תוצאת חיפוש

Impact of Clinical Pharmacist on Drug Therapy in Medical Departments

Ariel Hamerman, Rimona Rotem, Naftali Meidan, Avi Porath

Pharmacy Services, Hospital Management and Medical Dept. F, Soroka University Medical Center, Beer Sheba

Several studies have documented the impact of clinical pharmacy services on patient care and drug costs in hospital wards. However most hospitals in Israel do not provide such services and until recently their benefits in local health care have not been demonstrated. We therefor determined whether the activity of a pharmacist in the medical department of a medical center leads to improved quality of drug utilization and reduced costs.

During the first 3 months of the clinical pharmacist's work all interventions and consultation were documented. The effect of these interventions on drug costs was calculated by the change in drug acquisition costs during the study period compared with those of preceding months, as well as in the other 5 medical departments of the hospital without clinical pharmacy services.

During the study period the pharmacist joined 44 clinical rounds in which he documented 40 consultations in response to physicians' requests for drug information and 42 interventions on his own initiative. The pharmacist's recommendations were accepted in 38 of the 42 cases (90%). In 10 cases the pharmacist's initiative in improving the quality of drug therapy led to an increase in drug acquisition costs. However, the overall drug costs during the study period decreased 12.6%. During the same period drug costs in the other medical departments decreased only 2.2%.

The results of this study conform with those of many other studies that show a beneficial impact of the clinical pharmacist on the quality of drug therapy and on drug costs. They indicate that the clinical pharmacist can play a crucial role in the medical department.

Proper use of Pressurized Hand-Held Inhalers in Patients with Chronic Airway Obstruction 

Shabtai Varsano, Ilana Jacoby, Mila Garenkin

Asthma Care and Education Unit, Dept. of Pulmonary Medicine, and Epidemiology Unit, Meir General Hospital, Sapir Medical Center, Kfar Saba; and Sackler School of Medicine, Tel Aviv University

Inhaling drugs via hand-held inhalers in recommended for those with chronic obstructive airway disease (COPD). Approximately 8%-9% of Israel's population use hand-held inhalers, many of them pressurized. Skill in using them and ability of chronic users to learn their proper use have not been assessed.

During 1993 and 1994 we studied 200 patients with bronchial asthma or COPD who regularly used a pressurized hand-held inhaler (PI), but were not trained to use it in our out-patient pulmonary clinic. Only a third were found to be skilled in its use. About half were completely unable to use it properly, and 17% used it in a suboptimal way. Remarkably, only 40% had been taught anything with regard to its use. About 75% of the suboptimal users significantly improved their skill in its use immediately after receiving a single individual teaching and corrective demonstration session. While 15% failed to learn the proper use of the PI, many of those who improved immediately after a single teaching session retained the learned skills for months.

We conclude that the physician who recommends the use of a PI is responsible for the patient's being taught its proper use in a demonstration session. Skill in its use should be reassessed periodically during the entire treatment period.

Influence of Warning Labels on Medicines and Physicians' Orders on Patient Behavior

Yehuda Limony, Pesah Shwarzman

Child Health Center of Kupat Holim Klalit, Kiryat Gat and Dept. of Family Medicine, Ben-Gurion University of the Negev, Beer Sheba

Compliance of 40 mothers with a warning label, "for external use," on a medicine package was checked in a survey in a primary care clinic for children. We also checked parents' attitudes to giving a medicine to their child when instructions given by the physician or by a friend contradicted the printed warning on the label. All mothers who were told that the medicine was recommended by their physicians accepted the recommendation without hesitation. Another group included 20 mothers who were told that the medicine was recommended by a friend. 9 of 20 mothers in this group refused to use the medicine. Talking with the nurse about the potential risk of medicine in general, some mothers, after second thought, refused to give the medicine to their child. At the end, 65% of recommendations made by a friend were rejected by mothers as compared to only 15% of the physicians' recommendations.

35 of 40 mothers (87%) understood the meaning of the warning label, but only 13 (32%) had noticed it at all. We conclude that patients may accept their physicians' recommendation to use a medicine despite a contradictory warning label much more readily than when it was recommended by a friend. Therefore, any intervention program intended to promote a more cautious use of medicines should include not only the explanations of the various warning labels but should also promote a change in the patient's behavior to a more active search for warning labels.

Viagra, the First Oral Treatment for Impotence

Y. Assouline-Dayan, Y. Levi, Y. Shoenfeld

Medical Dept B, Chaim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University

Impotence, a common problem especially among older men, can now be treated with Viagra, This oral pill, unlike previous approved treatments mostly involving local injections, does not directly cause penile erection, but increases response to sexual stimulation. It acts by enhancing the relaxant effects of nitric acid on smooth muscle, and thus increases blood flow to certain areas of the penis, leading to erection. It has been evaluated in many randomized trials and in all was more successful in inducing erection than placebos. The most common side-effects include headache, flushing and indigestion, but there have also been reports of fatalities.

We describe a 75-year-old man who had an acute myocardial infraction in the past and who had maturity-onset diabetes and hypertension. In the week prior to admission he had a cardiac scan following a few weeks of exacerbation of anginal pain for which he had been taking nitrites. He took a Viagra pill without prescription or medical advice and 2 hours later, during intercourse with his wife, developed audible respiratory distress and lost consciousness. His wife started cardiac massage but not mouth-to-mouth breathing. The emergency team found ventricular fibrillation and gave 5 electrical shocks and amines and atropine. He remained unconscious, but his pulse returned and he was hospitalized. He then had several generalized convulsions treated with IV valium. 20 minutes after admission there was asystole and all attempts at resuscitation failed.

Cardiovascular status must be considered prior to prescribing Viagra, and the associated risk evaluated.