The perceived influence of clinical pharmacy services on physician prescribing behavior: a matched-pair comparison of pharmacists and physicians

In contrast with cross-sectional designs used in previous studies, this exploratory study compared survey data from 127 matched pairs of clinical pharmacists and physicians working together. Physicians' perceptions of the importance of clinical pharmacy activities for patient care and the competence of pharmacists performing the activities were examined for their influence on prescribing behavior in an institutional setting. Data from a national survey showed that physicians rated pharmacists higher regarding recommendations based on drug use evaluations (p = 0.004) and competency to provide all clinical pharmacy services. Scores for pharmacokinetics ratings were similar between pharmacists and physicians (p = 0.168). Pharmacists rated the importance of recommendations based on cost-effectiveness higher than physicians (p = 0.012). Overall, physicians' perceptions of activity importance for patient care and pharmacist competency appear to dictate pharmacists' influence on physician prescribing behavior (R = 0.723).     

Contribution of clinical pharmacists to patient care

Literature reports of the contributions of clinical pharmacists to patient care are reviewed. The topics covered are: clinical pharmacist functions in the drug use process, specific clinical activities of clinical pharmacists, and specialty areas of clinical pharmacy practice. It is concluded that more research needs to be done on the effectiveness and legal basis of clinical pharmacy services, and that adequate methods of payment for clinical pharmacy services must be developed.     

Surgeons in the United States. Activities, output and income

In a national surgical manpower questionnaire survey, 76% of those MD and DO surgeons who were contactable returned questionnaires that included a log diary reporting details of their daily activities. Comparisons were made of allocation of professional time, number of operations performed, and net income of respondents by physician classification (including certification), specialty, practice arrangement, age, and census division. The mean professional workweek was estimated at 46 hours for all respondents. More than two thirds of the total professional time was spent in direct patient care; about half the surgeon's time was spent in the hospital, with nearly 20% in the operating room. The median annual work load of respondents was 170 operations. Their median annual net income was $45,700.     

Accuracy of technicians versus pharmacists in checking syringes prepared for a dialysis program

The accuracy of pharmacy technicians versus pharmacists in checking drug doses prepared in syringes for a dialysis program was studied. Three pharmacy technicians from the pharmacy of a regional kidney disease program in Minnesota participated in the study after completing a training program and after common preparation errors had been identified by pharmacists. From November 1995 to April 1996, the technicians used labels printed from a database of pharmacist-verified orders to prepare and label i.v. syringes. Four medications were used-epoetin alfa, calcitriol, heparin prepared from beef lung, and heparin prepared from porcine intestinal mucosa. Each syringe was checked by one of nine pharmacists for accuracy of dose and medication, and all errors were recorded. The technicians checked syringes prepared by other technicians and also recorded errors. Accuracy rates (percentages of syringes correctly evaluated) for pharmacists and technicians were compared. A total of 10,608 syringes were checked. Accuracy rates for pharmacists and pharmacy technicians were 99.86% and 99.83%, respectively. Accuracy rates in checking syringes did not differ significantly between pharmacists and technicians in this study setting.     

Survey of inpatient counseling by hospital pharmacists

A survey was conducted to determine the inpatient-counseling practices of hospital pharmacists. A questionnaire about the frequency of inpatient counseling, barriers to counseling, and suggestions for increasing the level of inpatient counseling was mailed to 667 hospital pharmacists. Recipients were asked to rate six attitudinal statements about inpatient counseling. The response rate was 30%. The largest group of respondents worked in institutions where discharge counseling was provided to specific populations or as needed. Some 67% of respondents reported not counseling any patients. Barriers to counseling most often cited were lack of time and inadequate staff; facilitators most often cited were decentralization and resource availability. The most frequent suggestions for increasing the amount of counseling were making changes that provide more time, having adequate staff to provide counseling, and having a well-designed counseling program in place. Responses about barriers and facilitators varied with practice setting and frequency of counseling. On average, pharmacists reported a belief that they are the health care professionals most qualified to counsel inpatients about medications and that this is their responsibility. More than two thirds of the responding hospital pharmacists reported counseling no patients; the barrier to counseling most frequently reported was lack of time, and the facilitator most often reported was decentralization; on average, pharmacists reported that they believed they should have a role in inpatient counseling.     

