Asthma patients' satisfaction with the frequency and content of pharmacist counseling.

OBJECTIVE: To assess the level of expectation and satisfaction of patients with asthma regarding the counseling provided by community pharmacists, and to identify the counseling information patients consider important in helping them manage their asthma. DESIGN: Mailed survey. PARTICIPANTS: 208 patients seen in the University of Utah Asthma Clinic for at least 3 months, age 18 years or older, and on at least 1 asthma medication. MAIN OUTCOME MEASURES: Frequency of pharmacist-provided asthma medication counseling, patients' perception of the importance of counseling, and their satisfaction with counseling. RESULTS: Response rate was 55% (106 of 194 surveys returned). The majority of patients (> 90%) indicated that their community pharmacist "never" or "sometimes" discussed the management of their asthma with them. Frequency of counseling in three predefined areas of asthma education (role of medications, inhaler technique, and prevention of asthma attacks) was 1.91, 1.72, and 1.31, respectively (1 = never, 4 = always). Most patients (76%) considered these areas of counseling to be important for the management of their asthma. Most patients (62%) were "somewhat" to "pretty" satisfied with the type and amount of asthma counseling provided by their pharmacist. Counseling sessions averaged less than 3 minutes. Only 25% of patients would be willing to pay an additional amount for pharmaceutical care. CONCLUSION: Self-reported rates of patient counseling concerning asthma medications in the community pharmacy setting are low and adequately address neither the educational needs of patients nor the recommendations of the National Asthma Education and Prevention Program.     

Comparison of methods used for estimating pharmacist counseling behaviors.

OBJECTIVE: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. DATA SOURCES: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. STUDY SELECTION: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. DATA EXTRACTION: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. DATA SYNTHESIS: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. CONCLUSIONS: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.     

The relationship between patient variables and frequency of pharmacist counseling

Over the past 20 years, much research has focused on evaluating pharmacists' performance as drug consultants to patients and on identifying factors that affect pharmacists' performance in this role. Little has been done, however, to assess the impact of patient characteristics, such as age, income, education, and drug expenditures, on pharmacists' performance as drug consultants. The purpose of this study was to examine this impact. Data were gathered via a mail survey of 300 households in Raleigh, NC. Multiple regression analysis was used to analyze the data. Results indicated that pharmacists generally are available to answer patients' drug-related questions, that pharmacists usually do not provide counseling to patients voluntarily, and that pharmacists are significantly more likely to counsel patients who have lower educational attainment and higher drug expenditures. These results appear to suggest that pharmacists have adopted the role of drug consultant to patients, but only to a limited extent.     

Economic impact of pharmacist interventions in pediatric ambulatory care clinics

ObjectivesAmbulatory care pharmacists have a unique opportunity to identify and prevent adverse drug events (ADEs) throughout a patient’s treatment course. These interventions can reduce unexpected clinic visits or hospitalizations, which may lead to decreased health care costs. However, research on this topic has not been conducted in the pediatric population. This study explored the economic impact of pharmacist interventions related to ADEs in pediatric ambulatory care clinics. The primary objective was to determine the total cost avoidance of pharmacist interventions associated with the prevention or management of ADEs in pediatric ambulatory care clinics. The secondary objectives were to describe and quantify pharmacist interventions related to the prevention and management of ADEs in pediatric ambulatory care clinics.MethodsPharmacist interventions from pediatric ambulatory care clinics were collected from an electronic health record. These interventions were categorized into 1 of 4 categories: Drug interaction, drug not indicated, prevent or manage ADE, or prevent or manage drug allergy. A review panel consisting of ambulatory care pharmacists reviewed the interventions. The expected probability of the event occurring was classified according to the Nesbit method (0-0.6), and the level of care necessary to treat the potential ADE was determined. The levels of care included hospitalization, ambulatory care, and self-care. The cost avoidance associated with each prevented ADE was calculated by multiplying the probability of the ADE occurring by the average charge of the expected level of care.ResultsOf the 8755 interventions documented, 212 were included, leading to a total cost avoidance of $307,210 (range $76,802-$1,071,053). The estimated cost avoidance from each ADE subtype was $128,283 from drug interaction, $20,727 from drug not indicated, $157,993 from prevent or manage ADE, and $207 from prevent or manage drug allergy.ConclusionPediatric ambulatory care pharmacists optimize health care cost savings through the prevention and management of ADEs as integrated members of the health care team.     

