Showing papers in "Journal of the American Pharmaceutical Association in 2002"
TL;DR: The instrument provides information on patients' satisfaction with two dimensions of pharmacy services and may be useful to practicing pharmacists, but it should be used cautiously until it is tested among patrons of pharmacies known to provide different levels of care.
Abstract: Objective To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its factorial composition. Design Single intervention, noncomparative, 20-item self-administered questionnaire. Setting Iowa. Participants Seven hundred seventy-five prescription patrons of eight community pharmacies whose pharmacists had received training in pharmaceutical care but who had not yet implemented it. Interventions An instrument originally developed to measure patient satisfaction with traditional community pharmacy services was modified to focus on the elements of pharmaceutical care. This revised questionnaire was mailed to participants. Main Outcome Measures Participant responses to items in the questionnaire. Results The survey response rate was 55%. Factor analysis and item analysis identified two dimensions of pharmaceutical care. We labeled the dimensions Friendly Explanation (including items related to friendliness of care, the setting of care, and medication counseling) and Managing Therapy (items dealing with the concept of pharmaceutical care—managing drug therapy and solving therapy problems). Respondents scored items on the Managing Therapy scale lower than they did items on the Friendly Explanation scale. The scales were highly correlated. Two other hypothesized dimensions of care—Consideration/Caring Relationships and Setting—were subsumed in the final scale of Friendly Explanation. Conclusion The instrument provides information on patients' satisfaction with two dimensions of pharmacy services. The instrument may be useful to practicing pharmacists, but it should be used cautiously until it is tested among patrons of pharmacies known to provide different levels of care.
205 citations
TL;DR: Several natural products in common use can lower blood glucose in patients with diabetes, and pharmacists who have a stronger understanding of these products are better positioned to counsel patients on their appropriate use.
Abstract: Objective To review the efficacy and safety of natural products commonly used for diabetes Data Sources English and Spanish-language journals retrieved through a MEDLINE search of articles published between 1960 and December 2001 using these index terms: Opuntia, karela, gymnema, tecoma, alpha lipoic acid, thioctic acid, ginseng, panaxans, and diabetes Data Synthesis Natural products have long been used in traditional systems of medicine for diabetes Products in common use include nopal (prickly pear cactus), fenugreek, karela (bitter melon), gymnema, ginseng, tronadora, chromium, and alpha-lipoic acid The popularity of these products varies among people of different ethnicities Nopal is the most commonly used herbal hypoglycemic among persons of Mexican descent Karela is more commonly used by persons from Asian countries Some of these agents have gained universal appeal For a select number of products, studies have revealed single or multiple mechanisms of action For several of these, high soluble fiber content is a contributing factor Conclusion Based on the available evidence, several natural products in common use can lower blood glucose in patients with diabetes Commonly used natural products often have a long history of traditional use, and pharmacists who have a stronger understanding of these products are better positioned to counsel patients on their appropriate use
200 citations
TL;DR: The prevalence of inappropriate prescribing remains alarmingly high for the elderly in general and for nursing home residents in particular, and some attributes of the elderly groups most vulnerable to inappropriate prescribing are identified.
Abstract: Objectives To provide an updated review of the literature on the extent of and risk factors for inappropriate prescribing in the elderly. Methods A comprehensive review of the most recent publications in English assessing inappropriate prescriptions for elderly patients in the United States using the 1997 version of the Beers explicit criteria. The reviewed articles were obtained via an electronic search of the MEDLINE database for articles published between 1997 and 2001 and a manual search through major journals for articles referenced in those located through MEDLINE. Search terms were Beers, explicit criteria, inappropriate drug use, prescribing, prescriptions, medication use, elderly, and health outcomes . Results Using the updated explicit criteria, a total of 11 empirical studies were identified, all of which were conducted using observational surveys or claims databases. The reported prevalence of elderly patients using at least one inappropriately prescribed drug ranged from a high of 40% for a population of nursing home patients to 21.3% for community-dwelling patients over age 65. Propoxyphene, amitriptyline, long-acting benzodiazepines (e.g., chlordiazepoxide, diazepam, flurazepam), and dipyridamole are among the most commonly occurring inappropriate prescriptions. With a few exceptions, the most significant patientrelated predictors of inappropriate prescribing include polypharmacy, poor health status, and female sex. Other potential risk factors include prescribing location, ethnicity, age, and referral status. Limited evidence was found of increased health care utilization and poorer quality of life resulting from inappropriate drug use in the elderly in Medicare health maintenance organization and emergency department settings. Conclusion The prevalence of inappropriate prescribing remains alarmingly high for the elderly in general and for nursing home residents in particular. This review identified some attributes of the elderly groups most vulnerable to inappropriate prescribing. Future research should document more evidence regarding the adverse impact of inappropriate prescribing on total health care costs and patient health outcomes.
