Physicians' perceptions of communication with and responsibilities of pharmacists.

OBJECTIVE: To understand physicians' perceptions of (1) their communication with pharmacists, (2) pharmacists' professional duties, and (3) the degree of responsibility with which pharmacists perform these tasks. DESIGN: Structured interviews with convenience sample of physicians in phase 1; written survey mailed to convenience sample of physicians in phase 2. PARTICIPANTS: Six physicians in Wyoming in phase 1, and 313 primary care physicians who were members of the Wyoming Medical Society in phase 2. MAIN OUTCOME MEASURES: Physicians' attitudes and experiences related to their interactions with pharmacists and their perceptions about pharmacists' responsibilities. RESULTS: Usable surveys were returned by 176 physicians (response rate = 59.1%). Age ranged from 27 to 86 years (mean +/- SD = 43.5 +/- 10.4 years), 79.5% were men, and 50.6% were in family practice. Almost 25% had personal contact with pharmacists regarding patients' medications four or more times daily, but 20.6% rarely had this type of contact. Pharmacists contacted physicians' offices regarding prescription refills frequently, with 28.7% reporting 10 or more contacts daily. For 79.2% of respondents, an office nurse had the most contact with pharmacists. Respondents were most comfortable with pharmacists' responsibilities of catching prescription errors (88.0%), providing patient education (65.1%), suggesting nonprescription medications (63.4%), and suggesting prescription medications to physicians (52.0%). Respondent's age was negatively correlated with three functions related to pharmacotherapeutic regimens: designing regimens, monitoring effects of failed regimens, and monitoring outcomes. The most common negative experiences with pharmacists involved pharmacists' scaring the patient, dispensing unauthorized refills, and making inappropriate comments in the presence of patients. CONCLUSION: Future research with a larger, more representative sample of physicians will help explain this dynamic relationship. These preliminary results should be useful in training future physicians and pharmacists.

Bone marrow granulomas possibly associated with amiodarone.

Amiodarone is a class III antiarrhythmic agent that is effective in treating different types of cardiac dysrhythmias. It was approved only for treatment of life-threatening ventricular dysrhythmias refractory to other therapy; however, its use for atrial dysrhythmias such as atrial fibrillation is well accepted. Adverse effects associated with amiodarone include pulmonary, hepatic, thyroid, ocular, and neurologic toxicities. Our patient experienced intermittent fever, night sweats, and fatigue while taking the drug for treatment of atrial fibrillation. Bone marrow biopsy showed granuloma formation after 17 months of therapy with amiodarone. Amiodarone was discontinued due to significant hypotension and shortness of breath. To our knowledge, this is the third case report of granuloma formation in bone marrow possibly associated with this agent.

The conflict between ethics and business in community pharmacy: what about patient counseling?

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but these laws have had mixed results. This essay argues that community pharmacy's patient counseling conundrum can be solved through additional moral education persuasion, not through additional legal mandates.

Communication between pharmacists and patients: the role of place of residence in determining the expectations of older adults.

The relationship between the place of residence of elderly patients and their expectations about the content and style of their communication with pharmacists was studied. Using stratified random sampling of households, telephone interviews were completed in Spring 1994 with 200 rural and 200 urban persons age 65 or older currently taking a prescribed drug that they picked up at a pharmacy. Respondents were asked about their sociodemographic characteristics, health, and experiences with prescription drugs. Factor analysis of items measuring the elders' expectations yielded one factor with nine items. Multivariate analysis was used to examine the effect of residence while controlling for other variables. Subjects currently took 3.2 +/- 2.2 drugs (mean +/- SD). Fifty-two percent of rural elders used independent pharmacies, and 83% of urban elders used chain pharmacies. On six of the nine items in the expectation scale, rural elders held significantly different (higher) expectations for their pharmacists compared with urban elders. The most fully specified model contained five variables significantly associated with higher expectations: elders who took fewer drugs and who had a stroke, angina, osteoporosis, and no coronary heart disease. Although place of residence was a significant predictor of elders' expectations in the first three models, it was not when drug experiences were added in. Overall, older people in different places of residence have dissimilar personal and drug characteristics, and pharmacists practicing in different community contexts can anticipate encountering different patient expectations.

