Hospital formularies: organizational aspects and supplementary components

The organizational aspects and supplementary components of 44 formularies in teaching hospitals of 500 beds or more were compared. The aspects of formularies studied included prescribing regulations and technical aids, economic considerations, information on pharmacy services and procedures, information regarding drug products, hospital regulations, and format and readability. Many inconsistencies were found in the organization of the formularies and in the types of supplementary sections they included. It is suggested that the formulary has not been employed effectively as a document for transmitting drug information and hospital regulations.     

The in vivo effects of rhIL-1 alpha therapy on human monocyte activity

Pleiotropic cytokines such as interleukin-1 alpha (IL-1 alpha) have multiple effects on peripheral blood monocytes (PBMs). This study examined the ability of in vivo recombinant human IL-1 alpha (rhIL-1 alpha) therapy to enhance clinically important monocyte functions in ovarian cancer patients prior to chemotherapy. After 4 days of continuous infusion, in vivo rhIL-1 alpha therapy amplified both the number and activity of PBMs. Therapy with rhIL-1 alpha increased the number of PBMs sixfold. These monocytes had a significantly increased ability to produce superoxide anion in response to phorbol 12,13-dibutyrate stimulation. Their ability to secrete spontaneously the immunomodulatory cytokines IL-1 alpha and IL-1 beta was significantly increased, but their ability to secrete tumor necrosis factor alpha (TNF-alpha) was not significantly elevated. These effects of rhIL-1 alpha infusion on cytokine secretion by PBMs appear to be related to rhIL-1 alpha-induced increases in the mRNA levels for these cytokines. In contrast, rhIL-1 alpha therapy did not significantly alter PBM response to lipopolysaccharide (10 micrograms/ml). In summary, infused rhIL-1 alpha, in addition to its use as a myeloprotective agent, has enhancing effects on the number and activity of PBMs. The effects of rhIL-1 alpha infusion on PBM function demonstrated here should at least transiently increase the ability of monocytes to combat infection and enhance host immune response.     

Therapeutic-interchange program for oral histamine H2-receptor antagonists

A therapeutic-interchange (TI) program for oral histamine H2-receptor antagonists at a hospital is described. In 1992 the pharmacy and therapeutics committee at a large teaching hospital accepted cimetidine as the preferred oral H2 antagonist. However, the program to promote cimetidine met with little success. The manufacturer of nizatidine then offered the hospital that drug at a reduced cost relative to all other members of the drug class. The committee recommended including nizatidine on the formulary; implementing a TI program so that when an order for an oral H2 antagonist was written nizatidine would be dispensed; deleting cimetidine and ranitidine tablets from the formulary; and retaining cimetidine and ranitidine oral liquid and i.v. formulations. The program was approved by the medical executive committee and was implemented in August 1994. Extensive efforts to inform the pharmacy, medical, and nursing staffs about the program were undertaken, and the pharmacy established mechanisms for monitoring compliance. Two months into the program, 97% of eligible patients were receiving nizatidine. Actual cost savings in the first four months exceeded $40,000. In July 1997 the same program was applied to famotidine, which had replaced nizatidine as the most cost-effective H2 antagonist. A successful TI program for oral H2 antagonists was achieved by gaining physician support for the program, educating providers, monitoring compliance, and responding to changes in drug costs.     

Clinical pharmacy services in hospitals educating pharmacy students

In 1995 we conducted a national survey of 1102 acute care hospitals in the United States to determine types of clinical pharmacy services, patient-focused care, and pharmaceutical care used to educate and train pharmacy students, and compared outcomes with surveys in 1989 and 1992. Clinical pharmacy services offered in 50% or more of Pharm.D.-affiliated hospitals (core services) were drug-use evaluation, in-service education, pharmacokinetic consultations, adverse drug reaction management, drug therapy monitoring, protocol management (most common for aminoglycosides, nutrition, antibiotics, heparin, warfarin, theophylline), nutrition team, and drug counseling. Comprehensive pharmaceutical care programs were established in 64%, 42%, and 33% of Pharm.D., B.S., and nonteaching hospitals, respectively. Patient-focused care programs were beginning or established in 77%, 71%, and 60%, respectively. Pharmacists served as care team leaders in 23% of hospitals affiliated with a college of pharmacy. Most common ambulatory care clinics were oncology, anticoagulation, diabetes, geriatrics, refill, and infectious diseases/HIV. For-profit hospitals rarely provided education for pharmacy students. Thus patient-focused and comprehensive pharmaceutical care programs exist according to a hospital's academic program affiliation with Pharm.D. or B.S. degree program.     

Patterns of mental health services provided by HMOs.

