Role of a pharmacist in a seizure clinic

The involvement of a clinical pharmacist in a Department of Veterans Affairs seizure clinic is described. A pharmacist who had served a residency in ambulatory care began working in a seizure clinic in 1988 after obtaining the cooperation of a neurologist interested in a multidisciplinary approach to patient care. A clinical protocol was developed to guide the pharmacist's participation. The seizure clinic is staffed by the clinical pharmacist, a pharmacy resident, and a neurologist and is currently treating 162 adult male veterans. Of the 162 patients, 159 are receiving anti-convulsant therapy. The role of the pharmacist is to assist the neurologist in providing patient-care services. The pharmacist interviews each patient, performs a neurological assessment and mental status evaluation, and orders laboratory tests. Information is recorded by the pharmacist on a history form and a subjective and objective assessment and planning form. The pharmacist presents the findings to the neurologist, and the patient is then interviewed jointly by the pharmacist and the neurologist. Between appointments, the pharmacist follows up on abnormal laboratory test values and informs patients of any necessary dosage adjustments. More time is available for patient care, there has been an increase in the detection of adverse drug reactions and disease states, and record keeping has improved. A pharmacist assumed a primary-care role in a seizure clinic by interviewing and assessing patients, ordering laboratory tests, and participating in the selection and adjustment of anticonvulsant therapy.     

Providing clinical pharmacy services in an AIDS--oncology ambulatory-care clinic

The activities of a pharmacist in an ambulatory-care AIDS-oncology clinic are described. In December 1984, the chief of the AIDS Activities Division of San Francisco General Hospital's Department of Medicine hired a clinical pharmacist to develop the pharmacokinetics sections of investigational drug protocols, provide drug therapy consultations, and supervise the reorganization of the drug storage and inventory system. Since joining the clinic staff, the pharmacist has become active in a variety of clinical, research, and educational activities. The pharmacist conducts weekly medication refill clinics and developed drug information sheets for clinic patients and health-care professionals. The pharmacist also supervises timely collection of blood samples for serum drug concentration determinations and helps to prepare the investigational drugs for dispensing. The pharmacist developed policies and procedures for the safe handling of antineoplastic agents and standardized the accountability procedures for investigational drugs. The pharmacist also serves as a liaison between the clinic and the hospital's department of pharmacy and as a preceptor of pharmacy students and residents. A clinical pharmacist can make an important contribution to the research and patient-care activities in an AIDS-oncology clinic.     

Pharmacist management of antiemetic therapy under protocol in an oncology clinic

The development of a program for pharmacist prescribing of antiemetic agents for nausea and vomiting induced by antineoplastic agents given to ambulatory patients is described. The oncologist and the pharmacists developed a protocol and submitted it to the Washington State Board of Pharmacy, which can authorize a pharmacist to initiate or modify drug therapy in accordance with written guidelines or protocols. The protocol was approved and the pharmacists developed algorithms for antiemetic therapy, based on the emetic potential of the various antineoplastic agents. The oncologist writes an order for the pharmacist to prescribe antiemetic therapy for an individual patient, and the pharmacists selects an algorithm for each patient based on the antineoplastic agent that has the highest potential for causing emesis. The pharmacist writes orders for antiemetic agents to be administered in the clinic and at home, phones the patient 24 hours after antineoplastic drug therapy, and, if necessary, modifies the antiemetic therapy. Pharmacists have managed antiemetic therapy for more than 1200 patient visits and were able to use the first-line therapy in the selected algorithm in 78% of the cases without serious adverse effects. Pharmacist management of antiemetic therapy for nausea and vomiting associated with antineoplastic drug treatment has been well accepted by patients and professionals in this oncology clinic.     

Pharmacy-related health disparities experienced by non-english-speaking patients: impact of pharmaceutical care.

OBJECTIVES: To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non-English-speaking patients at this clinic. SETTING: A community health care center in a diverse neighborhood of Minneapolis, Minnesota. PARTICIPANTS: 40 pharmacies near the clinic and in the surrounding Minneapolis-St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments. INTERVENTIONS: Comprehensive drug therapy assessments were conducted for English- and non-English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacist's assessment were recorded in a patient management database. MAIN OUTCOME MEASURES: Language services provided by area pharmacies, frequency of drug therapy problems in English- and non-English-speaking patients, and the status of patient's medication conditions before and after provision of pharmaceutical care. RESULTS: Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non-English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers. CONCLUSION: Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non-English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.     

