Stephen M. Caiola

The Patient-Pharmacist Interaction in Two Ambulatory Settings — It's Relationship to Patient Satisfaction and Drug Misuse

Seventy-five clinic outpatients were randomly assigned to a Satellite Pharmacy with a private consultation room or a centralized Traditional Pharmacy with an open-window setting. A comparison of the patient-pharmacist interaction and its relationship to the patients satisfaction with pharmacy services and his drug-taking behavior was measured by the use of two questionnaires. A significant difference was found in the quantity of consultation activities performed by the pharmacists in the two settings. Patients were significantly more satisfied with the Satellite Pharmacy and seemed to favor the private setting over the open-window. Patient satisfaction was significantly correlated with the waiting time, the amount of time spent with the pharmacist, the total activities received during the interaction, and satisfaction with hospital services in general. Medication errors were not significantly different for the two patient groups when measured by verbal reports but compliance scores were significantly different for those patients taking drugs for which a tablet count could be done. Although analysis of the data showed a significant difference for only one measure of drug-taking behavior, improvement of drug use as a result of the interaction with the pharmacist in the Satellite Pharmacy was suggested. Compliance scores for regularly scheduled drugs correlated with the financial status of the patient, total interaction activities, and interaction time. Financial status, satisfaction with the drug, and the day of the second interview were significantly correlated with the PRN compliance scores.

Costs of Implementing Pharmaceutical Care in Community Pharmacies

OBJECTIVE To estimate the costs and benefits to community pharmacies of converting a traditional practice into one based on pharmaceutical care. SETTING Community-based ambulatory care pharmacies. PRACTICE DESCRIPTION Community pharmacy. PRACTICE INNOVATION Pharmaceutical care. MAIN OUTCOME MEASURES Costs incurred and revenues received. DESIGN Twenty-five community pharmacies that had made the transition from traditional practice to one based on pharmaceutical care returned a survey providing data on the costs and revenues associated with the transition. RESULTS Mean total cost of making the conversion for the 25 pharmacies was

Evaluation of a Condensed Training Program to Introduce the Process of Continuing Professional Development

36,207. The largest cost component associated with the transition was personnel, which had a mean cost of

Continuing professional development training program among pharmacist preceptors and nonpreceptors

16,512 per pharmacy. Mean revenues received for pharmaceutical care by these 25 pharmacies was

Analysis of the practice of nutrition support pharmacy specialists.

3,687, mainly for disease management services. Pharmacies that spent more on the conversions, and used brochures and physician detailing as well as consultants and franschises, tended to be more successful in generating revenues from pharmaceutical care. CONCLUSION Most pharmacies that have made the conversion to pharmaceutical care have not experienced an increase in profits as a result of that conversion. More effort needs to be directed toward improving the flow of revenues obtained from providing pharmaceutical care.

Evaluation of Pharmacist Continuing Professional Development Portfolios

Objectives: Continuing professional development (CPD) is a novel approach to learning and developing as a professional. The purpose of this study is to administer, observe, and evaluate a condensed CPD training program to determine its effectiveness. Study method: The program consists of a 2-hour home study section with reflective components and a 3-hour live portion complete with active learning activities and group exercises. Pre- and post-surveys were administered to participants, with several questions being asked to determine their perception of the CPD process. Results: Of the 21 participants that attended the program, 99% indicated on the post-workshop evaluation that they were able to accomplish the pre-stated program objectives. Of the 19 participants who completed the pre- and post-surveys, 88% responded that the program time was just right for them. After the post-survey, 71% responded that they were very familiar with the concept of CPD as opposed to 11% on the pre-survey. Conclusion: A combined 2-hour self-study and 3-hour live interactive program is efficient and effective in training professionals on CPD.

