Clinical research: national survey of U.S. pharmacy-based investigational drug services--1997.

The results of a survey on the status of pharmacy-based investigational drug services and ways in which some institutions have adapted to recent changes that may affect research are presented. A 99-item survey on investigational drug services was sent in February 1997 to pharmacy directors at 1495 hospitals affiliated with teaching institutions throughout the United States. The survey covered workload, inpatient and outpatient pharmaceutical services, marketing of services, quality assurance, committee involvement, funding sources, computerization, and educational activities. The response rate was 21%; 68% of the respondents were from sites involved in dispensing drugs used for clinical research, with pharmacies at larger hospitals being more likely to dispense investigational drugs than pharmacies at smaller hospitals. The pharmacies participated in a mean 51 active protocols for every full-time-equivalent employee budgeted to research protocols. The correlation between staffing level and number of protocols was high. The service provided most often was the maintenance of drug accountability records for study drugs dispensed to inpatients and outpatients. There was wide variation in the types of services provided to researchers by the pharmacies. Basic services, such as dispensing and inventory control, were provided by nearly all the pharmacies, whereas more-specialized services tended to be provided more often at institutions more heavily committed to research. Pharmacy-based investigational drug services at hospitals affiliated with teaching institutions offered basic services, such as dispensing and inventory control, almost universally and offered specialized services to varying degrees.

The impact of advertising on price and practice volume. A case study of dental markets.

Advertising is often considered a catalyst which stimulates competition by communicating the important attributes (information) of goods and services to consumers. Theoretically, advertising makes demand responsive to strategic price differences. This advertisement-induced price elasticity puts competitive pressure on the providers' pricing strategy. It has been assumed that this effect also exists in the health care market. This study investigates the impact that the advertising of services has on the price and demand behaviour in the dental care market. The sampling frame includes 1,326 dentists, 558 (44.3%) of whom have advertised their services. The statistical results seem to dispute the claim that advertising lowers the consumer's price and increases the advertising dentist's market share.

Determinants of hospital bad debt: multivariate statistical analysis.

Although the issue of uncompensated care (bad debt plus charity care) has been actively debated in the public arena, there has been little discussion of the bad debt issue alone. This issue is important since issues of bad debt, charity care and uncompensated care are significantly different from each other. Based on 1992 State of Missouri data, the results of our study indicate that more efficient hospitals (measured by occupancy rate), hospitals with more patients covered by prospective payment systems (measured by Medicare discharges), and for-profit hospitals incurred significantly less bad debt cost than other hospitals. However, the difference in bad debt between for-profit hospitals and not-for-profit hospitals is dissipated when using a multivariate statistical model. In addition, this study also reveals that hospitals which provide more charity care have the lowest bad debt costs. Policy implications are also discussed.

Health status of Asian Pacific Americans in Missouri.

The dramatic increase in Asian Pacific Americans has created a different set of social, economic and health issues for the country as well as for this state. Asian Pacific Americans are extremely heterogeneous and bipolar in socioeconomic status and health issues. Asian Pacific Islander Americans come from over 43 countries and speak over 100 languages and dialects. This study reveals that in this state, 23% of Asian Pacific American households are linguistically isolated. Almost 20% of Asian Pacific American families (married couples with children under 5 years old) have an income below the poverty line. The need for severe mental health service is four times higher for southeast Asian refugees than the overall population. The death rates from communicable disease and suicide are lowest for Asian Pacific Americans, and for Asian Pacific Americans, the age-adjusted death rates are widely different. For example, people with Hawaiian background appear to have a high incidence of death from heart disease (363.3 per 100,000) whereas Chinese experienced a higher incidence of death from cancer (70.2 per 100,000). The Asian Pacific Americans have the lowest infant mortality rate. This paper suggests that providers, educators and legislators should pay more attention to Asian Pacific American communities regarding socioeconomic and health care needs to create a healthy and productive community.

SSM Data Center: a tool in the healthcare apostolate.

In 1967 the Sisters of St. Mary established the SSM Data Center to support the mission of the healthcare system by providing computer tools for all areas involved in the care of the sick and injured. To accomplish this, the data processing function was organizationally structured to report to the highest decision-making body of the healthcare system. This has encouraged every unit in the healthcare system to actively participate in the development and use of the computer system. The key to the system is a distributed network, which includes a host computer interconnected with microcomputers and minicomputers at each institution within the healthcare system. The center provides services designed around the uppermost administrative level acting as the nucleus but flexible enough to be tailored to each hospital's specific needs. This encourages the sharing of ideas among organizations but allows each hospital to maintain its unique identity and culture. The data center also provides a Resource Center to help in the use of personal computers and a data processing account representative in each hospital who acts as a liaison with the data center.