临床药师参与1例肺动脉栓塞患者华法林抗凝治疗的实践

目的：探讨临床药师在抗凝治疗中的作用。方法：回顾性分析临床药师参与1例肺动脉栓塞患者华法林抗凝治疗过程。结果：临床药师参与了华法林抗凝治疗方案的制定和调整,分析了华法林抗凝过量的原因,对患者实施了药学监护。结论：临床药师在华法林抗凝治疗中发挥着重要作用,可降低患者抗凝治疗风险,提高患者抗凝治疗成功率。     

Nine-year experience with a pharmacist-managed anticoagulation clinic

A pharmacist-managed anticoagulation clinic is described, and information on patient outcome during a nine-year period is presented. Since 1974, a pharmacist has managed an anticoagulation clinic for ambulatory patients and inpatients at San Francisco General Hospital Medical Center. The pharmacist's primary responsibilities include the following: educating patients about their diseases and the importance of drug therapy, monitoring patients' vital signs, performing physical examinations, and adjusting warfarin dosage to maintain prothrombin times within the therapeutic range (1.7-2.5 times normal using control values of 1.0-1.2). These patients are also under the care of their primary physicians. The pharmacist's work is checked by the chief of the cardiac clinic at the end of each clinic session. The effectiveness of the pharmacist in managing clinic patients is reviewed periodically; from January 1975 through June 1984, the pharmacist had treated 140 patients (141 courses of therapy). Of 1792 prothrombin times taken during this time, 1060 (59.2%) were within the therapeutic range of 17-25 seconds, 510 (28.5%) were less than 17 seconds, and 222 (12.4%) were greater than 25 seconds. Only four major hemorrhagic events (0.002 hemorrhages per patient-treatment month) and 89 minor events (0.05 hemorrhages per patient-treatment month) occurred. The recurrence rate of thromboembolic events was 0.007 per patient-treatment month. Pharmacist-managed warfarin therapy in these clinic patients resulted in a level of anticoagulation control and morbidity that was acceptable to physicians.     

Pharmacist management of anticoagulant therapy in ambulant patients.

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.     

A pharmacist-managed clinic for treatment of latent tuberculosis infection in health care workers.

A pharmacist-managed clinic for treating latent tuberculosis infection (LTBI) in health care workers (HCWs) is described. The hospital-based clinic was begun in 1993 after a review showed that only 0.8% of HCWs at the institution who were prescribed isoniazid for LTBI completed it. The goals of the clinic are to improve HCWs' adherence to LTBI treatment, enhance outcomes, and minimize adverse drug reactions. The clinic is staffed by a pharmacist, a medical resident, and a nurse. If an employee is diagnosed with LTBI, he or she is referred to the clinic, where the pharmacist conducts an initial assessment and provides information on medication available for treatment. The worker is then scheduled for monthly follow-up visits with the pharmacist for the first three months of LTBI therapy, during which the pharmacist evaluates treatment adherence and potential adverse effects. Thereafter, the pharmacist interviews the patient monthly by telephone until therapy is complete. HCWs are allowed only a one-month supply of medication with each refill. From June 1993 through June 1997, of 131 employees who started treatment, 122 (93%) completed it. From June 1997 through December 2001, annual therapy completion rates ranged from 90% to 100%. No cases of active tuberculosis have been reported in treated patients, and only nine adverse drug reactions were reported for the 1997-2001 period. A pharmacist-managed clinic substantially improved rates of treatment completion among HCWs with LTBI.     

The pharmacy clinic: a new approach to ambulatory care

A pharmacy clinic was established to provide consultation and services to practitioners and patients in the ambulatory care department of a Veterans Administration hospital. Among the services provided by the pharmacist are drug therapy consultations and monitoring, drug use review, drug information, and patient education. The pharmacy clinic assures the staff of the pharmacist's availability for consultation, allows the pharmacist to better organize the time required for consultation, makes the services of the pharmacist available to all outpatients, and provides a good training environment for students.     

