labels or other medication information such as leaflets, pamphlets, and guides was offered to patients who requested it in 82.4% of pharmacies. Chain pharmacies reported a significantly higher capability to provide MLs than independent pharmacies (Adjusted odds ratio [AOR] = 0.28; 95% confidence interval [CI] = 0.19, 0.42; P < .0001). Pharmacies located in rural areas reported higher availability of MLs (AOR = 5.02; 95% CI = 2.00, 12.6; P < .001) than pharmacies in urban areas. Pharmacies with higher number of estimated limited English proficient (LEP) patients reported higher availability of MLs (AOR = 1.03; 95% CI = 1.02, 1.05; P < .0001) and verbal translations (AOR = 1.07; 95% CI = 1.03, 1.09; P < .0001). Conclusions There exists an unfulfilled need for providing MLs and/or verbal translations to LEP patients. Pharmacists and health care providers can fill this need to ensure appropriate medication usage and adherence and consequently reduce medication errors in this population.

Community pharmacy services to drug misusers in the south west of England: results of the 2003–2004 postal survey

Abstract Objectives To quantify current levels of methadone dispensing and supervised consumption for the treatment of drug misuse in community pharmacies in the south west of England. To compare 2003–2004 data to estimates made in 1995. Setting All community pharmacies in the strategic health authority areas of Avon, Gloucestershire and Wiltshire; Dorset and Somerset; and South West Peninsula (n = 903). Method A self-completion postal questionnaire was addressed to the ‘pharmacist in charge’, with up to three reminders. Descriptive data were collected on demography and drug misuse services provided by the pharmacist. Key findings An overall response rate of 78.3% (707/903) was achieved. Of all respondents, 69.2% (n = 489) dispensed methadone for the treatment of drug misuse, and 70.1% of these pharmacies (n = 343) reported providing a supervised methadone consumption service. The total number of clients receiving methadone through pharmacies in the south west was 3427, with a mean number of 7.0 clients per pharmacy; 49.5% of all clients receiving methadone had their daily doses supervised by the pharmacist. The majority of prescriptions issued for methadone (72.9%, n = 2503) were from general practice. Conclusions The majority of pharmacies (69.2%) in south west England dispense methadone and other drugs to drug misusers with just under half of the clients (49.5%) receiving their methadone by supervised consumption.

Medication therapy management services in West Virginia: Pharmacists' perceptions of educational and training needs

Background The Medicare Modernization Act of 2003 recognizes the challenges associated with drug therapy in elderly patients with multiple chronic diseases, and requires the development of medication therapy management services (MTMS) for such beneficiaries. Objective To assess pharmacists' perception of educational and training needs necessary to implement MTMS in community pharmacies in West Virginia, USA. Methods Self-administered mail surveys with an explanatory cover letter were mailed to the designated pharmacist-in-charge (PIC) of each licensed community pharmacy (506) in West Virginia. Main outcome measures included pharmacists' comfort level, perceptions of value to patients, barriers to provision of services, and pharmacists' interest in receiving education and training related to MTMS. Results Of the 503 surveys that were deliverable, 203 (40.4%) usable responses were received. Fifty-five (27.1%) PICs reported that MTMS are currently being provided in their pharmacy. Respondents were likely to use services that aid in the development of MTMS and disease-state management, felt relatively comfortable in providing MTMS, and had a favorable view of the value of services to patients, but reported that lack of time tended to be a barrier. Conclusion PICs in West Virginia are interested in and open to their pharmacists receiving education and training for implementation of MTMS.

