The next step in clinical intervention programs

Pharmacists should incorporate and modify existing clinical intervention programs to document pharmacists' effects on patient care and quality drug-therapy management. We have already demonstrated the pharmacist's role in drug cost savings through the intervention programs, and now QIP can assist us in taking the next step in providing quality patient care. If we endorse the principles of pharmaceutical care, we must assume the responsibility for documenting our value as pharmacists in managing drug therapy in patients. The clinical intervention programs will deemphasize the value of drug cost analysis and emphasize effects on patient-care outcome. We believe that facilitating positive patient outcomes will decrease overall health care costs. As managers, we must assist our pharmacists in endorsing this concept by developing our programs to show the maximum benefit of their efforts in the patient-care arena.     

Provision of pharmaceutical care to patients with limited English proficiency.

PURPOSE: A study was conducted to evaluate the current practices of pharmacists in ambulatory care clinics in communicating with and providing pharmaceutical care to patients who have limited English proficiency. METHODS: Semistructured surveys were used to gather data from 16 pharmacists and 8 physicians from 15 ambulatory care clinics in metropolitan Toronto. The survey examined pharmacists' knowledge about the linguistic services, policies, and guidelines in their ambulatory care practice settings; the strategies that pharmacists and physicians use to communicate with patients with limited English proficiency; the challenges pharmacists face when providing pharmaceutical care to those patients; the drug-related problems observed by pharmacists and physicians; and how pharmacists and physicians can collaborate to resolve medication issues for those patients. RESULTS: Many pharmacists (69%) were unaware of existing institutional policies for communicating with patients with limited English proficiency. Language interpretation services in clinics were nonstandardized and did not always reflect practitioners' preferences. All aspects of pharmaceutical care were reported to be difficult to accomplish in patients with limited English proficiency. Pharmacists and physicians identified similar drug-related problems, with nonadherence being the most commonly observed drug-related problem. Strategies suggested by pharmacists and physicians to improve communication with patients involved proactively identifying language needs of patients before appointments, having translated medication information available and using trained language interpreters. CONCLUSION: Pharmacists at 15 ambulatory care clinics reported difficulty communicating with and providing pharmaceutical care to patients with limited English proficiency. Strategies suggested by pharmacists and physicians to enhance communication with those patients may help improve the quality of pharmaceutical care delivered.     

Future of emergency contraception lies in pharmacists' hands.

OBJECTIVE: To increase community pharmacists' awareness about issues related to the provision of emergency contraception (EC) to women by describing pharmacist outreach and training programs and discussing pharmacy access and stocking issues, California's EC Pharmacy Program, methods for raising pharmacists' awareness, and professional development opportunities. SUMMARY: EC is both safe and effective in reducing the risk of unintended pregnancy after unprotected intercourse, yet awareness of and demand for the medication has not been high, and it often is not stocked in pharmacies. Various advocacy organizations have engaged in educating the public and physicians about EC, but relatively little attention and few resources have been targeted to ensure that the pharmacy community is aware of and educated about EC. Increased visibility and access to EC in the several states that allow pharmacists to provide EC directly to women have resulted from the active participation and leadership of pharmacists. In these states, women are showing interest in and receptivity to reproductive health services provided by pharmacists. In California, some 3000 pharmacists statewide have completed training, and in 2004 they provided EC directly to approximately 175,000 women. Pharmacists who provide EC overwhelmingly (91%) report that they do so because they see it as an important community service, and many (57%) recognize the opportunity for professional development. CONCLUSION: Pharmacists are uniquely positioned to improve access to EC, and leadership within the pharmacy community can facilitate efforts to improve access. Increased education and training of pharmacists about EC--such as continuing education programs available online at www.pharmacyaccess. learnsomething.com--are critical to ensure not only that EC is available in pharmacies but also that pharmacists are engaged in meeting the reproductive health needs of women. Increased access to EC can expand pharmacists' role in health care provision. State-specific information about EC pharmacy access initiatives is available on the Web at www.GO2EC.org.     