Should health care managers adopt Theory Z?

Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

CBC and differential in VLBW infants.

PURPOSE: This study tested the adequacy of established leukocyte indices in infants < or = 1,200 gm birth weight and < or = 32 weeks gestation. DESIGN: Charts of all admissions to the NICU from March 1991 through September 1994 were retrospectively reviewed. SAMPLE: All infants (n = 131) were outborn and admitted to the NICU within 24 hours after birth. MAIN OUTCOME VARIABLE: The leukocyte indices obtained during the first 72 hours after birth were plotted as a function of time in hours. RESULTS: Mode of delivery significantly affected total leukocyte count and absolute neutrophil count; sex and use of prenatal steroids did not. Ranges for total leukocyte count, absolute neutrophil count, and immature/total neutrophil (I:T) ratio demonstrate that normal values are variable and change over time. PRACTICE RECOMMENDATIONS: The wide distribution of values found, coupled with differences noted by mode of delivery, make normative data difficult to apply. The clinician must question the appropriateness of routinely obtaining a complete blood count and the clinical utility of the results.

Factors influencing referral decisions in physiatry.

As the population ages and more emphasis is placed on patient management than on curative exercise, physical medicine gains an important place in medical specialties. This study investigates the referral behavior in physiatry and compares it with referrals to other specialties. From a sample of 159 primary care physicians in the St. Louis metropolitan area who have a high probability of using physical medicine and rehabilitation, a referral model in physiatry was constructed. The results indicate that while the traditional determinants of referral decision play a significant role in influencing the referral behavior in physiatry, there also is a group of variables in physiatry that are significantly different from those of other subspecialties in determining referral process.

Shared hospital services: study report.

The study of shared hospital services reported in this article was conducted to determine the magnitude of shared administrative and clinical programs, what institutions participate, and most frequently shared services. To ensure that hospitals with different characteristics and in various areas were represented, the investigators mailed questionnaires to 1,731 of the nation's 5,987 short-term, acute care general hospitals in nine census regions. Responses indicated the following trends: Not-for-profit hospitals outrank other types of hospitals in using shared services. About 90 percent of hospitals with 200 to 499 beds shared services. For almost all categories of services, a percentage increase occurred in the number of hospitals participating in shared programs. The three most shared services were purchasing, data processing, and insurance programs. Hospitals shared more administrative than clinical services. According to administrators' responses, cost containment was the most common reason for sharing services. As the pressures to control health care costs increase, the investigators predict that hospitals will share more clinical services. Shared services decrease unit cost, however, only when providers have an excess capacity.

Do Foreign Medical Graduates (FMGs) Have Different Attitudes Toward Health Care Management?

A sample study of 216 physicians in the St. Louis Metropolitan area reveals a statistically significant difference in dealing with important issues in patient management between Foreign Medical and U.S. Medical graduates. Using the prospective payment systems (PPS) as a test case, this study shows that attitude toward patient management is significantly different in three controversial areas: consumer benefit, inclusion of physician's fee into the PPS, and quality of care. This study raises important questions in health care policy.

Causes of financial difficulty in Catholic hospitals.

A study was conducted to see which attributes contribute most to financial distress in Catholic hospitals. The 1982 total population of U.S. Catholic hospitals was examined. The reason for financial distress was found to be more related to management attributes than to financial variables.

Computerized medication administration records decrease medication occurrences.

Studies have demonstrated that medication errors occur at a number of locations in the continuum between ordering of drug therapy and administration of the medication. Computer management of patient medication profiles offers the opportunity to enhance communication between pharmacists and nurses, and to decrease medication errors and delays in delivery of therapy. A number of authors have postulated that computerization of medication profiles would enhance medication delivery accuracy and timeliness, but no study has demonstrated this improvement. We report the results of a retrospective analysis undertaken to assess the improvements resulting from sharing a computerized medication record. We used a broader definition of medication occurrences that includes the more traditional definition, and averted errors, delays in delivery of medications and information, and disagreements between pharmacy and nursing medication profiles. We compared medication occurrences reported through an existing internal system between two periods; the first when separate pharmacy and nursing medication records were used, and the second period when a shared medication record was used by pharmacy and nursing. Average medication occurrences per admission decreased from 0.1084 to 0.0658 (p < 0.01). Medication occurrences per dose decreased from 0.0005 to 0.0003 (p < 0.01). The use of a shared medication record by pharmacy and nursing led to a statistically significant decrease in medication occurrences. Information shared between the two professions allowed timely resolution of discrepancies in medication orders, leading to better execution of drug therapy, decreased medication occurrences, and increased efficiency.