188 citations
TL;DR: Pharmacists can play a critical role in monitoring medication concerns at the beginning of use, allowing for problem solving, reinforcement, and greater patient satisfaction with and adherence to medication therapy.
Abstract: Objective To examine the effects of pharmacist monitoring on patient satisfaction with and adherence to antidepressant medication therapy. Design In this prospective field study, we interviewed patients starting an antidepressant after a new prescription was dispensed and again 2months later. The first interview assessed patients' characteristics, antidepressant medication history, knowledge of antidepresant medications and their use, and beliefs about antidepressant medications. The second interview focused on pharmacist monitoring behavior and satisfaction with the antidepressant medication. Setting and Participants From 23 community pharmacies, we enrolled 100 patients, 59 of whom were taking an antidepressant for the first time. Main Outcome Measures Patient satisfaction with and reported adherence to their antidepressant medication regimen. Results Pharmacist monitoring of patients' antidepressant medication use varied. More than 70% of patients reported that pharmacists asked about medication concerns; 53% and 54% of patients, respectively, said pharmacists encouraged their questions and listened to their concerns; and 32% found pharmacists helpful in solving problems related to the antidepressant. Fifty-seven percent of patients reported feeling better a lot of the time since taking the antidepressant, 40% said the antidepressant did not bother them, and 83% reported missing doses, adding doses, or stopping the antidepressant during the study period. Initial beliefs about antidepressants were a strong predictor of patient outcomes. Pharmacist monitoring was predictive of satisfaction and adherence for individuals taking an antidepressant for the first time. Conclusion Pharmacists can play a critical role in monitoring medication concerns at the beginning of use, allowing for problem solving, reinforcement, and greater patient satisfaction with and adherence to medication therapy. Obstacles to effective pharmacist monitoring and follow-up need to be identified and addressed in future improvement efforts
125 citations
TL;DR: In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients and what factors limit the program was determined.
Abstract: Objectives To evaluate the community pharmacist’s capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program. Design Randomized, controlled study. Setting Private pharmacy caring for a semiliterate, rural Portuguese population. Patients Random sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months. Patients were randomly assigned to an intervention (n = 50) or a control (n = 50) group. Intervention Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure; assess adherence to treatment; prevent, detect, and resolve drug-related problems (DRPs); and encourage nonpharmacologic measures for blood pressure control. Control patients received traditional care. Main Outcome Measures Control of blood pressure; decreases in systolic/diastolic blood pressure; number of detected, resolved, and prevented DRPs. Results From the initial sample of 100 patients, 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study. After 6 months, prevalence of uncontrolled blood pressure decreased by 77.4% in the intervention group ( P P = .48). Systolic blood pressure fell from a mean – standard deviation of 152 mm Hg – 23 mm Hg to 129 – 15 mm Hg in intervention patients and 148 – 16 mm Hg to 143 – 20 mm Hg in control patients ( P Conclusion In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients.
93 citations
TL;DR: Findings show that pharmacists would prefer to devote more of their time to professional responsibilities, such as consultation and drug use management, and less time to medication dispensing and business management.
Abstract: Objectives To describe community pharmacists' work activities in the United States during 2000 and to investigate the effects of position, pharmacy type, and prescription volume on work activities. Design Cross-sectional descriptive survey of a systematic sample of 4,895 U.S. pharmacists, of which 2,250 responded. Setting United States. Participants A sample of 832 community pharmacists working full-time (at least 30 hours per week) out of the total of 2,250 who responded to the survey. Interventions Not applicable. Main Outcome Measures Workload (hours worked and proportion of prescriptions dispensed at the site with which the pharmacist was personally involved) and professional responsibilities (proportion of time spent in medication dispensing, consultation, business management, and drug use management). Results As of 2000, the typical community pharmacist in the United States devoted 56% of his or her time to medication dispensing responsibilities, 19% to consultation responsibilities, 16% to business management responsibilities, and 9% to drug use management responsibilities. These results were consistent for pharmacists regardless of pharmacy type or prescription volume; however, position did significantly affect the proportion of time spent in the various activities. Conclusion Pharmacists are still devoting the majority of their time to medication dispensing responsibilities. However, our findings also show that pharmacists would prefer to devote more of their time to professional responsibilities, such as consultation and drug use management, and less time to medication dispensing and business management.
90 citations
TL;DR: The practice of dividing tablets to save costs or to improve a dosage regimen may not cause problems for patients using drugs with low toxicity and relatively flat dose-response relationships, but it is not recommended for patients use drugs with more substantial toxicity and steep dose- response efficacy curves.
