The evolution and assessment of pharmaceutical care: Structure, processes, and outcomes

The evolution of pharmaceutical care is identified through a complete review of the literature published in the American Journal of Health-System Pharmacy, the sole comprehensive publication of institutional pharmacy practice. The evolution is categorized according to characteristics of structure (organizational structure, the role of the pharmacist), process (drug delivery systems, formulary management, acquiring drug products, methods to impact drug therapy decisions), and outcomes (cost of drug delivery, cost of drug acquisition and use, improved safety, improved health outcomes) recorded from the 1950s through the 1990s. While significant progress has been made in implementing basic drug distribution systems, levels of pharmacy involvement with direct patient care is still limited.^ A new practice framework suggests enhanced direct patient care involvement through increase in the efficiency and effectiveness of traditional pharmacy services. Recommendations advance internal and external organizational structure relationships that position pharmacists to fully use their unique skills and knowledge to impact drug therapy decisions and outcomes. Specific strategies facilitate expansion of the breadth and scope of each process component in order to expand the depth of integration of pharmacy and pharmaceutical care within the broad healthcare environment. Economic evaluation methods formally evaluate the impact of both operational and clinical interventions.^ Outcome measurements include specific recommendations and methods to increase efficiency of drug acquisition, emphasizing pharmacists' roles that impact physician prescribing decisions. Effectiveness measures include those that improve safety of drug distribution systems, decrease the potential of adverse drug therapy events, and demonstrate that pharmaceutical care can significantly contribute to improvement in overall health status.^ The implementation of the new framework is modeled on a case study at the M.D. Anderson Cancer Center. The implementation of several new drug distribution methods facilitated the redeployment of personnel from distributive functions to direct patient care activities with significant personnel and drug cost reduction. A cost-benefit analysis illustrates that framework process enhancements produced a benefit-to-cost ratio of 7.9. In addition, measures of effectiveness demonstrated significant levels of safety and enhanced drug therapy outcomes. ^

Las sociologías del tiempo y las Tecnologías Avanzadas al servicio de la comunicación de los Pacientes UCI. Diseño, desarrollo y validación de un Sistema Interactivo de Comunicación para el entorno hospitalario

Introducción: El ingreso en UCI dificulta significativamente la interrelación familia-paciente. El aislamiento del paciente tiene repercusiones para todo su entorno e influye también en la relación con el personal sanitario. El aumento de la ansiedad dentro de la estructura UCI genera en este microsistema social una situación compleja en la que el equipo sanitario, el paciente y su familia deben manejarse. Se ha producido una reflexión significativa en relación con las políticas de gestión UCI-paciente-familia que ha permitido sugerir cambios de enfoque en la organización hospitalaria de los cuidados intensivos. Sin embargo, no se ha conseguido definir el modo en que la implementación de esos cambios puede articularse y se alerta recurrentemente sobre la ausencia de soluciones prácticas que ayuden a impulsar su introducción. Material y métodos: El proyecto MELIADE parte del análisis sociosistémico de este contexto mediante la aplicación de las metodologías de investigación de la Teoría Fundamentada y profundiza en el estudio de las variables que afectan a este complejo proceso relacional para comprender el porqué de la dificultad de introducir los cambios propuestos hasta el momento por los teóricos e identificar alternativas que los promuevan limitando el conflicto interno. Resultados: Como resultado, se sugieren nuevas alternativas basadas en las tecnologías avanzadas de la comunicación que permitan mejorar la percepción de la calidad asistencial para, superando las actuales dificultades, contribuir a rebajar la tensión de este entorno. El sistema MELIADE de comunicación familia-paciente cuenta ya con su primera versión software y sus características se presentan en este artículo.

Miscellaneous selected Sessional paper reports(dated 1896-1909), some issued in C (Series) and: Cd. (Great Britain. Parliament)

Includes volumes published by both houses of Parliament.

Reducing the incidence of inappropriate drug therapy and drug costs in long-term care facilities /

Research conducted in cooperation with the University of Illinois at Chicago, Dept. of Pharmacy Practice.

Linking contracts, processes and services: An event-driven approach

This paper addresses the problem of mapping business contract conditions onto the messages and rules that represent service interactions in a collaborative business process. We describe why this mapping is not straightforward by means of an example. We then consider a message-driven process language as a target for the mapping and use this mapping solution to discuss broad range of problems related to the mapping problem.

Ethical issues about shared medical records

Focal points: Patient views on pharmacists' access to medical records was studied using a self-completion questionnaire in medical practice and two community pharmacies There was some support for pharmacist access to records with a third of the sample being unsure There was a majority support when the purpose was clearly pharmacy related A clear majority was confident of confidentiality in the pharmacy

Training and development needs of PCT strategic level pharmacists

Poster session - The aim of the study was to produce an analysis of the perceived training and professional development needs of strategic level pharmacists in primary care trusts - A survey was carried out in five areas in England of the training needs of PCT strategic level pharmacists on behalf of a West Midlands Workforce Confederation - The results show an increasing recognition by PCT pharmacists of the importance of business and management training - Several key topics of direct relevance to current heath policy were not highly rated by respondents - This study identified gaps in current training provision