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.     

Planning for ambulatory pharmacy services

To aid in the planning of patient-oriented pharmacy services in an ambulatory care center, the demographic profile of the patients visiting the pharmacist at the Sunol Health Center (SHC) pharmacy in Los Angeles, California was studied. Analysis of the data collected over a 6-month period revealed that female patient visits were double the number of male patient visits. Ten disease conditions requiring drug therapy accounted for 75% of all problems presented by the patients. The mean number of prescribed medications received per patient was 1.7. The ratio of newly prescribed medications versus refill medications was 2.5 to1 or 70% versus 30%. The proportion of new patient visits versus return patient visits was 55% versus 45%. With this information, the training of the pharmacist and the services of a pharmacy may be designed specifically to meet the needs of the patients in the community or the ambulatory care setting.     

Patients' experience of hospital pharmaceutical services

Objective This study aimed to investigate inpatients' and outpatients' need for information about medication, to what extent those needs were addressed and patient attitudes regarding pharmaceutical services. Method Self‐administered questionnaires were distributed to a sample of outpatients and inpatients in a UK district general hospital. Themes included satisfaction with information given about medication, potential confusion over medication prescribed by the general practitioner and by the hospital, access to a member of the pharmacy team and preferences on how information on medication should be given. Key findings Ninety‐one outpatient and 126 inpatient questionnaires were available for analysis. All outpatients who responded acknowledged that they were told how long they might need to wait for their medicines to be dispensed, although approximately one‐fifth felt they had to wait a long time. Nearly three‐quarters of outpatients felt there was an opportunity to ask medication‐related questions of the pharmacy team. Nearly three‐quarters of inpatients reported they were encouraged to bring into any hospital any medication they were taking at home. Twenty‐eight per cent of 95 inpatients reported that some of their existing medication was stopped while in hospital. For the inpatients who received information about new medication, this was explained to the patient verbally (76%) and both verbally and in writing (22%). Forty‐two per cent of inpatients (and 36% of outpatients) expressed a preference to receive information about medication both verbally and in writing. Thirty‐five (32%) of 110 inpatients were not aware that a pharmacy team had a presence on the ward. Conclusions Overall the majority of both in‐ and outpatients appeared to be receiving appropriate pharmaceutical services. There is a need to raise the profile of the pharmacy team in regards to provision of medication advice for inpatients. Consideration needs to be given to better provision of written information about medication for patients.     

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.     

Patients' perceptions of the benefits of pharmaceutical care

OBJECTIVE: To investigate patients' perceptions of the benefits of regular participation in pharmaceutical care services. DESIGN: Written survey of a convenience sample. SETTING: Pharmacist-run anticoagulation clinic in a Veterans Administration Medical Center. PATIENTS: 154 patients who had regularly scheduled appointments in the clinic. INTERVENTIONS: Patients were asked to complete a written survey. The survey was read to those who had trouble reading it. MAIN OUTCOME MEASURES: Patients' perceptions about the benefit of services provided in the clinic and the relationship between those services and reduced risks of medication-related problems. RESULTS: All components of anticoagulant-related pharmaceutical care were rated as at least fairly beneficial. Monitoring of warfarin blood levels and information on the appropriate use of warfarin were rated highest. The perceived benefits of the pharmaceutical care components were associated with patients' perceptions of the extent to which pharmaceutical care reduced their risk of experiencing blood clots or warfarin-related problems. Patients also perceived that their risk of developing blood clots or bleeding problems would be higher if they did not regularly visit the anticoagulation clinic. CONCLUSION: Patients' perceptions of the benefits of pharmaceutical care were associated with the perceived threat reduction capacity of the pharmacist's services. Pharmaceutical care providers may be able to enhance patient participation in their services by educating patients on the risks of medication-related problems and how frequent monitoring of key clinical indicators may help reduce those risks.     

Patients' expectations and their satisfaction with pharmacy services

OBJECTIVE: To identify whether prior experiences, ideal referents, or market-based expectations affect patients' satisfaction with pharmacy services. DESIGN: Ambulatory pharmacy patients were randomly assigned to groups receiving one of three surveys. Each survey varied by the type of expectation (independent variable) used to measure expectations for satisfaction with pharmacy services. We used regression analysis to evaluate the three different expectation measures in the satisfaction model. Each regression consisted of the same dependent variable (patient satisfaction). Each survey contained one type of expectation measure (independent variable): prior experiences, ideal referents, and market-based expectations. RESULTS: We received 315 evaluable surveys by mail (47% response rate). All three regression models were statistically significant; however, the independent variables in the models differed. CONCLUSION: Cognitive services are best evaluated from the patient's perspective by asking him or her how the services compare with what they should be (i.e., ideal referent). Tangible aspects of the services, such as informational leaflets or wait time, are best evaluated by asking patients how recent experiences compare with past experiences. Therefore, satisfaction surveys should be designed to specifically assess the type of services provided by the pharmacy.     

