Implementing California Senate Bill 493 in an Outpatient Pharmacy Within an Integrated Health System: Evaluation of the Operational and Clinical Effect of Pharmacist-Ordered Laboratory Tests.

BACKGROUND: Under California Senate Bill 493, pharmacists can order patient laboratory tests (labs). Currently, it is unknown if this service affects patient outcomes or pharmacy operations. Does lab ordering by pharmacists improve access to care, improve quality outcomes, and/or affect pharmacy operational functions? PROGRAM DESCRIPTION: A 13-month pilot study was conducted at 2 Kaiser Permanente (KP) outpatient pharmacies where pharmacists provided extended adherence consultations and ordered hemoglobin A1c (HbA1c) labs for patients nonadherent to their oral diabetic medications with an HbA1c ≥ 8% or missing annual labs. Clinical outcomes of the pilot study were compared with a similar patient population at KP who concurrently received lab orders from their primary providers, defined here as the "usual care model." OBSERVATION: Of the 793 HbA1c lab orders, 87 (11.0%) were generated by a pharmacist, and 706 (89.0%) were generated by the usual care group. Forty-three (49.4%) patients in the pharmacist group completed their labs compared with 279 (39.5%) patients in the usual care group (P = 0.10). A significantly greater proportion of patients in the pharmacist group achieved an HbA1c < 8% within the follow-up period of 30-180 days (34.9%), compared with the usual care group (12.2%, P < 0.01). Of the patients who completed labs during the evaluation period, 38 (43.7%) patients in the pharmacist group and 111 (15.7%) patients in the usual care group had prelaboratory values ≥ 8% within the previous 12 months. The average pre-HbA1c value was 9.47% in the pharmacist group, and the average post-HbA1c value was 8.68% (P < 0.01). For the usual care group, the average pre-HbA1c value was 9.70%, and the average post-HbA1c value was 9.43% (P = 0.06). When comparing the difference in HbA1c reduction between the 2 groups, there was a larger decrease in HbA1c in the pharmacist group, but this difference was not significantly different (P = 0.06). The pilot study added an average of 5 minutes per patient encounter to the pharmacy workflow but did not affect overall patient wait times for receiving outpatient prescriptions. IMPLICATIONS: Laboratory ordering by pharmacists in the outpatient setting improved access to care, improved quality outcomes, and did not adversely affect pharmacy operations. DISCLOSURES: No outside funding supported this project. The authors have nothing to disclose.

Getting Paid for Clinical Services.

Increasingly, pharmacists are providing advanced, patient-centered clinical services. However, pharmacists are not currently included in key sections of the Social Security Act, which determines eligibility to bill and be reimbursed by Medicare. Many state and private health plans also cite the omission from Medicare as the rationale for excluding reimbursement of pharmacists for clinical services. This has prompted forward-thinking pharmacists to seek opportunities for reimbursement in other ways, allowing them to provide value to the health care system, while carving out unique niches for pharmacists to care for patients.

Antibiotic Stewardship: New Frontier, Familiar Journey.

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Prescrição farmacêutica homeopática

O objetivo dessa monografia é abordar os aspectos da resolução 586 de 29 de agosto de 2013, assim como ampliar as discussões principalmente no que diz respeito à prescrição farmacêutica de medicamento homeopáticos, e em quais situações o farmacêutico poderá prescrever medicamentos homeopáticos. (AU)

Los complementos alimenticios y la salud. Papel del farmacéutico en la utilización de plantas / Food supplements and health pharmacist role in the use of plants

