Ethical, economic, and professional issues in home health care

Important ethical, economic, and professional issues in home health care (HHC) are identified and discussed. Patient services issues in HHC involve the ethics of providing high-technology feeding therapies to terminally ill patients and the controversies surrounding drug products, such as the appropriate amount of drug to be dispensed, the appropriate individual to compound home-care drug products, acceptable types of product packaging, and the impact of a switch in venders on the drug products supplied to patients. Economic issues include reasonable profit for HHC services, methods used to charge for products and services, payments to physicians for patient referrals, and pharmacies owned and operated by the HHC industry. Pharmacy relations issues center on the influence of nonpharmacists on pharmacy-based HHC services and the effect of HHC services on intraprofessional relations. How pharmacists resolve the many ethical, economic, and professional issues in HHC will determine the quality of services provided to patients, the nature of the working relationships between pharmacists and other health professionals, and the direction that pharmacy HHC services will take in the future.     

Research survey on the information gathering methods, attitudes, and requests from care managers about the pharmaceutical service by pharmacists in home care

Care Managers (CMs) were surveyed to clarify the issues involving the promotion of cooperation between care managers and pharmacists in long-term-care and explore solutions. The length of work experience, occupational background, experience of pharmaceutical service; pharmacist visit patients' home for providing medicine and pharmaceutical care into a care plan, degree of understanding on pharmaceutical service, and awareness of work involved in pharmaceutical service were studied to see whether there made differences in the requests from CMs for information on pharmacists and for information gathering methods. The χ(2) test was used to this end. The opinions and requests described by the CMs were validated through text mining. More CMs tended to obtain information and knowledge through training sessions and professional magazines than those who did so through cooperation with pharmacists on a practical level. However, the survey strongly indicated that CMs with high level of understanding and awareness of pharmaceutical service wished to obtain information on pharmacists through cooperation with them on a practical level, and CMs with low level of understanding and awareness of pharmaceutical service wished to obtain such information through training sessions and professional magazines. Results of text mining showed that CMs wished pharmacists to strengthen the cooperation with physicians and provide information on pharmaceutical service. These findings have led to the conclusion that the issues surrounding the promotion of cooperation between CMs and pharmacists centered around "work cooperation on a practical level" and "provision of information to CMs about the roles of pharmacies and pharmacists and their work."     

Advertisements in newspapers and magazines about patent medicines in the Meiji era (The first dissertation) (Part 2)

On January 20th of the 10th year of the Meiji era (1877) the government enforced the laws regulating patent medicines. Since then patent medicines were frequently attacked in the newspapers. Abuses of patent medicines became the target of criticism. Yukichi Fukuzawa had carried his comments against abusing patent medicines in "Minkanzasshi" for 4 days from March 24th in the 11th year of the Meiji era. Abuses of patent medicines prevented medical science from progressing. He pointed out the responsibility of newspapers which printed advertisement of ineffective patent medicines. "The kanayomi" which was a small newspaper company refuted his comments. Jihei Morita published the magazine "Houtan" in person, and he ran many advertisements about patent medicines. In October in the 15th year of the Meiji era, the law, which imposed a tax on patent medicines was enacted. In addition to the censure against patent medicines were an account in the newspaper successively. However, at the same time, these accounts had serious consequences the traders of medicine and they went to law by the reason which they led to serious interference with their business.     

Newspaper coverage of drug policy: an analysis of pre-election reporting of the Greens' drug policy in Australia

INTRODUCTION AND AIMS: With the headline 'Ecstasy Over The Counter' in a popular daily newspaper, the debate on drug policy officially entered the arena of the 2003 New South Wales (Australia) State Election. The debate resurfaced in the lead-up to the 2004 Australian Federal Election. This paper analyses the pre-election coverage of drug policy issues in four Australian newspapers. DESIGN AND METHODS: Four high-circulation daily newspapers were monitored for a one-month period prior to both elections and analysed for their coverage of drug policy, particularly with respect to the policy of the Greens. RESULTS: The newspapers took different perspectives on drug policy issues, with two framing it in emotive terms as a moral debate and two framing it as political manoeuvring. DISCUSSION AND CONCLUSION: The newspapers focused upon emotive and sensationalist factors. They did not provide their readers with information or a rationale for the formulation of drug policy, be this from a harm minimisation or zero tolerance perspective.     

