Drug therapy problems found in ambulatory patient populations in Minnesota and South Australia.

OBJECTIVE: To compare drug therapy problems identified by pharmacists in two patient samples, the Minnesota Sample and the South Australian Sample. METHODS: Two patient samples were selected for this comparison. Both sets of patients received pharmaceutical care services from pharmaceutical care practitioners between March 1999 and February 2000. The two databases were then compared for common drug therapy problems. MAIN OUTCOME MEASURE: Comparison of drug therapy problems in the two samples. RESULTS: Both patient samples included patients who were 40 years of age or older. The Minnesota Sample included 1,598 individual patients, of whom 70% experienced one or more drug therapy problems at some time during their care. The South Australian Sample included a total of 982 patients of whom 90% experienced one or more drug therapy problems at some time during their care. Conditions common to both patient samples include hypertension, diabetes, arthritis, ischemic heart disease, and osteoporosis. Frequently occurring drug therapy problems in the Minnesota Sample included the need for additional drug therapy, dosage too low and non-compliance and in the South Australian Sample included non-compliance, additional drug therapy and ineffective drug therapy. Frequent drug therapy problems associated with medical conditions in the Minnesota Sample included addition of new therapies for conditions such as arthritis, hypertension, hyperlipidemia and allergic rhinitis, while for the South Australian Sample included compliance issues with conditions such as asthma, diabetes mellitus, angina and digestive disorders. Frequent drug therapy problems with associated drug classes in the Minnesota Sample included additional therapy for classes such as salicylates and calcium supplements, while in the South Australian Sample included the need for therapy for pneumococcal vaccines, salicylates, calcium supplements and tetanus vaccines. CONCLUSION: These data demonstrate that this age group has significant drug therapy problems and therefore emphasize the need for pharmaceutical care services in this population. The provision of pharmaceutical care by experienced practitioners can result in improved recognition of the full range of drug therapy problems confronting patients. Analyses such as those presented here provide information to better focus the training of practitioners based on the most frequently encountered health problems and the nature of common drug therapy problems in the community setting.

Consistent standards in medication use: the need to care for patients from research to practice.

OBJECTIVE: To propose adoption of practice standards for pharmacists based on the principles of pharmaceutical care that are parallel to internationally accepted ethical precepts governing clinical research. DATA SOURCES: Relevant literature selected by the authors. SUMMARY: Pharmaceutical care practice standards can create a continuum of high quality care for patients from research through practice and are presented as a rational solution to managing the benefits and risks of medication use. By implementing these practice standards, patients are empowered to become active participants in the treatment process, knowledge of drug effectiveness and safety is increased, and the pharmaceutical care practitioner's responsibilities are delineated. More than a quarter century ago, the research community adopted the ethical principles of respect for persons, beneficence, and justice, as outlined in the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Under these guidelines, research subjects are considered participants, knowledge of medication efficacy and safety has increased, and investigator responsibilities have been defined. However, these guidelines only apply to the life cycle of a drug before approval by the Food and Drug Administration. Once the product is released for general use, fewer standards are applied. Pharmacy has the opportunity to establish parallel standards for the clinical use of medications in patients by establishing patient care practices in consonance with pharmaceutical care practice. CONCLUSION: Pharmaceutical care practitioners need to apply new practice standards that allow them to contribute meaningfully to appropriate, effective, safe, and convenient drug therapy for all patients. Such pharmaceutical care practice standards could ensure consistent vigilance throughout the life cycle of the drug product and result in rational, appropriate, effective, safe, and convenient drug therapy for all patients.

The impact of pharmaceutical care practice on the practitioner and the patient in the ambulatory practice setting: twenty-five years of experience.

This manuscript reviews 25 years of experience that include developing the practice of pharmaceutical care and initiating new practices. The impact this practice has on practitioners in the ambulatory setting is described as well as data that reflect its clinical and economic impact. There is a great need to prepare new practitioners to provide pharmaceutical care. A focused training program was developed and delivered to over 300 practitioners. The practitioners were prepared by providing direct patient care. They learned the philosophy of pharmaceutical care practice, to identify, resolve and prevent drug therapy problems, to document care using a specially designed software program called the Assurance Pharmaceutical Care program. The practitioners who participated in the training program reported that the average amount of time spent with patients increased three-fold, they now see four times more patients than prior to training, and the number of new patients referred by physicians increased nine-fold as a result of the program. These practitioners have now provided care to more than 25,000 patients in their practices. These data have now been consolidated and analyzed, and a portion of these results is reported here. The clinical and economic outcomes from 2,985 adult patients, who received pharmaceutical care between January, 2000 and December, 2003, are presented. At the first assessment by the pharmaceutical care practitioner, 61% of the patients had one or more drug therapy problems identified and resolved. This resulted in an improvement in the clinical status or maintaining a stable status in 83% of the patients. The health care savings realized from pharmaceutical care were $1,134,162. This represented a benefit to cost ratio of 2:1. Physicians who collaborate with pharmaceutical care practitioners have validated the work of the practitioners, and patients are recognizing the benefits of pharmaceutical care.

Critically examining pharmaceutical care.

In the past decade, growing numbers of practitioners worldwide have adopted pharmaceutical care as an integral component of pharmacy practice. Established models of pharmaceutical care can reduce the burden of preventable drug therapy problems, but this promise has not yet been realized. Although many challenges remain, the profession has key resources to expand and improve the delivery of pharmaceutical care.