P & T Committee perspectives: maintaining a successful formulary system in a private community hospital

Institution of an effective formulary and P & T Committee is a difficult but critical task for many private hospitals. In this exclusive Hospital Formulary interview, Drs. Benner, Mykita, and Brown, members of Sutter Memorial Hospital's Pharmacy, Formulary, and Therapeutic Review Committee (their name for the P & T Committee) emphasize the need for a sound formulary system in order to survive the current changes in health care. Sutter Memorial is sophisticated in its delivery of healthcare services, which include advanced neonatology and state-of-the-art heart transplantation. Although good patient care remains the foremost concern, these committee members acknowledge that care must be affordable as well as therapeutically sound. Key to their committee's success is the cooperative effort among the pharmacy, nursing, and medical staff. They foresee the issue of rational therapeutics as a major challenge in the 1990s.     

Family planning with norgestrel-ethinyl oestradiol in a private gynaecological practice

A clinical series in a private gynecological practice with 50 patients aged 19-43 years who were seen between January 1966 and July 1968 were given a daily dosage of .5 mg norgestrel and .5 mg ethinyl estradiol for a 21 day course. 7 of the women (14%) were seen for counseling in preparation for marriage, 29 were married and had delivered, and the remaining 14 wished to postpone pregnancy. In 88%, menstrual flow remained unchanged, while 6% reported a heavier flow with the duration of bleeding unchanged. 1 patient claimed her cycle was shortened. Breakthrough bleeding occurred in .3% of cycles. 3 patients complained of spotting. Side effects were minor and usually occurred in the first 2 cycles, but over 504 cycles the women remained well and made no complaints. 5 patients indicated a weight gain, and 12 complained of gastric intolerance. 56% continued oral contraceptive use, 6 discontinued for a planned pregnancy, and 8 were transferred to another contraceptive measure because of continued weight gain (4), gastric intolerance (1), shortened cycle (1), and wish to rest from oral contraceptives (2).     

Prevalence of probable overactive bladder in a private obstetrics and gynecology group practice

ABSTRACT

Objective: To examine the prevalence of probable overactive bladder (OAB) in black, Hispanic, and white women.

Research design and methods: This was a cross-sectional survey of women (aged ≥ 18 years) presenting to a private obstetrics and gynecology group practice. The survey consisted of the Overactive Bladder-Validated 8 (OAB-V8) and other questions related to ethnicity, health history, desire for treatment, and reason for visit.

Main outcome measure: The OAB-V8 is a validated, eight-item, self-administered questionnaire that assesses the degree of bother associated with OAB symptoms. Subjects scoring ≥ 8 on the OAB-V8 were considered to have probable OAB.

Results: A total of 947 women completed the OAB-V8: 82% were black, 10% were white, and 4% were Hispanic. The prevalence of probable OAB was similar among different races/ethnicities, with 35% of black, 36% of Hispanic, and 30% of white women scoring ≥ 8 on the OAB-V8. Micturition frequency, nocturia, and waking up at night were the most bothersome symptoms. History of constipation, history of urinary tract infection, and number of pregnancies were independent risk factors for probable OAB. Thirty-five percent of patients with probable OAB and 5% of those without OAB desired information about OAB treatment options; however, only 5% of patients reported visiting their doctor for reasons related to their bladder symptoms.

Conclusions: OAB is prevalent among black, white, and Hispanic women. Using a simple OAB awareness tool, such as the OAB-V8, can help clinicians identify patients with bothersome OAB symptoms who could benefit from treatment. The survey results may have been limited by incorrect self-reported responses, the demographics of the population, and incomplete surveys.     

Preoperative outpatient consultation in private anaesthetic practice

To assess the value of preoperative anaesthetic consultations done on an outpatient basis, questionnaires were sent to 150 consecutive private patients who had been seen during the previous six months. Replies were received from 72%, and of these, 88% found the visit to be beneficial, whilst 2% were critical of the practice. Twenty-three percent did not know that anaesthetists were medically qualified. A retrospective audit of a further 100 patients revealed that 52% of patients had had their preoperative management altered to some degree as a consequence of the appointment. Based on his own experiences and the comments received from patients, the author believes this practice should be more widespread.     

Methodology and results of a survey of adverse reactions to a drug in private practice

Summary A survey of tolerance of a drug, determined in private practice under naturalistic conditions by 591 physicians, and involving 22277 patients is presented. The procedure used in private practice to gather systematic information about reactions to the drug involved a system of data sheets with detachable cards for optical reading and computer analysis. The survey was conducted under the responsibility at regional level of a team of scientific coordinators-hospital pharmacologists and poison control centres. Possible side effects were noticed in 13,82% of patients, a figure similar to known nocebo reactions. Tolerance was significantly related to sex, age, weight, geographical area, duration of treatment, association with other drugs and therapeutic result. When related to individual physicians, the overall number of side effects and the frequency of three of them in particular did not follow a binomial distribution; the rate of adverse reactions was significantly related to the number of years of practice of the physicians.     

Implementing HIPAA privacy regulations in pharmacy practice

A worthy goal of HIPAA is to protect the privacy of patient health information. Final regulations for achieving this goal have been issued, and all covered entities, including all pharmacies that transmit health information electronically, must comply with these regulations by April 14, 2003. Pharmacists are strongly advised to begin educating themselves about the HIPAA privacy regulations and taking steps toward implementation as soon as possible. Because of the complexity of the privacy rule and the lingering ambiguities about how to implement the regulations, pharmacies also are encouraged to obtain expert guidance and stay up-to-date with the regulations and implementation recommendations posted by OCR.     

美国药动学临床服务药师培训与实践借鉴

目的：介绍美国匹兹堡大学医学中心（University of Pittsburgh Medical Center,UPMC）药动学临床服务的培训过程和实践情况,为国内开展此服务提供借鉴。方法：通过资深抗感染药师的带教,学习提供药动学服务药师的日常工作流程及药动学专业药师的培训过程。结果：UPMC已有10家医院的药师为临床提供药动学服务,其中针对抗菌药物的药动学工作对于抗菌药物的合理使用有很大的帮助。结论：UPMC成熟的药动学服务模式值得在国内学习和推广。