Pharmaceutical service differences between teaching and community hospitals.

The purpose of this study was to inventory the highly specialized units maintained in teaching hospitals and compare and contrast the scope and level of pharmaceutical services provided in teaching and similar-size community hospitals. In 1989, a 30-item questionnaire was mailed to a sample of 120 teaching hospitals. The scope and level of services provided was compared with similar size hospitals in the 1989 American Society of Hospital Pharmacists' survey of hospital-based pharmaceutical services. Teaching hospitals maintain more licensed and occupied beds, are more likely to be a member of a nonprofit multisystem organization, maintain many specialized care units and high speed transportation vehicles, exercise more control over specialized drugs and products, provide a broader array of pharmacy services to ambulatory patient populations, offer a more extensive and broader array of clinical services, maintain more extensive drug information resources, exercise more comprehensive formulary management initiatives, engage in broader diversified service initiatives, and generate 50% more annual pharmacy costs per occupied bed than do similar-sized community hospitals. Teaching hospitals are complex organizations that provide care to patients who require higher levels of pharmaceutical services than those provided in similar-sized community hospitals.

Nigerians' use of native and Western medicine for the same illness.

The impact of dual systems of health care on those who use them is not well understood. A study was undertaken in Nigeria to study this impact. A questionnaire about use of dual health care systems was prepared and tested and then administered to a study sample. This sample included representatives of the Hausa, Ibo, and Yoruba tribes, urban and rural residents, and Christians, Muslims, and traditional worshippers. Among 680 respondents, more of the Muslims than the other religious groups had used both Western and native medical care systems for the same illness, and the relationship between such dual use and religious preference was found to be significant. Also, almost three-fourths of the respondents who had used both native and Western medicine for the same illness had done so more than once. Among respondents who had used both for the same illness many times, there were almost twice as many males as females. Among the Ibos, 81.9 percent had used both systems more than once, compared with 77.2 percent of the Yorubas and 62.2 percent of the Hausas. The existence of pluralistic medicine is fairly common in both developing and developed countries. However, switching back and forth from native to Western medicine makes determinations of the relative efficacy of cures difficult. Also, simultaneous use of drugs from both native and Western health care providers has the potential of harming or even killing the patient.

A drug self-administration program: a behavioral approach to patient education.

This study is an evaluation of an in-hospital patient education and drug self-administration program. The main goal of this patient education strategy was to increase appropriate drug use by patients after they were discharged from the hospital. Patients first learned about their medications from hospital staff, including pharmacists, and then gradually assumed the responsibility for self-administration of their drugs. Patients practices taking their medication while hospital staff monitored their actions, correcting inappropriate use and reinforcing correct use. Results showed that the program significantly increased both levels of drug knowledge and patient compliance when compared to a control group. An analysis of covariance revealed that improved compliance was attributable to both participation in the program and to the increase in drug knowledge. Patients were more satisfied with pharmacy services and perceived the pharmacist as being more knowledgeable about prescription drugs after interacting with pharmacists in this program. Analysis of patient locus of control revealed that internally oriented patients complied better after participating in the program than did externally oriented patients. In the control group, externally oriented patients complied better after receiving typical hospital care than did internally oriented patients. Thus, results imply that this behavioral approach benefited internally oriented patients.

Chronopharmacology: a therapeutic frontier.

Chronopharmacology, the study of time-dependent physiological response to drugs, and its relationship to current drug therapy are discussed. The objective of chronotherapy is to apply chronobiologic principles to the treatment of human disease. The appropriate patients for chronotherapy are those who are receiving high-risk drugs, who have a high-risk disease (e.g., cancer) or who are receiving a high-cost drug. Although little is known of the chronobiologic characteristics of many drugs or diseases, researchers should take into account the possible relationship of chronobiology to drug effects when designing therapeutic trials. Drug therapy can be optimized by tailoring dosing schedules and distribution systems to chronobiologic patterns.

Monitoring drug therapy in skilled nursing facility patients.

A discussion of one system designed for monitoring drug therapy in skilled nursing facility (SNF) patients is presented. This system will enable the pharmacist to fulfill the federal requirement for monitoring drug therapy and will provide the opportunity for gathering and analyzing drug usage data in fulfillment of the facility's utilization review requirement. The system described was developed and tested at five SNF's. Follow-up studies at each of the five facilities were then performed for comparison purposes. The data presented describe and analyze the results from both studies for two of the ten drugs studied: digoxin and hydrochlorothiazide. The high rates of nonconformance to the established criteria are discussed and specific insights as to why drug therapy in these patients often seems inappropriate are provided.

Drug usage review sample studies in long-term care facilities.

The usage of 10 drugs in five long-term care facilities was reviewed to evaluate the effectiveness of a five-step systematic method of drug usage review. Medical care evaluation sample studies are required under the Medicare and Medicaid programs, and drug usage review sample studies may satisfy this requirement. The five-step method involved selection of the health problem to be studied; development of criteria of care; measurement of specific performance data and comparison with the criteria; establishment of the audit committee evaluation process; and design and implementation of educational activities. In each facility, data were collected on abstract sheets designed to indicate when a patient's drug usage did not conform to criteria established by a committee of health professionals. Incidents of nonconformance were then examined. The largest number of exceptions to the criteria related to monitoring the effectiveness of drug therapy. Data by drug revealed higher nonconformance rates for digoxin, hydrochlorothiazide, methyldopa and thioridazine. A small number of exceptions was found in drug administration, indicating that the patients were receiving medications as ordered and that few errors were made in transcribing. This systematic approach to identifying drug usage patterns can be used by pharmacists to coordinate sample studies and to fulfill their consultant role in long-term facilities required by federal regulations.

A client-developed methadone maintenance program.

A realistic methadone maintenance program is a continuum of four related areas: intake, rehabilitation with on-going evaluation, detoxification, and postdetoxification followup, each jointly administered by client volunteers and professional staff. In the early stages of client treatment, pharmacists have more frequent contact with program participants than do other staff professionals. At the Minneapolis Pilot City Health Center, 31 of 69 participants in the methadone maintenance program were interviewed by their pharmacist to determine client understanding of program objectives, interpretation of program effectiveness, and suggestions for program improvement. Client understanding of the objectives or program elements ranged from 30 to 97 %. Client evaluation of the effectiveness of program elements ranged from 0 to 65%. The client-developed program included intake procedures to establish for each client the program objectives, rules, evaluation, guidelines, client goals, dismissal guidelines, and a review of supportive services. Rehabilitation would be continuous with consistent on-going evaluation to measure goal attainment, a decline in disruptive behavior, and freedom from illicit drug use. Detoxification should be undertaken after the client's behavior has stabilized and he has developed a marketable skill. Monitoring of the client to assure a drug-free state would be an important element of the postdetoxification follow-up.