Pharmaceutical care research and education project: patient outcomes

OBJECTIVE: To compare patients' adherence to therapy, expectations, satisfaction with pharmacy services, and health-related quality of life (HRQOL) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care. DESIGN: Randomized controlled cluster design. SETTING: Sixteen community pharmacies in Alberta, Canada. PATIENTS AND OTHER PARTICIPANTS: Ambulatory elderly (> or = 65 years of age) patients covered under Alberta Health & Wellness's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles. INTERVENTION: Pharmacies were randomly assigned to either treatment (intervention) or control (traditional pharmacy care) groups. Patients at treatment pharmacies were recruited into the study, and pharmacists provided comprehensive pharmaceutical care services. Pharmacists at control pharmacies continued to provide traditional pharmacy care. MAIN OUTCOME MEASURES: Study participants' opinions, adherence to therapy, and scores on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: Compared with those of patients receiving traditional care, treatment patients' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period. Treatment patients' satisfaction with the constructs "trust," "evaluation and goal setting," and "communicates with doctor" were also positively affected. HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions. CONCLUSION: Successful implementation of a pharmaceutical care practice model has the potential to increase patients' satisfaction with their pharmacists' activities and may increase patients' expectations that pharmacists will work on their behalf to assist them with their health care needs. If pharmaceutical care affects patients' HRQOL, instruments more specific than the SF-36 may be needed to detect the differences.     

重大突发性公共卫生事件下临床药学服务在贵州省医疗救治体系中的应用现状研究

目的：调查临床药学服务在贵州省医疗救治体系中的开展现状,为未来在重大突发性公共卫生事件中最大化发挥临床药学服务效能提供相关建议。方法：通过三甲医院药学部门负责人个人深入访谈及10家三甲医院的药师、医师和住院患者实地问卷调查,对贵州省临床药学服务的开展现状进行调研。结果：本次调查的药师主要以大专/本科学历、拥有初级职称的青年女性为主;药师对临床药学服务的了解度与药师的学历（P=0.002）以及是否参与过临床药学服务培训（P=0.004）之间密切相关;医师对重大突发事件应急预案的了解度高于药师（P=0.024）;参与过重大突发事件的药师比未参与过的在日常药学服务上涉及更多的用药监测（P=0.027）和治疗方案制定（P=0.014）服务;参与过重大突发事件的药师比未参与过的更肯定自我地位（P=0.032）和临床药学服务能力（P=0.031）;62.7%的医师表示与药师的整体合作情况较好,78.0%的患者表示对临床药学服务不太了解,89.0%的患者对药师提供的临床药学服务表示满意但对其信任度较低。结论：三甲医院药师在自我认识、相关知识能力水平、临床药学服务种类提供和公众认知度方面有待提升;建议完善药学教育结构,丰富药事咨询服务形式,健全药品供应协调机制,加强安全用药与不良反应监测以及应急科普宣传工作。     

Pharmacists and immunizations: a national survey

OBJECTIVES: To obtain information about pharmacists' current involvement in and willingness to provide immunization services, and to assess perceived barriers to providing immunization services. DESIGN: Cross-sectional mail survey. SETTING: National. PATIENTS OR OTHER PARTICIPANTS: Random sample of 5,342 pharmacists from chain, independent, mass merchandiser/grocery, primary care clinic, and health maintenance organization settings. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to survey on pharmacy-based immunization services--current involvement, willingness to get involved, perceived obstacles, and patients' interest. RESULTS: Three mailings yielded a response rate of 25.3% (1,348 responses). Only 53.1% of respondents knew correctly whether their state allowed pharmacists to administer immunizations. Although a significant number of pharmacists were involved in immunization activities, such as counseling and promotion, only 2.2% and 0.9% of respondents were involved in actual administration of adult and childhood immunizations, respectively. In general, men, independents, owners/partners, and pharmacists who had attended immunization-related educational programs were more willing to provide immunization services than were women, chain and staff pharmacists, and educational program nonattendees. Pharmacists who had attended immunization-related educational programs also perceived pharmacist- and patient-related factors as less problematic for pharmacy-based immunization services than did nonattendees. CONCLUSION: This survey provides a baseline measure of the nature and extent of pharmacist involvement in immunizations that can be used now and in future years. The profession can use the findings on pharmacists' willingness to provide immunization services and their perception of obstacles to such services as a basis for targeted educational and promotional programs and materials.     

