Target drug monitoring: a cost-effective service provided by staff pharmacists

A concurrent drug use evaluation program that improves patient care while meeting JCAHO requirements was designed and implemented. Integration of staff pharmacists into the program has been an important component. The net annual savings of the program for H2 antagonists and cephalosporins was $16,756. The net annual cost of the program if all drugs were studied throughout each quarter would be $1,336. The program essentially pays for itself, meets medication use standards for JCAHO, and may save significant healthcare costs if potential drug misadventures are avoided.     

Medication therapy management services provided by student pharmacists

Objectives. To evaluate the impact of student pharmacists delivering medication therapy management (MTM) services during an elective advanced pharmacy practice experience (APPE).Methods. Student pharmacists provided MTM services at community pharmacy APPE sites, documented their recommendations, and then made follow-up telephone calls to patients to determine the impact of the MTM provided. Students were surveyed about the MTM experience.Results. Forty-seven students provided MTM services to 509 patients over 2 years and identified 704 drug-related problems (average of 1.4 problems per patient). About 53% of patients relayed the recommendations to their physician and 205 (75%) physicians accepted the recommendations. Eighty-eight percent of patients reported feeling better about their medications after receiving MTM services. A majority of the students perceived their provision of MTM services as valuable to their patients.Conclusions. Providing MTM services to patients in a pharmacy practice setting allowed student pharmacists to apply skills learned in the doctor of pharmacy (PharmD) curriculum.     

Clinical pharmacy services in a community hospital

An example is given of the implementation of clinical pharmacy service program in a community hospital. The need for establishing an efficient drug distribution system is discussed, and the feasibility of utilizing clinically motivated staff pharmacists is presented. A method of limiting the number of patients admitted to the clinical pharmacy service program is also given.     

Home intravenous antimicrobial therapy provided by a community hospital and a university hospital

A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.     

Extent of services provided by pharmacists in the Iowa Medicaid Pharmaceutical Case Management program

OBJECTIVE: To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN: Prospective pharmaceutical care intervention project. SETTING: One hundred seventeen community pharmacies in Iowa. PATIENTS: Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION: To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patents each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES: An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS: Fax survey results were retumed for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438 (23.2%) patients, pharmacy staffing or start-up issues for 419 (22.2%) patients, or no reason specified for 575 (30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION: Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.     

How community pharmacists prioritize cognitive pharmaceutical services

IntroductionThere is broad consensus that community pharmacists should focus on the provision of pharmaceutical care. Studies, however, have shown that community pharmacists still spend a considerable amount of time on traditional activities such as dispensing instead of cognitive pharmaceutical services (CPS). It is not clear whether community pharmacists prefer their current time-utilization or if they are willing to spend more time on CPS.AimThe aim of this study was to identify how community pharmacists ideally would prioritize CPS compared to other daily activities.MethodsA cross-sectional study design with Q-methodology was used to identify different viewpoints regarding task prioritization. Community pharmacists were asked to rank a total of 48 daily activities. Data was collected online using FlashQ^©. Q-sorts were analyzed by principal component factor analysis and varimax rotation using PQmethod 2.35.ResultsIn total, 166 community pharmacists participated in this study. Three distinguishing groups were found based on task prioritization explaining 59% of the total variance among respondents. All groups ranked the provision of CPS as important, in differing degrees. Group 1 ranked CPS as most important and was also the group that contained most participants. Group 2 and 3 ranked quality assurance as most important with CPS as second. Logistics and pharmacy management were ranked low by all groups.Discussion and conclusionCommunity pharmacists rank the provision of CPS as important. So factors, probably other than task prioritization, are keeping the pharmacist from focusing on CPS in daily practice. In other studies, time constraints are mostly mentioned as major barrier. Activities such as logistics and pharmacy management are given less priority and should be delegated to supporting staff members as much as possible, to enable pharmacists to focus their available time on activities they deem important.     

A quality assurance program for clinical pharmacy services provided to a long-term care unit in a community hospital.

This paper describes the development of a quality assurance program for the clinical pharmacy services being provided to a long term care unit in a community hospital. The functions, standards and criteria of these clinical services are presented and the results and impact of four completed audits are discussed. It is the intent of this article to demonstrate the ease with which a quality assurance program for clinical pharmacy services may be instituted and the potential benefits it may offer.     

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.     

