Automated pharmacy databases and behavioral health care quality assurance

Randomized, double-blind, placebo-controlled trials suggest that medications can be efficacious in several psychiatric disorders. The effectiveness of medications as they are used in practice remains to be seen. Automated pharmacy data give evaluation researchers tools to examine the quality of care for people using psychotropic medications. Reasonably convincing data indicates that automated pharmacy records are valid measures of medication consumption. Evaluation research is needed in areas such as standard setting, risk adjustment, and the linking of pharmacy data to outcome measures.     

Occupational adaptation to computerized medical information systems

This paper explores the effects of computerized medical information systems on the occupational communities of health care professionals in hospitals. Interviews were conducted with informants from the pharmacy and nursing departments at two hospitals currently using medical information systems for communicating physicians' medication orders from the nursing station to the pharmacy. Results showed changes in tasks for both pharmacy and nursing, resulting in increased interdependence between the two departments. This interdependence was accompanied by improved communication and cooperation, providing an opportunity to encourage better working relationships between departments. The use and maintenance of the common computerized data base became a superordinate goal for the two groups, with the computer system itself as the topic of communication.     

Occupational Values,Role Orientations,and Work Settings: the Case of Pharmacy*

The theoretical model positing that the occupational institution of business is based on pecuniary and extrinsic values while professions are predicated on altruistic service values is tested using the case of pharmacy. Pharmacists with business-role orientations are compared with those favoring a professional-role stance in terms of their occupational values. Results contrary to the model were found. Pharmacists, regardless of role orientation, were similarly motivated by service and income values. When the work setting was taken into account, it was found that altruism predominated in the business settings, and prestige and income values were deemed less important as compared to the hospital/clinic setting. Revisions of the theoretical model are suggested.     

Experience with a drug screening program at a school of pharmacy

Abstract Substance use and abuse among pharmacy students is a concern of pharmacy schools, boards of pharmacy, and training sites alike. Pharmacy students must complete approximately 30% of their academic coursework in experiential settings such as community pharmacies, hospitals, and other health systems as part of any accredited pharmacy school's curriculum, and these training sites are starting to require drug testing of pharmacy students as part of their contractual agreements with schools of pharmacy. The authors describe the implementation of a mandatory random urine drug screening program at their school as well as the changes that occurred owing to assessment of the program. The authors report the basic results to date of the drug screening program. The authors also speculate on secondary benefits of the drug screening program. Finally, the authors describe current and future evaluations that they are undertaking regarding this program.     

Gender and Clinical Pharmacy: The Career of an Occupational Ideology*

Cet article étudie le concept selon lequel, dans une profession en mutation, la pharmacie en l'occurrence, les femmes sont les principales personnes à transmettre les valeurs liées à la pharmacie clinique - une idéologic professionnelle prétendument instaurée afin de redonner sa place à la pharmacie dans la hiérarchie des professions. Si on constate la force des convictions des membres de la profession à l'endroit de la pharmacie clinique, on observe également que les femmes ne sont pas les premières à les dèfendre. Ni la socialisation des rapports entre les sexes ni une formation particulière en pharmacie n'ont rendu les femmes mieux disposées que les hommes à l'egard de la pharmacie clinique. Les divergences - et elles sont très importantes - au sein de la profession au sujet de la pharmacie clinique se font sentir selon les différents cadres de travail des pharmaciens et selon l'année d'obtention de leur permis d'exercice. Ce sont plus les lieux de travail que les rapports entre les sexes qui permettent de prévoir les attitudes à l'égard de la pharmacie clinique. Il semble done peu probable que le fait d'équilibrer le nombre d'hommes et de femmes dans un milieu de travail soit de nature à le faire évoluer. Quelle que soit, au départ, la conception des pharmaciennes à l'égard de leur profession, elle influe peu sur leur rapport à la pharmacie clinique. This paper explores the idea that in a changing profession, women are the principal value carriers of clinical pharmacy—an occupational ideology professedly developed to restore pharmacy's precarious standing in the occupational hierarchy. While the investigation uncovers considerable evidence for the vitality of clinical pharmacy beliefs among practitioners, women were not at the forefront of this trend. Neither general gender socialization nor specific pharmacy training has rendered females more sympathetic to clinical pharmacy than males. Differences within the pharmacy community regarding clinical pharmacy—and they are quite considerable— emanate from the varied work settings that practitioners occupy and their year of licensure. Attitudes to clinical pharmacy are better predicted by workplace than by gender. On the basis of our findings, it seems unlikely that balancing the number of men and women in an occupation or work organization will, in and of itself, change it. Whatever distinctive prior orientations to work that female pharmacists may hold, they have little impact upon how they think about clinical pharmacy.     

Experience With a Drug Screening Program at a School of Pharmacy

Abstract

Substance use and abuse among pharmacy students is a concern of pharmacy schools, boards of pharmacy, and training sites alike. Pharmacy students must complete approximately 30% of their academic coursework in experiential settings such as community pharmacies, hospitals, and other health systems as part of any accredited pharmacy school's curriculum, and these training sites are starting to require drug testing of pharmacy students as part of their contractual agreements with schools of pharmacy. The authors describe the implementation of a mandatory random urine drug screening program at their school as well as the changes that occurred owing to assessment of the program. The authors report the basic results to date of the drug screening program. The authors also speculate on secondary benefits of the drug screening program. Finally, the authors describe current and future evaluations that they are undertaking regarding this program.     

