摘要:

Dispensary workload is widely perceived by pharmacists as limiting the time available for customer contact. This study compared pharmacist work patterns at two neighbouring independent pharmacies, one without (A) and one with (B) a trained dispensing technician, using fixed interval activity sampling. Pharmacists were observed at work over two weeks; six half‐day observation sessions (A = 1,181 observations; B=1,348) could be matched for incoming dispensing workload. Data on 505 prescription issues and 74 over‐the‐counter events (advice requests, advised sales, and health information) were collected. Pharmacy B dispensed a greater proportion of antibiotics (19 per centv11 per cent,P<0.02) but there were no other significant differences. Pharmacists at site B spent 20 per cent less of their time on dispensary activities, 14 per cent more of their time on the counter and had 6 per cent more time to rest and read, but they did not spend significantly longer talking to customers about medicines and health. Skilled dispensing help released over an hour of pharmacist time per day, but these savings were linked to prescription workload, which is unpredictable. The pharmacists could not plan to give this extra time to their customers because they did not know when it would be available, or when it would be n

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00818.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms.Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00819.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Prescription forms listing more than one item, ie, multiple item prescriptions, may be termed non equivalent if the number of days' treatment prescribed for each of the drugs is different. Patients presenting such prescriptions at 15 community pharmacies were identified and records maintained of all prescriptions presented by these patients over a nine month period. The total amounts of drugs and number of days' treatment prescribed were identified and costed. A total of 53.5 per cent of the non‐equivalent items were for amounts representing between one and five days' excess treatment. Excess treatment represented 13.9 per cent of the total cost of these prescriptions. The estimated national cost of inadvertent excess prescribing for 1991/92, based on a projected calculation, was £60m (2.4 per cent of the total expenditur

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00820.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A prescribing decision model incorporating drug characteristics, professional opinions and past experience was used to predict the choices made by prescribers when selecting a non‐steroidal anti‐inflammatory drug (NSAID) for inclusion in a formulary. Thirty general practitioners (GPs) and 14 hospital doctors (HDs), most practising within the South East Thames regional health authority, were asked to select either ibuprofen, diclofenac or indomethacin, based on the needs of a described population, and then to answer a questionnaire.Looking at the relative importance of factors influencing the choice of treatment, there was generally a high degree of agreement between HDs and GPs. However, the majority of HDs ranked efficacy as the most important drug characteristic whereas GPs were generally more concerned with side effects. Fundholding GPs ranked cost more highly than did their non‐fundholding counterparts, and GPs working in single handed practices were more influenced by specialists and company representatives than were GPs working in groups. The decision model correctly predicted the drug choice of all the HDs and of 76 per cent of the GPs. These values were considerably better than the 33 per cent that would be predicted based on chance alone.Although various limitations of this type of study are noted, it is hoped that the model could be developed as a valuable tool to assist in understanding complex prescribing i

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00821.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The quality of pharmacy services can be assessed by using both profession‐based measures and customer feedback. The aim of this population‐based survey (n=848) in Finland was to evaluate how well the existing service level matched customer expectations and to examine whether pharmacy‐specific quality dimensions derived from recent service quality models were found in population‐based data. The survey indicated that the Finns seemed to be very satisfied with the professional competence and trustworthiness of pharmacy personnel. The highest dissatisfaction was experienced with queuing times, privacy and time for customer‐pharmacist interaction (40 per cent). Pharmacies also seem to have various opportunities to extend their services beyond traditional dispensing, especially in the field of patient counselling and diagnostic screening. The importance of customer‐based feedback through surveys will grow in the future when trying to develop pharmacy services. This study shows that theoretical models of service quality dimensions are suitable for processing the data although the methodology needs further

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00822.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The design and execution of a nationwide, one‐day telephone drug information service for the general public are described and data collected during the project analysed.The Australian public was provided with access to a toll‐free telephone service on September 4, 1992, for seeking direct information about medication from a team of pharmacists and medical practitioners based at a temporary telecommunications centre in Melbourne. Details of the project had been agreed by a multidisciplinary steering group. Over 2,000 calls were connected to the centre, averaging 167 calls per hour (range nine to 215). Calls were processed through central triage lines prior to referral to appropriate personnel. Information was gathered from 1,650 calls using a standard data collection form, and the details of a sample of 895 of these were analysed using Epi‐info 5.01a (public domain) software for epidemiology and disease surveillance.The success of this project, as well as that of other similar telephone information services in other countries, indicates a high level of interest among the public. In the future, information gained in this type of data collection process may be of benefit to clinicians in assisting them to provide information to patients about their drug th

