Pharmaceutical care services and results in project ImPACT: hyperlipidemia.

OBJECTIVE: To demonstrate that pharmacists, working collaboratively with patients and physicians and having immediate access to objective point-of-care patient data, promote patient persistence and compliance with prescribed dyslipidemic therapy that enables patients to achieve their National Cholesterol Education Program (NCEP) goals. DESIGN: Observational study. PARTICIPANTS: 26 community-based ambulatory care pharmacies: independent, chain-professional, chain-grocery store, home health/home infusion, clinic, health maintenance organization/managed care. MAIN OUTCOME MEASURES: Rates of patient persistence and compliance with medication therapy and achievement of target therapeutic goals. RESULTS: In a population of 397 patients over an average period of 24.6 months, observed rates for persistence and compliance with medication therapy were 93.6% and 90.1%, respectively, and 62.5% of patients had reached and were maintained at their NCEP lipid goal at the end of the project. CONCLUSION: Working collaboratively with patients, physicians, and other health care providers, pharmacists who have ready access to objective clinical data, and who have the necessary knowledge, skills, and resources, can provide an advanced level of care that results in successful management of dyslipidemia.

Health care trends, Part 2. The new health care team. Panel discussion.

In Part 2 of this third annual panel discussion, six experts talk about the growing diversity of health care providers and what it means for consumers and physicians. Americans are getting their wellness and health care services from a wider variety of non-physician practitioners than ever before. The number of allied health and alternative providers with direct patient access is likely to continue growing. This trend is being driven by consumer demand, by the lobbying efforts of non-physician providers, and by federal, state, and private payers who see the potential for reduced health care spending, greater consumer satisfaction, and better outcomes. In practice, this means physicians and non-physician providers, some of whom may not be sanctioned by the medical establishment, are obligated to collaborate as a team. Members of this new provider team will have to communicate effectively (with each other, with consumers, and with payers) and make evidence-based clinical decisions. Physicians may have to share decision-making with other members of this new health care team.

Designing solutions for securing patient privacy--meeting the demands of health care in the 21st century.

OBJECTIVES: To define the issues surrounding patient privacy, examine the political context in which debate is taking place, and present a novel technology model for addressing privacy, confidentiality, and security in 21st century health care. SUMMARY: The discussion of privacy addresses one of the basic issues in health care today--the tension between the needs of the individual patient for privacy and confidentiality and the needs of society to effectively manage health care practices and control health care costs. Patient concerns for privacy, confidentiality, and security are legitimate, and can usually be reduced to issues that potentially affect an individual's employment, ability to get and maintain health coverage, and have control over his or her records and care. These concerns, combined with several precipitating events, are forcing the issue of privacy into the political arena, where new health policy decisions will be made. The debate must be framed within a principle-centered approach that focuses on boundaries, security, consumer control, accountability, and public responsibility. A global, distributed electronic health record management model that provides location-independent, secured, authenticated access to relevant patient care records by qualified health care professionals on a need-to-know basis provides solutions. Information asset considerations should be designed to equitably represent the ownership needs of corporate entities, society, and the individual. CONCLUSION: A secure electronic health record structure that systematically ensures a high level of accountability combined with thoughtful dialogue among key stakeholders in the public policy development process can offer the privacy outcomes we seek.

Use of hand-held computers to record and analyze intervention data.

Using the Wizard to document clinical activities has been well received by the clinical staff. What had previously been a dreaded task has become an ongoing part of daily activities. The revised Clinical Activity Log also provided the staff pharmacists with an easier method of documenting their clinical activities. The task of inputing the information from the staff pharmacists' paper logs into the computer is time consuming and is currently being done by the clinical staff. Procurement of additional Wizards for the staff pharmacists to use in the central pharmacy and satellite pharmacies is currently being considered. Using the Wizard has enabled the clinical staff to document clinical activities into the computer database in an ongoing manner throughout the day. Documentation has increased and is now more complete. Productivity is being monitored. Physician responses and patient outcomes are now being documented. Most importantly the computerized system allows for easy retrieval of the documented information for evaluation so that tracking and trending can be done and we can thereby continue to improve the quality of pharmaceutical care being provided.

Design and implementation of an electronic investigational drug accountability system.

A software system designed to maintain protocol-specific investigational drug accountability records is described. The University of Texas M. D. Anderson Cancer Center and Cygnus Systems Development, Inc., worked together to create an electronic investigational drug accountability system (IDRx), which meets the requirements of the National Cancer Institute. This system performs record keeping, stores information on drugs and protocols, and generates standard and customized reports. On-screen assistance makes it easy to use. Security is achieved by granting access only to authorized users, and an audit trail is automatically generated. Systematic implementation at M. D. Anderson, initially in the investigational drug control area and subsequently in the satellite pharmacies, has resulted in increased accuracy and efficiency, and few problems have been encountered. The IDRx software package is useful for keeping records, generating reports, and tracking and evaluating data associated with an investigational drug accountability system.

QARx: the quality assurance prescription.

The QARx program provides the necessary tools for organizing and effectively implementing a quality assurance program for a pharmacy department that truly offers the ever-elusive potential for creating an environment that promotes on-going quality improvement for the department. Eventually there will be a plethora of criteria sets available so that a pharmacist will be able to just choose the pertinent indicators from the shelf (if you choose not to create your own). There is an option to import criteria sets from the utilities menu, and the availability of pertinent sets should provide an attractive option for actually selecting certain readily available sets of indicators, monitors, and outcomes to be automatically imported into your existing quality assurance plan. This program is a must for any department manager trying to organize and orchestrate an effective quality assurance program in a health care institution. For more information about QARx, contact the American Society of Hospital Pharmacists, Special Projects Division, 4630 Montgomery Avenue, Bethesda, MD 20814, (301) 657-3000.