A study of pharmacist intervention in patient care at institutional and community pharmacies [abstract]

The objectives of the study are: (1) To demonstrate the various types of pharmacist therapuetic interventions encountered in institutional and community pharmacies in Trinidad. (2) To identify the prevalent drug-related problems in therapeutic interventions. (3) To investigate the use of a more detailed form to document intervention in the provision of pharmaceutical care. The study used a detailed form to record the therapeutic interventions. It was conducted over a three-month period. The collected data were transcribed to a Patient Care Intervention (PCI) form with relevant categories for drug-related problems. It was analyzed and presented as frequencies on graphs and tables. From a total of 289 interventions, 174 interventions were collected from an institutional pharmacy and 115 from community pharmacies. Nineteen percent of the interventions were due to unclear instructions or no instructions to the patients, of which 92 percent were from the community pharmacies; 17 percent accounted for dosing problems where excessive was 9 percent and sub-therapeutic 8 percent; 6.9 percent were due to wrong choice of drug or dosage form. Others accounted for 55 percent of the interventions of which 92 percent were due to out-of-stock medications. The study showed that there is a variety of significant drug-related problems on prescribing. It highlighted the need for pharmacist intervention, thorough documentation of the interventions, effective pharmacist-physician communication and improved inventory management in order to achieve positive outcomes of patient medication therapy. Due to the limitations of the study, it is recommended that a further study should be done and it should include the pharmacoeconomic aspect of the interventions. (AU)

The prescribing patterns of doctors in the Kingston Metropolitan region of Jamaica

Rising inflation and the instability of the Jamaican dollar have impacted negatively on the health care of the Jamaican people. Prescription drugs constitute a major component of this health care expenditure. The Generic Act was introduced to promote the dispensing of generic drugs as affordable alternatives to brand-name drugs and seminars targeted doctors to practise rational prescribing of drugs. This study examined the current prescribing patterns of medical doctors with special regard to drug cost and generic prescribing. Six pharmacies were randomly selected from a list from the Pharmaceutical Association of Jamaica, stratified according to three locations. A total of 1020 prescriptions were analyzed for number of items, generics, antibiotics, analgesics, antihypertensives, antidiabetics and whether generic substituiton or repeat was allowed. A self administered questionnaire was also delivered to 170 physicians practising in the Kingston Metropolitan Region who were chosen randomly from a list supplied by the Medical Association of Jamamica. The questionnaire elicited information on demographic charcteristics, factors influencing prescribing decision, prescribing paractice and attitude to generic law and generic prescribing, knowledge of 10 commonly used drugs and sources of information on drug costs. Analysis of prescriptions showed the mean number of drugs prescribed was 1.2 per patient, antibiotics accounted for 30.9 percent of the components of prescriptions, 0.5 percent had substitution and 6 percent were repeat prescriptions. The percentage of drugs prescribed by generic name was 22.1 accounting for 34 per cent of prescriptions. There was no significant difference found by location of pharmacies (chi-squared+2.86, d.f=2, p=0.24). Doctors indicated that drug cost was the third most influential factor determining their prescribing decisions. There were no significant difference found in the prescribing of generics between public and private doctors (chi-squared=2.42, d.f.=2, p>0.05). Most were ignorant about the Generic law as well as the estimated costs of drugs. The respondents agreed that generics were clinically equivalent and more affordable than brand-name drugs. This survey reaffirms the importance of continued medical education being made available and accessible to doctors on relevant health care issues so as to provide better service through more cost effective means. (AU)