CPJ : Canadian pharmaceutical journal = RPC : la revue pharmaceutique canadienne最新文献

Patient care in health institutions has become more intensive, with greater use of drugs. Pharmacy departments have not been able to keep abreast of the demands placed on them by advances in clinical medicine. Medication errors occur too frequently and place the patient at risk. Use of the unit dose system would reduce these errors. Patient safety should be used as a measure of the effectiveness of pharmacy programs. Greater patient participation in the therapeutic process would improve the effectiveness of pharmacy services, as would therapeutic drug monitoring.

The cost of illness includes not only the funds required to treat illness, but also the effect on the patient's quality of life. Recent concern about rising health costs have focused on the direct expenditures without noting that the cost of illness in terms of mortality and morbidity has declined significantly. Pharmaceuticals have played a major role in reducing the total cost of illness. Several studies of the cost-effectiveness of past introductions of vaccines and pharmaceuticals reveal large cost savings. Although the focus of most studies has been on major advances, the continuing process of less dramatic therapeutic improvements has significantly trimmed the cost of illness. Cost-benefit studies of new drugs or changes in drug use, while more difficult to perform, make it possible to influence the selection of therapy. Since pharmaceuticals represent less than 10% of total treatment costs, reduction in the cost of pharmaceutical products can only have a minor impact on the total cost of illness. Pharmaceuticals can reduce the cost of illness by providing alternative therapies that reduce direct treatment cost or improve the public health.

Drug research and development in the U.S. tends to focus on drugs to treat common diseases because of the anticipated return on investment. To stimulate pharmaceutical manufacturers to pursue the development of drugs for rare conditions, the Orphan Drug Act was enacted by Congress on January 4, 1983. Under the provisions of this Act, the FDA can make recommendations on the investigations necessary for marketing approval; exclusive marketing privileges can be obtained; tax credits for expenses incurred are allowed; availability of orphan drugs on an investigational basis is encouraged; and the Orphan Product Board is established for the coordination of research efforts and their reimbursement. The effects of this legislation are evident in the continuing increase in orphan drug designations.

Computer-generated refill reminder notices were mailed to patients receiving continual medication for cardiovascular diseases to measure improved compliance and to discover whether a computer-assisted program was economically viable. Guidelines were established to define compliance. A computer-assisted compliance intervention program did not significantly improve the rate at which patients had their prescriptions filled "on time" and the mean compliance rate for both experimental and control groups was greater than 79%. Also discussed were cost and compliance strategy implications and the receptiveness of patients to the reminder program.

The first of a two part article entitled "Prescription Pricing Across Canada" appeared in the June issue of CPJ. The article was prompted by recent press reports of a prescription drug study commissioned by the Saskatchewan government, and the consequent attention-getting headlines. The first article dealt with the Western provinces. The second part discusses prescription pricing in Ontario, Québec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland, and the Northwest Territories.

As pharmacists increase their involvement in patients' drug therapy, the lack of opportunity for advanced clinical and administrative training becomes more critical, particularly for community pharmacists. To assist in the postgraduate development of community pharmacists, the faculty of pharmaceutical sciences at the University of British Columbia began a residency program in community pharmacy practice in June 1981. Modeled on the successful hospital pharmacy residencies, the program goals are to provide advanced clinical training in ambulatory patient care, and detailed and practical management training, and to develop pharmacists with skill in clinical teaching who will participate in the undergraduate programs of the faculty. The 12-month residency includes guided self-study and a series of practica in areas of therapeutics, management, drug information, clinical and teaching skill, professional service, and continuing education. These practica are served mainly in clinical practice settings such as community pharmacies, clinics, physicians' offices, and teaching hospitals. The residency has demonstrated its value and viability. Growing interest in such programs, and the success of this program in particular, should encourage the development of similar programs in Canada.

Drug holiday programs have been implemented in many long-term care facilities in North America to reduce drug use, decrease nursing time in drug administration, and assess the need for drugs in elderly patients. Before the program begins, adequate preparation of staff and discussions among patients and families are encouraged. The pharmacist's role is to coordinate inservice programs for nursing and medical staff, develop policies and procedures, dispense drugs as prescribed and assist in program evaluation.