苏州市姑苏区社区卫生服务机构药学服务现况探讨

目的：调查苏州市姑苏区社区卫生服务机构开展药学服务的现况,探讨其发展。方法：设计调查问卷,对部分药学人员、临床医师开展调查。结果：药学人员和临床医师对药学服务均有较高的认知,绝大多数被调查人员认为有必要开展社区药学服务,服务对象为社会公众、患者、临床医师。仅少数调查对象认为药学人员在校学习的知识能满足开展社区药学服务需要。目前已开展的社区药学服务内容主要是药品调剂、参与机构药品遴选和药物信息宣传。此外,可开展的药学服务内容有患者用药咨询和指导、处方点评、参与全科团队等。半数以上调查对象认为开展社区药学服务存在障碍,主要是药学人员自身专业知识所限,其次是领导不够重视。结论：重视社区药学服务,加强专业培训,开展形式多样的药学服务,才能更好促进合理用药。     

The pharmacist as prescriber: A discourse analysis of newspaper media in Canada

BackgroundLegislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing.ObjectiveThis study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented.MethodsNews items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing.ResultsThe results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue.ConclusionsMultiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services.     

Online resources for news about toxicology and other environmental topics

Technology has revolutionized researchers' ability to find and retrieve news stories and press releases. Thanks to electronic library systems and telecommunications--notably the Internet--computer users in seconds can sift through millions of articles to locate mainstream articles about toxicology and other environmental topics. But that does not mean it is easy to find what one is looking for. There is a confusing array of databases and services that archive news articles and press releases: (1) some are free; others cost thousands of dollars a year to access, (2) some include hundreds of newspaper and magazine titles; others cover only one publication, (3) some contain archives going back decades; others have just the latest news, (4) some offer only journalistically balanced reports from mainstream news sources; others mix news with opinions and advocacy and include reports from obscure or biased sources. This article explores ways to find news online - particularly news about toxicology, hazardous chemicals, environmental health and the environment in general. The article covers web sites devoted to environmental news; sites and search engines for general-interest news; newspaper archives; commercial information services; press release distribution services and archives; and other resources and strategies for finding articles in the popular press about toxicology and the environment.     

Availability of and attitudes toward resources on alternative medicine products in the community pharmacy setting.

OBJECTIVE: To examine the availability of resources on dietary supplements in the community pharmacy setting and to assess the attitudes of community pharmacists toward these resources. DESIGN: Cross-sectional study. SETTING: Community pharmacies in New York and New Jersey that serve as experiential sites for senior student pharmacists at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University. PARTICIPANTS: Preceptors or full-time pharmacists. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Frequency of use, availability of, and pharmacists' satisfaction with resources on alternative medicines, defined in the survey as any product including herbal remedies, vitamins, minerals, and natural products that may be purchased at a health food store, pharmacy, supermarket, alternative medicine store/magazine for the purpose of self-treatment. RESULTS: A total of 64 pharmacists characterized their frequency of use of resources on alternative medicines while formulating responses to questions as: never (n = 5; 7.8%), seldom (n = 31; 48.4%), often (n = 24; 37.5%), or always (n = 4; 6.3%). A total of 30 different resources were available to 40 respondents. The most commonly available resources were the PDR for Herbal Medicines (42.5%), The Review of Natural Products (20.0%), and the Web site of the National Center for Complementary and Alternative Medicine (12.5%). Of 54 respondents, 4 (7.1%) reported being completely dissatisfied with the available resources; 17 (31.5%) were somewhat dissatisfied; 25 (46.3%) were somewhat satisfied; and 8 (14.8%) were completely satisfied with the resources available to them. Topics the pharmacists most commonly wanted to see improved included safety (72.7%), interactions (70.9%), and uses (69.1%). CONCLUSION: Community pharmacists do not use information resources on alternative medicine products frequently, and many are not satisfied with the resources available to them.     