临床药师干预提升碳青霉烯类抗菌药物合理使用效果分析

目的探析临床药师干预碳青霉烯类抗菌药物合理使用效果。方法采用安徽省儿童医院美康临床药学管理系统生成随机数的方法随机抽取 2017年 8—12月(干预前)与 2018年 8—12月(干预后)使用碳青霉烯类抗菌药物的住院病例各 100例,进行合理性分析。结果临床药师干预后,该院碳青霉烯类抗菌药物使用评价得分由( 74.45±7.26)分升高到( 94.70±5.31)分;适应证合理率由 86%提高到 98%;品种选择合理率由 87%提高到 99%;单次剂量、溶液及配伍合理率由 65%提高到 98%;药敏送检率由 78%提高到 95%;申请会诊单由 72%提高到 100%;出院病儿碳青霉烯类抗菌药物使用强度由干预前( 3.96±0.86) DDDs·(100人) -1·d-1降到( 2.27±0.72)DDDs·(100人) -1·d-1。均差异有统计学意义( P＜0.05)。结论临床药师干预显著提高碳青霉烯类抗菌药物合理使用率,规范临床碳青霉烯类抗菌药物的应用情况,进一步促进临床合理用药。     

Effect of a consultant pharmacist on medication use in an institution for the mentally retarded

The effect of a consultant pharmacist on medication use in an institution for the mentally retarded was studied. One year after hiring the consultant pharmacist and the implementation of a multidisciplinary approach to patient care at institution A, a previous medication survey was repeated for 715 patients. Medication use at a nearby mental retardation institution (institution B) with 1049 patients was surveyed once. The overall percentage of patients receiving antipsychotics or anticonvulsants in institution A was not different in the two surveys. There was a significant increase in the percent of patients receiving single drug entities in the second survey (for antipsychotics, 4.9% versus 9.1%; for anticonvulsants, 2.7% versus 15.1%). The use of long-term medications decreased from 76.1% to 56.8% of the population, and the use of individual antipsychotic agents changed significantly. The survey at institution B, a similar facility with less direct pharmacy involvement, showed significantly more use of antipsychotics than at institution A (34.2% versus 16.8%) and fewer patients receiving no long-term medications (29.2% versus 43.2%). The results suggest that the direct clinical involvement of skilled pharmacists in cooperation with other health professionals can significantly alter the patterns of medication use in a long-term care facility for the mentally retarded.     

Benefits of individualized counseling by the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong

A prospective controlled study on the benefits of pharmacists' individualized counseling on drug compliance, cholesterol concentration reduction, attainment of National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) low-density lipoprotein cholesterol (LDL-C) goals, and patient satisfaction was carried out in a private community hospital in Hong Kong. All patients who were newly prescribed with lipid-lowering drugs for primary prevention were included. The patients in the individualized counseling group received "intense" counseling and follow-up of cholesterol concentration by a pharmacist for 3 months. The control group received routine counseling. Fifty patients completed the study (26 in the individualized group, 24 in the control group). Compliance was assessed, and those patients who achieved 75% compliance were defined as compliers. In the individualized group, 76.9% were compliers compared with 41.7% in the control group (p < 0.01). The individualized group achieved 28.3%, 27.7%, and 26.1% reduction in total cholesterol, LDL-C, and triglycerides, respectively, compared with 15.3%, 16.3%, and 10.6% in the control group (p < 0.05 for all). Also in the individualized group, 80.8% achieved the ATP III LDL-C goals compared to 58.3% in the control group (p < 0.05). Of patients in the individualized group, 85% felt that the pharmacist counseling service could improve their disease management. The study demonstrated that pharmacists' individualized counseling, together with the assessment of cholesterol concentrations, had positive impacts on the management of hyperlipidemia, including improved drug compliance, better treatment endpoints, and patient satisfaction.     

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.     

Effect of nebulizer configuration on delivery of aerosolized tobramycin.

