Browsing by Author "Patry, Roland A."
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Item A computer program for monitoring food-drug interactions in nursing home patients(1980) Phillips, Linda Lou; Driever, Carl W.; Patry, Roland A.; Webber, M. George; Ballentine, Rollin L.This study involved the development of the data base for a computer program capable of screening computerized patient profiles for potential food-drug interactions, specifically food effects on drugs. Data files listing the drugs, foods, interaction mechanisms, and recommendations comprised the data base for the food-drug interaction program. The program can be used to routinely monitor nursing home patient profiles for information about potential food-drug interactions and can deliver the results in a simple printout format. The program was utilized to review nursing home patient profiles for potential food-drug interactions in one test nursing home and later, in 213 nursing homes. In the total study population of 19,248 nursing home patients, the program detected 1,460 potential food-drug interactions among 1,367 patients. Homes that had greater than 11.18% of the patients with potential food-drug interactions were considered problem homes. The computer program could benefit the pharmacy consultant by detecting the potential food-drug interactions, thus allowing the consultant to spend his time actually correcting problems at the targeted nursing homes. The computer program was further beneficial since it could be readily adapted at a moderate financial cost for utilization by a pharmacy consultant who- already utilized a computer system for monitoring nursing home patient profiles.Item A study of prescribing and utilization patterns in three long-term care facilities. Utilization of a capitation fee or unit dose drug distribution under the Texas Medicaid Program(1977) Patry, Roland A.; Kroeger, Ruth C.; Hudson, Harold D.; Driever, Carl W.; Willems, Edwin P.; Fishman, DorisThe increased longevity of the average American has helped make more visible the natural degenerative processes of the cellular components of the human body. Lay-terms such as 'stroke' and 'hardening of the arteries' define medical problems which may not have been prominent 200 years ago. To those individuals afflicted by debilitating medical problems, nursing home care is offered as a less expensive means to receive quality care. Unfortunately, Senate hearings on kickbacks, drug misuse and misappropriation of funds has tarnished the reputation of this health care industry. This two phase investigation was conducted as a pilot study on prescribing habits and drug utilization and their relationships to the use of a capitation system or unit dose drug distribution system in Texas nursing homes. [...]Item Capitation as a reimbursement alternative and a survey of medicaid regulations and physician prescribing habits(1980) Weast, Billy G.; Kroeger, Ruth C.; Patry, Roland A.; Driever, Carl W.; Hudson, Harold D.; Webber, M. GeorgeThe cost of medical care is increasing at an alarming rate and has therefore become an important issue for the American people, insurance companies, and both state and federal governments. One measure that would decrease the cost of the Drug Vendor Program in the State of Texas is a capitation fee form of reimbursement for pharmacy services. Four monthly capitation fees were determined for Medicaid patients residing in three long term care facilities. All included the cost of the drug product as part of the capitation fee. The ideal capitation fee would compensate the patient for all prescription medications prescribed during a specified time period. This would necessitate revocation of the current three prescriptions per patient per month limit on Medicaid recipients Revocation of the three prescriptions per patient per month limit could potentially cause an increase in drug usage among Medicaid patients residing in nursing homes. To gauge the potential for an increase in drug usage, a survey was mailed to 660 physicians practicing within the confines of Harris County.Item Compliance with accepted criteria : a drug utilization review study in two hospitals(1979) Huber, Stephen Lee; Kroeger, Ruth C.; Patry, Roland A.; Fishman, Doris A.; Webber, M. George; Hudson, Harold D.Drug misutilization, Professional Service Review Organization (PSRO) legislation, and Joint Commission on Accreditation of Hospitals (JCAH) requirements have increased the need for Drug Utilization Review (DUR). Private and governmental forces act on the American health care system to further establish the need for DUR. A retrospective DUR was completed on a total of 229 inpatients at two hospitals, Hospital A and Hospital B. Identical DUR criteria for methyldopa, cefazolin, and nafcillin were approved by physicians at each hospital prior to beginning the DUR. Each hospital assigned a standard, expressed as a percentage, to the individual criteria. The standards assigned represented acceptable deviations from the criteria at each study hospital. Hospital A failed to satisfy their predetermined standards for eleven (28%) of the DUR criteria. Following