Surveyed 145 US health maintenance organizations (HMOs) to determine outpatient mental health services offered, psychologists and other providers used, and practices followed in offering such services. Results show that basic assessment and intervention modalities were available to almost all HMO members. Health education programs (weight control, smoking control, and stress adaptation) were not as broadly available as were the more traditional mental health efforts. Almost all HMOs utilized psychologists as providers, either as employees or consultants; subdoctoral qualifications for employment were accepted by one-fifth of the plans. In most plans, physicians referred patients for psychological services. HMOs based on individual practice association models offered fewer services than either group or staff models. The level of mental health service required for federal qualification is exceeded by plans enrolling 82% of all members. Data did not support the argument that requiring mental health services results in forcing both services and costs upward. It is concluded that the current rate of HMO growth will not provide large numbers of additional jobs for psychologists. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacy-based special infant formula service

The preparation of infant formulas by a hospital pharmacy for a 280-bed department of pediatrics is discussed. A formulary of acceptable special therapeutic formulas was developed in conjunction with the pediatricians. Space and equipment originally intended for intravenous admixture and total parenteral nutrition services were supplemented to include special infant formula services. The personnel and equipment requirements, and quality control procedures, of the service are discussed.     

Rural hospital health promotion: programs, methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N = 124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.     

Cost of comprehensive pharmaceutical services in a 45-bed rural hospital

The financial impact of a comprehensive pharmacy program on patient charges and hospital operating costs in a 45-bed community hospital was studied. Data were collected retrospectively for the fiscal year prior to initiating pharmacy services (FY73), the fiscal year during program development (FY74) and the fiscal year following full operations (FY75). The total cost of pharmacy services increased 75% from FY73 to FY75, with the largest dollar increase being in pharmacy salaries. Large increases among other cost items also were noted. The average total cost for pharmacy services increased from $3.28 per patient day in FY73 to $6.04 in FY75 (84%). Total hospital cost per patient day increased by approximately $35 from FY73 to FY75 (5%). The pharmaceutical services fee per dose of medication administered did not change from FY73 to FY75. Patient charges per day for medications and pharmaceutical services increased $0.55 (9.8%) from FY73 to FY75. There was a 55% reduction in the number of items carried in pharmacy inventory from FY73 to FY74 following the initiation of a formulary and a unit dose drug distribution system.     

A comparison of computer-based versus traditional individual psychotherapy.

Professional psychologists are challenged to determine the appropriate use of interactive computer therapy programs. Although such programs have the potential of enhancing delivery of mental health services and reaching ever broader audiences, they raise serious clinical, legal, ethical, and practical concerns. This article reports on a controlled clinical trial comparing short-term traditional individual therapy with a computer-based intervention among 90 adults overseen by a therapist. Results were favorable and comparable in both conditions, with individual therapy outperforming computer-based therapy on some measures. The practitioner's use of computer-based psychotherapy interventions is discussed and some guidelines offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A battery powered operating table with a removable stationary column base and a detachable table top

The development of a program to monitor the use of pharmacy personnel is described. The program is part of a hospital-wide Labor Information System developed to support requests for additional staff, to highlight opportunities for improved and allocation of manpower, and to serve as a conceptual model of the department from a manpower perspective when communicating with other members of the hospital organization. Nine major functions of the pharmacy department were identified. Detailed activities for each function were listed along with the type of personnel who performed each activity. Standards representing the amount of time spent on each activity were then developed. Variable, fixed, and open standards were used. Workload volumes are tabulated on a biweekly basis and entered into a computer. Payroll data covering the same period are simultaneously fed into the computer system. The resulting computer-generated report compares the service hours necessary to perform the actual workload (based on the predetermined time standards) to the available hours actually worked by each job category of pharmacy personnel. The ratio of service hours to available hours measures the use of personnel by functional activity. The system has been successfully applied to support requests for additional personnel, to forecast staffing needs for new programs, and to make operational improvements. In addition, the system has the capacity to accurately monitor personnel time for providing clinical services.     

Developing and marketing a community pharmacy-based asthma management program

OBJECTIVE: To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. SETTING: Community-based ambulatory care. PRACTICE DESCRIPTION: Independent community pharmacy. PRACTICE INNOVATION: Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. MAIN OUTCOME MEASUREMENTS: Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. RESULTS: A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. CONCLUSION: The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.     

Endometrial cytology in postmenopausal hormone replacement therapy

INTRODUCTION: The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competitive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans. METHODS: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs. RESULTS: California's HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%-3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. CONCLUSION: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.     

Drug abusers on the job

Drug abusers in the working population range from the functional to the dysfunctional. Functional drug-abusing employees may work as productive members of a company for years without incident or detection. Cases have been documented of long-term heroin addicts with stable 10- and 20-year work histories., Studies of drug addicts in treatment with known work histories reveal that such persons can, and do, hold a broad range of jobs in the work force. In a study by Levy of 95 former addicts with histories of simultaneous employment and undetected drug abuse (including on-the-job use by 91 of the 95 addicts), the following occupations were found: bank teller; mail clerk; secretary; delivery man; stock clerk; college registrar; typist; baker; nurses aide; medical supply clerk; messenger; pharmacy clerk; receptionist; teletype operator; men's clothing salesman; truck driver; busboy; telephone installer; roofer; clothing designer; assembly line worker; waitress; auto mechanic; security officer; postal worker; credit collector; plant manager; and rigger. Reports from CODAP, a Federal statistical system covering drug treatment programs, indicate that about 20% of opiate users admitted to treatment were employed full time at the time of admission. Caplovitz found that the stable worker-addict is more similar in basic characteristics to other workers than to nonworking addicts.