Paul L. Ranelli

The Conflict Between Ethics and Business in Community Pharmacy: What About Patient Counseling?

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but these laws have had mixed results. This essay argues that community pharmacys patient counseling conundrum can be solved through additional moral education and moral persuasion, not through additional legal mandates.

ASHP statement on the role of health-system pharmacists in public health

Pharmacists who practice in hospitals and health systems (health-system pharmacists) play a vital role in maintaining and promoting public health. The American Society of Health-System Pharmacists (ASHP) believes that all healthsystem pharmacists have a responsibility to participate in global, national, state, regional, and institutional efforts to promote public health and to integrate the goals of those initiatives into their practices. Furthermore, health-system pharmacists have a responsibility to work with public health planners to ensure their involvement in public health policy decision-making and in the planning, development, and implementation of public health efforts. The primary objectives of this statement are to (1) increase awareness of health-system pharmacists’ contributions to public health, (2) describe the role of health-system pharmacists in public health planning and promotion, and (3) identify new opportunities for health-system pharmacists’ involvement in future public health initiatives. This statement does not provide an exhaustive review of healthsystem pharmacists’ public health activities. Its intent is to stimulate dialogue about the role that health-system pharmacists can play in providing care that improves public health in the United States.

Influence of gender on outcomes of medication-history interviewing

This study investigated the influence of patient and provider gender on the outcomes of medication-history interviewing. In a previous study, 112 pharmacy students conducted medication-history interviews with 2 simulated patients. A secondary analysis was accomplished using complete data from 85 of the original 112 pharmacy students. The other 27 students were eliminated because of missing data. Factor analysis and canonical correlation were used to assess associations between the prior studys set of predictor variables and measures of interview completeness and patient satisfaction with the interview. Female and male pharmacy students appear to use different expressive, interactive, and interrogative skills. Allergy-asking was more complete when female pharmacy students interviewed a male patient. Emotive patient satisfaction was found to be associated more positively with a female student and female patient while teleological patient satisfaction between a male student and male patient was nearly double the result of the female-female dyad. Medication-history interview outcomes appear to differ as a consequence of the use of different sets of skills during same-sex or opposite-sex interviews.

Bone marrow granulomas possibly associated with amiodarone.

Amiodarone is a class III antiarrhythmic agent that is effective in treating different types of cardiac dysrhythmias. It was approved only for treatment of life‐threatening ventricular dysrhythmias refractory to other therapy; however, its use for atrial dysrhythmias such as atrial fibrillation is well accepted. Adverse effects associated with amiodarone include pulmonary, hepatic, thyroid, ocular, and neurologic toxicities. Our patient experienced intermittent fever, night sweats, and fatigue while taking the drug for treatment of atrial fibrillation. Bone marrow biopsy showed granuloma formation after 17 months of therapy with amiodarone. Amiodarone was discontinued due to significant hypotension and shortness of breath. To our knowledge, this is the third case report of granuloma formation in bone marrow possibly associated with this agent.

The utility of nonverbal communication in the profession of pharmacy

Abstract The nonverbal communication relationship between a pharmacist and 243 subjects was investigated by using 18 black and white, 35 mm, 2 × 2 in., slides depicting a male pharmacist in a neighborhood pharmacy setting. A five-point modified Likert questionnaire measured the subjects attitude toward the pharmacist by scoring certain distance and position control slides to the nonverbal communication dimensions of likability and advice potential. Results indicate the subjects had a significantly more positive attitude toward the pharmacist when he was closer, in an eye level position, and when he was not screened by any obstacle such as a sales counter or prescription work area.

Partners in Public Health: Public Health Collaborations With Schools of Pharmacy, 2015:

To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.

An Opportunity for Pharmacists to Help Improve Coordination and Continuity of Patient Health Care

Pharmacist workforce researchers are predicting a potential surplus of pharmacists in the United States that might result in pharmacists being available for engagement in new roles. The objective for this study was to describe consumer opinions regarding medication use, the health care system, and pharmacists to help identify new roles for pharmacists from the consumer perspective. Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Out of the representative sample of 36,673 respondents living in the United States, 80% (29,426) submitted written comments at the end of the survey. Of these, 2178 were specifically about medicines, pharmacists or health and were relevant and usable for this study. Thematic analysis, content analysis, and computer-based text mining were used for identifying themes and coding comments. The findings showed that 66% of the comments about medication use and 82% about the health care system were negative. Regarding pharmacists, 73% of the comments were positive with many commenting about the value of the pharmacist for overcoming fears and for filling current gaps in their healthcare. We propose that these comments might be signals that pharmacists could help improve coordination and continuity for peoples’ healthcare and could help guide the development of new service offerings.

Stigma, conflict, and the approval of AIDS drugs.

A preliminary report questioning the efficacy of zidovudine (AZT) in the early treatment of Acquired Immunodeficiency Syndrome (AIDS) implicitly questions the expedited process by which AZT was approved. While the public historically has influenced drug policy, recent changes were brought about by activists threatening civil insurrection to expand access to unapproved treatments. Turners social conflict theory is used to explain the recent structural changes in the drug approval process in terms of the overt struggle for control over access to potentially life-saving drugs. This passion for change is shown to be a result of the stigma of the disease itself. Challenging the hegemony of the FDA was a mechanism by which activists coped with the imputed stigma of AIDS. While controversial, activism has increased access to new drugs and will have a far-reaching impact on how future drugs are approved.