Management of drug-interaction alerts in community pharmacies

Drug-interaction alert systems are commonly used in community pharmacies to identify potential drug-drug interactions. However, depending on the software default setting, pharmacists may override alerts because they are too numerous. We explored the handling of drug-interaction alerts by community pharmacies in Switzerland. Data were collected by 15 trained pharmacy students in 15 Swiss community pharmacies. The medication history and the drug-interaction alerts of 600 patients who had >or=2 drugs on prescription were assessed, and the pharmacists in charge were interviewed about their management of drug-interaction alerts. In the 15 pharmacies studied, the computer systems were programmed to flag only 'severe' drug interactions in four, 'severe or moderate' in six or 'severe, moderate or minor' in five pharmacies. The median frequency of drug-interaction alerts increased with decreasing default severity level from 0.5 to 40, respectively, to 76 per 40 patient visits and pharmacy. Because of these default settings, 277 (35 x 2%) of 787 potential drug-interaction alerts on new or repeated prescriptions were overridden by the computer systems. Only 256 (32 x 5%) of 787 potential drug interactions emerged from new prescriptions. The alert systems produced 656 alerts of which 146 were irrelevant because of multiple alerting of the same interaction or of drug combinations currently no longer taken. Of the 510 remaining relevant drug-interaction alerts, 289 (56 x 7%) were overridden by community pharmacists without any action taken. If the pharmacist took care of a patient's prescription him- or herself (as opposed to just controlling a prescription after a technician took care of the patient), fewer drug-interaction alerts were overridden by the pharmacist [Odds ratio (OR) 0 x 6, 95% confidence interval (CI) 0 x 42-0 x 98; P=0 x 042). Technical overrides (by default settings) and pharmacists' overrides together accounted for 71 x 9% (566 of 787 potential drug interactions). Of the remaining 211 interactions alerts, 87 (41 x 2%) were checked more closely by consulting the literature, contacting the prescribing physician or discussion with the patient. This led to 55 (63 x 2%) interventions (close monitoring, adjustment of dose or ingestion time, therapy stop or switching to alternative therapy). Determinants associated with action taken after an interaction alert were potential high severity (severe or moderate) (OR 3 x 34, 95% CI 1 x 77-6 x 31; P<0 x 001) and alert flagged for the first time (OR 3 x 76, 95% CI 1 x 98-7 x 14; P<0 x 001). All severe potential drug interactions (n=10) generated an alert and all caused an intervention. Pharmacists override a substantial proportion of drug-interaction alerts of minor or moderate potential severity by ignoring them or by programming the system to only flag drug interactions of potentially high severity. More sophisticated systems with improved sensitivity and specificity are required. Until these become available, it is important to ensure that at least potentially severe drug interactions are not missed; a goal that seems to be largely achieved.

Inventing the randomized double-blind trial: the Nuremberg salt test of1835

Inventing the randomized double-blind trial: the Nuremberg salt test of1835

Prevalence of Compounding in Independent Community Pharmacy Practice

To determine the extent of prescription compounding in independent community pharmacies and identify factors that influence the decision of independent pharmacists whether to provide compounding services. Cross-sectional survey. Illinois, Missouri, Kansas, and Iowa. 370 pharmacists in charge. Anonymous questionnaire mailed in January 2005. Percentage of pharmacies that provide compounding; percentage of dispensed prescriptions that require compounding; factors contributing to decisions whether to provide compounding service. Overall, 94% of respondent pharmacies provided compounding services at the time of this survey. Prescriptions that required compounding represented less than 1% of total prescriptions for the majority (58.3%) of respondents. The main reasons for the decision to provide compounding service were wanting to provide full pharmaceutical care to patients (73.8% of compounders) and responding to requests by prescribers (48.7%). Pharmacies that did not provide compounding service cited the main reason as not receiving prescriptions that required compounding (63.6% of noncompounders). Compounding remains a component of pharmacy practice in the independent community setting. Prescriptions that required compounding represented 2.3% of all prescriptions dispensed by compounding pharmacies.

AEDs Availability and Professional Practices in Delivery Outlets in a City Center in Southern Vietnam

In developing countries, from 80 to 90% of the people with active epilepsy do not have access to treatment. A multitude of factors such as nonavailability of antiepileptic drugs (AEDs) contributes to the treatment gap in epilepsy. Our study carried out in 2003 in southern Vietnam showed that 57% of pharmacies had AEDs. A majority of these pharmacies were located in specific areas like market area or hospital area. The pharmacist in charge was present in only 24% of the pharmacies. The different kinds of AEDs available were carbamazepine (94%), phenytoin (61%), valproate (56%) and diazepam (16%). The maximum stock of a drug was two box. The availability of AEDs in southern Vietnam can be regarded as sufficient but does not allow an adequate treatment for a long time. An effort must be made to sensitize professional health workers to decrease the treatment gap in epilepsy.

Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany

To investigate a new method for evaluating counselling performance of staff in community pharmacies and to assess the quality of patient counselling. Trained pseudo customers, instructed to play their role according to two different self-medication scenarios, visited voluntarily participating community pharmacies in Berlin. After documenting the counselling process, immediately after each visit, outside the pharmacy on an assessment form, the pseudo customer re-entered the pharmacy and gave detailed performance feedback to the counsellor and the pharmacist in charge in order to provide support for improving counselling skills and practice behaviour, when appropriate. This was followed with a written summary of the general performance of all participating pharmacies and additional individual feedback and suggestions for improvement. Educational needs were identified for subsequent performance-based educational strategies such as group-workshops, team-training and on-site team-coaching. Forty-nine community pharmacies in Berlin volunteered to participate in this pilot study. Ninety-eight per cent of the participating pharmacies offered advice. However, in 36% of the cases, advice was only given on request. The different types of scenarios--presentation of a symptom or request for a specific product--made a great difference to the spontaneity of questions and advice. At least one question to check on accuracy of self-diagnosis was asked in 95% of the cases of symptom presentation but in only 47% of the cases of specific product request. Information on appropriate self-medication was provided on at least one item in 74% of pseudo customer visits, but most of the time the information was not sufficient. Communication skills (nonverbal elements, comprehensibility etc.) were very good or good in 54% of the visits. Potential for improvement was mainly in relation to the use of open-ended questions to gain more information and on counselling about appropriate self-medication. Direct feedback was given in 96% of the pharmacies (one person refused to accept feedback and one feedback had to be postponed because of time shortage). All of the participants regarded counselling as an important subject in pharmacy practice. The pseudo customer method was successfully used in this study of German community pharmacies. It was shown that pseudo customer visits and performance feedback following the counselling process, were feasible in daily practice and well accepted by the participants. A training program, focussing on areas in most need of improvement, has been developed. The promising results have led to the Federal Chamber of Pharmacists in Germany adopting this method as part of a continuous quality improvement program in community pharmacies.

Factors related with prescription requirement to dispense in Spain.

To identify factors associated with prescription requirement to dispense. We carried out a cross-sectional study on a sample of 166 pharmacists in North-West Spain. The following independent variables were collected through a personal interview: pharmacist's education and speciality, characteristics of the pharmacy, and its socio-economic environment. We constructed multiple regression models using as dependent variables: requirement of prescription to dispense five drugs which have to be dispensed with a prescription; and opinion on whether a prescription should be required to dispense these drugs. The response rate was 98.8%. A proportion of 65.9% of pharmacists dispense antibiotics without any prescription. This proportion is 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for ACE inhibitors, 13.4% for benzodiazepines and 84.8% for oral contraceptives. A higher requirement prescription was found to be associated with the antecedent of a speciality training of the pharmacist (p = 0.028) and his or her age (p < 0.001). A low prescription requirement is associated with the condition of being owner of the pharmacy (p = 0.032), with a high economic level of the population attended (p = 0.016) and with the size of the pharmacy (p = 0.045). The proportion of pharmacists who dispense drugs without a prescription is extremely high. Our results suggest that in order to increase quality of dispensing, it is necessary to increase pharmacist education and direct efforts of awareness primarily at pharmacists in charge, who are young and work in large pharmacies.

¿Comprenden los pacientes el tratamiento antibiótico prescrito?

To assess to what degree patients who had been prescribed an antibiotic understand the dose and duration of the prescription. Descriptive, cross-sectional. Primary care in Toledo. People over 18 who attended 10 pharmacies in Toledo with an antibiotic prescription in April and May 2000. The prescriptions were dispensed by a pharmacist in charge at each establishment. After receipt of the prescription, the patient was asked about the dose of the drug prescribed. This was then compared with the instructions on the drug. 155 women and 163 men made up the sample, with an average age of 46.42 (SD, 17.2). The most commonly prescribed antibiotics were: a) amoxycillin (24.2%), 2) amoxycillin-clavulanic acid (18.2%), and c) ciprofloxacin (10.6%). 63.2% of those interviewed remembered correctly the dosage prescribed without having to consult any kind of instruction, whereas 17.6% did need to consult instructions. 33% brought instructions written by the doctor. The average age of those who answered incorrectly was 52.8; and of those who answered correctly, 44.9 (p < 0.01). There were no significant differences between men and women. There is an important number of patients, especially older ones, who have not received or have not understood the instructions received from their doctor.

Pharmacy personnel and fever: a study on perception, self-care and information to customers.

To study the fever perception and self-care of pharmacy personnel as well as the information given to customers about the management of fever problems, a random sample of 152 Norwegian pharmacists and 150 pharmacy technicians were interviewed, in 1989, by a national opinion poll company. One-third thought that body temperatures between 39.0 degrees C and 40.5 degrees C could be life-threatening. Of all respondents 24% (33% of technicians, 16% of pharmacists) assumed body temperatures to be rising when sweating accompanied fever. In cases of common cold or influenza accompanied by fever 56% of the personnel would use antipyretics. 7% Of the staff (14% of technicians, 1% of pharmacists) believed penicillin to be effective against viral infections. Antipyretic drug preferences were consistent, but a wide range of perceptions was revealed, in particular with respect to start of antipyretic therapy and seeking medical care for children. Undergraduate and postgraduate education of pharmacy personnel should aim more at satisfying the demand for information of the general public and focus more on the symptomatic treatment of fever and minor illness in general. Pharmacists in charge have a special responsibility in counselling their assistants.