Abstract: Objective To divide 11 commonly split tablets and evaluate the resulting half-tablets for content uniformity. Design Pre-post comparison. Setting Laboratory. Interventions: A trained individual split tablets of 11 products using a single-edged razor blade and 3 products by hand alone. Main Outcome Measures The Uniformity of Dosage Units test published in the United States Pharmacopeia 24 (USP), which applies to whole tablets, was adapted liberally to assess the dose uniformity of the resulting split tablets. Results Of the 11 razor-split products, 8 failed the liberal adaptation of the USP uniformity test. No visible tablet features (e.g., scoring) predisposed a product's split tablets to pass or fail the uniformity test. All three hand-split tablets failed the uniformity test and yielded worse results than did razor-split tablets. Conclusion The majority of the 11 drug products we tested, when assessed for their ability to be split into half-tablets of equal dose, failed a liberally interpreted USP uniformity test. The practice of dividing tablets to save costs or to improve a dosage regimen may not cause problems for patients using drugs with low toxicity and relatively flat dose-response relationships, but it is not recommended for patients using drugs with more substantial toxicity and steep dose-response efficacy curves.
87 citations
TL;DR: Patients should be reassured that early initiation of insulin therapy is a positive event that should improve their long-term health and does not represent a decline in the course of their disease.
Abstract: Objective To review the increasingly common use of insulin therapy in patients with type 2 diabetes and the practical aspects of initiating insulin therapy in these patients. Data Sources Recent scientific and clinical literature identified through MEDLINE searches for the years 1995-2001 using the terms oral agents, type 2 diabetes, insulin therapy, glycemic control and diabetic complications, glucose toxicity, insulin lispro, insulin aspart, and insulin glargine. Study Selection Reports of key large (1,000 patients or more) and significant smaller, randomized, controlled clinical trials were reviewed. For studies comparing insulin analogs, the authors reviewed a sampling of the identified trials for their characteristics and clinical importance Data Synthesis Tight blood glucose control can help reduce the risk of diabetes complications. Evidence suggests that early insulin therapy can help correct the underlying pathogenetic abnormalities in type 2 diabetes and improve long-term glycemic control. For these reasons, some diabetes experts advocate the initiation of insulin therapy earlier in the course of type 2 diabetes than has been common in the past. Insulin regimens should be designed to mimic the body's natural physiologic secretion of insulin, including the basal amounts released continuously by the pancreas and the insulin surges produced in response to glucose loads. Using new insulin analogs is a useful approach to achieving this ideal. Insulin glargine provides a nearly constant, peakless release of insulin when injected subcutaneously once daily. Two new rapid-acting insulin analogs, insulin lispro (Humalog—Lilly) and insulin aspart (NovoLog—Novo Nordisk), enhance patients' flexibility in terms of meals by permitting injection immediately before meals, rather than 30 minutes before meals, as with regular insulin Conclusion Patients should be reassured that early initiation of insulin therapy is a positive event that should improve their long-term health and does not represent a decline in the course of their disease
79 citations
TL;DR: Tablet splitting resulted in an unacceptably high incidence of weight variation and standards should be developed to ensure uniformity of split tablets.
Abstract: Objective To determine the level of weight uniformity of fragments from tablets split into halves and dispensed by pharmacists. Design Pre-post comparison. Setting Laboratory analysis of split tablets returned unused from four long-term care facilities. Interventions Twenty-two dispensed prescriptions containing 560 split tablet halves were collected, and fragment weights (FWs) were determined. Theoretical weights (TWs) of split tablets of the same medications were determined mathematically. Main Outcome Measures Comparison of the mean FW with the mean TW of each dispensed prescription and determination of whether fragments met United States Pharmacopeia 24 (USP) criteria for weight variation of whole tablets. Results A significant difference ( P Conclusion Tablet splitting resulted in an unacceptably high incidence of weight variation. Standards should be developed to ensure uniformity of split tablets.
70 citations
TL;DR: Compared with other types of previously reported interventions, a community pharmacist-managed smoking cessation clinic achieved greater long-term smoking cessation rates.
Abstract: Objective To describe and assess the effectiveness of a smoking cessation clinic. Design Single group, unblinded study. Setting Seven chain (mass-merchandise) community pharmacies in Virginia. Participants Forty-eight patients who were smokers when admitted to the study. Interventions Fifteen community chain pharmacists were trained using a smoking cessation training manual developed at the Virginia Commonwealth University School of Pharmacy. From April 1, 1997, through December 31, 1999, interested patients met individually with a study pharmacist during scheduled clinic times in semiprivate counseling areas. A patient chart was maintained at the site and updated after each visit. The first 30 patients completed a questionnaire after the third visit to the smoking cessation clinic to assess satisfaction with pharmacists and the overall program. Main Outcome Measures Rate of long-term smoking cessation. Results Of the 48 patients, 12 (25.0%) abstained from smoking cigarettes for 12 months or more beyond their predetermined quit dates. Abstinence rates for 1, 3, and 6 months were 43.8%, 31.3%, and 25.0%, respectively. Women were nearly five times more successful in attaining long-term abstinence than were men (33.3% versus 6.7%; P = .047). No significant differences were observed in cessation rates related to age, number of cigarettes smoked per day, level of nicotine dependence, number of previous quit attempts, or method of cessation. Increased appetite and weight gain were the most frequently reported withdrawal symptoms (16.7% of patients). Patients expressed satisfaction with the pharmacists and the smoking cessation program. Conclusion Compared with other types of previously reported interventions, a community pharmacist-managed smoking cessation clinic achieved greater long-term smoking cessation rates.