Los suplementos dietéticos juegan un papel cada vez más importante en la alimentación. Cuando los complementos alimenticios contienen plantas conocidas por sus propiedades medicinales, se hace a menudo una interpretación de los efectos beneficiosos de las referencias de la Fitoterapia. La Fitoterapia, considerada por la población como útil en la prevención y el tratamiento de las enfermedades sigue despertando el interés que la caracteriza desde la antigüedad. Existen plantas alimentarias, utilizadas en la cocina, que al mismo tiempo pueden tener propiedades medicinales, dependiendo tanto del tipo de uso como de la cantidad ingerida. Al analizar caso por caso descubrimos que, en pleno siglo XXI, nuestro conocimiento sobre los beneficios de la utilización de plantas en la alimentación son limitados, por lo que es importante estimular los esfuerzos internacionales de investigación así como las actividades de las agencias reguladoras. En este artículo se analizan las directrices más recientes publicadas por la Agencia Europea de Seguridad Alimentaria (EFSA) sobre las alegaciones de salud relacionadas con el uso de plantas en alimentación, así como el marco internacional, con un breve resumen de las normas aplicadas por la Food & Drug Administration (FDA) y la Administración de Productos Terapéuticos (Therapeutic Goods Administration, TGA (AU)

The dietary supplements play an increasingly important role in feeding. In this context, the medicinal use of plants for the treatment and prevention of diseases is common among ordinary people. Perceived by a common citizen as useful both in the prophylaxis and for the treatment of diseases, the Phytotherapy continues to drive the interest which has always characterized the field since ancient times. There are plants known as nutrients, or used in culinary, and which may exhibit medicinal properties simultaneously, a matter that depends not only in the type of use but also in the ingested quantities. When we go case by case, we find, in the XXI century, that our knowledge about the benefits of the use of plants in foods, after all, is limited, so it is important to stimulate the international efforts in research as well the regulatory agencies activities. In this paper we analyze the most recent guidelines published by the European Food Safety Authority (EFSA) on health claims related to the use of plants in food, and also the international framework, with a brief summary of the rules applied by the Food & Drug Administration (FDA) and the Therapeutic Goods Administration (TGA) (AU)

Os suplementos alimentares desempenham um papel cada vez mais importante na alimentação. Quando os suplementos alimentares contêm plantas conhecidas pelas suas propriedades medicinais, faz-se, muitas vezes, a interpretação dos efeitos benéficos do suplemento utilizando referenciais da Fitoterapia. A Fitoterapia, entendida pelo cidadão comum como útil na prevenção e no tratamento de doenças, continua a suscitar o interesse que a caracteriza desde a antiguidade. Existem plantas que são nutrientes, ou são utilizadas em culinária, e podem simultaneamente ter propriedades medicinais, dependendo não só do tipo de utilização como das quantidades ingeridas. Ao analisarmos caso a caso, descobrimos, em pleno século XXI, que o que sabemos ainda é pouco, afinal, relativamente à classificação do benefício das plantas na alimentação, pelo que é importante acompanharmos os esforços internacionais da investigação e das agências reguladoras. Neste estudo analisam-se as orientações mais recentes sobre alegações de saúde relacionadas com plantas, em suplementos alimentares, da Agência de Segurança Alimentar Europeia (EFSA), situando-as relativamente ao contexto internacional, em relação às regras da Food & Drug Administration (FDA), e da Therapeutic Goods Administration (TGA ) (AU)

[Protomedicato and pharmacy in Castile at the end of the sixteenth century: "Catálogo de las Cosas que los Boticarios han de tener en sus Boticas" (Catalogue of the things that apothecaries must have in their shops), by Andrés Zamudio de Alfaro, Protomédico General (1592-1599)]. / Protomedicato y farmacia en Castilla a finales del siglo XVI: edición crítica del "Catálogo de las Cosas que los Boticarios han de tener en sus Boticas," de Andrés Zamudio de Alfaro, Protomédico General (1592-1599).

In this article we present a catalogue of medicinal products preserved in a manuscript copy among the papers of a druggist who died in Madrid in 1599. This catalogue, whose title expresses its normative character, contains 423 entries and is signed by Andrés Zamudio de Alfaro, Protomédico General of Castile from 1592 until his death in 1599. It was presumably issued by the Real Tribunal del Protomedicato during the last decade of the sixteenth century for the use of the protomédicos and examiners who carried out official visits to apothecaries under the aegis of the Tribunal, in accordance with the royal decrees of 1588 and 1593, and was also distributed among the apothecaries themselves and their suppliers, such as the druggist who possessed the copy edited here. The document offers valuable evidence of the policy of normalization of medical, and specifically pharmaceutical, practice imposed during this period by the State through the Protomedicato.

