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Publications in this journal

• Prescriber, pharmacist, and patient interpretation of commonly used prescription directions.

  Authors: A Taubman, L Swanson, G Alpers, R Enfanto, L Moss, K Johnson

  Contemporary pharmacy practice. 5(1):10-3.

  Prescriber, pharmacist, and patient interpretations of commonly used prescription directions were assessed. Results indicated that: 1) Attempts to make directions more time-specific withoutPrescriber, pharmacist, and patient interpretations of commonly used prescription directions were assessed. Results indicated that: 1) Attempts to make directions more time-specific without indicating actual hours for ingestion of the medication tends to lead to patient confusion and potential compliance problems; 2) Some prescribers do not understand the potential interpretation of their own directions; 3) Patients tend to base drug ingestion time on their lifestyles, and unless directions are actually time-specific (e.g., one at 8 a.m., 1 p.m., and 7.p.m.), compliance problems will probably continue; and 4) The prescribed and the pharmacist cannot assume understanding on the part of the patient for nonspecific directions. They must not only reinforce directions, but must also determine the patient's level of understanding, so that actual compliance with the directions intended has a chance for success.

• Pharmacy in the health care center: a model for health care delivery.

  Authors: D C Stark, A I Wertheimer

  Contemporary pharmacy practice. 5(1):27-31.

  Health care consumers use a plethora of services which are accessible on an ambulatory basis. These include the services of pharmacists, optometrists, nurses, dentists, audiologists, orthotics, andHealth care consumers use a plethora of services which are accessible on an ambulatory basis. These include the services of pharmacists, optometrists, nurses, dentists, audiologists, orthotics, and so forth. Since many of these services are provided in physically and financially separate facilities and often are not located in close proximity to one another, consumers may spend a large amount of time traveling between locations. Economic inefficiencies due to the size and dispersion of separate and independent facilities may produce an increase in the cost of ambulatory health care services. Thus, the concept of a health care center, an ambulatory health care analog to the multispecialty shopping center, is proposed as a potential alternative and improvement in the delivery of these services. Space, location, personnel, and initial capital requirements for a model health care center are projected based on existing data for the establishment of each separate auxiliary health care facility. Projections are made to determine the appropriate and necessary site for the health care center's trade area. Potential revenues are calculated by examining some pharmacy operations which are beginning to pioneer these areas and utilizing revenue figures for the various individual services. The results indicate that the pharmacy, as a frequently visited health care facility, may be an excellent choice around which to develop the health care center concept in metropolitan areas.

• Experiences with the compliance clinic: assessment of the effect.

  Authors: G L Cable, P J Schneider

  Contemporary pharmacy practice. 5(1):38-44.

  A retrospective study was conducted to determine the clinical and financial impact of a pharmacy-based compliance clinic. Charts of patients referred by physicians to the clinic were reviewed. DataA retrospective study was conducted to determine the clinical and financial impact of a pharmacy-based compliance clinic. Charts of patients referred by physicians to the clinic were reviewed. Data were collected during compliance clinic consultation and compared to pre-clinic data to determine if the pharmacists' services were of merit. During the 33-month study period, 25 patients were referred to the pharmacy. Fourteen (56 percent) of these patients were seen regularly by the pharmacist. Eleven of the 14 patients (79 percent) achieved greater than 80 percent compliance with their medication regimen. Six of the 14 (43 percent) demonstrated significant reductions in emergency room visits comparing pre- and post-clinic records. Eight patients (57 percent) exhibited reduced hospitalization. Aggregate cost savings resulting from these reductions totalled $43,314 for the study period. It is concluded that: physicians are willing to ask pharmacists to assist in managing compliance problems; compliance can be improved when treatment is tailored to patient need; improved compliance may not result in better therapeutic outcome; and cost savings resulting from those patients responding can exceed the costs of providing the service.

• Community-oriented hospital pharmacy services.

  Authors: L D Perkins, A J McCormack

  Contemporary pharmacy practice. 5(1):56-9.

• The clinical pharmacist as a member of the burn team.

  Authors: P O Anderson, T L Wachtel, H A Frank, B G Trubo

  Contemporary pharmacy practice. 5(2):120-3.