Ostomy Patient Care Program

OBJECTIVES To administer, observe, and evaluate the effectiveness of a condensed continuing professional development (CPD) training program among chain community pharmacy preceptors and nonpreceptors in North Carolina. METHODS 120 community preceptors and nonpreceptors affiliated with a large community chain pharmacy completed a 5-hour CPD program consisting of home study and live portions and were given pre- and postintervention surveys. The main outcome measures were knowledge and familiarity of CPD among community chain pharmacy preceptors and nonpreceptors, effectiveness of the condensed training program, and perceptions on implementing the CPD process after training. RESULTS Before the educational activity, differences between participants were (1) the percent of women pharmacists (40% of preceptors and 65% of nonpreceptors) and (2) that preceptors were more likely to accomplish planned learning activities compared with nonpreceptors. Of 97 nonpreceptors and 23 preceptors trained, more than 90% reported being able to achieve the program objectives and responded positively to the survey questions and 100% indicated that the educational activity enhanced their knowledge and skill levels. At least 85% of participants responded that the program length was satisfactory. The postsurvey revealed that 87% of participants were at least moderately familiar with the concept of CPD. Of respondents, 83% indicated that they will implement CPD at their practice site. CONCLUSION A condensed CPD program is efficient and effective in training community chain pharmacy preceptors and nonpreceptors. The majority of the pharmacists who responded indicated that they will implement CPD at their practice site after going through this program.

Appropriate Use of Heparin: Empiric vs Nomogram-Based Dosing

In 1988 the Board of Pharmaceutical Specialties (BPS) recognized nutrition support pharmacy practice (NSPP) as one of four specialty areas in pharmacy. The BPS appointed a specialty council to develop and manage the process for board certification of qualified specialists. One step was to identify and validate activities performed by the specialists. This was accomplished by conducting a study that delineated the role of these practitioners and also provided information for developing a blueprint for a certification examination. The results revealed the types of practice settings, education, and training for specialists, and the distribution of professional time devoted to nutrition support activities.

North Carolina Family Practice Physicians’ Perceptions of Pharmacists as Vaccinators

Objective: The purpose of this study was to conduct a random continuing professional development (CPD) portfolio audit to assess the portfolios of pharmacists who completed CPD training in the state of North Carolina and reported adopting it in place of the annual 15-hour continuing education (CE) requirement when applying for re-licensure. Methods: The NC Board of Pharmacy (NCBOP) staff randomly selected 30 pharmacists to provide CPD portfolio documentation to the Board electronically or in paper format. This documentation included their completed learning plan, a learning activity worksheet for each completed activity, and the Accreditation Council on Pharmacy Education (ACPE) universal activity number for the CPD training program attended. The Task Force used a multicomponent audit tool to assess each portfolio. Results: Eighty percent of portfolios had at least 15 hours of learning reported. Portfolio assessments indicated an average of 5 learning objectives per individual. Based on the scale of 1 to 5, the Measurable and Specific sections of the objectives scored the lowest with an average score of 3 on both sections. An overall assessment of “adequate” or “comprehensive” was noted for 60% of the portfolios. Conclusion: Pharmacists completing CPD training are capable of following the CPD process with some potential challenges in documentation. Information submitted to the board of pharmacy is considered sufficient for license renewal purposes.

Well-Being: A North Carolina Study

The ostomate is often a forgotten patient with regards to proper psychological and emotional preparation for his surgery and proper continuing care of his ostomy. The pharmacist can play an important role in aiding the ostomy patient, especially in providing him adequate appliances and ostomy-care information. The development and implementation of the ostomy program of the N. C. Memorial Hospital Pharmacy is presented in detail. A brief explanation of why ostomy surgery is necessary, of the various types of ostomies and of the various appliances utilized is also presented. The following services of the program are described: Use of a patient profile card in order to have on record the patients specific appliance and replacement parts; Fitting the new ostomate with the proper appliance and instructing him on its proper use; Interviewing patient on return clinic visits to determine if the patient is having ostomy-related problems or needs any replacement parts for his appliance; Providing patients appliance needs through the mail or through communication with the patients local community or hospital pharmacist, and Conducting a presurgical consultation with the future ostomate to briefly explain appliances and how their use will affect his life, plus answer questions which may be making him apprehensive.