Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility

Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study

Objective

To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research.

Method

A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation.

Key findings

The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups.

Conclusion

Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.

Use of pharmacy claims databases to determine rates of medication adherence

Failure to adhere to pharmaceutical therapy leads to poor clinical outcomes and substantially increased healthcare costs. Pharmacy claims databases contain all the information required to determine adherence to therapy for populations and individual patients, but extraction and analysis of these data are difficult and time-consuming. The Standardized Therapy Adherence Research Tool (START) converts pharmacy claims databases into a standardized format to rapidly obtain comprehensive adherence information that can be used to design interventions aimed at improving adherence rates.

Pharmacist-patient privilege, confidentiality, and legally-mandated counseling: a legal review

OBJECTIVE

To indicate the necessity for uniform, privileged status of pharmacist-patient communications.

DATA SOURCES

Published cases (LEXIS), literature (NEXIS and MEDLINE), and abstracts available through November 1997. CASE SELECTION AND DATA ABSTRACTION: Selected by the authors for inclusion based on objectives, publication in English, and usefulness of information for practicing pharmacists.

DATA SYNTHESIS

Since pharmacists are now legally required to counsel patients under federal and state laws, protection of the confidentiality of such information is of concern. Statutes are largely silent on the issue of pharmacist-patient communications, particularly oral communications. Some states recognize privilege (protection from subpoenas and court orders), others provide confidentiality only (information must be divulged only upon subpoena or court order), and most states specify neither type of protection for pharmacist-patient communications. An evaluation of case law indicates personal and legal risks, for both pharmacist and patient, associated with unprivileged communications occurring within a counseling situation.

CONCLUSION

Pharmacist-patient communications must be granted privileged status, in all states, to protect both pharmacist and patient if pharmacists are to fulfill their legally-mandated counseling responsibilities.

Low pharmacist counseling rates in the Kansas City, Missouri, metropolitan area

OBJECTIVE

To quantify the percentage of patients counseled by community-based pharmacists.

METHODS

Phase I consisted of a 15-minute observational period of pharmacist counseling in 50 randomly selected pharmacies in the Kansas City, MO, area. In phase II, a survey was mailed to the same pharmacies to obtain policies, self-reported rates of counseling, baseline workload, and personnel information, as well as perceived communication barriers.

RESULTS

Forty-six of 50 pharmacies were observed in phase I after excluding 10 ineligible pharmacies and adding 6 replacement pharmacies. Pharmacists provided counseling in only 14 of the 46 pharmacies (30%). Nineteen percent (20/106) of all patients received pharmacist-initiated counseling. Pharmacists in independent pharmacies were observed counseling a significantly higher percentage of patients than were pharmacists in chain pharmacies (44% vs. 11%; p = 0.014). Technicians were observed counseling 5 patients in chain pharmacies. Detailed verbal counseling, defined as four or more of a group of major counseling components, was provided to only 8 of the 20 patients who were counseled by a pharmacist (40%; 8% of all patients). In phase II, 31 of 51 surveys (61%) were returned. During the requested survey time period, pharmacies estimated that approximately five prescriptions were filled every 15 minutes, 51.5% of which were new. Pharmacists in chain pharmacies reported dispensing greater numbers of prescriptions than did pharmacists in independent pharmacies. These data and the reported counseling rates indicated that 50% of all patient prescriptions should be counseled. This is a higher rate than actually observed. All pharmacies reported that pharmacists completed the counseling; however, 10% of the respondents reported that technicians also counseled patients. Contrary to the findings in phase I, slightly more than 50% of the pharmacists reported using detailed verbal counseling.

CONCLUSIONS

The overall observed rate of counseling in community pharmacies is low. In the Kansas City area, independent pharmacists counsel a greater than average percentage of their patients. Even if the national counseling rate is double what was observed, millions of patients are leaving pharmacies without the benefit of pharmacotherapeutic guidance. If pharmacists are slow to meet these challenges, other service providers will relieve pharmacists of that responsibility.

On-line DUR messages: pharmacists' attitudes and actions in response

Community pharmacists are encountering on-line drug utilization review (DUR) messages with increasing frequency. DUR messages are sent by third party claims processors and generated by pharmacies' in-house computer systems. The purpose of this study was to ascertain community pharmacists' attitudes toward on-line DUR messages and the actions most often taken by pharmacists after receiving these messages. A 28-item questionnaire was mailed to a random sample of 1,500 community pharmacies throughout the United States. Four hundred twenty-seven questionnaires were returned and analyzed (a 28.5% response rate). The majority of respondents were male pharmacists practicing in independent community pharmacies in cities with populations of less than 50,000. The low response rate from chain pharmacies was an important limitation of this study. The results indicate that pharmacists find DUR messages related to medication overuse and drug interactions to be the most useful. Interventions are not performed for all DUR messages received, and interventions usually consist of telephoning physicians and talking to patients. This study demonstrates that many types of DUR messages are useful to pharmacists; however, additional research and further refinement of DUR messages appear necessary.