64 citations
TL;DR: No evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed and efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.
Abstract: Objective To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. Design Pre–post comparison. Setting In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. Main Outcome Measures Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. Results Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% ( P ever pharmacy use increased: 4.9% to 12.5% ( P Conclusion To date, no evidence of harmful effects (discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.
TL;DR: 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 pharmacist's compliance with the study protocol was low due, in part, to patient- and practice-related obstacles.
Abstract: 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.
TL;DR: 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), and satisfaction surveys should be designed to specifically assess the type of services provided by the pharmacy.
Abstract: 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.
TL;DR: A community pharmacy-based osteoporosis screening program using NOF materials was well accepted by physicians and can provide a strong foundation for such programs.
Abstract: Objectives To assess the feasibility of establishing an osteoporosis screening program in rural community pharmacies based on information and resources provided by the National Osteoporosis Foundation (NOF), to survey primary care providers regarding the usefulness of this screening program, and to recommend strategies for pharmacists interested in working with patients at risk for osteoporosis. Design and Participants Pharmacists and/or nurses enrolled women 65years of age and older into the study, measured calcaneal bone density, administered a questionnaire to ascertain subjects' osteoporosis risk factors, and provided NOF literature to subjects. With their agreement, women's bone mass data and risk factor assessments were provided to primary care providers along with NOF's Physician's Guide to Prevention and Treatment of Osteoporosis. These providers were surveyed as to whether they found this information useful. Setting Five independent community pharmacies in rural Wisconsin. Results We enrolled and tested 133 women. Of these, 122 (92%) agreed to have information mailed to their primary health care providers. These 57 providers were surveyed and 24 (42%) responded; of these 24, 20 (83%) found the information they received useful. Conclusion A community pharmacy- based osteoporosis screening program using NOF materials was well accepted by physicians. NOF resources and recommendations can provide a strong foundation for such programs.
TL;DR: Although IVIG preparations are derived from human plasma, they have a long safety record and a low risk for transmitting viral infections, and viral validation studies demonstrated that the processes discussed herein differ in their capabilities to inactivate lipid-enveloped and nonlipid-enclosed viruses.
Abstract: Objectives To discuss the current procedures and processes by which viral safety is ensured for intravenous immunoglobulins (IVIGs), to place in context the current increase in clinical indications for IVIGs, and to describe the safety issues that have led to product shortages. Data Sources Articles on viral safety retrieved from MEDLINE using the search terms gamma globulin, Intravenous, adverse reaction, and Infection and information from the manufacturers’ literature and Food and Drug Administration package inserts. Study Selection and Data Extraction Studies that specifically addressed the areas of major concern or advancement in viral safety of IVIGs, including donor selection, plasma screening, and other quality control procedures to ensure safety of source plasma; detection of viruses that may have escaped antibody screening tests through the use of polymerase chain reaction-based assays, which are capable of detecting small amounts of viral genomic material (e.g., hepatitis C virus, hepatitis B virus, and human immunodeficiency virus [HIV]) in small plasma pools; and industrial-scale, validated viral inactivation methods, such as pasteurization and solvent/detergent treatment, that have been incorporated into the manufacturing processes of immunoglobulins to further minimize the risk of viral transmission. Data Synthesis In addition to the treatment of primary immunodeficiency disorders, the clinical uses of IVIGs have expanded to include treatment of Kawasaki's syndrome, idiopathic thrombocytopenic purpura, infection following bone marrow transplantation, secondary immunologic disorders (e.g., pediatric HIV infection), hematologic disorders (e.g., chronic lymphocytic leukemia), and neurologic indications (e.g., Guillain-Barre syndrome). Although IVIG preparations are derived from human plasma, they have a long safety record and a low risk for transmitting viral infections. Conclusion Viral validation studies demonstrated that the processes discussed herein differ in their capabilities to inactivate lipid-enveloped and nonlipid-enveloped viruses.
TL;DR: Limited and inconclusive evidence about whether computer-aided prospective drug utilization review systems are effective and what system features are optimal may explain the wide variation among systems in terms of what problems are screened and may also explain clinicians' uncertainty about their value.
