A New Paradigm for Pharmacy Practice and Education (original) (raw)
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Pharmaceutical Care Research and Education Project: Pharmacists' Interventions
Journal of the American Pharmaceutical Association (1996), 2001
To describe the processes of care used by community pharmacists participating in the Pharmaceutical Care Research and Education Project (PREP) in terms of drug-related problems (DRPs), pharmacists' recommendations, and status of DRPs at follow-up, and to determine characteristics associated with DRPs. Design: Descriptive analysis of the treatment group from a larger randomized, controlled cluster design. Setting: Five independent community pharmacies in Alberta. Participants: One hundred fifty-nine patients who were covered under Alberta Health and We"ness's senior drug benefit plan (j.e., 65 years or older), were taking three or more medications concurrently according to pharmacy records, were able to complete telephone interviews as determined by pharmacists, maintained residence in Alberta for 12 ofthe 15 study months, agreed to receive their prescription medications only from the study pharmacy during the study period, and provided informed consent. Main Outcome Measures: Frequency of DRPs, recommendations, status of DRPs, and analysis of clinical results as determined during pharmacists' follow-up care. Results: In telephone surveys, patients reported taking 4.7 prescription medications per day, but pharmacists documented 8.7 prescription medications per day in their records. Pharmacists documented 559 DRPs, a mean (± SD) of 3.9 ± 3.2 problems per patient. Approximately 39% of problems were actual DRPs, while 60% were potential DRPs. Medical conditions associated most frequently with a DRP involved the respiratory, cardiovascular, and musculoskeletal systems. The most common DRP categories were "patient requires drug therapy" or "patient requires influenza or pneumococcal vaccination." Pharmacists wrote 551 initial clinical notes using the subjective, objective, assessment, plan (SOAP) format, and they recorded 346 follow-up interventions, also using SOAP notes. Counseling, preventive consultations, and clinical monitoring represented 40% of their recommendations. In 80% of situations, the pharmacist made the recommendation directly to the patient. On follow-up, 40% of the 559 DRPs identified were resolved, controlled, or improved. Patients accepted 76% of pharmacists' recommendations, and physicians accepted 72% of pharmacists' suggested resolutions of DRPs. Pharmacists were more likely to follow up about actual DRPs, as compared with potential ones; overall, they followed up on 62% of identified DRPs. Conclusion: Pharmacists identified more DRPs for study patients than previous community-based, observational studies have reported. Undertreatment appears to be a prevalent DRP. Community pharmacists' recommendations to prevent and resolve DRPs were made primarily to patients and were we" accepted. More fo"owup was needed for a" DRPs. When follow-up occurred, the DRP results generally showed improvement.
Clinical pharmacy and pharmaceutical care: a need to homogenize the concepts
American journal of pharmaceutical education, 2010
To the Editor. Over the last 4 decades, the pharmacy profession has witnessed tremendous practice changes, especially after the introduction of clinical pharmacy concepts in the late 1960s, followed by the philosophy of pharmaceutical care in the early 1990s1-9. The introduction of these concepts and philosophy in modern day pharmacy practice has transformed the pharmacist's role to focus more on patient-oriented services rather than the traditional focus on product and dispensing services. Over the years, after the successful introduction of clinical pharmacy concepts and services in the United States and Europe, the rest of the world has followed suit in transforming pharmaceutical services. Along with adopting these concepts and philosophy, these countries also need to change the existing pharmacy curriculum to provide the necessary training so that future pharmacy practitioners are equipped with the necessary knowledge and clinical skills. The impact of these changes was str...
The Excellence of Pharmacy Service: Past, Present and Future
2019
Pharmacy education continues to evolve to better prepare pharmacists for their roles and responsibilities in an increasingly complex health care environment with advanced patient health needs. Another important factor is the pharmacists themselves. Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today's pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs. All people who take medications are at risk of actual or potential drug therapy problems. These problems are a significant source of morbidity and mortality when left undetected and unresolved and drive huge costs across the health system. As drug therapy experts, pharmacists provide drug therapy management services built around a partnership between the pharmacist, the patient (or his or her caregiver), physicians and other members of a patient's health care team.
Clinical pharmacy, pharmaceutical care, and the quality of drug therapy
Pharmacotherapy, 2004
Because of concerns about patient safety and the quality of health care in America, in particular about drug therapy, pharmacists have unprecedented opportunities to increase their value and significance. When defining clinical pharmacy and pharmaceutical care, pharmacists long ago recognized the need to improve the safety and effectiveness of drug therapy. To describe how clinical pharmacy and pharmaceutical care, closely related concepts, can contribute to a strategy for improving the quality of drug therapy. Commentary and review of selected publications. Pharmacists can improve the quality of drug therapy by improving the organizational structures through which drug therapy is provided, specifically by creating medications use systems and by regularly evaluating their performance. As envisaged by the Institute of Medicine, these systems must be patient centered, cooperative, and interprofessional. To maximize pharmacists' participation in such systems, pharmaceutical educati...
American Journal of Health-system Pharmacy, 2013
Purpose. The results of the 2016 ASHP national survey of pharmacy practice in hospital settings are presented. Methods. A stratified random sample of pharmacy directors at 1,315 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method offering a choice of completing a paper survey or an online survey. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. Results. The survey response rate was 29.8%. Drug policy development by pharmacy and therapeutics committees continues to be an important strategy for improving prescribing. Strict formulary systems are maintained in 63.0% of hospitals, and 89.7% of hospitals use clinical practice guidelines that include medications. Pharmacists have the authority to order laboratory tests in 89.9% of hospitals and order medications in 86.8% of hospitals. Therapeutic interchange policies are used in 89.2% of hospitals. Electronic health records (EHRs) have been implemented partially or completely in most hospitals (99.1%). Computerized prescriber-order-entry systems with clinical decision support are used in 95.6% of hospitals, and 92.6% of hospitals have barcode-assisted medication administration systems. Transitions-of-care programs are increasing in number, with 34.6% of hospitals now offering discharge prescription services. Pharmacists practice in 39.5% of hospital ambulatory or primary care clinics. The most common service offered by pharmacists to outpatients is anticoagulation management (26.0%). When pharmacists practice in ambulatory care clinics, 64.5% have prescribing authority through collaborative practice agreements. Conclusion. Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth.
American Journal of Health-system Pharmacy, 2004
Results of the 2010 ASHP national survey of pharmacy practice in hospital settings are described. Methods: A stratified random sample of pharmacy directors at 1968 general and children's medical-surgical hospitals in the United States was surveyed by Internet and mail. SDI Health LLC supplied data on hospital characteristics; the survey sample was drawn from the SDI Health hospital database. Results: In this national probability sample survey, the response rate was 28.8%. Patient-specific pharmacist activities are increasing, as shown by the substantial use of pharmacist empowered therapeutic interchange programs, extensive prevalence of pharmacist review of medication orders before doses are available for administration to patients, and the widespread use of pharmacist consultations by prescribers, with almost complete acceptance of pharmacist recommendations. Pharmacists are also leading antibiotic stewardship programs, managing anticoagulation medication therapy, addressing pharmaceutical