Evaluation of cognitive functions after anesthesia with propofol

Retail pharmacies in developing countries are one of the most important sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff has been found to be far from acceptable. In childhood diarrhea, for example, oral rehydration salts (ORS), the appropriate diarrhea treatment, are recommended much less than pharmaceuticals of limited value, such as antimotility agents, adsorbents, etc. Little information is available for reasons underlying such behaviors. In this paper, we present a conceptual framework in which to analyze factors that may affect retail pharmacy prescribing, and we suggest strategies for behavior change. We developed this framework after examining relevant literature on retail pharmacy prescribing. We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could be used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion. The behavior and intervention frameworks presented in this paper should also help in guiding further research in this area. For example, new information on the effects of ownership type, availability vs actual role of professional staff and authority structure on pharmacy treatment behaviors would be useful areas for future research. Similarly, additional research is needed on the comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.     

Saskatchewan dial-access drug information service

In September 1974 the colleges of pharmacy and medicine of the University of Saskatchewan began offering a drug information service to the pharmacists and physicians of Saskatchewan without charge. With the help of a radio-page system, calls are taken immediately by experienced pharmacists and pharmacologists. The cost of long-distance phone calls is borne by grants from the Saskatchewan medical and pharmaceutical associations. During the 1st year of operation 415 requests for information were received. Of 93 persons who called up to Feb. 28, 1975, 76% responded to an evaluation questionnaire; virtually all described the service as very valuable. The information received resulted in the alteration of drug therapy in one third of calls requesting information to assist in current treatment of a patient.     

Doctorates in medicine and pharmacy

Pharmacists had to wait until the Delong Act in 1979 to obtain a diploma of professional practice giving them the title of doctor. Since 1898, some of them could be called "Doctor of Pharmacy", but this title was neither a university degree nor a diploma of professional practice. A state doctorate of pharmacy was created in 1939 and replaced in 1977 by the doctorate of pharmaceutical sciences which was suppressed in 1984, like all other doctorates as university degrees. With the present reform, the doctorate of medicine, which was both a university degree and a diploma of professional practice, has only kept this latter qualification as "state diploma of doctor of medicine", like the pharmacists new diploma of professional practice. Physicians and pharmacists can now only obtain the highest university grade with the "doctorate" created in 1984. The conditions of obtention are indicated.     

Renal stone analysis: is there any clinical value?

OBJECTIVE: To provide national-level data concerning the percentage of pharmacies selling tobacco products, examine relationships between selling practices and pharmacy characteristic variables, and explore perceptions of conflicts between tobacco-selling activity and professional and personal values and the potential effects of such conflicts. DESIGN, SETTING, PARTICIPANTS: Data were collected from a geographically stratified systematic random sample of 899 pharmacies. Multiple mailings were sent to the attention of the pharmacy manager. A random sample of nonrespondents was also contacted by telephone, urging participation. MAIN OUTCOME MEASURES: Whether the pharmacy currently sold cigarettes and/or smokeless tobacco products, and if so, whether these practices differed from what respondents' personal or professional values tell them to do. Scales designed to measure job satisfaction, job-induced tension, and propensity to leave were also included. RESULTS: Slightly more than half (50.5%) of the pharmacies sold cigarettes and 35.4% sold smokeless tobacco products. Independents were less likely than chain pharmacies to sell tobacco products. For those respondents working in pharmacies where tobacco products were sold, 47.6% responded that this practice differs from what their personal values tell them to do and 63.9% replied that this practice differs from what their professional values tell them to do. Even when controlling for pharmacy type, respondents working in pharmacies that sold tobacco products had significantly lower levels of global job satisfaction, higher levels of job-induced tension, and a higher propensity to leave than did respondents working in pharmacies that did not. CONCLUSION: Decision makers in pharmacies where tobacco products are still sold should take a serious look at the justification for the continued availability of tobacco products in an environment that has a goal of promoting health.     