a peer-review of these deviations, it was determined that ten patients exceeded the recommended maximum daily dose (6 gm/day) of cefazolin without any documented indication for high dose therapy. Hospital B failed to satisfy their predetermined standards for eight (20%) of the criteria. Failure to administer the drug as ordered by the physician occurred in 15% of the patients reviewed. Cefazolin was used for surgical prophylaxis 55% of the time at Hospital A and 84% of the time at Hospital B. The mean duration of prophylactic therapy was 5.6 days at Hospital A and 3.7 days at Hospital B. It was recommended that guidelines for surgical prophylaxis be developed by the Surgery Service at the respective hospitals.Item Drug-disease state interactions in nursing home patients : a pilot study(1982) Buck, David Walter; Driever, Carl W.; Patry, Roland A.; Kroeger, Ruth C.; Webber, M. GeorgeThis study involved the development of a computer program which was used to screen computerized patient profiles for potential drug-disease state interactions. The data base for the computer program was constructed using drugs and disease states common in nursing home residents and from information supplied predominately by pharmaceutical manufacturers. The program was utilized to review the computerized medication profiles of 168 nursing home residents. Potential drug-disease state interactions were detected in 37 of the 166 patients. A manual search of the profiles by this investigator led to some alterations in the findings presumably due to the method of the data base construction. The combined computer and manual search found 49 drug-disease state interactions in 38 different patients. Additionally, the program was able to indicate disease states in the medication profiles that did not appear to be treated by any drugs of the patient. Conversely, drugs the patients were receiving that did not match up with any disease state in the profiles were also identified. The results were intended to provide consultant pharmacists with a starting point in their monthly drug therapy reviews. No judgements as to the clinical significance of any of the potential drug-disease state interactions were attempted by the computer program. Any recommendations regarding a specific clinical situation will be made by the consultant pharmacist.Item Effect of extent of infection, urease production, catheterization, ascorbic acid, and urine pH on generation of formaldehyde from methenamine(1982) Robbins, Terry S.; Patry, Roland A.; Buckley, Joseph P.; Kroeger, Ruth C.; Alam, Maktoob; Feldman, StuartThis study examined the utilization and effectiveness of methenamine carpounds as suppression therapy in nursing hare patients with chrcnic urinary tract infections (DTI). Physician prescribing patterns and documentation of synptoms in nursing home residents were obtained by conducting a Drug Utilization Review (DUR) of the patients' charts. This information was compared to data generated by spectrephotometric assay of urine formaldehyde (HCHO) and subsequent bacteriological testing of the patients1 urine. Analytical procedures known as the Riker Method were used to test for the conversion of methenamine to HCHO. Modification, using Sorenson's Phosphate Buffer, pH 6.5, was required to enable collection, transport of the urine samples, and performance of the assay with minimal changes in HCHO concentration. Established bacteriological procedures were utilized to screen for the presence of urease producing gram negative bacteria. Results of the DUR showed that monitoring practices were uncommon for such things as urine pH, recent culture and sensitivities, and renal status. Assay results of urine samples indicated 57% of the study patients with HCHO levels of less than 10 mcg/ml. Bacteriological findings revealed 73% of the patients with significant bacteriuria. NO differences existed in mean pH and HCHO levels when the subjects were grouped according to extent of infection, presence of urease producing bacteia, catheterization, and daily dose of ascorbic acid. Eleven of 13 patients with urease producing bacterial infections had urine pH values of greater than 6.5 As expected, urine pH had a moderate but significant effect on observed HCHO concentration. Overall, the use of methenamine corpounds for suppression of urinary tract infections was not found to be an effective treatment mode for this nursing home population.Item Stability of doxorubicin, dacarbazine, and 5-fluorouracil in plastic syringes(1982) Montalvo, Abel A.; Driever, Carl W.; Ballentine, Rollin L.; Patry, Roland A.; Feldman, Stuart; Buckley, Joseph P.The stability of doxorubicin, doxorubicin in combination with dacarbazine, dacarbazine, and 5-fluorouracil in plastic syringes was determined. Drugs were reconstituted according to manufacturers' instructions and added to 0.9% sodium chloride injection in clear plastic syringes. One-half of the filled syringes in the study were protected from light with aluminum foil. The admixtures were distributed into different experimental groups and stored at room temperature, refrigerated and frozen. Stability was determined over 72 hours (96 hours for doxorubicin and 5-fluorouracil) by high-performance liquid chromatography for dacarbazine and dacarbazine in combination with doxorubicin; a direct spectrophotometric assay was employed to determine the concentration of doxorubicin, doxorubicin in combination with dacarbazine and 5-fluoro- uracil. The solutions of doxorubicin were stable for the duration of the study when stored at room temperature, refrigerated and frozen in clear or foil covered syringes, showing no substantial loss of drug concentration. The solutions of 5-flourouracil were also shown to remain stable for the duration of the study both at room temperature and under refrigeration in clear or foil covered syringes. At 48 hours, the solution of dacarbazine and the mixture of dacarbazine and doxorubicin demonstrated acceptable stability. However, by 72 hours an average decrease in drug content of 22 percent was observed in each of the solutions. This was evident at room temperature and refrigerated in both clear and foil covered syringes. The frozen solutions (dacarbazine alone and the mixture of dacarbazine and doxorubicin) were shown to remain stable for the duration of the 72 hour study. For those drugs listed as stable there was a less than 10 percent decrease in drug content for the duration of the study.Item The effects of expanded pharmacy services in a hospital based home care program(1982) Galt, Michael A.; Patry, Roland A.; Kroeger, Ruth C.; Driever, Carl W.; Haney, C. AllenHome health care is one of many health care modalities available to the elderly who are chronically ill as an alternative to placement in an institution. Home health care may be defined simply as the provision of health care and health related services to individuals in their place of residence. Numerous reports in the literature describe serious drug related problems found among the home bound elderly. Medication compliance and adverse drug reactions appear to be the most commonly cited problems; however, the literature clearly lacks studies that evaluate possible roles or responsibilities of the pharmacist in home health care. A review of the current literature indicates a need for controlled studies that document the possible effects of pharmacy services in the home health field. The present study evaluated the effects of expanded pharmacy services in a federal hospital-based home care program over a 6 month period. The primary objectives of the study were to initiate patient- oriented pharmacy services and to critically evaluate the effects of these services. Study patients were randomly assigned to an experimental group or a control group. Expanded pharmacy services were provided to the experimental group. These services included patient counseling, maintenance of computerized medication profiles, and agency staff consultation. Parameters studied to evaluate the impact of expanded pharmacy services were patient self-medication errors, the patient's knowledge of drug regimens, the detection of potential drug interactions and adverse drug reactions, and the number of inappropriate medications prescribed. Data collection was accomplished through home interviews with patients and by prospective and retrospective medical chart reviews. The results of this study indicate that expanded pharmacy services provided by the pharmacist significantly affected all the parameters studied. Self-medication errors consisting of medication compliance and medication storage decreased significantly in the experimental group. The patient's knowledge of his/her drug regimen increased significantly in the experimental group as measured in this study. The number of potential drug interactions and adverse drug reactions documented in the experimental group was clearly enhanced as compared to the control group. The number of inappropriate medications prescribed to the experimental group was also affected, primarily, by decreasing the number of duplicate medications. None of the parameters studied changed significantly from prestudy to poststudy within the control group. The findings reported in this study demonstrate not only that patient-oriented pharmacy services had an impact on the patients in the hospital-based home care program studied; but also that there is a clear need for the pharmacist's drug therapy expertise in the health care of these patients. A specific role model for the home care pharmacist, however, has not been established. Although the study involved both direct patient services in the home and agency staff interaction, probably the greatest effect on the home health patient can be accomplished through the agency staff rather than the patient or caretaker directly. The home care pharmacist may serve hospital-based home care programs most efficiently as a regular consultant to the home care staff. Periodic home visits by the the consultant pharmacist may be indicated for those patients identified as having unusual drug related problems. The results of the study indicate that the pharmacist's participation in home health care is most likely feasible; however, the lack of reimbursement for services by third-party insurers is a