Pharmacy practice in a chemical-dependency treatment center

The role of a pharmacist in a chemical-dependency treatment center is described. A pharmacist joined the staff of an outpatient methadone maintenance and chemical-dependency clinic at the request of the clinic's medical staff. In addition to the standard dispensing role, the pharmacist provides drug information, counsels staff and patients, and serves as the medical clinic coordinator. The pharmacist is also responsible for taking medical and drug-use histories, initially evaluating the degree of chemical dependency, assisting in the development of drug therapy plans for chemically dependent patients, and monitoring the effect of prescribed regimens. Other duties include serving as a health educator within the community and as a preceptor for baccalaureate and Doctor of Pharmacy students during substance abuse clerkships, and consulting on the management of chemically dependent patients who are hospitalized for other illnesses or specific conditions. The pharmacist's knowledge of pharmacotherapy and drug products and skill in assessing and managing problems related to substance abuse allowed physicians and nurses more time for other patient-care activities and helped the behavioral counselors develop a better understanding of the pharmacologic aspects involved in the health care of chemically dependent patients. The inclusion of a pharmacist in the chemical-dependency health-care team in this outpatient setting was accepted, valued, and recommended by the rest of the clinic staff.     

CHIP: new opportunities in adolescent health care delivery

Children's Health Insurance Programs (CHIP), usually targeted to infants, toddlers, and school-aged children, have been expanded to include adolescents. Adolescents need some form of health insurance in order to access needed care. Moreover, programs and services that provide them with health care must be adolescent-friendly, adolescent-focused and adolescent-sensitive, and include specialized training for primary care providers. Translating this philosophy into a successful health care delivery program involves addressing the psychological, institutional and financial barriers that make it difficult for adolescents to access health care. Overcoming these barriers, especially the financial ones, requires that primary care providers advocate for teenagers and take advantage of resources made available for them. CHIP provides a critical opportunity for policy-makers and health care providers to further improve adolescent health care and to more fully integrate adolescents into the health care system.     

Outcomes of pharmacist-managed diabetes care services in a community health center.

PURPOSE: The outcomes of pharmacist-managed diabetes care services in a community health center were studied. METHODS: Eligible patients were over age 18 years and had a diagnosis of type 2 diabetes mellitus. Patients were randomly assigned by the clinical pharmacist and nurse to the intervention group (n = 76) or control group (n = 73). Patients in the intervention group were enrolled in a pharmacist-managed diabetes care program. Patients in the control group received the standard diabetes care. The primary endpoint was reduction in glycosylated hemoglobin (HbA(1c)); secondary outcome measures included weight loss, an improved body mass index, decreased blood pressure, and an improved lipid panel. Quality-of-life measures (health level, satisfaction, impact, worry about disease, and worry about social and vocational issues) were also assessed. RESULTS: Demographic differences between groups were not remarkable. Mean HbA(1c) levels fell significantly (p < 0.05) from baseline to nine months in both groups. A difference of 1.0 was reported between the groups' HbA(1c) levels (95% confidence interval, 0.08-1.78; p < 0.05). Satisfaction level improved from 63.7 to 77.4 in the intervention group, which was significant when compared with the control group, whose satisfaction score improved from 57.0 to 63.4 (p < 0.05). CONCLUSION: Patients with type 2 diabetes mellitus who received pharmacist-managed diabetes care demonstrated improved HbA(1c), systolic blood pressure, and low-density-lipoprotein cholesterol levels and quality-of-life measures and met treatment goals more often than patients receiving standard care.     

Pharmacy information system for a health maintenance organization.

A computerized pharmacy system developed for a health maintenance organization (HMO) is described. The system has been operational for nearly three years. It is based on a coding scheme for (1) all drugs in the HMO formulary and (2) prescribing information. The information is processed by a computer which generates a variety of usage information. The system produces reports on frequency of drugs dispensed, number and percentage of patients obtaining each drug, and age-sex distribution of patients using a particular drug. The special characteristics of an HMO pharmacy as they relate to computerized systems are discussed. System requirements, maintenance procedures and cost estimates are also presented.