Abstract: Objective To describe the controversies and review the evidence about computer-aided prospective drug utilization review (PDUR) systems. Data Sources MEDLINE search of the literature. Study Selection Published studies of the effectiveness of computer-aided prescription screening. Data Synthesis One randomized, controlled trial and four nonrandomized studies constitute the evidence base. The five studies are inconclusive with respect to whether computer-aided prescription screening causes health care providers to take action, either because of a no difference finding or because there was no comparison group. In the one randomized, controlled trial, a substantial number of actions were taken by the control group whose members did not receive alerts. No study evaluated the total effect of screening by in-store and payer (online) systems. Specific research recommendations are made to increase the evidence base. Conclusion Limited and inconclusive evidence about whether these systems are effective and what system features are optimal may explain the wide variation among systems in terms of what problems are screened and may also explain clinicians' uncertainty about their value. A comprehensive national research agenda for reducing medical errors should include research on the effectiveness of computer-aided PDUR.
TL;DR: Convenience is still the primary determinant of pharmacy selection, and most consumers continue to use a single pharmacy, and Exploratory analysis suggests a direct association between active information seeking from the pharmacist and consumers' satisfaction with pharmacy services.
Abstract: Objectives To determine the types of pharmacy services used by consumers, to determine what sources they accessed for information on health and prescription drugs, and to assess their satisfaction with these information sources. Design Telephone survey. Setting Households. Participants Random sample of 1,201 consumers who reported having used the Internet during the previous 2 months and having filled at least one prescription within the past 6 months. Results Convenience continues to be the primary patronage motive for using a particular pharmacy, followed by price and service. Satisfaction with pharmacy services remains high, with 85% of respondents reporting being satisfied with the process of filling a new prescription and 90% being satisfied with the refill process. Exploratory analyses showed that respondents who reported they always asked questions of their pharmacists were consistently more satisfied with pharmacy services. Consumers ranked physicians and pharmacists as the first and second most important sources for drug information, and they were more satisfied with information obtained from these sources than they were with information obtained from print or electronic information sources. Thirty-six percent of respondents had searched the Internet for information on prescription medications within the past year. Conclusion Convenience is still the primary determinant of pharmacy selection, and most consumers continue to use a single pharmacy. Exploratory analysis suggests a direct association between active information seeking from the pharmacist and consumers' satisfaction with pharmacy services. J Am Pharm Assoc. 2002;42:568-76.
TL;DR: Improved syringe disposal options, continuing education programs, and clarification of existing laws and regulations would encourage more pharmacists in Denver to sell syringes to injection drug users (IDUs).
Abstract: Objective To identify factors influencing pharmacists' decisions about selling syringes to injection drug users (IDUs). Design Audiotaped interviews. Setting Denver, Colorado. Participants Thirty-two pharmacists at 24 pharmacies. Intervention One-hour semistructured interviews. Main Outcome Measures Practices regarding syringe sales to IDUs and factors influencing the practices. Results Of the 32 pharmacists interviewed, 16 indicated that they sold syringes to all customers ("pro-sell"), 11 refused to sell unless shown proof of diabetic status ("no-sell"), and 5 were "undecided." Several factors influenced the decision to sell. A perceived conflict between prevention of disease and prevention of drug abuse most clearly distinguished the three categories, with pro-sell pharmacists more likely than others to prioritize disease prevention and believe that syringe sales would not increase drug abuse. Business concerns, such as the effect of the presence of IDUs on other customers and the possibility of discarded syringes around the store, were especially prevalent among no-sell and undecided pharmacists. Seventeen pharmacists did not know about Colorado laws governing syringe sales. Four no-sell pharmacists used the laws to justify their decision not to sell, and two undecided pharmacists said they used the law when they did not want to sell syringes to IDU. All pharmacists supported syringe exchange programs. Conclusion One-half of the pharmacists sold syringes to IDUs, and several more indicated that they would do so if certain concerns were addressed. These data suggest that improved syringe disposal options, continuing education programs, and clarification of existing laws and regulations would encourage more pharmacists in Denver to sell syringes to IDUs.
TL;DR: The findings of this study suggest that syringe and drug possession laws could deter IDUs from participating in safe syringe disposal programs, and indicates that criminal laws do influence the syringe possession behavior of IDUs.
Abstract: Objective: To review state laws and judicial decisions for potential barriers to proper syringe disposal by injection drug users (IDUs) Design: Using standard legal research methods, this study reviewed drug paraphernalia, syringe prescription, drug possession, and syringe exchange laws and relevant case decisions in 59 jurisdictions Main Outcome Measures: Drug paraphernalia, syringe prescription, and drug possession laws Results: Drug paraphernalia laws prohibit all possession of syringes by IDUs in 31 jurisdictions Syringe prescription laws prohibit possession in 7 jurisdictions In 53 jurisdictions, IDUs may be subject to prosecution for the possession of drug residue in used syringes Only two states (HI, RI) have no legal barriers to safe syringe disposal by IDUs Sixteen jurisdictions that have tried to expand syringe access for IDUs by authorizing SEPs or by deregulating pharmacy sale of syringes continue to have criminal law provisions that could pose barriers to proper disposal Conclusion: IDUs are a significant source of syringes disposed of outside the health care system Involving IDUs in safe community sharps disposal programs is an important public health goal, but may be frustrated by legal barriers Although this study looked only at law on the books, and not law as actually applied, ethnographic and survey research indicates that criminal laws do influence the syringe possession behavior of IDUs The findings of this study suggest that syringe and drug possession laws could deter IDUs from participating in safe syringe disposal programs
TL;DR: Syringe access laws in most states may reasonably be interpreted to allow pharmacists to sell syringes to IDUs to prevent disease, however, unclear laws and pharmacist uncertainty as to their interpretation may constitute continuing barriers to syringe access for IDUs.