Influence of gender on outcomes of medication-history interviewing.

This study investigated the influence of patient and provider gender on the outcomes of medication-history interviewing. In a previous study, 112 pharmacy students conducted medication-history interviews with 2 simulated patients. A secondary analysis was accomplished using complete data from 85 of the original 112 pharmacy students. The other 27 students were eliminated because of missing data. Factor analysis and canonical correlation were used to assess associations between the prior study's set of predictor variables and measures of interview completeness and patient satisfaction with the interview. Female and male pharmacy students appear to use different expressive, interactive, and interrogative skills. Allergy-asking was more complete when female pharmacy students interviewed a male patient. Emotive patient satisfaction was found to be associated more positively with a female student and female patient while teleological patient satisfaction between a male student and male patient was nearly double the result of the female-female dyad. Medication-history interview outcomes appear to differ as a consequence of the use of different sets of skills during same-sex or opposite-sex interviews.

Residential differences in the use of pharmacies by older adults and their communication experiences with pharmacists.

This investigation compares adults (65 and older) living in two different types of communities on the characteristics of the pharmacies they use and their patterns of communicating with pharmacists. Telephone interviews were conducted with a random sample (N=400) of respondents, half residing in six nonmetropolitan counties (containing no towns of more than 4,000) and the other half in a single city (population approximately 130,000) located within a metropolitan county. Elders living in the sparsely populated nonmetropolitan areas were more apt to purchase their medications from an independent neighborhood pharmacy than their counterparts who lived in the large city. These pharmacies, however, were more likely to be located in another town. Differences between residential groups were also observed in the communication patterns that older patients had with their pharmacists. Elders residing in sparsely populated areas reported more frequent conversation with their pharmacists about general topics, although not about medicines or other health-related topics. The elders living in small and remote places also reported that they talked with their pharmacists longer, that communication about medications were more often initiated by the pharmacist, and that they were more likely to talk about their medications directly with their pharmacist rather than a non-pharmacist employee. The overall greater frequency of contact and communication between nonmetropolitan elders and their pharmacists would seem to be precursors to establishing a positive provider-client relationship and may increase the probability of more personal, medication-related discussions. Further research is needed, however, to determine if these potentials are transformed into realities and if they lead to more positive medical outcomes for older persons.

Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility.

OBJECTIVE: To examine the relationship between pharmacists' willingness to assume further professional responsibilities, as measured by attitudes to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requirements, and their attitudes toward voluntarism as their responsibility to society and their level of interest in their jobs. DESIGN: A survey was distributed to a convenience sample of 443 pharmacists who were asked to indicate their responses on a number of items. SETTING: Surveys were distributed to participants in an annual pharmacy continuing education program. PARTICIPANTS: The response rate was 65 percent with completed surveys from 290 Florida pharmacists who were typically male (73 percent) and practicing in the community setting (39 percent) for over 25 years (33 percent). MAIN OUTCOMES: Questions were aimed at gathering the following information: (1) demographics; (2) attitudes concerning the benefits of the three OBRA '90 requirements: patient counseling, prospective drug-use review (DUR), and information recording; (3) attitudes toward voluntarism; and (4) job interest. RESULTS: Pharmacists tended to agree that all three of the OBRA '90 mandates will be beneficial. Fifty-six percent favored the prospective DUR requirements, while 68 percent favored the patient counseling requirements and 66 percent favored the information-recording requirements. Logistic regression analysis showed that unit increases in scaled responses, indicating more favorable attitudes toward believing that voluntarism was one's responsibility, increased the odds of favoring counseling by 38.7 percent and information recording by 32.4 percent. A similar directional relationship was found for the DUR requirement. Job interest did not add to the predictive ability of the variables already in the models. CONCLUSIONS: This study suggests a possible association between pharmacists' attitudes toward social responsibility and their acceptance of expanded professional responsibility.

Medication-related stressors among family caregivers.

