ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--1999

The general pharmacy work explored in The Netherlands

Objective To determine the frequency and nature of general pharmacy work at three Dutch community pharmacies. Methods In a purposive and convenience sample of three Dutch community pharmacies the general work was investigated. Multi-dimensional work sampling (MDWS) was used. The study took six weeks: two weeks at each pharmacy. Main outcome measure The number of care related items emerging in the general work. Results Care related work represented 34% of all pharmacy activities. Conclusion Although care related work was present at all three studied pharmacies, this part of the work still needs serious attention of Dutch pharmacists in order to advance pharmaceutical care. It is suggested that an efficient pharmacy organization in combination with robotization, task specialization, and interior design can expand the care related work at the pharmacy.

ASHP survey of ambulatory care pharmacy practice in health systems--2004

PURPOSE

The characteristics of and trends in pharmacy practice in ambulatory care settings across the United States were studied.

METHODS

A 2004 national survey of the ambulatory care responsibilities of pharmacists across a spectrum of organizational types (community hospitals, county facilities, Indian Health Services facilities, Veterans Affairs (VA) facilities, teaching institutions, integrated health networks, military facilities, and health maintenance organizations) was conducted and related to organizational features that could promote pharmacist participation.

RESULTS

From 1672 deliverable Web-based surveys, 233 organizations reported at least some pharmacist involvement in ambulatory activities, while 475 reported none. Over half of the 228 organizations with some pharmacist involvement reported pharmacists tracking adverse drug reactions (67%), providing written (53%) or oral (52%) information with new prescriptions, and conducting medication management programs (51%). Some 85% reported having at least one clinic with pharmacist involvement. Clinics for anticoagulation services (36%) and oncology services (28%) were most prevalent, followed by primary care or family practice clinics (23%) and diabetes clinics (21%). New survey items found a high prevalence of pharmacist involvement in emergency preparedness programs (90%), medication management services in complex medication situations (63%), and using evidence-based practice guidelines (60%). Of nine enabling factors (factors potentially promoting pharmacist involvement) investigated, participation on multidisciplinary teams and having collaborative practice agreements were significantly associated with pharmacist participation in at least one ambulatory care activity. Having at last one ambulatory care staff pharmacist with advanced training, having at least one residency program, and having collaborative practice agreements were significantly associated with pharmacist participation in at least one clinic or program. Pharmacist participation in ambulatory care activities was not equally distributed across different types of organizations, and VA facilities were notable for the amount and extent of participation.

CONCLUSION

Pharmacists' roles and responsibilities in ambulatory care appear to continue to evolve, with VA facilities leading the way.

Pharmacoeconomic fellowships: the need for outcome measures

Pharmacoeconomic fellowship programmes have been in existence for more than 10 years, but their effectiveness has not been evaluated. The aim of this project was to construct a framework to examine the potential outcome measures for pharmacoeconomic fellowships so that the effectiveness of these programmes may be determined. Using the Donabedian model, the structures, processes, and outcomes of pharmacoeconomic fellowship programmes were investigated. The structures of these programmes include the facilities, qualifications of the teaching staff and organisation, and operations of the institution. Most pharmacoeconomic fellowships are based in academic institutions and the pharmaceutical industry. Credentials of the preceptors and teaching staff consist of an advanced degree and relevant expertise in pharmacoeconomics and outcomes research. The processes of pharmacoeconomic fellowships include the duration of the programme as well as the research skills and the educational components taught. However, current guidelines do not define outcome measures for these pharmacoeconomic fellowships. Potential outcomes may include whether or not a degree was obtained, the management and research skills acquired, as well as the type of experiential training received. Further research is required to develop these outcome measures, so the effectiveness of pharmacoeconomic fellowship programmes may be assessed.