Improving medication use through pharmacists' access to patient-specific health care information

OBJECTIVE: To review and discuss the importance of pharmacists having access to patient-specific health care information in order to provide pharmaceutical care. DATA SOURCES: Articles identified through searches of MEDLINE and International Pharmaceutical Abstracts using the following key words: information, decision making, and pharmacist. STUDY SELECTION: English-language articles were evaluated for inclusion. DATA SYNTHESIS: Pharmacists have demonstrated their ability to positively affect patient outcomes related to medication use, including reducing patients' risk for medication-related adverse effects. CONCLUSION: Pharmacists, with proper access to patient-specific health care information, can reduce patients' risk for medication-related problems and improve the quality of their health care.     

姑息和临终关怀中的药师职能

目的：论述药师在姑息和临终关怀中的职能。方法：参考相关文献和美国医院药剂师学会的陈述加以总结。结果：国外先进经验表明，高质量的姑息和临终关怀需要药师大量的活动。结论：积极参与临终关怀事业，将是我国药学工作者重要的职责，也是药学服务的重要内容。     

药学监护:医院药学未来发展的趋势

本文提出药学监护(Pharmaceutical Care)是我国医院药学未来发展的趋势.药学技能和知识的巨大发展给了药师一个历史性机遇即对药物治疗转归分担应承担的责任.药师应具备提高药物治疗转归(Outcomes)的技能、知识和为达到这一目标所具备的责任感.药学监护不只是关心提供服务的行为本身,而更应关注患者的生命质量.药师与其他医务人员平等地工作以保证达到药物治疗目标,避免发生药源性疾病,或能尽快发现和及时解决已发生的药源性疾病.通过政府机构、药学院校和药师个人的共同努力,才能将有必要实施药学监护转变为患者、保险公司、政府卫生组织对药学监护的直接需求.本文从药学监护的起源、定义(正确理解“监护”;为治疗转归负责;功能、技巧和模式)、药师的能力、市场需求和实施药学监护等方面来把握药学监护的内涵.     

Older patient, physician and pharmacist perspectives about community pharmacists' roles

Objectives To investigate older patient, physician and pharmacist perspectives about the role of pharmacists in pharmacist-patient interactions. Methods Eight focus-group discussions were held in senior centres, community pharmacies and primary care physician offices. Participants were 42 patients aged 63 years and older, 17 primary care physicians and 13 community pharmacists. Qualitative analysis of the focus-group discussions was performed. Key findings Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists' ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impeded patient counselling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counselling, including lack of knowledge about medication indications and physician treatment plans. Conclusions Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management.     

Health promotion beliefs and practices among pharmacists

OBJECTIVE: To examine the health promotion beliefs and practices of pharmacists. DESIGN: Cross-sectional mail survey. SETTING: Indiana. PARTICIPANTS: Staff pharmacists. METHODS: Of the 1,440 registered Indiana pharmacies, one-half were selected using a systematic random process. Questionnaires were mailed to the 720 selected pharmacies asking one staff pharmacist to complete a 73-item questionnaire. RESULTS: A total of 552 pharmacists responded to the questionnaire, providing a 76.7% response rate. The majority of pharmacists believed that 10 of the 20 behaviors encouraged by national health objectives were very important for the average person. There was, however, considerably less agreement among pharmacists about the importance of the other 10 behaviors and practices. Pharmacists' involvement, preparation, and confidence in specific health promotion areas and activities were limited. A number of barriers were cited by respondents that could have hindered pharmacists' involvement in public health education activities. Despite these hindrances, pharmacists appear to be making strides toward providing health promotion education and activities. CONCLUSION: Pharmacists are readily accessible sources of information concerning the importance of needed lifestyle factors on health. They can provide valuable education to patients about improvement of lifestyles as a routine component of pharmaceutical care.     

Physician-pharmacist collaborative care in dyslipidemia management: The perception of clinicians and patients

Background

Collaborative practices allow physicians and pharmacists to comanage pharmacotherapy to maximize the benefits of medication regimens. The Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia (TEAM) study compared the efficacy of a physician-pharmacist collaborative primary care (PPCC) intervention, where pharmacists requested laboratory tests and adjusted medication dosage, to the usual care (UC) for patients under treatment with lipid-lowering medication.

Objective

In a qualitative study nested within the TEAM study, the perceptions of physicians, pharmacists, and patients regarding the PPCC model, interprofessional collaboration, and the clinicians' willingness to implement the model in their practice were explored.