  Pharmacists are becoming involved increasingly in a patient care. At the University of California, San Diego Medical Center, a pharmacist has become a member of the multidisciplinary burn team.Pharmacists are becoming involved increasingly in a patient care. At the University of California, San Diego Medical Center, a pharmacist has become a member of the multidisciplinary burn team. Through participation in work rounds and team conferences, the pharmacist has had a considerable beneficial impact on drug therapy, drug dosing, monitoring adverse drug reactions, and total parenteral nutrition. Specific benefits to patient care that the pharmacist provides are discussed and also the benefits derived in using a burn unit as a clinical teaching rotation for pharmacy students. The pharmacist has found his association with the burn unit to be professionally rewarding and the attending surgeons and surgical house staff have found his input to be valuable. The authors encourage other burn units to enlist a pharmacist as part of their burn team.

• A survey of pharmacist group practice.

  Authors: W F Appel, J K Martilla

  Contemporary pharmacy practice. 5(2):136-8.

• Refilling prescriptions and physician consent.

  Authors: K F Bobrt, A A Purohit

  Contemporary pharmacy practice. 5(2):80-4.

  Much has been written regarding physicians' prescribing behavior. However, a literature search revealed a dearth of information regarding physicians' refilling behavior. The purpose of this study wasMuch has been written regarding physicians' prescribing behavior. However, a literature search revealed a dearth of information regarding physicians' refilling behavior. The purpose of this study was to explore how authorization is given to community pharmacists for refilling a prescription by telephone. A total of 30 physicians (general practitioners and internists) was systematically selected with a random start from the telephone directory of a large metropolitan city. A surveyor acting as a registered pharmacist from a fictitious pharmacy called and requested refill authorization from a prescriber using a simulated patient's name and prescription. Half of the 30 phone calls utilized a controlled substance as the drug in question, and the remaining half utilized a noncontrolled legend drug. All of the phone calls were made either during late afternoon or evening. The results of this study show that 48.3 percent of the physicians authorized refills. Positive refill authorization was given in 29 percent of the instances with the controlled drug and 66 percent of the instances with the noncontrolled legend drug. Only 27.6 percent of the physicians checked their records.

• Use of the countersuit by pharmacists who have been groundlessly sued for malpractice.

  Authors: D B Brushwood

  Contemporary pharmacy practice. 5(2):95-101.

  Attorneys for patients who have been injured by adverse reactions to drugs often name as defendants the prescribing physician, the drug manufacturer, and the pharmacist. In many jurisdictions neitherAttorneys for patients who have been injured by adverse reactions to drugs often name as defendants the prescribing physician, the drug manufacturer, and the pharmacist. In many jurisdictions neither the law of warranty nor the law of strict liability will support a cause of action against a pharmacist who has done nothing more than correctly dispense a drug which was correctly prescribed. If the lawsuit against the pharmacist can be shown to have been filed for no other reason than to coerce a nuisance settlement or just to be cautious, the pharmacist may have available a remedy in the form of a countersuit. Malicious prosecution is one cause of action which might be maintainable as a countersuit. The elements of the cause of action are: 1) the initiation of a lawsuit; 2) lack of probable cause; 3) malice; 4) termination in favor of the pharmacist; and 5) damages. Lack of probable cause and malice are interrelated and are the two most difficult elements to prove. Abuse of process is another possible cause of action. The elements are: 1) an illegal, improper, or perverted use of the process; 2) an ulterior motive or purpose; and 3) damages. Other causes of action which have been considered by attorneys for groundlessly sued health professionals are barratry, defamation, attorney negligence, prima facie tort, and violation of a disciplinary rule.

• Patient behavior patterns regarding prescription refills.

  Authors: R M Schulz, J P Gagnon

  Contemporary pharmacy practice. 5(3):150-5.

  This study was conducted to examine the association between drug price, drug category, duration of coverage of the original prescription, units prescribed per day, and a patient's failure to obtainThis study was conducted to examine the association between drug price, drug category, duration of coverage of the original prescription, units prescribed per day, and a patient's failure to obtain authorized refills of prescription medication. A two-stage sampling of pharmacies and prescriptions yielded a total sample of 1,058 prescriptions. The Drug Possession Ratio (DPR), defined as the ratio of number of days of medication dispensed to number of days of medication prescribed, was significantly related to drug price and drug category (p less than 0.05). The highest DPR was associated with the most expensive medication. Tranquilizers, antidepressants, and sedative hypnotics exhibited high DPR, while antihistamines and decongestants exhibited low DPR.