Abstract: Objectives Laws limiting access to sterile syringes impede the public health goal that injection drug users (IDUs) use a new, sterile syringe for every injection to reduce blood-borne disease transmission. We sought to determine the legality of selling or giving syringes to IDUs to prevent disease. Design We used standard legal research methods to identify and analyze laws and regulations influencing the distribution of syringes in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. Results A total of 51 jurisdictions had drug paraphernalia laws; 14 had syringe prescription laws or regulations; 11 required purchasers to show identification; 13 had legislation authorizing syringe exchange programs (SEPs). Since the beginning of the human immunodeficiency virus epidemic, 11 states have fully or partially deregulated syringe sales. Nonprescription retail syringe sales to IDUs for disease prevention purposes are clearly legal in 20 states, and have a reasonable claim to legality in 22 more. Sales to IDUs with a prescription are clearly illegal in only 3 jurisdictions. SEPs can operate legally in at least 21 states. Conclusion Syringe access laws in most states may reasonably be interpreted to allow pharmacists to sell syringes to IDUs to prevent disease. In practice, however, unclear laws and pharmacist uncertainty as to their interpretation may constitute continuing barriers to syringe access for IDUs. A comprehensive public policy of ensuring syringe access for IDUs requires eliminating legal barriers to the sale, possession, and disposal of syringes, and educating pharmacists and law enforcement officials about the legality and public health importance of sterile syringe access.
TL;DR: IDUs' access to sterile syringes from pharmacies in Atlanta, would likely be increased by providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterilization supplies and why blood-borne infection prevention is a legitimate medical purpose for selling syringe sales.
Abstract: Objective To better understand the individual (e.g., attitudes and beliefs) and structural (e.g., laws and regulations) factors that influence and shape pharmacists' decisions about selling syringes to injection drug users (IDUs). Design Qualitative research. Setting Metropolitan Atlanta. Participants 20 practicing pharmacists who work in or near areas of high drug use in Atlanta, and nine pharmacists who are considered leaders in their profession in Georgia. Interventions Semistructured, in-depth interviews. Main Outcome Measures Individual and structural factors that influence pharmacists' decisions about selling syringes to IDUs. Results Pharmacists reported that they use their professional discretion in making syringe sale decisions and that these decisions are influenced by individuals factors such as their personal attitudes and beliefs about the nature and causes of drug use, and by structural factors such as the Georgia Board of Pharmacy regulation stating that syringes cannot be sold if they will be used for an "unlawful purpose." Conclusions IDUs' access to sterile syringes from pharmacies in Atlanta, would likely be increased by (1) providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterile syringes and why blood-borne infection prevention is a legitimate medical purpose for selling syringes and (2) removing or modifying the restrictive Board of Pharmacy regulation governing syringe sales.
TL;DR: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.
Abstract: Objective: To describe a pharmacist-operated program to help people stop smoking. Setting: Community chain (mass-merchandise) pharmacy practice sites in Virginia. Participants: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. Practice Description: Smoking cessation clinics within the pharmacy departments of seven Target stores. Practice Innovation: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerstrom Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. Results: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. Conclusion: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.
TL;DR: How to use relationship marketing to create and maintain a network of productive relationships with selected groups of patients and other partners to expand the delivery of pharmaceutical care services is described.
Abstract: More than a decade ago, Hepler and Strand1,2 introduced the concept that the therapeutic relationship between pharmacist and patient was an integral component of pharmaceutical care. They saw pharmaceutical care as “a covenantal relationship between a patient and a pharmacist in which the pharmacist performs drug use control functions (with appropriate knowledge and skill) governed by the awareness of and commitment to the patient’s interest.”1,3 An empathetic and trusting pharmacist–patient relationship is now widely recognized as the cornerstone of pharmaceutical care. Far less appreciated, however, is how important the pharmacist–patient relationship is for successfully marketing pharmacy-based clinical services. Close collaborative relationships with patients, physicians, and other potential partners (i.e., other stakeholders in patient care) are the keys to creating and sustaining demand for pharmacy services on a long-term basis. Ideally, a network of mutually rewarding relationships should form the foundation of a pharmaceutical care marketing plan. In the pharmacy setting, interactions are increasingly anonymous, as more prescriptions are being filled through Internet pharmacies and automated refill programs. Pharmaceutical care, however, emphasizes a patient-centered focus that is mutually rewarding to all parties. Similarly, relationship-centered marketing focuses on the pharmacist-patient bond and represents a major shift in practice from traditional marketing, which emphasizes discrete (one sale at a time) and often impersonal exchanges between organizations and customers. In this article, we describe how to use relationship marketing to create and maintain a network of productive relationships with selected groups of patients and other partners to expand the delivery of pharmaceutical care services. The article also draws upon the first-hand experience of one of the authors (McDonough) and other pharmacists at Main at Locust Pharmacy in Davenport, Iowa, who used this innovative marketing approach to increase patient participation in a Weight Control and Wellness Program in their pharmacy clinic.