Pharmacy practice in a chemical-dependency treatment center

The role of a pharmacist in a chemical-dependency treatment center is described. A pharmacist joined the staff of an outpatient methadone maintenance and chemical-dependency clinic at the request of the clinic's medical staff. In addition to the standard dispensing role, the pharmacist provides drug information, counsels staff and patients, and serves as the medical clinic coordinator. The pharmacist is also responsible for taking medical and drug-use histories, initially evaluating the degree of chemical dependency, assisting in the development of drug therapy plans for chemically dependent patients, and monitoring the effect of prescribed regimens. Other duties include serving as a health educator within the community and as a preceptor for baccalaureate and Doctor of Pharmacy students during substance abuse clerkships, and consulting on the management of chemically dependent patients who are hospitalized for other illnesses or specific conditions. The pharmacist's knowledge of pharmacotherapy and drug products and skill in assessing and managing problems related to substance abuse allowed physicians and nurses more time for other patient-care activities and helped the behavioral counselors develop a better understanding of the pharmacologic aspects involved in the health care of chemically dependent patients. The inclusion of a pharmacist in the chemical-dependency health-care team in this outpatient setting was accepted, valued, and recommended by the rest of the clinic staff.     

Beneficial effect of a pharmacist refill evaluation clinic.

A study of 32 patients attending a pharmacist-run clinic was performed. This pharmacist refill evaluation clinic (PREC) assesses the continuation of maintenance drug therapy and is an alternative to the physician's clinic. This study evaluated total time spent at the clinic, reasons for refill requests, number of refills requested, number of requested refills approved, and number of physician consults and referrals required. The total clinic visit time at the PREC was 60 +/- 35.9 minutes versus a total time required at physicians clinic of 129 +/- 115.2 minutes. Of the patients treated at the PREC, 90.6% required no physician consult or referral. An estimated $135 savings in drug cost was approximated by the clinic during this small sample (a 30-day study), plus a difference in clinic fee that would amount to $1120 not including the difference in the pharmacist and physician's salaries. Other contributions attributed to this clinic were better patient compliance, accurate documentation of medication records, drug abuse surveillance, and drug therapy efficacy.     

The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist

BACKGROUND: A primary care practice in the West of Scotland used clinical governance funding to develop a heart disease prevention clinic to target patients with existing heart disease. The practice nurse enlisted the help of the practice pharmacist and the protocol for the clinic was subsequently developed with the involvement of both practitioners. OBJECTIVE: The aim of this project was to identify and offer health screening and appropriate disease modifying treatment to patients of a primary care (or general medical) practice suffering from cardiovascular heart disease in a clinic run jointly by a practice nurse and pharmacist. METHOD: Patients identified by the practice pharmacist were offered a full health screen. Their clinical parameters were assessed and appropriate disease modifying drug therapy and lifestyle advice was offered in a review clinic with the practice nurse and pharmacist. RESULTS: The practice pharmacist identified over 212 patients over a 30-month period. A majority demonstrated hypertension (91%) and angina (89%), while over half (57%) had suffered a heart attack. Statin therapy was modified in a large number of patients (47%) and the number of patients with satisfactory total cholesterol levels has increased from 30% to 57% (P < 0.001). Aspirin and beta-blocker therapy has been initiated in a significant number of patients (53% and 26% respectively). Twelve patients (6%) stopped smoking; however, many 42% continued to smoke. The general medical doctors (GPs) who demonstrated a change in their own practice readily accepted changes to therapy recommended by the practice nurse and pharmacist. The practice pharmacist offset the additional cost of drug spend on statin therapy by making savings in other therapeutic areas. CONCLUSION: A secondary heart disease clinic can benefit patients by optimising drug and lifestyle therapy. While the inclusion of a pharmacist confers clinical and economic benefits.     

临床药师下临床的实践与体会

目的探讨临床药师在血液科促进合理用药的工作方式。方法介绍我院临床药师深入血液科,促进合理用药的工作内容与体会。工作内容主要是参与医生交接班会及查房、书写药历、提供用药咨询、收集药品不良反应、开展治疗药物监测等。结果通过上述工作,可协助临床医生制定和调整药物治疗方案,给患者提供充分的用药指导,监测药品不良反应,充分发挥临床药师在临床合理用药中的作用。结论临床药师深入临床可使临床用药更加合理、安全、有效。     

Clinical and economic effects of pharmacy services in geriatric ambulatory clinic

Pharmacy services were introduced in an established multidisciplinary geriatric ambulatory clinic. The pharmacist collaborated with primary care providers to optimize patients' drug regimens. Over 8 months there were 250 patient visits to the clinic. Traditional medical care was provided at 144 (57.6%) of these visits and traditional medical care plus pharmacist evaluation was provided at 106 (42.4%). The pharmacist identified 220 potential and actual drug-related problems. Acceptance of pharmacist-recommended changes in drug therapy was 98.6%. A mean reduction of 3.4 agents/patient was achieved in the intervention group (p<0.0001). Clinical outcomes of changes in drug therapy were neutral or positive in 99.5% of cases. Pharmacy services resulted in net savings of $7,788 annually.     