• Compensation for consultant pharmacy services to long-term care facilities.

  Authors: S S Sones

  Contemporary pharmacy practice. 5(3):161-5.

  Little has appeared in the professional pharmacy literature on the subject of compensation for consultant pharmacy services in the long-term care facility. The objective of this paper was to provideLittle has appeared in the professional pharmacy literature on the subject of compensation for consultant pharmacy services in the long-term care facility. The objective of this paper was to provide an historical review of this issue and to provide a potential methodology for determining the costs to the consultant of providing the comprehensive services as delineated in federal and state regulations. It is hoped that this methodology will become a standard mechanism for states to determine the costs of provision of the required services. The presented methodology indicates that in the region used as an example (central Connecticut), cost of providing comprehensive pharmacy consulting services are ten cents ($0.10) per patient/day.

• Legal aspects of clinical pharmacy practice.

  Authors: J E Clark, P U Nwangwu

  Contemporary pharmacy practice. 5(3):198-203.

  Recent trends in pharmacy have emphasized the concept of a more clinical professional role and a new level of skilled practice for pharmacists. These new roles and responsibilities create a number ofRecent trends in pharmacy have emphasized the concept of a more clinical professional role and a new level of skilled practice for pharmacists. These new roles and responsibilities create a number of legal questions concerning the clinical activities pharmacists can legally perform, and the liabilities pharmacists must bear in the performance or negligence of these duties. The law is not completely clear on all aspects of clinical pharmacy practice. This paper explores the legal basis of certain specific functions performed by pharmacists, and the inherent liabilities involved in the performance of these functions.

• Analysis of the use and potential use of the pharmacist in preventive health services.

  Authors: R F Oyegbile, A I Wertheimer

  Contemporary pharmacy practice. 5(3):205-7.

• Characterization of pharmacy workload and pharmacist activities in a Canadian community pharmacy.

  Authors: R Boyd, W A Parker, D K Yung

  Contemporary pharmacy practice. 5(4):219-25.

  The present study was undertaken to obtain data which would characterize pharmacist activities and prescription workload in a community pharmacy. Data on pharmacist activities were obtained by usingThe present study was undertaken to obtain data which would characterize pharmacist activities and prescription workload in a community pharmacy. Data on pharmacist activities were obtained by using a work sampling methodology. The proportion of time spent on each of 44 activities was obtained, and it was found that the proportion of time spent on professional activities (17.6 percent) was notably less than the time spent on nonprofessional activities (82.4 percent). Data on prescription workload were obtained by the design of a data sheet which was to be completed by each pharmacist for every prescription dispensed. The collected data characterized the number of prescriptions dispensed, which were related to the time of day and day of the week; they also provided information on the types of prescriptions dispensed, the age of patients (e.g., pediatric, geriatric), and the methods of payment.

• Pharmacists' perceptions of their patient counseling activities.

  Authors: D M Kirking

  Contemporary pharmacy practice. 5(4):230-8.

  The counseling of patients regarding their drug therapy has been advocated as an important part of pharmacy practice. Both the need and potential for this counseling have been demonstrated. Yet,The counseling of patients regarding their drug therapy has been advocated as an important part of pharmacy practice. Both the need and potential for this counseling have been demonstrated. Yet, studies generally have been critical to the extent and quality of the counseling provided. This report describes counseling as it is perceived by community pharmacists who perform this activity. A mail survey, developed from interviews with pharmacists, was distributed to a random sample of Ohio community pharmacists. A net response of 76.8 percent (506 usable questionnaires) was achieved. Respondents have strong positive beliefs about counseling. When the service is provided by pharmacists, counseling sessions are usually brief, pharmacist-initiated, and one-way conversations to the patient. Although there is considerable variation as to the classes of drugs for which counseling is provided and the types of people who receive it, the components of counseling appear to be constant. Attempts to change or expand counseling activities may be compromised unless there is a common understanding among all parties involved of what counseling is. This report is one step toward achieving that understanding. It may be used by community pharmacists to measure and compare their counseling behaviors and beliefs with those of their peers and as a means of identifying possible areas for change in their own practices.

