Jack M. Rosenberg

Weight Variability of Pharmacist-Dispensed Split Tablets

OBJECTIVE To determine the level of weight uniformity of fragments from tablets split into halves and dispensed by pharmacists. DESIGN Pre-post comparison. SETTING Laboratory analysis of split tablets returned unused from four long-term care facilities. INTERVENTIONS Twenty-two dispensed prescriptions containing 560 split tablet halves were collected, and fragment weights (FWs) were determined. Theoretical weights (TWs) of split tablets of the same medications were determined mathematically. MAIN OUTCOME MEASURES Comparison of the mean FW with the mean TW of each dispensed prescription and determination of whether fragments met United States Pharmacopeia 24 (USP) criteria for weight variation of whole tablets. RESULTS A significant difference (P < .05) between mean TW and mean FW was found in 2 (9.1%) of the 22 dispensed prescriptions. Overall, 30 (5.4%) of 560 fragments, contained in 10 (45.5%) of the 22 dispensed prescriptions, had weights that deviated by more than 15% from the mean FW. Of the 560 fragments, 32 (5.7%), contained in 10 (45.5%) of 22 dispensed prescriptions, had weights that deviated by more than 15% from mean TW. A total of 15 (68.2%) of the 22 dispensed prescriptions had standard deviations (SDs) that were more than 6% of the mean FW. None of the TWs displayed an SD greater than the USP limit of 6%. Only 7 (31.8%) of the 22 dispensed prescriptions met USP standards, with FWs not exceeding 15% of mean FW and SDs of no greater than 6%. CONCLUSION Tablet splitting resulted in an unacceptably high incidence of weight variation. Standards should be developed to ensure uniformity of split tablets.

The Current Status of Pharmacist-Manned DICs in the United States

The purpose of this article is to communicate current information concerning the status, availability, and scopc of activities of pharmacist-manned drug (medicinal) information centers in the United States (DICs), mainly to provide this data to health professionals who may wish to avail themselves of such services. It is gencrally recognized that one of the deficiencies in the health care system is the unavailability of adequate information for those who prescribe, dispense and administer drugs. Busy clinicians find it impossible to stay abreast of all advances being made every day in drug therapy. This deficiency has resulted in inappropriate drug use and an unacceptable frequency of drug-induced disease. A survey of 19,314 physicians for the Food and Drug Administrations Bureau of Drugs, the largest survey of its type in the United States to date, was conducted to determine the drug information needs, lacks, practices, preferences, and opinions of prescribers. Computer and telephone links to consultants from a university generated the highest level of interest (an estimated 68 per cent of all physicians) as a new source of drug information. I I t appears that the practicing health professional must learn to depend less on a personal individualistic approach to maintaining professional sophistication about drug therapy, and learn to rely on resources that

Implementation of a Capstone Pharmacotherapeutics Course in the Entry-level Doctor of Pharmacy Program

This project was to implement a ”capstone” pharma- cotherapeutics course to: (1) Develop students’ ability in assemblingknowledge from previous courses; (2) Expose students to different aspects of pharmacypractice. The course consisted of 3-h lecture, 1-h recitation and 1-h group project per week. Topics covered include: patient management issues in ambulatory care, critical care, long term care and hospice care, and providing pharrnaceu- ticalconsultation.Students were dividedinto groups and assigned projects to complete and present towards the end of the semester. Projects included developing drug formulary kits, medication utilization criteria, education symposiums and providing medical-legal and market- ing consultation. Overall, students performed well in the course (class average 84%). Students provided neutral feedback to whether the course had achieved its objectives. More assessment in problem-solving skills and student feedback needs to be obtained in order to justify whether this course helps students to apply the growing body of pharmaceuticalknowledge.

Fee-For-Service and Cost Justification Activities of Pharmacist-Manned Drug Information Centers in the United States

In the current era of economic constraints, it is becoming increasingly difficult to obtain sufficient funds for drug information services. Many drug information centers (DICs) are becoming less financially secure and so alternative funding sources are becoming essential for maintaining quality services. Additionally, it is becoming more important for centers to provide cost justification data to support their existence There is a paucity of published data concerning cost effectiveness and fund-generating activities of DICs. The purpose of this article is to present an overview of and recommendations for fee-for-service and cost-justification activities of DICs in the United States DICs offer valuable services that can be enhanced through additional revenue gained from fee-for-services activities. To sell drug information services, centers must provide cost-justification data to current and prospective subscribers. In the cost containment world of the 1990s, DICs must be able to prove that they save money by lowering medical costs. Results indicate the need for cost-justification studies and demonstrate the hazards of less than rigorous study. Cost-effectiveness evidence is likely to emerge as the driving force behind DIC funding in the future

Comparison of Drug Information Practice in Hospitals and Industry

To assess the type of information requested of a pharmaceutical manufacturer, requests received over a 12 month period in the Professional Services Department of Sterling Drug Inc were reviewed. To compare drug information services of Sterling Drug with those of pharmacist-operated drug information centers (DICs), requests were classified as to the nature of the question, category of requestor, and patient specificity. Questions regarding dosage or administration, drug identification, and adverse drug events were common in both DICs and industry. At Sterling Drug Inc the largest number of requests were for literature reprints or physician drug samples and dosage or administration. This contrasts with hospital-based DICs, where the largest number of requests pertained to therapeutic use and drug efficacy or adverse drug events. At Sterling and DICs few questions pertained to pharmacology, toxicology or poisoning, and pharmacokinetics. Physicians comprised the largest group of requestors in DICs. Professional and support staffing of DIC and industry drug information practice are compared. Staffing by PharmDs and RPhs was practically identical for drug information services regardless of whether the practice site was industry or DIC.

A Survey of Fee-for-Service Activities of Drug Information Centers

A survey was conducted to evaluate the fee-for-service (FFS) activities of drug information centers (DICs). Questionnaires were sent to 103 DICs across the United States. Centers were queried about funding source(s), percentage of funds obtained from fees-for-service, fee schedules and rates, and changes in revenue over the previous 5 years. Hospitals, universities, fees, grants, pharmaceutical companies, and unspecified source(s) were reported as funding source(s). Seventeen (22.4%) of the 76 responding DICs reported obtaining revenue from service fees; these DICs utilized various fee schedules and rates, including annual rates, hourly rates, per request charges, and a “900” toll phone line. Of the DICs that reported FFS revenue, nine centers (52.9%) ranked their sources. An increase, decrease, or no change in FFS revenue over the past 5 years was reported by eight centers (47.1%), two centers (11.8%), and seven centers (41.2%), respectively. It was concluded that the FFS activities of DICs have remained essentially unchanged over the past 2 decades.