Emergency pharmacy services

As pertinent variables are identified, it will become clear that some data will be easily obtainable, whereas information on other variables will be extremely difficult to acquire. Pharmacy-related data often are easily retrievable because much of the information can be obtained directly from the pharmacy s prescription computer program (and the patient profiles). Patient demographic information such as gender and age generally is also stored on the pharmacy computer. However, depending on the research question, data from other areas of the health care system may need to be collected as well. For instance, one hypothesis could be that a pharmacy service may result in a reduction in emergency department visits. Pharmacists often do not have access to data on emergency department visits in their own records. 

The emergence of clinical services during this phase of pharmacy practice is exemplified by the development of clinical pharmacy services in the U.S. Indian Health Service (IHS). The IHS provides health care services for 1.4 million American Indians and Alaska Natives. The IHS s health care facilities are in rural areas near or on Indian reservations in 34 states, mainly in the western part of the U.S. and Alaska. In the 1960s, pharmacists within the IHS began to provide services that were the predecessors for current models of patient care. Pharmacists working within the IHS provided primary care to patients with minor conditions, monitored them for adverse drug reactions, provided patient education, and developed disease prevention programs.il... 

Pharmacies are continually looking for new and better ideas to differentiate themselves from other retail outlets and to offer additional health care services to their customers. The addition of in-store medical clinics allows customers to receive medical care that is quick, inexpensive, and convenient (Fig. 23-7). Staffed by nurse practitioners and physician assistants that have prescribing authority, patients can choose from a posted list of services provided, receive treatment, and be on their way in less time than at a medical clinic or emergency room. Patients who need OTC or prescription items can pick up these items right in the store. 

Costs of goods and services seem intuitively simple to quantify. However, a number of potentially complicated issues must be considered. When identifying the goods or services, will the actual cost (wholesale cost) to the pharmacy or health care organization be measured, or will the charge to the patient or payer (retail cost) be measured Sometimes access to cost data may be limited, or the data may be entirely unavailable. For instance, if Cynthia Marshall was using a hospital database to collect hospitalization and emergency department information for the HMOs heart failure patients, it may be impossible to isolate the actual costs related to heart failure, particularly if a patient was admitted for multiple reasons. 

Depending on the needs of the individual pharmacy, several different types of insurance policies may be required to provide adequate risk protection for the business. The geographic location, type of practice, and services offered will influence the types of insurance needed. The risk management process is a continuous process, and periodic evaluations are necessary to address new or emerging risk threats to the pharmacy. Emerging threats discussed later in this chapter exemplify how recent changes in health care practices (privacy issues) and technology create new and different risk threats to the pharmacy. 

Patients may come into the pharmacy and request a supply as with the standard emergency supply or they may be referred to the pharmacy either by an out-of-hours service (for example, NHS 24 which provides health information and self-care advice in Scotland), a GP or an accident and emergency department of a hospital. 

Finally, a number of nontraditional practice sites have been described in which pharmacist have participated in natural disaster relief or as part of a humanitarian effort relief team. These nontraditional practices have included a pharmacy consultative service for wilderness emergency drug planning, pharmacy involvement in emergency preparedness/response, the provision of pharmaceutical services at a medical site after Hurricane Andrew in Florida, and the experience of several pharmacists providing service in Bosnia-Herzegovina. ° ... 

Some research projects promoted or initiated by the Foundation are currently ongoing. A European research consortium, with the participation of different countries, is proposed to study the influence of pharmaceutical care in the control and treatment of minor diseases from community pharmacists, and it has submitted to the European Community in Brussels asking for economic support. Such research will be coordinated by the School of Pharmacy of the University of Manchester, United Kingdom. A project promoted by the European Society of Clinical Pharmacy is currently studying the number of drug related problems (DRP) identified by community pharmacists on patients discharged from the hospital. A research study on the number of DRP identified by pharmacists in patients admitted to emergency services of hospitals was initiated... 

There is considerable confusion in pharmacy concerning current definitions of practice sites and practice philosophies. Ambulatory care includes all health-related services in which patients walk to seek their care. " These services may be provided in emergency rooms, urgent centers, private offices, primary care clinics, specialty and subspecialty clinics, and community pharmacies. 

In the Zambian emergency contraception voucher scheme, all public maternal and child health units had to be excluded from the list of service providers because of their restricted working hours (Monday to Friday only). Since, to be effective, emergency contraception needs to be taken within 72 hours of unprotected sex, any outlet that could potentially be contracted had to be open 24 hours a day, 7 days a week. The agency eventually chose private pharmacies and hospital outpatient departments. Pharmacies have the additional advantage of anonymity, which is particularly well suited to a sensitive issue such as emergency contraception. 

The National Disaster Medical System (NDMS) is a section within the United States. DHS is responsible for supporting federal agencies in the management and coordination of the federal, medical response to major emergencies, such as acts of terrorism, including the potential use of chemical agents. Special teams available under NDMS include Disaster Medical Assistance Teams, Veterinarian Medical Assistance Teams, Disaster Mortuary Operational Response Teams, National Nurse Response Teams, and National Pharmacy Response Teams (U.S. Department of Health and Human Services Web site). 

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