Methods

In the area of Montreal (Quebec, Canada), TEAM study participants assigned to the PPCC group were invited to participate. Individual semistructured interviews with physicians (n = 7) and 2 six-member focus groups with pharmacists (n = 12) and patients (n = 12) were analyzed using a phenomenological approach.

Results

The vast majority of participants reported PPCC was more structured and systematic than the UC they had received previously, wherein physicians prescribe and adjust pharmacotherapy and pharmacists provide the counseling and dispense medications. Many patients felt they received better follow-up and reported being reassured and well informed, making them more inclined to care for themselves better. These feelings were attributed largely to the pharmacists' accessibility and ability to communicate with them easily. Given the physician shortage, physicians perceived interprofessional collaboration as almost inevitable. They considered PPCC to be safe and effective. However, obstacles were also identified. Physicians were concerned that it might alter their special relationship with patients and threaten their overall medical follow-up. Pharmacists felt enthusiastic about their new role, but found PPCC time consuming and thought it might not be applicable to all the patients.

Conclusions

PPCC model was highly appreciated by patients, and clinicians saw it as beneficial to patients. However, several obstacles still have to be overcome before the model can be implemented in the current health care context.     

Improving pediatric asthma outcomes in the community setting: does pharmaceutical care make a difference?

OBJECTIVE: To assess the effect of a structured program of pharmaceutical care on changes in disease control, functional status, and health services utilization for pediatric and adolescent patients with moderate-to-severe asthma. DESIGN: Randomized, controlled trial. SETTING: Community and clinic pharmacies (14 intervention and 18 usual care pharmacies) in western Washington State. PATIENTS: Three hundred thirty children, aged 6 to 17 years, with asthma. INTERVENTION: Structured training for the intervention group pharmacists to provide individualized asthma management services during patient-pharmacist encounters for up to 1 year following the patient's enrollment into the study. MAIN OUTCOME MEASURES: The primary outcome measure was change in pulmonary function as measured by peak expiratory flow rate and spirometry. Secondary outcome measures included changes in functional status and use of asthma-related health care services. RESULTS: The intervention had no significant effect on the health or health services use outcomes of study subjects. When compared with the usual care group, there was no evidence that patients from the intervention group experienced improvements in pulmonary function, functional status, quality of life, asthma management, or satisfaction with care. In addition, there were no differences between groups in use of anti-inflammatory medications, total or asthma-related medical care utilization, or total or asthma-related school days lost. CONCLUSION: This pharmaceutical care intervention had no significant effect on the health or health services use outcomes of pediatric patients with asthma. The intervention may not have been powerful enough to significantly affect pharmacists' behaviors and asthma patients' outcomes in community pharmacy settings, and there is evidence that the pharmacists' compliance with the study protocol was low due, in part, to patient- and practice-related obstacles.     

Clinical pharmacy interventions: an optimum way to accomplish positive patient care outcome

In this age of demand for optimum quality of care and shortened length of patient stay in the hospital, the opportunities for clinical pharmacy interventions are enormous. Pharmacists, with their unique background in clinical therapeutics, can make a significant difference in patient outcome. As in our case, initially there may be some skepticism among some of the physicians about the intent of pharmacy interventions. However, pharmacists' continual striving for improvement of quality of care can persuade skeptical physicians to consider pharmacists as their allies in achieving optimum quality of care. At our institution, our consistent approach has resulted in support from our physicians. Continuous feedback from managers to staff pharmacists (our monthly performance review feedback program) also helps to continue consistency of the program. The recent focus of the Joint Commission on optimum quality of care has also created an arena of tremendous opportunities for pharmacists to work with the physicians and other health care professionals to accomplish excellence in quality of care.     

The pharmacist's role in the optimal delivery of primary care in a managed care world

For managed care to continue positive growth, pharmacists will have to offer support measures for primary care physicians, even as efforts are made to increase the supply of these physicians. The pharmacy practice at Medical University of South Carolina Family Medicine Center has gained national recognition for providing an expansive role model for pharmacists who are committed to providing pharmaceutical care and related services in primary care surroundings. This article discusses managed care in the primary care arena and pharmacists' role in providing pharmaceutical care and teaching future pharmacists their role in a managed primary care world.