The Psychiatric Medication History

Abstract

This article presents The Psychiatric Medication History: An Interview Schedule, a 30-step semi-structured protocol designed to help practitioners understand how clients manage their psychotropic medications and interpret their effects. The critical perspective leading to the design of this interview schedule, its purposes for clients and practitioners, its divergence from traditional treatment histories, and its uses and limitations are discussed. The author contends that, in a safe space, taking a psychiatric medication history according to these suggested guidelines offers clients an opportunity to construct an independent, evidence-tested personal narrative about their medication use. To practitioners, taking such a medication history offers a person-in-en-vironment point of entry into the psychopharmacology scene.     

Effects of wearing a pressure redistribution belt while lying in a hospital bed

Bedsores (ulcers) are caused by multiple factors which include, but are not limited to; pressure, shear force, friction, temperature, age and medication. Specialised support services, such as specialised mattresses, sheepskin coverings etc., are thought to decrease or relieve pressure, resulting in a lowering of pressure ulcer incidence [3]. The primary aim of this study was to compare the upper/central body pressure distribution between normal lying in a hospital bed versus the use of a pressure redistribution belt. The study involved 16 healthy voluntary subjects lying on a hospital bed with and without wearing the belt. Results showed that the use of a pressure redistribution belt results in reduced pressure peaks and prevents the pressure from increasing over time.     

Effect of immunomodulatory therapy and other factors on employment loss time in multiple sclerosis

The factors that influence time missed from work among individuals diagnosed with multiple sclerosis were the focus of this study. Records of individuals who were employed and diagnosed with multiple sclerosis between the years 1999 and 2002 (N=284) were examined for details pertaining to their medical claims. Multivariate regressions, controlling for demographic characteristics, type of immunomodulatory medication, and overall severity of illness, were used in the examination of the total number of days missed from work for any reason and those missed due to absenteeism, short-term disability, or worker's compensation. Results indicate that lost work time is affected by severity of illness, and type of immunomodulatory therapy. Comparing individuals treated with the specific immunomodulator glatiramer acetate, interferon beta-1a (intramuscular), or interferon beta-1b, to those who did not receive multiple sclerosis medications of this type; only glatiramer acetate was associated with significantly fewer days missed from work for short term disability (18.24 fewer days, P<0.03), worker's compensation (29.50 fewer days, P<0.04) or any reason (53.70 fewer days, P< 0.003).     

THE EFFECTIVENESS OF PSYCHOEDUCATIONAL FAMILY THERAPY IN THE TREATMENT OF SCHIZOPHRENIC DISORDERS

A review of the literature on family psychoeducational interventions in schizophrenic disorders revealed two generations of studies. The first generation compared the clinical efficacy of psychoeducational family treatments and medication to medication only or routine care. A second generation of studies used more complex experimental designs that often narrowed the differences between the experimental treatment and comparison conditions. The results of the first generation of studies are unequivocal in demonstrating the superiority of family intervention plus medication over medication alone in delaying psychotic relapses. The second-generation studies had more equivocal results; they suggest that the efficacy of family intervention as an adjunct to medication in schizophrenia is in part a function of the type and format of the intervention being delivered, the treatment setting, and other variables.     

Medication education: increasing patient compliance.

The medication education program described is based on group discussion and individual counseling in a partial hospital setting. It is one model for promoting medication compliance. The important issues are those presented by the patients themselves. Nurses can and must help patients understand the influences on patient decision-making processes and encourage them to make sense of the wealth of information regarding health care and medications now available to them as consumers. Nurses should also introduce patients to the successful methods invented and refined by others to manage medication difficulties. We can also support the patient in the lifelong processes of developing a clearer understanding of their relationships with health-care providers and of promoting sound health practices.     

The Development of Idealism in Pharmacy School

This article traces the transformation and development of idealism in a cohort of pharmacy students in a Canadian pharmacy school. The data show that a form of professional idealism which emphasizes a patient-oriented practice of pharmacy and reflects the profession's vision of the future role of the pharmacist emerges during the first year of study, wanes during the second year, is revitalized during the latter part of the third, and develops throughout the fourth, reaching its peak as students approach graduation. This unusual pattern is explained in terms of factors related to and arising from the attempt to reprofessionalize pharmacy.     

Potential for the Abuse of Medication for the Elderly in Residential and Nursing Homes in the UK

ABSTRACT

Abuse of the medication prescribed to the elderly living in long-stay care homes may be perpetrated by a minority of unscrupulous doctors, pharmacists, or home staff caring for the residents. Disorganised practices and homes, poor communications, and sloppy professional practices may create opportunities for over-dosing, errors, fraud, or theft. This article describes the circumstances leading to the potential abuse of elderly residents' medication, and the measures that may be taken to avoid or minimise such abuse from occurring.     

Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?     

Do you feel powerless when a patient refuses medication?

1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication. 2. Overall, nurses were more apt to identify with indirect indicators than they were to identify words that address the concept directly (control and powerlessness). 3. The most common hazard identified in a medication refusal event was the potential for injury, and the individuals most at risk were the nurse giving the medication and other personnel on the unit. 4. The most prominent nursing response to medication refusal was counseling. Nearly all the nurse subjects believed that the medication refusal event negatively influenced nursing care, the patient/nurse interaction, and patient teaching.