Differences in the reported efficacy of aerosolized aminoglycosides may be due, in part, to differences in aerosol delivery. Optimization of delivery systems of bench testing of nebulizers in a manner that simulates clinical conditions can lead to enhanced lung deposition in subsequent clinical studies. In the present study, we assessed the effects of varying nebulizer configuration on the performance of ultrasonic and jet nebulizers. Tobramycin was mixed with a radiotracer (99mTc) to facilitate measurement of nebulizer output and particle size. A piston ventilator provided a simulated breathing pattern, and the dose delivered to a filter corresponded to what would have been inhaled by a patient (percentage of nebulizer charge inhaled). Particle size was measured using a cascade impactor, sampling at 1 L/min. An ultrasonic nebulizer (Ultra-Neb; DeVilbiss, Somerset, PA), ventilated at 20 breaths per minute, charged with 600 mg of tobramycin (in 30-mL volume) and fitted with its standard tubing, was tested with and without the addition of one-way valves to the inspiratory and expiratory ports of the mouthpiece. In order to assess the degree of environmental contamination associated with jet nebulizer therapy, a filter was placed at the expiratory port of all jet nebulizer experiments. The addition of the valves reduced the percentage of charge inhaled from a mean +/- standard deviation (SD) of 29.2% +/- 1.4% to 7.6% +/- 2.3% and reduced mass median aerodynamic diameter [MMAD (sigma g) from 4.3 microns (2.1) to 1.45 microns (1.65)]. A Circulaire (Westmed, Tucson, AZ) jet nebulizer (7 L/min flow, 50 pounds per square inch gauge (psig), 20 breaths per minute, containing 160 mg of tobramycin in a 4-mL volume) was tested in two configurations: using a plain T-piece and using a valved inflatable aerosol chamber. The use of the holding chamber resulted in an almost twofold reduction in MMAD [MMAD (sigma g) = 2.45 microns (2.0); T-piece; 1.25 microns (2.0), holding chamber]. A slight reduction in the percentage of nebulizer charge inhaled using the holding chamber, compared to the plain T-piece, was not statistically significant (mean +/- SD of percentage inhaled with holding chamber = 20.8% +/- 1.6%; with T-piece = 23.6% +/- 0.5%). With both the jet and ultrasonic nebulizers, breathing frequency influenced percentage inhaled, with a higher percentage inhaled at 20 breaths per minute compared to 15 breaths per minute. The use of the plain T-piece at 20 breaths per minute was associated with more environmental contamination than the use of the holding chamber with the same breathing pattern (26.7% +/- 1.0%, T-piece; 4.5% +/- 0.3%, holding chamber, P < 0.0001). We conclude that nebulizer configuration can potentially affect both the amount of aerosol inhaled and the particle size, and needs to be specified precisely in treatment protocols.     

Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention

ObjectivesTo determine the accuracy of medication reconciliation in an internal medicine clinic and to evaluate pharmacist interventions targeted at improving the accuracy of medication reconciliation.DesignProspective case series.SettingMemphis, TN, from October 2007 to March 2008.Patients180 adults attending an internal medicine appointment.InterventionOn patient arrival, a nurse completed the medication reconciliation form. In Phase 1 of the study, a pharmacist randomly selected and reviewed a patient's medication reconciliation form, interviewed the patient, and verified information if indicated. A total of 90 forms were reviewed and compared to determine baseline medication reconciliation accuracy. Education interventions were held with the medical and nursing staff, targeting areas for improvement. In Phase 2 of the study, 90 additional medication reconciliation forms were reviewed in the same manner. Phase 1 and Phase 2 results were compared to evaluate differences in accuracy after the pharmacist's education interventions.Main outcome measuresAccuracy of medication reconciliation forms and number of potentially significant errors at baseline and after pharmacist interventions.ResultsIn Phase 1, 14.4% of medication reconciliation forms were correct. The remaining forms contained 190 potentially significant errors. After the education interventions, 18.9% of medication reconciliation forms were correct and the others contained 139 potentially significant errors.ConclusionMedication reconciliation accuracy is poor. Although education interventions showed a trend toward improvement, continued education training for staff and patients is needed in addition to other interventions to optimize this process and prevent medication errors.     