major deterrent to expanding pharmacy roles. Medicare regulations should be expanded to include the pharmacist as a drug therapy consultant similar to that outlined in the Medicare regulations for skilled nursing facilities. Such proposed changes will require extensive documentation of cost effective pharmacy involvement within various home health care settings. This study attempts to objectively evaluate the services of a pharmacist in a home health program by using a randomized, control group design. Additional multi-center studies are necessary to further evaluate possible roles for the home care pharmacist and to provide additional data concerning the impact of various services. Data from this study and future evaluations which finally determine the optimal role model for the home care pharmacist may then be utilized by innovative administrators to propose progressive pharmacy services in the home health field.Item Use of the job diagnostic survey for analysis of motivation and job attitudes involving hospital pharmacists in three hospitals(1980) Albracht, Glen Edward; Patry, Roland A.; Kroeger, Ruth C.; Terborg, James R.; Driever, Carl W.The professional literature is incomplete with respect to determining motivation of hospital pharmacists. This research attempted to address this deficiency by analyzing data, obtained by questionnaire, from pharmacists in three Houston, Texas area teaching hospitals. A modified version of the Job Diagnostic Survey (JDS) as developed by Hackman and Oldham was administered to participating staff pharmacists on job release time. This instrument is based on a specific theory of how job design affects work motivation, and provides measures of objective job dimensions, affective reactions of employees to the job and work setting, and individual growth need strength. Concurrently, participating pharmacy supervisors were administered an accompanying instrument; a modified version of the Job Rating Form. All eligible pharmacists participated in the survey. The analyses of the resultant data were accomplished by use of the provided Scoring Key and the SPSS computer software package. The study data, when compared to other jobs with professional properties, showed hospital pharmacy to be generally lower in perceptual responses to the measured variables of the JDS. Pharmacy as a profession has been shown to have many inherent motivational deficiencies. Further research into the measurement of job dimensions and the determination of the motivating potential of pharmacy as a job should be dealt with in the future to help identify and attempt to correct motivational deficiencies.Item Use of time series analysis to measure impact of changing controlled substance IV admixture systems(1983) Lajeunesse, Joel D.; Patry, Roland A.; Ballentine, Rollin L.; Holsomback, Thelma C.; Decker, MichaelOften pharmacy managers must implement innovative policies or procedures without adequate historical knowledge of the effects that they have on operations. Even within the pharmacy department, the measurement of the effect of a policy or procedure implementation may be obscured by factors many of which are uncontrollable either by design or by traditional statistical methods. There has been virtually no documentation in the pharmacy literature describing systems that deliver controlled substance (CS) IV admixtures. As such, no evaluative studies have been found on this subject, however recent reports in the literature indicate that controlled substance intravenous (IV) admixtures are used to manage severe pain. A study, using an interrupted time series design, was conducted to evaluate the impact of a new system for delivering controlled substance IV admixtures. The number of CS IV admixtures prepared and wasted was determined on three nursing units by examining distribution and delivery records. Data were collected from two nursing units both pre- and post implementation of the new system for the distribution of controlled substance IV admixtures, whereas the third nursing unit served as a control. The data were analyzed as a time series using the Box-Jenkins approach or autoregressive integrated moving average (ARINA) model building. Results from test units indicated that there were no significant increases in the number of units made with the implementation of the floor stock system. The ARINA models identified for the waste time series were not satisfactory. It was concluded that a quasi-experimental time series designs are more amenable to institutional pharmacy practice than are more traditional experimental designs, since time series designs control for many threats to validity that are otherwise difficult to control in non-laboratory settings. However, the limitations of time series designs and analysis, such as the ability to measure impact of binary interventions only and the inability to account for changes in the process yielding the time series, must be recognized. Time series analysis provides a method for pharmacy managers to evaluate the impact of new systems or procedures such as the floor stock distribution system for CS IV admixtures in actual practice settings.