Advertising representation,treatment menu and economic circulation of substance misuse treatment centers in Iran: A rapid survey based on newspaper advertisements

BackgroundDaily newspapers are the main platform by which substance misuse treatment (SMT) centers in Iran advertise their services. However, these advertisements provide little information on treatment options or costs. The current research aimed to use advertisements to compile a schema of treatment services and to map the extent and nature of drug treatments offered.MethodsDuring a four-week period (April to May) in 2009, the four most popular Persian newspapers printed in Tehran were reviewed. Across these publications 1704 advertisements were posted by 66 SMT centers. Each center was then contacted by telephone to complete a structured interview about services offered and related costs. The advertisements were also decoded through a quantitative contextual analysis method.ResultsOn average, each SMT center published 26 advertisements during the review period, costing 421 US$. In addition, advertisements included word signifiers in six main categories including centers’ introduction (100%), treatment types (91%), treatment duration (68%), medicines (70%), treatment features (60%) and psychological facilities (52%). The three detoxification programs advertised were the rapid method (57% of clinics, 443.23 US$), buprenorphine (68%, 265 US$) and methadone (71%, 137 US$). More than 90% of the centers in Tehran were offering methadone maintenance (99 US$, per month).ConclusionSMT services in the Iranian market ranged from abstinence to maintenance programs, with opiates as the main focus. This review of centers’ advertisements provides an indirect but rapidly obtained picture of the drug misuse treatment network.     

Pharmaceutical education and the practice of pharmacy

Community pharmacy has undergone a process of relative deprofessionalization; most community pharmacists are now and will continue to function primarily as drug distributors. More sophisticated professional services can and will be offered mainly in hospitals and clinics. There is need for a rigorous and objective assessment of future needs and career opportunities in pharmacy. Many of the expanded roles for pharmacists have not yet been justified by proper functional and economic evaluation. The acceptance of those who fill these new and nontraditional roles cannot be ascertained adequately as long as they are supported extensively by schools of pharmacy rather than by professional fees or by salaries from the institutions in which they practice. There has been an unwillingness or inability on the part of academic pharmacy to make objective and rigorous assessments of the career potential of the various new roles envisaged for pharmacists. Other important issues that have not been explored objectively include drug information leaflets for patients and the single professional degree (Pharm.D.). A good case can be made for having physicians rather than community pharmacists provide drug information literature to patients. There must be pharmacists with one of three different levels of training: the B.S., the Pharm.D., and the Ph.D. Of these, the most critically needed at the present time are Ph.D. pharmacists qualified for positions in drug discovery, formulation, pharmacokinetics and pharmacodynamics, and in the development and evaluation of new drug delivery systems.     

Community pharmacists,injecting drug misusers and the reduction of HIV transmission

The role of 268 community pharmacists in reducing human immunodeficiency virus (HIV) transmission by providing advice and injecting equipment to drug addicts was investigated. Postal questionnaires were issued to proprietors or managers of all (362) community pharmacies in two family health services authorities within the North West Thames regional health authority to determine their current activities concerning the reduction of HIV transmission between injecting drug misusers (IDMs). More than half of the pharmacists supplied injecting equipment to IDMs, most frequently as 1ml disposable insulin syringes. Eleven per cent of those pharmacies from which equipment was sold provided disposal facilities. More than half of those without disposal facilities failed to provide information regarding safe disposal when supplying injecting equipment. Virtually all the pharmacists surveyed did not supply accompanying health education literature when they sold injecting equipment     

Potential roles of the pharmacist in chronic pain management: a multidisciplinary perspective in primary care

Patients in the community with chronic pain may have poor pain control and use both prescribed and alternative therapies, often inappropriately, to try to optimise pain relief. They may benefit from management by a multidisciplinary primary care team involving a pharmacist. This study used postal questionnaires to determine community pharmacists' attitudes to involvement in pain management and the perceptions of general practitioners and physiotherapists of the current and potential roles of the pharmacist within a chronic pain care team. The three professions' views on factors which could influence chronic pain management were also determined. Sixty-three GPs (63 per cent), 59 community pharmacists (59 per cent) and 33 physiotherapists (66 per cent) responded. None of the pharmacists was currently involved in chronic pain management, but 58 (98 per cent) wanted to develop such a role, especially within pain clinics. Pharmacists and physiotherapists were more likely than GPs to identify that limited opportunity for personal involvement and expertise within a pain team reduced the likelihood of achieving optimal chronic pain management. Only 17 of the GPs had an established multidisciplinary pain care team; two of these had pharmacist involvement. All GPs and physiotherapists agreed that pharmacists had an important role to play in chronic pain management, particularly in the provision of drug information to patients and medication review.     

