Community Practice

Switching community-acquired pneumonia patients as quickly as possible from intravenous to oral antibiotics reduces hospital stays and improves the quality of care, according to many studies. One recent study suggests that even patients with severe CAP may be safely moved to oral antibiotics early in their stay. Health-system pharmacists should be aggressive in promoting that switch, say several clinical pharmacists.

A 75-year-old man, D.P., is seen regularly in your hospital clinic for severe chronic obstructive pulmonary disease (COPD) as a result of a 50-year pack-a-day habit (FEV<50% predicted). He quit smoking last year but still admits to being a heavy drinker. His current medications include fluticasone/ salmeterol 250/50 mcg (Advair, GlaxoSmithKline) one puff twice daily and albuterol inhaler when needed. He has had several COPD exacerbations within the past year, necessitating oral steroid therapy. He was just diagnosed with osteoporosis: recent X-rays show two vertebral fractures. His physician is contemplating osteoporosis therapy. What do you recommend?

Practitioners will now have access to consensus standards for the treatment of venous thromboembolism (VTE). The National Quality Forum (NQF) has announced publication of a new report, National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures.

CHD Meridian Healthcare, an I-trax Inc. company, appears to have struck the right note with large corporations seeking to bring on-site clinics to their employees.

Picture this. A man walks into a pharmacy to buy condoms. He hopes he can quickly whisk them from the shelf and pay for them without attracting attention. But ... they are locked up in a case along with the razor blade cartridge replacements. A note on the cabinet states, "Please ask attendant for assistance for items in this case."

Seeking to provide hard data on the efficacy and impact of medication therapy management (MTM) sessions, a Florida Quality Improvement Organization (QIO) is studying the MTM results of Humana and AvMed Medicare patients in that state. The Florida Medicare Quality Improvement Organization (FMQAI) is working with the two prescription drug plans (PDPs) and pharmacists to set up the programs and educate patients and will publish its results in late 2007. FMQAI is the third-largest QIO in the country and has the second-largest beneficiary population.

For years, industry experts have touted the advantages of e-prescriptions, hoping to reduce medical errors and increase efficiency, while at the same time auger in a new era of electronic medical records. Still adoption of e-prescription technology has lagged in the United States. While more than 90% of pharmacies have the ability to receive e-prescriptions, fewer than 5% of doctors have ordered a prescription electronically.

Have you heard the joke about the pharmacist? Well you can bet Nicholas Hoesl has. In more than 40 years as a pharmacist, Hoesl has probably heard them all, and he has taken it as his mission to share humor with the rest of the world.

Less than a year after it first began to receive applications, interest in the Pharmacy Compounding Accreditation Board's (PCAB) seal of approval appears to be growing. "We now have 100 pharmacies going through the process," said Ken Baker, the board's executive director. "We are looking to reach 300 by the end of 2008. Interest among compounding pharmacies has been extremely high."

On average, people who have a first cancer have a 14% higher risk of a subsequent primary cancer than the general population, according to a major monograph just released by the National Cancer Institute (NCI). The report, "New malignancies among cancer survivors," looks at two million cancer survivors over a nearly 30-year period and is called "by far the largest study to date of subsequent cancers."

The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) recently released guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP). These guidelines are the first collaborative effort between these two organizations on CAP guidelines. IDSA last updated its CAP guidelines in 2003.

New data from an innovative head-to-head phase II study of Abraxane (paclitaxel protein-bound particles for injectable suspension [albumin bound], Abraxis BioScience) versus standard Taxotere (docetaxel, Sanofi-Aventis) showed that weekly Abraxane boosted the tumor response rate by more than 60% over Taxotere given every three weeks in first-line treatment of metastatic breast cancer.

According to recent results from a Crohn's and Colitis Foundation study, 65% of patients with ulcerative colitis (UC) are poorly compliant with their medication. Now, a new therapy for the condition with once-daily dosing may offer patients a better chance for compliance. In January, the Food & Drug Administration approved Lialda, from Shire plc. Lialda is a delayed-release mesalamine product that utilizes MMX technology, a pH-dependent gastro-resistant coating that delays the release of the medication until it reaches the colon, the site of the inflammation in UC.

When it comes to the cost of dispensing medications and the dispensing fee paid by Medicaid, a new study confirms the bad news that many pharmacists already know. The national average cost of dispensing medications is $10.50 per prescription, not including the cost of the medicine, according to The Cost of Dispensing, a national study released recently by the Coalition for Community Pharmacy Action (CCPA). The coalition is an alliance between the National Association of Chain Drug Stores and the National Community Pharmacists Association.

An increasing number of community pharmacies are venturing into the specialty pharmacy arena. Despite what some industry experts describe as a fragmented marketplace, community pharmacy leaders say they are poised to take on and develop this segment of the industry and keep specialty drugs in their settings.

Like it or not, health-system pharmacies are under tremendous pressure to perform at a high level. Addressing patient safety concerns, improving outcomes, implementing state-of-the-art technology, and keeping drug costs down requires a juggling act that pharmacists must perform on a daily basis.

NIOSH, the National Institute for Occupational Safety and Health, is updating its list of hazardous pharmaceutical products. The new list will become part of the organization's 2004 alert, Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings.

When Michelle Rutledge, Pharm.D., heard about the fatal shooting of a hospital pharmacist at Shands Jacksonville hospital in Florida last November, it really hit home. The victim, 37-year-old Shannon McCants, was a fellow graduate of the Florida A&M College of Pharmacy. McCants was shot by a customer who was waiting for a prescription to be filled in the outpatient pharmacy. Rutledge, an associate investigator at the James A. Haley VA Hospital in Tampa, said that e-mails from former student-colleagues began pouring in.

According to the latest census of pharmacists from the National Association of Boards of Pharmacy, the number of pharmacists and technicians continues to grow across the country. In the NABP annual survey of state boards of pharmacy licenses, the total number of pharmacists, technicians, and pharmacies all grew, although some states did see declines.

An increasing number of community pharmacies are venturing into the specialty pharmacy arena. Despite what some industry experts describe as a fragmented marketplace, community pharmacy leaders say they are poised to take on and develop this segment of the industry and keep specialty drugs in their settings.

Treating heart attacks and agents affecting risk factors for heart disease were among the hot topics explored at the American Heart Association's 2006 annual meeting held recently in Chicago. Also, a program on increasing adherence to pharmacotherapy among the elderly was of interest to attendees.