Gireesh V. Gupchup

The Impact of Pharmaceutical Services in Community and Ambulatory Care Settings: Evidence and Recommendations for Future Research

OBJECTIVE: TO review and evaluate research on pharmaceutical services in community and ambulatory care pharmacy settings, specifically study designs and patient outcome measures, and to provide recommendations to improve future research on pharmaceutical services in community and ambulatory care pharmacy settings. DATA SOURCE: English-language articles were identified by searching MEDLINE (1966-December 1998) and International Pharmaceutical Abstracts (1970-December 1998), using a combination of search terms: pharmacist services, pharmacist interventions, community pharmacy, ambulatory care, primary care, and patient outcomes. Relevant studies were selected based on article abstracts. DATA EXTRACTION: From each relevant study, we extracted the study objectives, sample size, study period, study design, major tasks performed by pharmacists, and economic, clinical, and humanistic outcomes (ECHO). Results were tabulated separately for research on community pharmacy and ambulatory care pharmacy settings. RESULTS: We identified 95 relevant studies. Of these, 21 studies were conducted in community pharmacy settings and 74 in ambulatory care settings. Ten community pharmacy studies used prospective, single group, pretest/posttest, or posttest only designs; seven used prospective two or more group comparison designs; and four used randomized, controlled designs. Nine studies on community pharmacies measured clinical outcomes, two measured humanistic outcomes, and five measured economic outcomes. Four studies measured both clinical and humanistic outcomes and one measured humanistic and economic outcomes. No study measured all three ECHO variables. Twenty-three studies in ambulatory care settings used prospective or retrospective, single group, pretest/posttest or posttest only designs; 21 used prospective or retrospective two-or-more group comparison designs; and 30 used randomized, controlled designs. Thirty-six measured clinical outcomes, five measured humanistic outcomes, and 15 measured economic outcomes. Fifteen studies measured clinical and economic outcomes and three measured clinical and humanistic outcomes. CONCLUSIONS: Only 21 of 95 selected studies were conducted in community pharmacy settings and measured the impact of pharmaceutical services on patient outcomes. Few studies employed adequate research designs to control threats to internal and external validity. In order to obtain a comprehensive and accurate picture of the impact of pharmaceutical services on patient outcomes, an attempt must be made to measure all three ECHO variables while employing adequate research design.

Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients.

OBJECTIVE:To determine health care costs associated with pressure ulcers, ulcers of the lower limbs, other chronic ulcers, and venous leg ulcers from the New Mexico Medicaid fee-for-service program perspective. DESIGN:Retrospective analysis of claims database MAIN OUTCOME MEASURES:Physician visit, hospital, and prescription costs were determined for New Mexico Medicaid patients with a primary and/or secondary diagnosis of 1 of 4 identified categories of skin ulcers from January 1, 1994, through December 31, 1998. Costs were determined in terms of mean and median annual cost per patient and total costs per year. Zero dollar claims were included within the cost calculations. All costs are expressed in 2000-dollar values. MAIN RESULTS: Mean annual physician visit costs per patient ranged from

Impact of Pharmacists’ Directive Guidance Behaviors on Patient Satisfaction

71 (standard deviation [SD] =

Reliability and validity of the asthma quality of life questionnaire—marks in a sample of adult asthmatic patients in the United States

60) for venous leg ulcers in 1998 to

Assessment of Pharmacy Student Professionalism Across a Curriculum

520 (SD =

Depressive Symptoms in Patients with Type 2 Diabetes Mellitus: Do Stress and Coping Matter?

1228) for pressure ulcers in 1996. Mean annual hospital costs per patient ranged from

Development of a Scale to Measure Directive Guidance by Pharmacists

266 (SD =

The cost-effectiveness of two strategies for vaccinating U.S. veterans with hepatitis C virus infection against hepatitis A and hepatitis B viruses

348) for other chronic ulcers in 1998 to

Economic, clinical, and humanistic outcomes (ECHOs) of pharmaceutical care services for minority patients: A literature review

15,760 (SD =

A modified work locus of control scale: preliminary investigation of reliability and validity in a sample of pharmacists.

30,706) for pressure ulcers in 1998. Mean annual prescription costs per patient ranged from