临床药师参与1例重症天疱疮患者的药学监护

目的:探讨临床药师在重症天疱疮患者药物治疗过程中的作用。方法:临床药师参与1例重症天疱疮患者的药物治疗过程。根据患者出现的症状、不良反应及时调整医师的用药方案:针对可能因糖皮质激素减量所致的双手、后背出现数粒新发水疱,临床药师建议将醋酸泼尼松片用量调整为入院前剂量70 mg,每日1次;针对患者感染控制不佳,建议将米诺环素胶囊剂量调整为100 mg,每日2次;针对低钾血症,临床药师嘱患者口服补钾,并将其加入果汁、牛奶或者蜂蜜中服用;为预防糖皮质激素引起的骨质疏松,临床药师建议患者服用碳酸钙D3咀嚼片的同时加服阿仑膦酸钠维D3片70 mg,每周1次;针对患者口腔黏膜出现的白色念珠菌,根据药敏试验结果,临床药师建议将伊曲康唑胶囊调整为氟康唑胶囊50 mg,每日1次;同时密切关注利妥昔单抗注射液输注后可能出现的输液反应,并行不良反应监测、出院用药教育等药学监护。结果:医师均采纳临床药师建议。患者病情好转,于治疗47 d后出院。结论:临床药师参与了重症天疱疮患者的药物治疗过程,协助医师完善了其治疗方案,保证了患者用药的有效性和安全性。     

临床药师参与1例术后感染患者的抗感染治疗实践

目的:探讨临床药师在患者术后抗感染药治疗中如何选择药物,促进患者康复。方法:介绍临床药师参与1例术后感染患者的抗感染治疗过程,临床药师从抗感染药选择、给药剂量、给药方法、不良反应监测等方面为患者制订个体化给药方案并进行药学监护。结果与结论:临床药师发挥药学专业特长,使患者获得了更好的药物治疗。临床药师与临床医师合作可充分发挥团队作用,促进合理用药,提高药物治疗水平。     

1例急性心肌梗死合并肺部感染患者的药学监护

摘 要 目的： 探讨临床药师在急性心肌梗死患者治疗过程中发挥的作用。方法: 临床药师对1例急性心肌梗死患者实行药学监护,对药物相互作用、药物不良反应等进行分析识别,对抗感染治疗方案提出建议,评估出血倾向与栓塞风险并存时的治疗矛盾,提出合理的处置方案。结果: 在临床药师的参与下,患者接受合理有效的治疗后病情好转出院。结论:临床药师参与临床诊治可提高药物治疗的有效性与安全性。     

The pharmacist as physician extender in family medicine office practice.

OBJECTIVE: To describe the role of the pharmacist as a salaried physician extender in a private practice diabetes management clinic. SETTING: Columbus, Ohio. PRACTICE DESCRIPTION: Private suburban family medicine office practice. PRACTICE INNOVATION: Clinical pharmacy physician-extender practice in a private medical office and direct compensation to pharmacist. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Financial reimbursement for providing pharmaceutical care; improvement in disease outcomes; pharmacist and student pharmacist satisfaction. RESULTS: Family medicine physicians hired a pharmacist to extend their diabetes care for complex metabolic syndrome patients and other patients with diabetes who had therapy management problems. The pharmacist, working with student pharmacists, develops treatment plans for drug therapy, nutrition, exercise, and foot care that are reviewed and approved by the managing physician and implemented by the pharmacist and other office staff. More than 260 patients have been referred and managed by the practice with favorable results. The pharmacist is reimbursed as an employee and the practice receives revenue for the pharmacist's practice. CONCLUSION: Working in a private physician office practice provides a unique means of providing pharmaceutical care with reimbursement for the pharmacist.