临床药师学员的病例教学方法探讨

目的:探讨适合带教临床药师学员的病例教学模式。方法:根据临床药师学员工作的基本要求,采用以问题为导向的病例教学方法、模拟病例教学法以及DV演示教学法对临床药师学员进行带教。结果:通过对临床药师学员的病例教学经验进行总结,制定病例教学流程。通过病例教学,可以培养临床药师学员信息收集、整理的能力,训练学员交流沟通和参与临床药物治疗的能力,使其能够更快的掌握开展临床药学服务的方法。结论:病例教学法是提高临床药师学员带教质量和学员素质的有效方法。     

Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis

Background

Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make.

Aim

To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators.

Method

Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015.

Site 1

was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team.

Site 2

was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines.

Results

Key performance indicators from Site 1 (n?=?75 records), which incorporated a clinical pharmacist, demonstrated significantly (p?<?0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n?=?59).

Conclusion

Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.

     

Prospective student pharmacist interest in a rural pharmacy curriculum

Objective. To determine prospective student pharmacists' interest in a rural pharmacy health curriculum.Methods. All applicants who were selected to interview for fall 2011 enrollment at the UNC Eshelman School of Pharmacy were invited to participate in a Web-based survey. Questions addressed participants' willingness to participate in a rural health pharmacy curriculum, interest in practicing in a rural area, and beliefs regarding patient access to healthcare in rural areas.Results. Of the 250 prospective student pharmacists invited to participate, 91% completed the survey instrument. Respondents agreed that populations living in rural areas may have different health needs, and students were generally interested in a rural pharmacy health curriculum.Conclusions. An online survey of prospective student pharmacists was an effective way to assess their interest in a rural pharmacy program being considered by the study institution. Location of the rural program at a satellite campus and availability of housing were identified as factors that could limit enrollment.     

Impact of automation on pharmacist interventions and medication errors in a correctional health care system.

The implementation and impact of an automated check-and-sortation system in a correctional health care system are described. In February 1998 the Managed Health Care Division of the University of Houston College of Pharmacy submitted a proposal to the Texas State Board of Pharmacy for installing an automated check-and-sortation device in its distributive system serving Texas Department of Criminal Justice offenders. The new system would eliminate final visual verification of medication orders by pharmacists and thereby give them more time for in-depth reviews of patient profiles and for recommending clinical interventions. A vendor interested in developing a prototypic automated system was identified, and a disease management training course was developed to enable staff pharmacists to provide evidence-based pharmacotherapy recommendations. Twelve months of data before automation (February 1997 to January 1998) were compared with 16 months of postautomation data (June 1998 to September 1999). The number of clinical interventions increased from 396 per 100,000 medication orders filled before automation to 1075 per 100,000 orders after automation. Dispensing errors decreased from 6.3 to 4.1 per 100,000 medication orders filled. Identified filling errors increased from 224 to 256 per 100,000 orders. The reliability of the automated system was evidenced by a dispensing error rate of 0.6 per 100,000 orders. Implementation of an automated check-and-sortation device in a correctional health care system appeared to reduce dispensing errors and give pharmacists more time to review patient profiles and recommend clinical interventions.     

Addressing the global need for public health clinical pharmacists through student pharmacist education: a focus on developing nations

It is time for pharmacists to begin advancing their roles in public health and play a more integral part in public health initiatives. Within developed nations, the profession has demonstrated its value in advancing preventive care; however, the same cannot be said for pharmacists worldwide. Emphasis on training public health pharmacists should also be on developing nations, where the need for preventive care is highly unmet. To ensure all graduating pharmacists are prepared to engage in public health activities, education in this field must be provided during their main years of pharmacy school. In conclusion, public health education should be incorporated into pharmacy curriculae within developing nations so all pharmacy graduates are prepared to engage in public health activities.     

