Shifts in expectations: evaluating physicians' perceptions as pharmacists become integrated into family practice.

The objective of this study was to measure how primary care family physicians perceived their own and pharmacists' contributions to medication processes as pharmacists become integrated into primary care group family practices. The 22- item Family Medicine Medication Use Processes Matrix was mailed to physicians in seven sites at the 3rd, 12th and 19th month of pharmacist integration. Paired sample t-tests for the third month results were conducted to compare perceptions between pharmacist and physician contributions. One way repeated measure ANOVA test was conducted to determine significant changes over time. Physicians initially perceived their own contributions to be significantly higher than pharmacists in three subscales: Diagnosis & Prescribing, Monitoring and Administration/Documentation and their own contributions to be significantly lower than the pharmacists in the Education subscale. Over time, physicians perceived increases in the pharmacists' contribution to the Diagnosis & Prescribing, Monitoring and Medication Review subscales and decreases in their own contribution to the Diagnosis & Prescribing and Education subscales. Changes in family physicians' perceptions of pharmacists' contribution demonstrate an initial underestimate of pharmacists' role in primary care family practice and a gradual recognition of expertise and competence. This may have led to increased comfort in sharing aspects of contribution to medication use processes.

Influenza outbreak in a long-term-care facility: considerations for pharmacy.

The role played by a hospital pharmacy department in managing an influenza outbreak at an affiliated long-term-care facility is described. In February 1998 an outbreak of influenza A was confirmed in a 570-bed long-term-care facility. During the outbreak, a total of 48 cases of influenza-like illness (ILI) were reported to infection control, and 62 staff members missed work because of ILI. Infection control measures included a recommendation for prophylaxis with amantadine. Pharmacists assumed responsibility for educating patients and families about amantadine prophylaxis, providing individualized dosing, evaluating reported adverse effects, and drug distribution. Pharmacists developed an information sheet on amantadine for patients and met with patients and their families. The overall acceptance rate for chemoprophylaxis was 91%. Of the 349 patients receiving amantadine during the outbreak, 203 (58%) were given 100 mg daily, 136 (39%) were given 100 mg every other day, and 10 (3%) were prescribed 100 mg weekly. Pharmacists confirmed a total of 22 adverse effects; generally the problem was solved by reducing the dosage rather than discontinuing the drug. In all cases, the first dose of amantadine was provided to the nursing units within three hours of an order being written. Pharmacists played an active role in managing an influenza A outbreak at a long-term-care facility.

Critical analysis of the pharmaceutical care research literature.

OBJECTIVE: To describe and evaluate published pharmaceutical care research and make recommendations to improve the quality of the literature. DATA SOURCES: MEDLINE and International Pharmaceutical Abstracts using the key word "pharmaceutical care," limited to research articles published January 1988-December 1996. STUDY SELECTION: Articles that evaluated the provision of pharmaceutical care in a defined population. DATA EXTRACTION: Citations (title and abstract) identified were reviewed. Articles potentially meeting the inclusion criteria were screened and scored according to the Pharmaceutical Care Research Checklist for the presence of criteria including pharmaceutical care process, methodology, and measures/outcomes. RESULTS: A total of 979 citations were identified. Of 57 abstracts identified as potentially meeting the inclusion criteria, 43 articles were eliminated, 2 were rejected, and 12 were accepted for analysis. Deficiencies identified included: a lack of research in community practice (n = 2), randomized controlled trials (n = 3), workload measurement (n = 6), and patient satisfaction (n = 1). Scoring according to the Pharmaceutical Care Research Checklist also identified the following deficiencies (maximum Composite Criterion Score [CCS] of 24): description of population sample (CCS 17), dropouts (CCS 13), informed consent (CCS 8), pharmacist training/qualifications (CCS 9), instrument validity (CCS 10), structure criteria (CCS 4), patient outcomes (CCS 11), and economic outcomes (CCS 12). The mean total checklist score was 37 of 50 (range 31-46). CONCLUSIONS: Few research studies have evaluated the provision of pharmaceutical care in a defined population. Deficiencies identified by low CCSs demonstrated the need for quality research design and a clear description of the pharmaceutical care process to evaluate the impact of pharmaceutical care. Recommendations for improvement in research design were made.