Computerized monitoring protocols as a pharmaceutical care practice enhancement: a conceptual illustration using diabetes mellitus

OBJECTIVE: To illustrate how a computer system used in an ambulatory care pharmacy setting might enhance care of patients with diabetes by prospectively monitoring and prompting them to seek routine medical care. DATA SOURCES: A MEDLINE search to identify existing works on informatics was conducted. An epidemiology and general medical literature review of diabetes mellitus was also performed via MEDLINE. Additionally, known textbooks on the disease were consulted. CONCLUSIONS: Programming a computer system to prompt pharmacists to remind their patients of necessary medical interventions could save medical resources by warning chronically ill patients not to ignore routine medical care. Also, this would allow the pharmacist to prospectively monitor patient outcomes. By knowing when medical interventions are due and obtaining feedback from patients on the results of the medical contact, pharmacists increase their knowledge about patient outcomes and the rationale behind changes in pharmacotherapy. It is expected that such a system would prevent the inconspicuous development of chronic complications.     

Pharmacies during the transformation of health care. IV. Sociologic study of pharmacy service

In Slovakia, similarly as in the Czech Republic, marked changes in the pharmaceutical services have gradually been taking place since 1990. Principal legal and organizational changes have been connected also with the extent and standard of provided pharmaceutical services. The present paper reports the results of a questionnaire research regarding the evaluation of the standard of pharmaceutical services in the year 1995 where there existed both state-owned and private public pharmacies. The questionnaire research was carried out in 20 pharmacies of the Region of West Slovakia, 407 questionnaires were evaluated. The questionnaires were evaluated from the viewpoint of sociological classification of respondents (economically active persons, old-age pensioners) as well as the sex of pharmacy customers. The results confirmed relatively little significant differences between the satisfaction with pharmaceutical services either according to the sex or the social position of the respondents. A relatively significant proportion of the respondents have expressed critical views about the participation of the patient in covering the costs of drugs and slow execution of order of drugs.     

Professional Identity of Counseling Psychologists.

This research investigated the professional activities of members of the Division of Counseling Psychology (Division 17) of the American Psychological Association. A random sample of 700 Division 17 members was sent surveys; 304 (43.4%) respondents returned completed surveys. Participants perceived themselves as most involved with professional activities associated with short-term, goal-directed counseling and program development and least involved with research and working with paraprofessionals. Participants differed in terms of the frequency with which they perceived themselves performing certain professional activities as well as the importance they placed on these activities as a function of job setting, whether or not they were licensed for private practice, whether or not they were members of a Division other than Division 17, and whether they identified themselves as counseling or clinical psychologists. Despite these differences, common interests emerged among those Division 17 members sampled, indicating a definable applied specialty within psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing disease management in community pharmacy practice

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes. DM differs from pharmaceutical care in that pharmaceutical care targets not only patients with specific diseases but also those with risk factors for drug-related problems, a history of nonadherence, and frequent changes in medication regimens. Steps to starting a DM program include: (1) identifying a target population based on the population's strategic importance to the goals and aims of the organization; (2) assessing the organization's available resources, both internal and external; (3) defining key indicators with which to assess the program for the purposes of internal quality control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smoking cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because they are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as it evolves.     

Billing third party payers for pharmaceutical care services

OBJECTIVE: To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. DATA SOURCES: Government publications; professional publications, including manuals and newsletters; authors' personal experience. DATA SYNTHESIS: Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. CONCLUSION: Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.     

Strategic planning in the community pharmacy

The extent and quality of strategic planning by community pharmacy owners and/or managers was assessed. Also examined were factors that may explain respondents use of the strategic planning process. A mail questionnaire on strategic planning yielded a total of 562 usable surveys (37.4% response rate). An unexpectedly small proportion (less than 31%) of respondents reported using strategic planning. Respondents who conducted strategic planning rated significantly higher the time available for their knowledge of, and the importance of strategic planning than those respondents who did not conducts strategic planning.     

Work Setting and Burnout Among Professional Psychologists.

How does work setting relate to burnout among professional psychologists? Five hundred and seventy-one doctoral psychologists responded to a survey about professional activities, work environment, and burnout. Solo and group independent practitioners reported a greater sense of personal accomplishment than agency respondents. However, women experienced higher levels of emotional exhaustion in agency settings than in either solo or group independent practice, whereas men experienced higher exhaustion in group independent practice. Overall, greater emotional exhaustion was associated with less control over work activities, working more hours, spending more time on administrative tasks and paperwork, seeing more managed care clients and fewer direct pay clients, and having to deal with more negative client behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)