• Discretionary justice and state boards of pharmacy.

  Authors: R R Abood

  Contemporary pharmacy practice. 5(4):250-6.

• Pharmaceutical services in long-term care facilities: a certificate approach to teaching skills.

  Authors: R L Davis, G E Farr

  Contemporary pharmacy practice. 5(1):1-6.

  The University of Tennessee College of Pharmacy has developed a certificate program for Pharmaceutical Services in Long-Term Care Facilities. Pharmacists who are required to provide such servicesThe University of Tennessee College of Pharmacy has developed a certificate program for Pharmaceutical Services in Long-Term Care Facilities. Pharmacists who are required to provide such services generally have had minimal experience in doing so. The certificate is composed of six home-study courses, a researched paper, and an on-site clerkship experience. Each pharmacist is evaluated for his or her mastery of the material at regular intervals. The program is designed to be completed in 6 months.

• The community pharmacist and health education.

  Authors: B T Lively

  Contemporary pharmacy practice. 5(1):14-20.

  A behavioral-oriented approach to providing information to patients was examined. The goal of the approach was to produce behavioral change through health education. The pharmacist's role as a healthA behavioral-oriented approach to providing information to patients was examined. The goal of the approach was to produce behavioral change through health education. The pharmacist's role as a health educator was discussed, and patient education was distinguished from information dispensing. It was concluded that the preventive medicine concept makes the pharmacist's educational role important and requires communication and education skills to make that role viable. Pharmacy curricula and continuing education should address the need for such skills.

• Building a structured learning package.

  Authors: N Ferencz

  Contemporary pharmacy practice. 5(1):32-7.

  Pharmacists must become educators of patients and of pharmacy technical personnel. The literature cited in this paper has found that problems of patient compliance, personnel management, the highPharmacists must become educators of patients and of pharmacy technical personnel. The literature cited in this paper has found that problems of patient compliance, personnel management, the high cost of medical care, and patient medical self-help may very well be solved in part through the application of competently written learning packages. One specific approach to learning package creation is illustrated in this paper, using the training of a unit-dose technician as an example. The subjects of student motivation, step-wise learning using subobjectives, learning feedback, material relevance, and student evaluation are discussed. Higher-level cognitive skills and readability are briefly discussed and illustrated to focus the readers' attention on the more difficult aspects of building learning packages.

• Power -- an essential need for effective managers: Part III.

  Authors: A E Perez, T H Perez

  Contemporary pharmacy practice. 5(1):50-2.

• Prenatal drugs: patient information and its source.

  Authors: P L Doering, Y Brackbill, K McManus, L Woodward, J T McClave

  Contemporary pharmacy practice. 5(2):112-9.

  Pregnant women consume numerous medications, some of which are potentially harmful to the fetus. It is especially important that these women are provided with information about these drugs. ThisPregnant women consume numerous medications, some of which are potentially harmful to the fetus. It is especially important that these women are provided with information about these drugs. This study was undertaken, in part, to document the amount of information pregnant women have about the drugs they consume and the sources of their information. Study participants were 304 women selected at random from the postpartum inpatients at a teaching hospital. Mothers were interviewed to obtain drug exposure data and to determine what, if any, information they had about the drugs. The source of information for each drug consumed was also determined. Results show that pregnant women have little information for each drugs they consume. Mothers most often cited primary medical personnel (physicians and nurses) as sources of information about specific drugs. In contrast, only six patients cited the pharmacist as a source of information about specific drugs. However, patients ranked the pharmacist high as a source of general drug information. This report emphasizes the need for more drug information for pregnant women and highlights the role of the pharmacist in providing such information.

• Pharmacists' and physicians' responses to the South Carolina Product Selection Act of 1978.

  Authors: E D Sumner, A W Karig, H H Hunt

  Contemporary pharmacy practice. 5(2):124-9.