The contribution of medications to stress among family caregivers and the need of caregivers for pharmaceutical care services were studied. Persons in northern Florida who were caring for a family member at home who was at least 55 years of age and routinely took at least one medication were asked if they would consent to an interview. The interview was designed to elicit information about the characteristics of the caregiver and care recipient, stressors stemming directly from the medications (such as adverse effects) and arising from problems in managing the drug regimen (such as compliance), the mediators of medication-related stress (such as services received from the pharmacist), and the outcomes of stress (such as the caregiver's satisfaction with services). A total of 31 caregivers agreed to be interviewed. The mean +/- S.D. ages of caregivers and recipients were 63 +/- 13 and 80 +/- 10 years, respectively. Medication-related tasks accounted for only 7.7% of the total caregiving time. However, medications contributed substantially to caregivers' stress, with 10 caregivers (32%) reporting problems directly related to medications and 6 (19%) and 16 (52%) reporting problems in managing the drug regimen currently or within the past year, respectively. Twenty-two (71%) used the same pharmacy regularly, and 18 (58%) saw the same pharmacist regularly. Twenty-five caregivers talked with others about medication concerns. Of these, 18 (72%) discussed their charge's drug therapy with a physician but only 10 (40%) with a pharmacist.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of vitamin and mineral supplements by pharmacy students.

Use of vitamin and mineral supplements by undergraduate pharmacy students and the students' perceptions and beliefs about these products were studied. Undergraduate pharmacy students from two schools in Philadelphia completed a questionnaire in which they were asked whether they had taken vitamin or mineral supplements within the preceding two weeks, the reason for taking the supplements, and the identity of the type of products taken. General demographic information and a self-assessment of health and diet were also obtained. In addition, using a five-point Likert scale, students were asked to rate the degree to which they agreed with five controversial statements regarding vitamin and mineral supplements. Of the 692 students completing the questionnaire, 47% had taken supplements in the preceding two weeks. This percentage is higher than that determined in surveys of the general population and of professionals in other health disciplines. No significant difference was noted in the percentage of men and women who took supplements, but the types of products taken by men and women differed significantly. The most common reasons for taking supplements were inadequate diet, to improve energy, for stress, and for colds. Year in school had a modest influence on the beliefs about vitamin and mineral supplement use expressed by students. The use of vitamin and mineral supplements among pharmacy students was high. Pharmacy schools should devote time in the curriculum to the sociological and clinical aspects of vitamin and mineral therapy.

Factors affecting outcomes of medication-history interviewing by pharmacy students.

Factors affecting outcomes of medication-history interviewing by pharmacy students were studied. Data were obtained from fourth-year pharmacy students enrolled in a required course in fall 1984. Each student conducted a medication-history interview with one of two simulated patients who presented a predetermined history; interviews were videotaped from behind a one-way mirror. Students also completed an interviewing-orientation survey and a personal report of communication apprehension (PRCA). Trained raters evaluated the videotaped interviews using measures of interview skill and interview completeness. The simulated patients completed a patient-satisfaction form after each interview. Two path models were developed that were identical except that one had completeness and one had patient satisfaction as the dependent variable. Interview skill was the final factor in each model, preceded by variables representing the student's background and orientation factors, PRCA, and simulated-patient gender. Of 112 students conducting the interview, 107 (95.5%) and 95 (84.8%) completed the PRCA and orientation surveys, respectively. The models explained 36% and 27% of the variance in patient satisfaction and completeness, respectively. Shown in parentheses are the significant direct predictors of variables in the model of patient satisfaction: satisfaction (skill, prepharmacy grade point average [preGPA], people and health-care [PHC] orientation); skill (interviewing orientation, preGPA); interviewing orientation PHC orientation, preGPA, PRCA); and (PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation. For the model of completeness, direct predictors were as follows: completeness (skill, PHC orientation, student gender, simulated-patient gender); skill (interviewing orientation, preGPA); interviewing orientation (PRCA, preGPA, PHC orientation); and PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation and PHC orientation on completeness. Results suggest that one path model reflects the patient's assessment of interviewer competence in terms of satisfaction, and the other reflects the clinician-rater's assessment of interviewer competence in terms of interview completeness. The interviewing process positively influences both patient satisfaction and interview completeness.