This prospective, randomized, controlled trial, based in a Veterans Administration Hospital general medicine clinic, compared the cost effectiveness of two behaviorally oriented interventions designed to reduce physicians' drug prescribing costs. Clinical pharmacists visited one group of 11 physicians during weekly clinic sessions to counterdetail the prescribing of certain targeted drugs. A second group of 10 physicians were given data each week comparing their individual prescribing costs to those of their colleagues (peer-comparison feedback). A control group of 10 physicians received neither intervention. Written patient-specific suggestions for cost-effective prescribing were employed in both intervention groups. Baseline prescribing costs were monitored through the hospital's computer during a three-month, preintervention period and a seven-month intervention period. The 2026 written suggestions made by the doctors of pharmacy resulted in 613 (30.3 percent) prescribing changes, including deletion, substitution, or change in dosage of targeted drugs. There were no intergroup differences in the response to written suggestions. However, the group receiving face-to-face visits from the clinical pharmacists achieved lower average prescription costs than the control group during seven of eight months. Intergroup differences were statistically significant (p < 0.05) during three of the last five months of the study. The face-to-face meeting intervention was cost-effective, saving $478 per physician over seven months after accounting for Pharm.D. salary costs. There was no significant decrease in the number of prescriptions written by the face-to-face group compared with the control group, suggesting that drug substitution rather than deletion was the method used by physicians to lower drug costs. No savings resulted from the use of peer-comparison feedback. We conclude that personal visits by a Pharm.D. are a cost-effective technique for reducing physicians' prescribing costs, and are superior to peer-comparison feedback.
Improper inhalation technique with beta-agonist metered-dose inhalers (MDIs) decreases efficacy of the bronchodilator. The success of demonstrating the correct technique and the pharmacist's role in patient education has been reported. To obtain information regarding the routine patient education practice of pharmacists when dispensing a beta-agonist MDI (albuterol), the following study was performed. Fifty-two prescriptions for an albuterol MDI were presented to 52 randomly chosen community pharmacists in three Tennessee cities. Twenty-six independent and 26 chain pharmacies wer evaluated. Pharmacists' practice with regard to patient education, instruction, and demonstration of the correct usage of the MDI was observed and recorded. Overall, 13 percent of the pharmacists initially offered to educate the patient-investigator (PI) regarding the correct usage of the MDI without being asked for information. Fifty-three percent of pharmacists offered information only upon being asked specifically how to use the MDI. Of the pharmacists who offered to educate the PI, 71 percent discussed less than half of the eight steps correctly. Only 1 of the 52 pharmacists actually demonstrated MDI inhalation technique, and this in response to a request. No pharmacist asked the PI to perform the technique while he/she observed. No pharmacist offered information on delivery enhancement devices. Our results demonstrate that few pharmacists educate patients on the correct usage of an MDI, and that many pharmacists are not aware of the correct technique.
Objective: To determine any differences in career paths and career attributes of pharmacists who have completed a PGY1 community pharmacy residency program (CPRP) as compared to those that have not completed a PGY1 CPRP. Methods: A web-based survey evaluating various aspects of community pharmacists' careers was distributed to 274 CPRP graduates in addition to a random sample of 7,376 community pharmacists. The survey contained 32 questions evaluating various career attributes. Questions that assessed level of agreement were on a 6-point Likert-type Scale (1=strongly disagree; 6=strongly agree). Results: A total of 353 participants completed the survey, with 224 indicating that they had not completed a CPRP. Pharmacists who completed a CPRP responded that they spend significantly more time on patient care services, teaching, and research, and spend less time dispensing medications compared to those that have not completed a CPRP. Compared to those that did not complete a CPRP, CPRP graduates were less likely to agree that current level of workload negatively impacts job performance, motivation to work, job satisfaction, mental/emotional health, and physical health. Conclusion: Pharmacists completing a CPRP noted significant differences in their current employment and job responsibilities. Additional expansion and education regarding the importance of CPRPs should be considered. Type: Original Research
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