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00823.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The appropriateness of empiric therapy, how closely prescribers adhered to hospital guidelines for use of antimicrobial drugs and how relevant these guidelines proved in providing cover for the infecting pathogen were assessed from a retrospective survey of culture and sensitivity reports issued during a one‐month period in a district general hospital. Blood, stool, pus, sputum and mid‐stream urine specimens were reviewed. Urine specimens from a fundholding general practice unit were also included. Catheter specimens of urine and specimens from other body sites were excluded. Of 290 specimens sent for culture, 99 (34 per cent) were positive. One hundred patients, of whom 54 (19 per cent of the total) were subsequently demonstrated to have a positive culture, had been treated empirically. In 38 per cent of cases the pre‐report empiric treatment was considered appropriate for the isolated pathogen, while 46 per cent of patients had negative cultures and 16 per cent had positive cultures but had been given unsuitable antibiotics. In hospitalised patients, 73 per cent of antibiotic treatments were prescribed according to hospital guidelines, although this was the case for only 45 per cent of community‐based patients. Hospital guidelines were a relevant and useful aid to rational prescribing in that 75 per cent of organisms isolated were sensitive to guideline antibiotics. The guidelines were least appropriate for urine specimens from hospital. This reflects the range of organisms encountered and the emergence of resistant strains, reinforcing the need for regular updating and amending of prescribing recommen

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00824.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

An activity sampling technique was used to compare the work patterns of clinical pharmacists at hospital ward level within six specialties at the West Suffolk hospital, UK. Significant differences were found between specialties for the activities of prescription and clinical monitoring, stock control and the transcription of prescriptions, travel, annotation, intervention with a doctor or nurse, information to a patient and unproductive time (P<0.05).On the psycho‐geriatric and long‐stay geriatric wards, a substantial proportion of pharmacist activity was found to be devoted to stock control and transcription. Two new systems of drug supply were then introduced to these wards and the activity sampling procedure was used to evaluate the effect of the change. It was found that a system employing a technician top‐up service significantly reduced the proportion of time the pharmacist spent on stock control and transcription (P<0.0001) and increased the time spent on clinical monitoring (P<0.05). An estimate based on “total contact time” per occupied bed showed that this new method of supply was achieved at little or no increase in cost, and was arguably a more effective use of pharmacist and technici

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00825.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Hospital pharmacists are increasingly becoming an integral part of the clinical team, with many pharmacists now attending clinicians' ward rounds. This exploratory study observed five pharmacists attending ward rounds in hospitals in South East England, each on two or three occasions. The pharmacists volunteered to take part in the study and consent was obtained from the clinicians in charge. Each round was observed, tape recorded and transcribed. The verbal contributions of each member of the team to the discussions of drugs were analysed and categorised using the stages of the drug use process.The rounds involved 109 patients and there were 269 separate conversations involving medication. Of these, 135 were patient‐specific drug discussions where therapy was reviewed; the pharmacists made proposals to start, stop or alter therapy in nearly half of these discussions. There was no review of therapy in 38 per cent of patients in the study, ranging from 0 per cent on a medical round, to 75 per cent on a surgical round. The pharmacists were particularly involved in selecting the most appropriate dose, stopping drug therapy, and monitoring drugs. The clinicians were more involved in initiating drug therapy. All doctors questioned expressed their satisfaction with the pharmacists and their contribution to the ward round

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00826.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The objectives of the study were to determine whether, by providing caffeine‐free tea and coffee, plasma caffeine concentrations would fall in elderly hospitalised patients, and whether, as a result, sleep profiles and urinary incontinence would be altered.Twenty‐eight patients in two wards of an elderly care hospital received caffeine‐containing or caffeine‐free tea and coffee for consecutive three week periods in a study which was blinded to patients, nurses and investigator. Median caffeine concentration (μg/ml) was stable between the run in period at 2.3 (range 0–5.8) and the caffeine‐containing period at 1.6 (range 0.4–6.0), but fell significantly to 0 (range 0–0.7), during the caffeine‐free period (P<0.001). In spite of significantly lowered caffeine concentrations, no change in sleep patterns or urinary incontinence was noted. Of 12 patients with sleep problems a benefit to sleep quality was reported by two individuals, one of whom was prescribed hypnotics from which she subsequently suc

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00827.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY