Daniel T. Kennedy

Pharmacists' Knowledge and Attitudes toward Herbal Medicine

OBJECTIVE The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications. METHODS A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion. RESULTS Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacists professional responsibility (p = 0.02 and p = 0.01, respectively). CONCLUSIONS The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.

Evaluation of echinacea for treatment of the common cold

Considered to have immunostimulating activity, echinacea is a widely used phytomedicinal for treatment of the common cold and upper respiratory tract infections (URTIs). We reviewed the literature from the MEDLINE database (January 1966–July 1999), International Pharmaceutical Abstracts (IPA) online database, Cambridge Scientific Abstracts Biological Sciences online database, Alt‐Health Watch online database, EMBase CD‐ROM database, and references from published articles, reviews, and letters to evaluate evidence from clinical trials of echinaceas purported efficacy for treating or preventing URTIs. Twelve clinical studies published from 1961–1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URTI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodologic uncertainties, such as small populations and use of noncommercially available, nonstandardized dosage forms. Although evidence for echinaceas efficacy is inconclusive, it appears to be safe. Patients without contraindications to it may not be dissuaded from using an appropriate preparation to treat the common cold.

Results of a Smoking Cessation Clinic in Community Pharmacy Practice

OBJECTIVES To describe and assess the effectiveness of a smoking cessation clinic. DESIGN Single group, unblinded study. SETTING Seven chain (mass-merchandise) community pharmacies in Virginia. PARTICIPANTS Forty-eight patients who were smokers when admitted to the study. INTERVENTIONS Fifteen community chain pharmacists were trained using a smoking cessation training manual developed at the Virginia Commonwealth University School of Pharmacy. From April 1, 1997, through December 31, 1999, interested patients met individually with a study pharmacist during scheduled clinic times in semiprivate counseling areas. A patient chart was maintained at the site and updated after each visit. The first 30 patients completed a questionnaire after the third visit to the smoking cessation clinic to assess satisfaction with pharmacists and the overall program. MAIN OUTCOME MEASURE Rate of long-term smoking cessation. RESULTS Of the 48 patients, 12 (25.0%) abstained from smoking cigarettes for 12 months or more beyond their predetermined quit dates. Abstinence rates for 1, 3, and 6 months were 43.8%, 31.3%, and 25.0%, respectively. Women were nearly five times more successful in attaining long-term abstinence than were men (33.3% versus 6.7%; P= .047). No significant differences were observed in cessation rates related to age, number of cigarettes smoked per day, level of nicotine dependence, number of previous quit attempts, or method of cessation. Increased appetite and weight gain were the most frequently reported withdrawal symptoms (16.7% of patients). Patients expressed satisfaction with the pharmacists and the smoking cessation program. CONCLUSION Compared with other types of previously reported interventions, a community pharmacist-managed smoking cessation clinic achieved greater long-term smoking cessation rates.

Development and implementation of a smoking cessation clinic in community pharmacy practice.

OBJECTIVE To describe a pharmacist-operated program to help people stop smoking. SETTING Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerström Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.

Implementing disease management in community pharmacy practice

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes. DM differs from pharmaceutical care in that pharmaceutical care targets not only patients with specific diseases but also those with risk factors for drug-related problems, a history of nonadherence, and frequent changes in medication regimens. Steps to starting a DM program include: (1) identifying a target population based on the populations strategic importance to the goals and aims of the organization; (2) assessing the organizations available resources, both internal and external; (3) defining key indicators with which to assess the program for the purposes of internal quality control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smoking cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because they are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as it evolves.

Cost-effectiveness of sevelamer versus calcium carbonate plus atorvastatin to reduce LDL in patients with chronic renal insufficiency with dyslipidemia and hyperphosphatemia

We conducted a cost‐effectiveness analysis to compare costs and clinical outcomes of sevelamer versus calcium carbonate plus atorvastatin for treatment of dyslipidemia in patients with chronic renal insufficiency. The model was from the third‐party payer perspective. Efficacy and adverse event rates for each regimen were obtained from published clinical trials. Drug costs were based on average wholesale prices; monitoring costs were based on Medicare reimbursement rates. Our model suggests that the combination of calcium carbonate plus atorvastatin is substantially more cost‐effective than sevelamer in reducing low‐density lipoprotein (LDL) in these patients. Oneway sensitivity analyses were performed to assess if 25% and 50% price reductions in sevelamer affected overall cost‐effectiveness results. A 50% sevelamer price reduction was less expensive than combination therapy but remained less cost‐effective. A two‐way sensitivity analysis on the probability that a patient achieves the goal of a 35% LDL reduction resulted in calcium carbonate plus atorvastatin remaining more cost‐effective. Further cost‐effectiveness studies are necessary to corroborate our data.

A Smoking-Cessation Program Consisting of Extensive Counseling, Pharmacotherapy, and Office Spirometry: Results of a Pilot Project in a Veterans Administration Medical Center

Study Objective. To describe the 1‐year outcomes of a Veterans Administration smoking‐cessation program that demonstrates a standard of care comprising extensive counseling, pharmacotherapy, and office spirometry.