TL;DR: In North Carolina, a substantial number of pharmacists provided PCS in 1999 or planned to do so in the near future, however, the number of patients receiving PCS was relatively low and practice setting, pharmacist education level, and prescription volume were weakly predictive of the numbers of patients received PCS.
Abstract: Objective To describe the extent of and factors associated with the provision of pharmaceutical care services (PCS) and value-added pharmaceutical services (PS) by pharmacists in North Carolina, the physical changes made in pharmacies to accommodate these services, the nature and extent of prior consent or collaborative practice arrangements between North Carolina pharmacists and prescribers, and the frequency of reimbursement for PCS. Design Descriptive study based on a mail survey. Participants Pharmacist– managers at each of the 2,048 licensed pharmacy sites in North Carolina; a list of licensed pharmacies provided by the North Carolina Board of Pharmacy was used as the sampling frame. Main Outcome Measures Pharmacists' reports of PCS and pharmacy demographics. Results Response rate was 40%. More than 30% of respondents provided PCS at their site, although only 20% met our more stringent definition of PCS (i.e., ensuring appropriate pharmacotherapy, ensuring patient understanding and adherence, and monitoring and reporting patient outcomes). Services were more frequently offered by university-affiliated (35%) or independent (32%) pharmacies. The median number of patients receiving PCS across all sites was 10 per week. Diabetes was the most common health problem for which PCS were offered. Three variables—weekly prescription volume (positive correlation); number of staff pharmacists with advanced training, specifically fellowship training; and medical clinic/health maintenance organization setting—were significant predictors of the numbers of patients provided PCS. Independent community pharmacies were most likely to have private counseling areas and to bill for and receive payment for PCS. Conclusion In North Carolina, a substantial number of pharmacists provided PCS in 1999 or planned to do so in the near future. However, the number of patients receiving PCS was relatively low. Practice setting, pharmacist education level, and prescription volume were weakly predictive of the number of patients receiving PCS. Pharmacists commonly used prior consent arrangements with physicians in their practices, but primarily to facilitate generic substitution. Relatively few pharmacists billed for PS or PCS.
TL;DR: It is important to be familiar with patients' self-treatment habits in order to identify potential caffeine-drug interactions or caffeine-laboratory interactions resulting in false laboratory values and increase health care costs by creating adverse effects and causing misdiagnoses.
Abstract: Objective To review the pharmacology, pharmacokinetics, adverse effects, and drug interactions associated with caffeine and to raise awareness of the caffeine content of many prescription, nonprescription, and herbal drugs, beverages, and foods. Data Sources Articles in English retrieved through a MEDLINE search (1966-August 2000) using the terms caffeine, human, and systemic. Additional product information was obtained from manufacturers’ Web sites, through direct communications with manufacturers or distributors, and via Internet searches using the AltaVista search engine and the term caffeine. Only the first 10 Web sites selling caffeine products identified were visited. Study Selection All articles and correspondence items from data sources were evaluated, and all information deemed relevant was included. Priority was given to information provided by manufacturers. Conclusion With the increase in consumers’ use of over-the-counter products for health maintenance and self-care, it is imperative for pharmacists to be knowledgeable about the caffeine content of all drug and herbal products. It is important to be familiar with patients’ self-treatment habits in order to identify potential caffeine-drug interactions or caffeine-laboratory interactions resulting in false laboratory values. These interactions increase health care costs by creating adverse effects and causing misdiagnoses.
TL;DR: This supplement to the November-December 2002 issue of JAPhA highlights pharmacy and public health cooperation to increase pharmacy syringe sales to injection drug users and to promote safe community syringe disposal.
Abstract: This supplement to the November-December 2002 issue of JAPhA highlights pharmacy and public health cooperation to increase pharmacy syringe sales to injection drug users and to promote safe community syringe disposal.
TL;DR: Community pharmacists are in an ideal position to promote smoking cessation because of the number of patients they interact with in their practice settings and because of their knowledge of pharmacokinetics and prescription and nonprescription nicotine replacement therapies.