Progressive pharmaceutical services in a small community hospital

The pharmaceutical services in an 86-bed community hospital in rural Maine are described. With a staff of two full-time pharmacists, one hospital pharmacy resident, and 2.6 full-time equivalent technicians, the pharmacy department operates a 24-hour unit dose drug distribution system with complete i.v. admixture services. In addition, the department supervises nurses on medication administration and i.v. therapy teams. Clinical pharmacy services include patient-education programs, protocols giving pharmacists responsibility for initiating and monitoring specific drug therapies when authorized by a physician, and concurrent antibiotic review. The department publishes a bimonthly newsletter for physicians and nurses and a quarterly newsletter for hospital employees and patients; it also conducts continuing-education programs for nurses. By maintaining a delicate balance between creativity and practicality, pharmacists in small hospitals can develop progressive services.     

Impact of wellness coaching and monitoring services provided in a community pharmacy

ObjectiveTo assess the clinical and patient-centered outcomes of health coaching provided in the workplace by community pharmacists.DesignProspective interventional cohort study.Setting11 independent community pharmacy chain locations in northwest and central Missouri, from January 2010 to January 2011.Participants81 benefit-eligible patients and 23 community pharmacy coaches employed by the self-insured pharmacy chain.InterventionPatients were stratified into monitoring groups according to baseline screening values for cholesterol, blood pressure, fasting blood glucose (FBG), body mass index (BMI), and waist circumference. Patients selected their pharmacist coach. Follow-up appointments occurred monthly to quarterly. Appointments consisted of education, goal setting, and monitoring through evaluation of treatment goals and physical assessment.Main outcome measuresChange from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, systolic blood pressure (SBP), diastolic blood pressure (DBP), FBG, weight, BMI, waist circumference, health-related quality of life (HRQoL), and patient satisfaction.ResultsPatients' total cholesterol, LDL cholesterol, HDL cholesterol, DBP, and FBG were reduced significantly. Mean changes in triglycerides, SBP, weight, BMI, and waist circumference were not statistically significant. The 36-Item Short-Form Health Survey version 2.0 showed improvements in both the Physical and Mental Component Summaries but did not reach statistical significance. More than 90% of patients were satisfied with the service and the care they received.ConclusionWellness coaching by a pharmacist provided in a community pharmacy can result in significant improvements in cardiovascular risk factors, with a trend toward improved HRQoL. In addition, patients were satisfied with the wellness program from the start of the project.     

Influence on medication therapy of increased patient services by pharmacists in a pediatric hospital.

The effect of decentralized pharmacy services on medication therapy was studied. The records of 200 patients at a 175-bed, nonprofit, pediatric hospital were reviewed to determine the drug therapy received agreed with the indications, contraindications, ages and dosages recommended by the official labeling. Half the patients received treatment before decentralized pharmacy services and half after. For all drug-use variables, a one-way analysis of variance revealed no significant differences between the two groups of patients.     

Aminoglycoside dosing service provided by baccalaureate-level pharmacists

An aminoglycoside pharmacokinetic dosing service operated primarily by baccalaureate-level pharmacists is described. The service was initiated gradually by the clinical pharmacy coordinator. After detailed policies and procedures were developed, staff pharmacists received 14 hours of training in pharmacokinetics. The training program consisted of written study material and application to actual patient cases. The pharmacokinetic dosing service is initiated upon the written request of a physician. Nurses on the pharmacy i.v. team administer aminoglycoside doses, collect blood samples, and record sample collection and drug infusion times whenever possible; when workload is heavy, floor nurses and laboratory personnel assist in these functions. The entire dosing consult requires approximately one hour of pharmacist time per patient. A $20 fee is assessed for completed dosing consults. Approximately 50 consults are provided per months, and a survey showed that 50-70% of all hospital patients (except newborns in intensive care) receiving aminoglycosides had their dosages calculated by the service. A carefully developed limited aminoglycoside dosing service provided primarily by baccalaureate-level pharmacists has given the pharmacy department at this hospital an opportunity to further expand its involvement in clinical pharmacokinetics.     

The role of hospital and community pharmacists in pharmacovigilance

In this paper, we give an overview of the role pharmacists actually have and could have in collecting reports of adverse drug reactions (ADRs) and more widely in pharmacovigilance.In the literature, several ways are mentioned in which the pharmacist, both the community pharmacist and the hospital pharmacist, can contribute to the safe use of drugs. In addition to their responsibilities regarding drug dispensing and compliance, they can have a substantial role in ADR reporting.Especially, hospital pharmacists can play a significant role in ADR reporting because the most serious adverse drug events occur in hospitals, and ADRs account for a substantial proportion of hospital admissions.Community pharmacists, however, can also play an important role in ADR reporting. This is, for example, the case in the Netherlands where community pharmacists contribute substantially, both in numbers and in quality of ADR reports.The contribution of the pharmacist to pharmacovigilance should, however, not be limited to ADR reporting. The various pharmaceutical disciplines could also greatly enhance our understanding of the nature of ADRs. If those involved in pharmaceutical disciplines can rise to this challenge, they will significantly help deepen our insights into ADRs.