Medical marijuana and the developing role of the pharmacist.

PURPOSE: The pharmacology, therapeutic uses, safety, drug-drug interactions, and drug-disease interactions of medical marijuana are reviewed, and the legal issues related to its use and the implications of medical marijuana for the pharmacist are presented. SUMMARY: Marijuana contains more than 460 active chemicals and over 60 unique cannabinoids. The legal landscape surrounding marijuana is surprisingly complex and unsettled. In the United States, 11 states and several municipalities have legalized medical marijuana. Another state provides legislation that allows patients to claim a defense of medical necessity. Nevertheless, patients using medical marijuana may never interact with a pharmacist. Marijuana is a Schedule I controlled substance and its use is illegal under federal law. Marijuana has a number of purported therapeutic uses with a broad range of supporting evidence. There are five general indications for medical marijuana: (1) severe nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, including HIV infection and cancer, (3) spasticity secondary to neurologic diseases, such as multiple sclerosis, (4) pain syndromes, and (5) other uses, such as for glaucoma. Marijuana is associated with adverse psychiatric, cardiovascular, respiratory, and immunologic events. Moreover, marijuana may interact with a number of prescription drugs and concomitant disease states. CONCLUSION: Several states have legalized the use of marijuana for chronic and debilitating medication conditions. Pharmacists need to understand the complex legal framework surrounding this issue so that they can protect themselves and better serve their patients.

Factors related with prescription requirement to dispense in Spain.

PURPOSE: To identify factors associated with prescription requirement to dispense. METHODS: We carried out a cross-sectional study on a sample of 166 pharmacists in North-West Spain. The following independent variables were collected through a personal interview: pharmacist's education and speciality, characteristics of the pharmacy, and its socio-economic environment. We constructed multiple regression models using as dependent variables: requirement of prescription to dispense five drugs which have to be dispensed with a prescription; and opinion on whether a prescription should be required to dispense these drugs. RESULTS: The response rate was 98.8%. A proportion of 65.9% of pharmacists dispense antibiotics without any prescription. This proportion is 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for ACE inhibitors, 13.4% for benzodiazepines and 84.8% for oral contraceptives. A higher requirement prescription was found to be associated with the antecedent of a speciality training of the pharmacist (p = 0.028) and his or her age (p < 0.001). A low prescription requirement is associated with the condition of being owner of the pharmacy (p = 0.032), with a high economic level of the population attended (p = 0.016) and with the size of the pharmacy (p = 0.045). CONCLUSIONS: The proportion of pharmacists who dispense drugs without a prescription is extremely high. Our results suggest that in order to increase quality of dispensing, it is necessary to increase pharmacist education and direct efforts of awareness primarily at pharmacists in charge, who are young and work in large pharmacies.

Lessons from Korea's pharmaceutical policy reform: the separation of medical institutions and pharmacies for outpatient care.

In Korea, until recently, both physicians and pharmacists were allowed to prescribe and dispense drugs for outpatient care. Along with other deep-rooted structural problems, this worked against the quality and efficiency of the health care system. To rectify this problem, the Korean government launched a drug policy reform in July 2000. However, the drug policy reform was more drastic than initially intended--driven by political factors, the reform ended up bringing about complete separation of medical institutions and pharmacies. Also, unlike in many other countries, Korea did not take a gradual approach, but instead, it implemented the reform all at once and nation-wide. As a result, the reform has faced criticism and protests, thereby generating unprecedented social turmoil and even strikes by physicians. Still, it is not clear what benefits Korea gained from this reform, when we look at the price which has had to be paid, including greater inconvenience, worsened access to medical care, increased drug spending, increased market share for multinational drug producers, and a greater deficit in the budget of the Korea's national health insurance system. Based on Korea's costly experience, we attempt to draw some policy implications for the future development of a better health care system.