Abstract: The use of tobacco leads to more than 400,000 deaths each year in the United States.1 Surveys have shown that 70% of the 46 million smokers in the United States have some desire to stop.2 Fortunately, drug and behavioral therapies are available to assist smokers in their cessation efforts. However, the powerfully addictive nature of nicotine prevents many people from quitting on their own. Community pharmacists are in an ideal position to promote smoking cessation because of the number of patients they interact with in their practice settings and because of their knowledge of pharmacokinetics and prescription and nonprescription nicotine replacement therapies.3,4
TL;DR: Higher rates of DG behaviors by pharmacists are associated with greater patient satisfaction with pharmaceutical care services, compared with patients in community pharmacies.
Abstract: Objective To determine the impact of directive guidance (DG) behaviors by pharmacists on patient satisfaction with pharmaceutical care services. DG behaviors are social support behaviors and include such activities as supplying information about medications and providing encouragement and feedback regarding drug therapy. Design Cross-sectional observational study using a self-administered survey. Setting Two university-affiliated ambulatory care clinics, two chain pharmacies, and one independent pharmacy. Patients One hundred sixty patients with a chronic disease (e.g., asthma, hypertension, diabetes). Main Outcome Measure Patient satisfaction with pharmaceutical care services. Results A total of 160 completed questionnaires were collected from patients at 5 sites. Overall, patients patronizing ambulatory care clinics perceived higher rates of DG behaviors and were more satisfied with pharmaceutical care services, compared with patients in community pharmacies ( P F 13,112 = 4.9091, P (P Conclusion Higher rates of DG behaviors by pharmacists are associated with greater patient satisfaction with pharmaceutical care services.
TL;DR: Examination of pharmacists' attitudes and practices surrounding human immunodeficiency virus (HIV) prevention among injection drug users found educational programs for pharmacists may be valuable in HIV-prevention efforts.
Abstract: Objective To examine pharmacists' attitudes and practices surrounding human immunodeficiency virus (HIV) prevention among injection drug users. Design Focus groups. Setting Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. Patients or Other Participants: Eight focus groups, with 4 to 11 pharmacists participating in each group. Interventions Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of NUD*IST. Main Outcome Measures Willingness to sell syringes to all customers, views on syringe exchange programs (SEPs), knowledge of laws governing syringe sales and racial, ethnic, or gender biases in syringe selling practices. Results Two pharmacists established their own policies of selling syringes to everyone, and three expressed a willingness to have their pharmacies serve as SEPs. A total of 20% of the pharmacists expressed an interest in learning more about the efficacy of SEPs and distribution of syringes by pharmacists, and were willing to change their views based on this information. Many also indicated a general willingness to work with SEPs or to participate in the effort to curb the spread of HIV. However, a majority of pharmacists opposed having SEPs in their pharmacies and reported selling syringes only within specific limits: to known diabetics, to individuals who looked reasonable, or to individuals who presented a logical explanation. No racial, ethnic, or gender bias was observed. Conclusion Opinions among pharmacists varied across and within sites. While a majority of pharmacists would not establish SEPs in their own pharmacies, nearly all would participate in other HIV-prevention programs. Educational programs for pharmacists may be valuable in HIV-prevention efforts.
TL;DR: For the most part, participants understood the need for sterile syringes in order to protect themselves from HIV, hepatitis B virus, and hepatitis C virus and saw pharmacies as the best source of sterile Syringes.
Abstract: Objective To examine injection drug users (IDUs) opinions and behavior regarding purchase of sterile syringes from pharmacies. Design Focus groups. Setting Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. Patients or Other Participants: Eight focus groups, with 4 to 15 IDU participants per group. Interventions Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of the software program NUD*IST. Main Outcome Measures Knowledge of human immunodeficiency virus (HIV), pharmacy use, barriers to access from pharmacies, high-risk and risk-reducing behavior, and rural/urban difference. Results Almost all participants knew the importance of using sterile syringes for disease prevention and reported buying syringes from pharmacies more than from any other source. Two IDUs believed pharmacists knew the syringes were being used for injecting drugs and perceived pharmacists' sales of syringes to be an attempt to contribute to HIV prevention. Most IDUs reported that sterile syringes were relativity easy to buy from pharmacies, but most also reported barriers to access, such as having to buy in packs of 50 or 100, being made to sign a book, having to make up a story about being diabetic, or having the feeling that the pharmacists were demeaning them. While the majority of IDUs reported properly cleaning or not sharing syringes and safely disposing of them, others reported inadequate cleaning of syringes and instances of sharing syringes or of improper disposal. There were few differences in IDUs' reported ability to buy syringes among states or between urban and rural sites, although the data suggest that IDUs could buy syringes more easily in the urban settings. Conclusion For the most part, participants understood the need for sterile syringes in order to protect themselves from HIV, hepatitis B virus, and hepatitis C virus and saw pharmacies as the best source of sterile syringes. Although these data are not generalizable, they suggest that pharmacists can and do serve as HIV-prevention service providers in their communities.