To evaluate the community pharmacist’s capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program.
Randomized, controlled study.
Private pharmacy caring for a semiliterate, rural Portuguese population.
Random sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months. Patients were randomly assigned to an intervention (n = 50) or a control (n = 50) group.
Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure; assess adherence to treatment; prevent, detect, and resolve drug-related problems (DRPs); and encourage nonpharmacologic measures for blood pressure control. Control patients received traditional care.
Control of blood pressure; decreases in systolic/diastolic blood pressure; number of detected, resolved, and prevented DRPs.
From the initial sample of 100 patients, 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study. After 6 months, prevalence of uncontrolled blood pressure decreased by 77.4% in the intervention group (P < .0001) and by 10.3% in the control group (P = .48). Systolic blood pressure fell from a mean – standard deviation of 152 mm Hg – 23 mm Hg to 129 – 15 mm Hg in intervention patients and 148 – 16 mm Hg to 143 – 20 mm Hg in control patients (P < .001). Twentyfour of 29 (83%) detected actual DRPs were resolved. About 40% of potential DRPs were prevented.
In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients.
To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City.
Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001.
Brooklyn and Queens, New York City.
IDUs.
Attemptsto purchase syringes from pharmacies and success in doing so.
Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%.
The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.
To document changes in pharmacists’ opinions and practices from the time of passage to implementation of a law permitting selling syringes without a prescription (the Expanded Syringe Access Demonstration Program [ESAP]).
Two cross-sectional randomized telephone surveys.
High-risk neighborhoods of New York City.
Pharmacists.
Support for selling syringes without a prescription to injection drug users (IDUs).
We completed 130 surveys at baseline (BL) in August 2000, from neighborhoods with high numbers of injection-related acquired immunodeficiency syndrome (AIDS) cases and 231 surveys at law change (LC) in January 2001. To correct for differences in sampling, we limited the analysis to pharmacies in ZIP Codes represented in both samples and weighted results to adjust for the median income level of those postal codes. From BL (n = 83) to LC (n = 84), law awareness increased (43% to 90%, P < .001), as did personal support for selling syringes without a prescription to IDUs (36% to 63%, P < .001). From BL to LC, a larger proportion of supporters believed that selling syringes was an important part of human immunodeficiency virus (HIV) prevention and would help decrease HIV transmission, and a smaller proportion was concerned about customer discomfort and increased drug use. A total of 40% of respondents were ESAP registered at LC but registration was not associated with support for selling syringes to IDUs.
Support for ESAP among pharmacists increased in high-risk neighborhoods as the program was implemented. The finding that some pharmacists were ESAP registered but did not support selling syringes to IDUs and others were supportive, but not ESAP registered, may have program implications.
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