Evaluation of pharmacist management of streptococcal throat infections in a health maintenance organization.

A program within a health maintenance organization in which pharmacists were delegated the responsibility of treating and managing adult patients whose throat culture results were positive for group A, beta-hemolytic Streptococcus was evaluated. Results of 50 patients who received diagnostic throat cultures and treatment from internists, physician's assistants and nurse practitioners were compared with results of 58 patients treated and managed by pharmacists who followed procedures defined by physicians. Six hypotheses were tested with respect to the pharmacy program: (1) provider time is saved; (2) the time between throat culture and therapy initiation is shortened; (3) there are fewer return sick visits; (4) there are more reculture follow-up visits; (5) the medication regimen which exhibits a higher rate of cure (oral vs injection) is used more often; and (6) cost savings are realized. Hypotheses 1, 2 and 6 were supported by the results, 3 and 4 were possibly supported, and 5 was not testable. Pharmacists appeared to be as effective as the other practitioners in the management and treatment of streptococcal sore throat.     

Drug product selection: legal issues.

OBJECTIVE: To review the potential legal liability of the pharmacist in the drug product selection process. DATA SOURCES: Published articles identified through MEDLINE, published law reviews identified through InfoTrac, and appellate court decisions. Search terms used included pharmacist liability, drug product selection, and generic substitution. Additional articles, books, and appellate court decisions were identified from the bibliographies of retrieved articles and citations in appellate court decisions. DATA SYNTHESIS: Pharmacists engaging in drug product selection are civilly liable under three legal theories: negligence, express or implied warranties, and strict product liability. Potential criminal liability includes prosecution for insurance fraud, deceptive business practices, and violation of state drug product selection laws and regulation. CONCLUSION: Pharmacists increase their liability when engaging in drug product selection, but the increase is small. Still, the law continues to evolve as pharmacists seek expanded roles and responsibilities. When courts give closer examination to pharmacists' expanded role, it is likely that pharmacists' liability will increase.     

Telepharmacy in a health maintenance organization.

PURPOSE: A telepharmacy service in a health maintenance organization is described. SUMMARY: Kaiser Permanente Colorado Region's clinical pharmacy call center (CPCC) was established in 1996 after an audit showed that the third most common type of call to the regional call center involved questions about drug therapy. The service was developed through collaboration among the pharmacy department, the medical group, and the health plan to care for patients with medication-related questions. CPCC pharmacists work closely with the physicians, nurses, and service associates of the regional call center; primary care physicians; and other pharmacy department members. The CPCC team answers approximately 1200 telephone calls daily, including calls from new members regarding their transition into the health plan, calls about medications for patients recently discharged from outside hospitals, questions about medication-related news releases, and general drug therapy questions. CPCC pharmacists collaborate with physicians to care for patients with allergic rhinitis and to complete projects that improve the quality and cost-effectiveness of drug therapy regimens. Many of CPCC's interactions are entered into an electronic medical record. CPCC has helped over 40,000 new members with their transition into the health plan since January 2000, and significant cost savings have resulted. CONCLUSION: CPCC has used telephonic, electronic, and other means of communication in an effort to reduce costs and improve the quality of care.     

Obtaining pharmacoeconomic data in health care organizations

The article illustrates the process and techniques of obtaining or collecting pharmacoeconomic data in various health care organizations, focusing on hospitals, physicians' offices, and pharmacies as the research settings. The role that pharmacoeconomic data have in the decision-making process as well as the perspective of the decision maker are also discussed. The three primary components needed to conduct a complete pharmacoeconomic analysis (clinical outcomes, humanistic outcomes, and economic outcomes) are described in relation to the health care organization. The strengths, weaknesses, advantages, and disadvantages of such data are discussed. Various databases that are accessible within each organization are also outlined.     

山区农村基层医疗机构药品使用与监管状况

2003年夏季，笔者对浙江省台州一山区县农村基层医疗机构的药品使用与监管状况进行调研，发现很多问题，实在令人担忧。     

Drug product selection and the law

Pharmacists are reported to be concerned about their liability exposure when engaging in drug product selection. A review of the elements of a suit for negligence is presented along with a brief application of those principles to a suit for negligence in drug product selection. The role of the manufacturer in assuring product integrity is emphasized. A liability suit also could be based on contract law principles, which are discussed. A few reasons that may explain why no suit has been successfully maintained in this area to date are presented. Finally, discussion of legislative provisions that attempt to contain the pharmacist's liability exposure are considered.     

Drug use and HIV risk-taking behaviour among clients in methadone maintenance treatment.

Current drug use and HIV risk-taking behaviour of a sample of 95 methadone maintenance clients was investigated. Subjects had been on their current programme for an average of 70.9 weeks with a mean daily dose of methadone of 65.6 mg. Two-thirds had injected heroin, and 82% had injected a street drug in the month prior to interview. Over 20% of subjects had shared a needle in the month before interview, all with only one other person. Subjects who had injected cocaine in the month before interview had significantly higher levels of injecting risk-taking behaviour than those subjects who had injected but not used cocaine. Condom use among subjects was low, particularly in regular relationships. While knowledge concerning HIV was high among subjects, there was no relation between level of knowledge and actual behaviour. It is concluded that knowledge alone is not sufficient to ensure behaviour change.     

保健品市场的营销策略

回顾中国保健品市场的发展过程，每一时期都有其代表性的保健药品，如上世纪八十年代的太阳神时代，九十年代中期的三株时代，九十年代后期的红桃K时代，现在的百家争鸣时代。通过对保健品发展过程的划分，使我们看到了中国的保健品是从启蒙、混战到平稳；消费者对保健品的认识是从崇拜、怀疑到理智使用；保健品的终端销售市场是从鼎盛、整顿到按照市场规律运做的发展过程。     

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.