Documentation of pharmacists' interventions in an emergency department and associated cost avoidance.

PURPOSE: An analysis was conducted of pharmacist interventions and resuscitation experiences, including pharmacist participation in a hospital emergency department (ED), and the potential cost avoidance associated with the interventions made by the pharmacists. METHODS: All pharmacists working in the ED prospectively documented the pharmacist interventions that were accepted by physicians and nursing staff and entered into a spreadsheet on a weekly basis, between September 1, 2003, and December 31, 2003. Intervention categories included the provision of drug information; recommendations for dosage adjustment, formulary interchange, initiation of medications, alternative drug therapy, discontinuation of drug therapy, changes in medication therapy due to allergy notification, drug therapy duplication prevention, or changes in the route of drug administration; questions from nursing staff; order clarifications; drug compatibility issues; patient information; toxicology; and drug interaction identification. Intervention data were analyzed and the likelihood of harm was scored; interventions were classified and analyzed by calculating average cost, probability of harm, and potential cost avoidance. RESULTS: During the study, 2150 pharmacist interventions were documented. Pharmacists participated in the care of 1042 patients triaged to the resuscitation area of the ED. Cost avoidance during the study was determined to be 1,029,776 dollars. CONCLUSION: The most commonly documented interventions made by pharmacists involved in the care of patients visiting the ED included provision of drug information, dosage adjustment recommendations, responses to questions from nursing staff, formulary interchanges, and suggestions regarding initiation of drug therapy. The potential cost avoidance attributable to the pharmacist interventions during the study period was over 1 million dollars.     

Reported value of cannabis seizures in Australian newspapers: Are they accurate?

Introduction and Aims. The news media is often touted as an important, yet inaccurate source of information about drug issues for the general public. This paper investigates the accuracy of reporting in the Australian media regarding the value of cannabis seizures made by the police. Design and Methods. A sample of Australian newspaper articles, which featured both a direct estimate of the value of a cannabis seizure and the number of plants seized, were examined. The reported values from these articles were then compared with a range of estimates made using data on cannabis plant yield and price, taken from research literature. Results. Fifteen articles were examined, referring to fourteen different seizures. The reported value of cannabis seizures in this sample of articles was highly inflated when compared with the authors' estimated value. The reported newspaper values of seizures were between 1.8 and 11.9 times higher than our middle estimate. Discussion and Conclusions. The most likely reason for the wide difference between the reported and estimated value of these seizures is the possible variability in cannabis plant yield. Whatever the reason for the discrepancy between the reported values and our estimates, greater transparency surrounding the valuations of cannabis seizures would help to better determine the true impacts of law enforcement interventions on this illicit drug supply chain.[Matthew‐Simmons F, Shanahan M, Ritter A. Reported value of cannabis seizures in Australian newspapers: Are they accurate? Drug Alcohol Rev 2011;30;21–25]     

Effectiveness of newspaper advertising for patient recruitment into a clinical trial

Aims

To measure the impact of newspaper advertising across Scotland on patient interest, and subsequent recruitment into the Standard Care vs. Celecoxib Outcome Trial (SCOT), a clinical trial investigating the cardiovascular safety of non-steroidal anti-inflammatory drugs in patients with osteoarthritis or rheumatoid arthritis.

Methods

Newspaper advertisements about the SCOT trial were placed sequentially in regional and national Scottish newspapers. The number of phone calls as a result of exposure to the advertisements and ongoing study recruitment rates were recorded before, during and after the advertising campaign. To enroll in SCOT individuals had to be registered with a participating GP practice.

Results

The total cost for the advertising campaign was £46 250 and 320 phone calls were received as a result of individuals responding to the newspaper advertisements. One hundred and seventy-two individuals were identified as possibly suitable to be included in the study. However only 36 were registered at participating GP practices, 17 completed a screening visit and 15 finally were randomized into the study. The average cost per respondent individual was £144 and the average cost per randomized patient was £3083. Analysis of recruitment rate trends showed that there was no impact of the newspaper advertising campaign on increasing recruitment into SCOT.

Conclusions

Advertisements placed in local and national newspapers were not an effective recruitment strategy for the SCOT trial. The advertisements attracted relatively small numbers of respondents, many of whom did not meet study inclusion criteria or were not registered at a participating GP practice.