  The "Drug Product Selection act of 1978" became effective in South Carolina on January 1, 1979. All written prescription forms must be printed with two signature lines. Under the line at the left,The "Drug Product Selection act of 1978" became effective in South Carolina on January 1, 1979. All written prescription forms must be printed with two signature lines. Under the line at the left, "DISPENSE AS WRITTEN" must be printed. Under the line at the right, "SUBSTITUTION PERMITTED" must be printed. In addition, the pharmacist must receive the patient's consent before substitution can occur. This study investigated the impact of the Act on physicians' prescribing habits and pharmacists' responses to drug product selection initially and 3 months after enactment. The data were analyzed according to the drugs prescribed, permitted substitutions, physicians' specialties, use of correct prescription blank, drug category, date, and drug actually dispensed. Physicians permitted substitution for 27.19 percent of all prescriptions written. There were 499 prescriptions out of 1,835 authorizing substitutions. A total of 127 of these drugs were for single-source items, as 162 were written for generic items. In the remaining 210 prescriptions for brand name items, pharmacists selected another brand only 24 percent of the time.

• Role effectiveness of a pharmacist in the maintenance of patients with hypertension and congestive heart failure.

  Authors: P J Schneider, J N Larrimer, J A Visconti, W A Miller

  Contemporary pharmacy practice. 5(2):74-9.

  This study was designed to measure the role effectiveness of pharmacists in the management of patients with hypertension and congestive heart failure. Based on therapy protocols established byThis study was designed to measure the role effectiveness of pharmacists in the management of patients with hypertension and congestive heart failure. Based on therapy protocols established by physicians and pharmacists prior to the study, the pharmacist was measured against the standard for providing primary care--i.e., the physician. The study showed that the pharmacist competently elected drug therapy and identified adverse drug reactions. As a group, the 20 study patients, whose therapy was determined by the pharmacist, were better managed than the 20 control patients (p less than 0.05). It is suggested that the pharmacist is effective in the role of managing patients with hypertension and congestive heart failure.

• Inadequately written prescriptions: prescriber rationales for "take as needed" and "take as directed.".

  Authors: J T Cirn, D K Helling

  Contemporary pharmacy practice. 5(2):85-8.

  An audit of a large sample of prescriptions written by 39 physicians revealed considerable variation in the rate at which they specified adequate dosage instructions. When asked for their rationalesAn audit of a large sample of prescriptions written by 39 physicians revealed considerable variation in the rate at which they specified adequate dosage instructions. When asked for their rationales for saying "Take as needed" or "Take as directed" on prescriptions, the physicians cited several circumstances where these instructions may be indicated. "Take as directed;; is defended 1) when the patient has a history of compliance with the regimen being prescribed; 2) when the prescription is accompanied by verbal or auxiliary written instructions; 3) when oral contraceptives are ordered; and 4) when the prescribers may need to make frequent changes in a regimen and wish to communicate these changes orally. "Take as needed" is defended when the drug is to be taken only when the patient determines that sufficient symptoms have appeared. Prescribers are cautioned to consider whether the assumed advantages of nonspecific dosage instructions are outweighed by the possible risks of patient confusion.

• PPIs: community pharmacists' perceptions.

  Authors: E R Kaczmarek, J E Stewart, R A Hutchinson

  Contemporary pharmacy practice. 5(3):143-9.

  In order to measure pharmacists' perceptions about the PPis for estrogen and oral contraceptives, questionnaires were distributed to a random sample of 105 community pharmacists in a large midwesternIn order to measure pharmacists' perceptions about the PPis for estrogen and oral contraceptives, questionnaires were distributed to a random sample of 105 community pharmacists in a large midwestern city. Seventy completed questionnaires were returned, producing a response rate of 67 percent. A slight majority of the responding pharmacists indicated that pharmacists should be responsible for distribution of these PPIs but that physicians should be responsible for determining whether a patient should receive a PPI. The pharmacists indicated that patient information should be verbally communicated and accompanied by a written summary sheet and that patients neither read nor understand these PPIs. Although limited in size and geographic area, this study suggests that retail pharmacists have doubts about the current PPI program mandated by the Food and Drug administration.

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

  Authors: R S Beardsley, C A Johnson, H F Kabat

  Contemporary pharmacy practice. 5(3):156-60.

  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 patientsThis 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.

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