Pharmacy benefits management and ambulatory pharmacy services

The business of pharmacy is changing dramatically as new components are added to our health care system and new terms developed to describe existing functions. For example, payment for pharmacy products and services are increasingly coming under control of Pharmacy Benefits Management (PBM) companies who are also racing to develop Disease State Management Programs. Additionally, health care purchasers have welcomed the development of HEDIS (Health Employer Data Information Set) as another tool to evaluate both the cost and quality of health care provided to their enrollees. All this means pharmacy will have to change its paradigm from dispensing to managing the medication consumption/compliance process in addition to traditional dispensing activities.     

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.     

Stepwise approach to implementing ambulatory clinical pharmacy services.

PURPOSE: A methodological approach was developed to facilitate expansion of clinical pharmacist-managed anticoagulation services across an integrated health care delivery network. METHODS: A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services was used to facilitate expansion of pharmacist-managed anticoagulation clinics in a university hospital setting and a community hospital within the same health network. RESULTS: The Health Alliance of Greater Cincinnati successfully created a care delivery model using clinical pharmacists to provide comprehensive anticoagulation management services at a university hospital and a community hospital. The incidence of thromboembolic events was significantly lower in the pharmacy anticoagulation service patients versus the patients in the usual care setting (p=0.005). A statistically significant decrease in minor bleeding events was observed in the pharmacist-managed group (p=0.038). Although a decrease in major bleeding events was observed, it was not statistically significant (p=0.075). International Normalized Ratio values of the patients managed by the pharmacy anticoagulation clinics were within the therapeutic range approximately 75% of the time. CONCLUSION: A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services has facilitated the expansion of pharmacist-managed anticoagulation clinics across an integrated health system. This may serve as a valuable template for other systems as they strive to develop medication therapy management services.     

Pharmacists' perceptions of consumer demand for patient-oriented pharmacy services

This study examined pharmacists' perceptions of consumer demand for various patient-oriented pharmacy services. Data on pharmacists' perceptions were gathered by a mail questionnaire of pharmacist-managers in Raleigh, NC. Conjoint and regression analyses indicate that pharmacists perceive little demand either for voluntary provision of advisory services or for patient medication records, and that pharmacists' perceptions of the demand for patient medication records relate significantly to their provision of this service. Comparison of pharmacists' perceptions of demand with previously collected consumer data indicates that pharmacists underestimate the demand for patient medication records but not for voluntary provision of advisory services. These findings suggest that pharmacists' perception of consumer demand is as important as actual consumer demand in explaining why pharmacists do not provide patient-oriented pharmacy services more frequently.     

Evolution of ambulatory pharmacy services at a public health department

This article is a narrative of the development of several key pharmacy services at a public health department in a metropolitan area fraught with many urban problems and obstacles for delivery of health services to the underserved. The pharmacy operation evolved from a traditional dispensing role to fully integrated clinical pharmacy services.     

Patients' perceived benefit from and satisfaction with asthma-related pharmacy services.

OBJECTIVE: To determine whether patients targeted to receive intervention from an asthma management program reported receiving more services and had greater perceived benefit and satisfaction with those services compared with asthma patients not targeted by the program. DESIGN: Mailed survey. SETTING: Community pharmacy. PATIENTS: 471 community-based patients receiving asthma medications from 44 intervention pharmacies and 1,164 patients from 46 usual care (control) pharmacies. MAIN OUTCOME MEASURES: Five-point agreement scale measuring asthma services received, perceived value of the services, and satisfaction. RESULTS: Usable surveys were received from 39.0% of intervention patients and 42.4% of controls. There were no statistically significant differences between groups in the frequency of provision of listed services. Approximately 60% of respondents from both groups received written materials on asthma medications and 54% received inhaler counseling; both were rated high for perceived benefit. Fewer than 20% reported being counseled about asthma triggers. Fewer than 5% reported pharmacists talking to physicians on their behalf. General satisfaction with pharmacy services was high (78.2% agree or strongly agree), but not statistically different between groups. More than 65% believed that pharmacists spend enough time counseling patients. Several comments indicated that patients did not expect or ask for information because they were unaware that services were available and/or they had already been counseled by their physician. Responses to the statement "my asthma is better controlled because of help given to me by the pharmacist" were equivocal and not different between groups. CONCLUSION: Overall, there were few differences between groups. General satisfaction with pharmacy services is high, but patients' perceived benefit and satisfaction with cognitive services is lower. Increased public awareness of pharmacists' capabilities and a more proactive approach to providing cognitive services is needed.     

Physician perceptions of clinical pharmacy encounters in a family practice clinic

The purpose of this study was to classify pharmacist-physician encounters in a family medicine center into three progressive levels of service in order to determine the physician's perception of the relative value of each level. The three levels of service were drug information, pharmacy consultation individualized to the patient, and pharmaceutical care-consultation with follow-up to monitor patient outcome. Physicians received a questionnaire with each encounter and were asked to rank questions regarding the quality of the information provided, the impact they perceived that the information had on patient care, and to assign a monetary value for each encounter. A total of 106 of 141 (75 percent) questionnaires suitable for analysis were stratified into drug information (25.5 percent), pharmacy consultation (49 percent), and pharmaceutical care (25.5 percent). Physicians' perceptions toward the quality, impact, and value of pharmacy services were favorable overall, but they perceived a significantly higher quality, impact, and value to pharmaceutical care encounters than for drug information and pharmacy consultation (p < 0.05).