Effect of pharmacist intervention on control of resistant hypertension

The effect of a pharmacist's clinical intervention on blood pressure control in ambulatory adults with resistant hypertension was studied. Twenty patients of an internal medicine clinic who had diastolic blood pressures greater than 96 mm Hg on two consecutive visits and antihypertensive regimens consisting of two or more agents were entered in the study between November 1, 1980, and February 1, 1981. After asking each patient 15 questions about hypertension and its treatment, the pharmacist counseled the patient about antihypertensive therapy, obtained a medication history, and discussed diet. The patient's blood pressure was measured, and the pharmacist evaluated the appropriateness of the patient's antihypertensive regimen (based on compliance, adverse reactions, and regimen complexity) and possible reasons for the poor response to treatment. The pharmacist then recommended drug therapy to the physician; stepped care including hydrochlorothiazide, reserpine, and hydralazine was used when possible. Patients' mean age was 56 years. Most did not know the names of their medications or understand their dosage schedules. Eight patients had severe hypertension (193/124 +/- 23/4 mm Hg), five had moderate hypertension (161/109 +/- 20/2 mm Hg), and seven had mild hypertension (171/100 +/- 29/0 mm Hg). Factors contributing to poor blood pressure control were noncompliance and adverse drug effects. After five to eight months of follow-up, mean blood pressures for patients with severe, moderate, and mild hypertension were, respectively, 140/92 +/- 23/10 mm Hg, 131/92 +/- 8/6 mm Hg, and 137/88 +/- 26/3 mm Hg; the mean for each group was significantly different from baseline. In this study, pharmacists intervened successfully with patients and physicians to enhance blood pressure control through drug therapy.     

A preliminary study on the effect of pharmacist counseling on awareness of and willingness to quit smoking in Malaysian population

Objectives This paper presents an outcome of pharmacist counseling among Malaysian smokers for their awareness of and willingness to quit smoking. Method It was a cross-sectional study during a 3-day public health campaign at a shopping complex. Each self-referred participant was asked to complete a questionnaire apart from the question regarding improvement, and if any in their awareness and willingness to quit smoking, were asked to respond after counseling. Pharmacists counseled each participant about smoking cessation strategies and smoking related diseases. The data were analyzed by χ ² test. Results Among respondents, 25.5% had been smoking for more than 10 years, 31% for 5–10 years, 25.4% for 2–5 years and 18.3% for 1–2 years. The participants declaring no awareness about smoking were 22.9%, with little awareness 44.3%, having moderate awareness 25.7% and with considerable awareness were 7.1%. After counseling, 4.1% revealed unawareness, 17.8% little awareness, 43.8% moderate and 34.2% had considerable awareness on the above aspects. The post counseling awareness on smoking was observed to be significantly higher (P< 0.01). Among smokers studied, 67% showed willingness to quit smoking. Conclusion Increase in awareness of and willingness to quit smoking reflects that pharmacist counseling seems to be helpful in cessation of smoking.     

围术期应用乌司他丁对老年患者脏器功能的保护作用及机制

目的研究围手术期应用乌司他丁（u-II）对老年患者器官功能保护方面的作用及保护机制。方法选择择期上腹部手术老年患者80例,随机分为2组,各40例。u组患者于术前1d开始用UTI2．0万u·Kg^-1加入50ML生理盐水中用微泵注射,qd,使用至术后第5天止,手术日开放中心静脉后立即用微量泵快速泵入Url;C组均以50mL生理盐水代替uri使用,其他常规治疗同u组。并选择不同时间点检测患者的血清TNF-Gt、IL-6及HO-1;分别检测两组术前1d及术后1、3,5d血清1NF．a、1L-6、IL-8,即时记录两组患者术后体温变化情况。结果应用2．0万U·Iqgll唧后u组在不同时间点IL-6、心na的各项检验值均显著低于C组（P〈O．05）;且术后12、24h的HO-1活性显著升高,两组间对比差异有统计学意义（P〈O．05）。结论UTI具有抑制促炎因子释放作用,同时可降低患者体内促炎因子孙限a、IL-6、1L-8的水平,促进HO-1反应性上调,发挥抗缺血一再灌注损伤能力,从而起到脏器保护作用。