Effects of a student pharmacist consultation on patient knowledge and attitudes about vaccines

ObjectiveTo measure the impact of student pharmacists’ consultation on participant knowledge and attitudes about influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines.DesignPre- and post-consultation surveys.SettingFree health care service and immunization clinics in Vallejo and Martinez, CA.ParticipantsChildren and adults 13 years of age or older.InterventionA convenience sample of participants completed a preintervention survey (PrIs) on basic vaccine knowledge and attitudes. Student pharmacists then delivered the intervention, which consisted of a 5-minute consultation on vaccines. A postintervention (PoIs) survey was administered immediately after the intervention.Main outcome measuresCumulative scores for eight knowledge-based questions and four attitude-based questions.Results198 participants completed both PrIs and PoIs. Compared with the PrI scores, the PoI scores showed significant improvement in basic vaccine knowledge and attitudes toward receiving vaccinations. Participants also were more likely to view pharmacists as a source of information about vaccines after the intervention. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations.ConclusionA short, 5-minute consultation by a student pharmacist may increase vaccination rates and help serve as a vehicle to change the public's view of vaccines as well as pharmacists and their role in primary and preventive care.     

Impact of a pharmacist education program on nonformulary drug use

The effect of an educational program for pharmacists that included instructions for handling nonformulary drug requests and determining suitable formulary alternatives for frequently prescribed nonformulary drug requests was measured. Results indicate a significant increase in the number of appropriate nonformulary drug dispensings when the postintervention phase was compared with the preintervention phase. Other values, including the financial impact per nonformulary drug request, did not differ significantly between the two phases. Since all nonformulary drug requests require pharmacist time, a more cost-effective nonformulary drug policy might focus the pharmacist's efforts on nonformulary drug products that are more costly than their formulary alternatives.     

The impact of faculty and student pharmacist relationships on burnout

BackgroundStudents in health professions, including student pharmacist, are at an increased risk of psychological distress. Unfortunately, effective efforts to combat burnout for student pharmacists are still lacking in the literature and create a void in schools and colleges of pharmacy that seek to assist their students.ObjectivesThe objective of this study was to explore how increasing positive out-of-class interactions between the student pharmacists and faculty members affect burnout, especially in work exhaustion and interpersonal disengagement. Professional fulfillment was also assessed as a primary outcome.MethodsThe institutional review board approved this study consisting of 4 faculty members and 12 students. After providing informed consent, the participants were assigned to one of 4 groups. Each group included 1 faculty member and 3 students. At the start of the study, each participant completed a modified Stanford Professional Fulfillment Index questionnaire to measure baseline burnout characteristics and initial level of professional fulfillment. For 8 weeks, the groups met weekly to discuss a topic related to burnout and professional fulfillment. After 8 weeks, each participant completed the postquestionnaire. Wilcoxon signed-rank tests were performed to the mean scores (pre vs. post) in each of the 3 constructs. The statistical significance was set at P < 0.05.ResultsThe results of the Wilcoxon signed-rank analysis showed a statistically significant difference in the burnout constructs, work exhaustion and interpersonal disengagement. There was not a statistically significant change in professional fulfillment.ConclusionsImproving relationships between student pharmacist and faculty through increasing out-of-class interactions benefits individuals who are at risk of experiencing burnout. Future initiatives can focus on effective strategies that target work exhaustion and interpersonal disengagement and build on the social networks that develop in pharmacy school.     

Impact of pharmacist outreach on glucagon prescribing

BackgroundHypoglycemia is a major limiting factor in the glycemic management of diabetes. As a method of treating hypoglycemia, the American Diabetes Association recommends glucagon to be prescribed for all individuals at increased risk of clinically impactful hypoglycemia. Glucagon Emergency Kits have been shown to reduce emergency department visits and overall health care costs. Despite these known benefits, glucagon continues to be underprescribed. Previous pharmacist-led interventions embedded in a single clinic have been shown to positively affect the rate of glucagon prescribing in patients with diabetes.ObjectiveThis study aimed to compare the rate of glucagon prescribing between quality improvement remote pharmacist outreach to multiple primary care and endocrinology specialty clinics and the control group in 1 month following a pharmacist-led provider outreach.MethodsThis was a single-center, 2-arm study with a simple randomization design.ResultsOn pharmacist outreach, 61 of 109 patients (56.0%) in the outreach group were prescribed a glucagon product within 1 month of their primary care provider (PCP) or endocrinology appointment compared with 1 of 113 (0.9%) of patients in the control group (P < 0.001). Glucagon prescribing occurred in 25 of 35 Black patients (71.4%) compared with 36 of 73 white patients (49.3%) in the outreach group. Glucagon prescribing was associated with race (P = 0.03; chi-square test).ConclusionsThe pharmacist-led provider outreach before a PCP or endocrinology appointment has a positive and statistically significant impact on glucagon prescribing rates. The pharmacist outreach had a higher impact on Black patients than white patients, possibly because of a lower rate of glucagon prescribing in Black patients before the outreach.     

Impact of a pharmacist on drug costs in a coronary care unit.

The impact of clinical pharmacy services on direct drug costs in a coronary care unit (CCU) was studied. An observational, nonrandomized study was conducted on all patients admitted to the CCU to evaluate the impact of clinical pharmacy services on direct drug costs. Clinical pharmacy services were introduced into the CCU in July 1998. Patient characteristics, mean drug costs per admission, mean drug category costs per admission, and total hospital costs per admission were determined for October 1997 to June 1998 (nonintervention period), July 1998 to March 1999 (intervention period 1), and April 1999 to December 1999 (intervention period 2). The Clini-Trend program was used to estimate the total reduction in drug costs associated with documented pharmacist interventions from January to December 1999. Mean patient age, sex, admitting diagnosis-related group, Medicare case-mix index, ventilator days, length of stay, and number of deaths did not differ significantly among the three study periods. Mean +/- S.D. drug costs per admission for the nonintervention period were $374.05 +/- $75.51. With the introduction of clinical pharmacy services, mean +/- S.D. drug costs per admission were $381.94 +/- $66.16 (p > 0.1 for intervention period 1 compared with the nonintervention period) and $233.74 +/- $84.16 (p = 0.002 for intervention period 2 compared with the nonintervention period). From January to December 1999, 4151 pharmacist interventions were documented. The estimated reduction in drug costs associated with the interventions totaled $372,384. A pharmacist's clinical services in the CCU allowed for significant estimated reductions in total drug costs.     

Impact of a pharmacist on the educational value of pharmaceutical industry film showings

A controlled trial was performed to assess the impact of drug information provided by a pharmacist on the educational value to physicians of pharmaceutical manufacturers' film showings. The trial consisted of two teams of physicians who attended pharmaceutical manufacturers' films and who afterward answered multiple choice questions on the drug being promoted. In one group, the liaison pharmacist, who had no knowledge of the content of the questionnaire, presented information on the drug being featured prior to the film showing while the control group did not have a pharmacist presentation. Out of a perfect score of five, there was a higher test score in the group of physicians who attended the pharmacist presentation/film showing (n = 75) than in the group which only attended the film (n = 65) (3.3 +/- 1.1 versus 2.8 +/- 1.2, respectively (p = 0.017)). While there was no difference in the scores obtained by the clerks, interns and residents (3.2 +/- 1.1, 3.3 +/- 0.9, 3.4 +/- 1.2 respectively) when a pharmacist was present, in his or her absence the scores for clerks, interns and residents were 2.5 +/- 1.3, 2.8 +/- 1.0, 3.6 +/- 1.2 respectively with residents scoring higher than clerks (p = 0.047). A pharmacist can enhance the educational value of a pharmaceutical manufacturer's film showing.     

Marketing the pharmacist as a community health specialist.

The marketing of pharmacy services in the community setting has traditionally focused on the sale or delivery of a product. The public in general is not aware of the typical community pharmacist's involvement in the overall health and well being of the populace he or she serves. This paper proposes a new focus to the marketing of pharmacy services that will highlight the expanded health role of pharmacists in the community and allow them to move away from a product-oriented practice toward a more service-oriented practice. Several examples of specialized services that can be easily implemented in the community setting are also presented.