galenicals presentation 2libvolume6.xyz/.../pharmaceutics1/galenicals/galenicalspresentation2… ·...
TRANSCRIPT
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Chapter 1
The Profession
of Pharmacy
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Chapter 1 Topics
• Ancient Origins
• Pharmacist
• Pharmacy Technician
• Pharmacy Workplace of Today
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Learning Objectives
• Describe the origins of pharmacy
• Describe the four stages of development of the
pharmacy profession in the twentieth century
• Enumerate the functions of the pharmacist
• Discuss the educational curriculum for today’s
pharmacy student
• Explain the licensing requirements for pharmacists
• Identify the duties and work environments of the
pharmacy technician
• Differentiate among the various kinds of pharmacies
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Ancient Origins
• Pharmacy comes from the Greek word
pharmakon, meaning drug
• Scientific approach to medicine began with the
ancient Greeks
• Hippocrates
• Proposed that disease came from natural, not
supernatural causes
• Established the theory of humors
(blood, phlegm, black bile, yellow bile)
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Ancient Origins
Galen
• Conducted animal experiments
• Produced a systematic classification of drugs for
treatment of disease
• Galenical pharmacy described the process of
creating extracts of active medicinals from plants
Diascorides• First century A.D.
• De Materia Medica (standard text on drugs for 1500
years)
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Ancient Origins
Dr. John Morgan
• Eighteenth Century
• Supported the separation of the professions of
pharmacy and medicine
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• pharmakon
• theory of humors
• galenical pharmacy
• De Materia Medica
Terms to Remember
Learn more at American Institute of the History of Pharmacy (AIHP)
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Discussion
How has the profession and practice of
pharmacy evolved since ancient times?
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Pharmacist
• The profession of pharmacy exists to safeguard the health of the public
• The pharmacist is one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professional
• The role of the modern pharmacist evolved
– from compounder and dispenser
– to providing medication information and preventing medication-related problems
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Evolution of the Pharmacist’s Role
During the twentieth century, the pharmacy
profession has evolved through four stages.
• Traditional Era
• Scientific Era
• Clinical Era
• Pharmaceutical-care Era
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Traditional Era
• Early twentieth century
• Formulation and dispensing of drugs from
natural sources
– Pharmacognosy
• The study of the medicinal properties of natural
products of animal, plant, and mineral origins
– Galenical pharmacy
• Techniques for preparing medications
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Scientific Era
• Began after World War II
• Emergence of the pharmaceutical industry
– Drugs made in factories, not apothecary shop
• Pharmacy education emphasized sciences
– Pharmacology
• The scientific study of drugs and their mechanism of
action including side effects
– Pharmaceutics
• Release characteristics of drug dose forms
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Clinical Era
• 1975: Millis Report, Pharmacists for the Future
• New educational emphasis on clinical (patient-oriented)
pharmacy
– Pharmacokinetics
• the activity of a drug within the body over a period of
time; includes absorption, distribution, metabolism, and
elimination
– Pathophysiology
• the study of disease and illnesses affecting the normal
function of the body
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Pharmaceutical-Care Era
• 1990: Hepler and Strand defined
• Pharmaceutical care
– a philosophy that expanded the pharmacist’s role to
include appropriate medication use to achieve
positive outcomes with prescribed drug therapy
– includes
• Monitoring response to therapy
• Educating patients and dispensing prescriptions
Visit the American Pharmacists Association (APhA)
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Discussion
How does the pharmaceutical care model
affect the duties of pharmacists in the 21st
Century? medication outcomes?
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Terms to Remember
• pharmacist • pharmaceutics
• pharmacognosy • pharmacokinetics
• galenical pharmacy • pathophysiology
• pharmacology • pharmaceutical care
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Role of the Pharmacist
Today’s pharmacist:• Compounds and dispenses drugs
• Gathers information about patients
• Counsels on possible side effects and adverse reactions
• Monitors for drug interactions
• Screens, monitors, and advises for self-treatment with over-the-counter (OTC) products sold without a prescription
• Provides drug information to other healthcare professionals
• Advises on home healthcare supplies and medical equipment
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Community Pharmacist
• Dispenses drugs for exiting disease
• Involved in patient care initiatives to prevent or identify disease
– Administration of immunizations
– screening for and educating about hypertension, diabetes, and other conditions
– providing education about lifestyle choices and dietary supplements
• Runs a business
– hires and supervises employees
– deals with insurance companies
– maintains inventory
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Hospital Pharmacist• Dispenses oral medications
• Prepares and dispenses parenteral medications
• Sometimes specializes, with advanced training in an area of patient care
• Educates and counsels patients
• Provides drug information
• Administers a department– develops policies and procedures
– purchases drugs and supplies
– monitors drug use in the hospital
Learn more about hospital pharmacy at the web site of the
American Society of Health-System Pharmacists (ASHP)
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Home Healthcare Pharmacist
• Prepares medications and IVs for home delivery
and use
– including IV nutrition and antibiotics
– cancer chemotherapy
– pain medications
• Educates patient or caregiver on appropriate and
safe medication use
• Monitors patient’s response to prescribed
therapies
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Other Pharmacy Settings
• Health maintenance organization (HMO)
• Long-term care facilities
• Specialized practice
– psychiatry
– drug abuse
• Nursing homes
– geriatrics
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Nuclear Pharmacy
• Nuclear pharmacist
– Procures, stores, compounds, dispenses, and provides
information about radioactive pharmaceuticals
used for diagnostic and therapeutic purposes
Learn more about nuclear pharmacy at the Cardinal Web site
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Education and Licensing Requirements
• Education
• 6 year program
• 2 years prePharmacy
– calculus, chemistry, biology
• Pharmacy College Admission Test (PCAT)
• Doctor of Pharmacy (PharmD) degree
• basic science courses
• practice setting experience
• Residency in specialty area is optional
For a listing of accredited schools of pharmacy, visit the Web site for
the American Association of Colleges of Pharmacy (AACP)
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Education and Licensing Requirements
• Licensing
– required by all states
– overseen by board of pharmacy
– involves
• graduation form an accredited college of pharmacy
• passing state board certification examination
• serving an internship
– continuing education for license renewal
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Discussion
• What are the differences and similarities
between and among the various
pharmacy practice settings?
• How does specialized training affect the
role of the pharmacist?
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Terms to Remember
• compounding
• over-the-counter (OTC)
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Pharmacy Technician
• A pharmacy technician, also called the pharmacy
tech, is an individual working in a pharmacy who,
under the supervision of a licensed pharmacist,
assists in pharmacy activities that do not require
the professional judgment of a pharmacist.
• Regardless of practice setting, the pharmacy tech
can assist with workload.
– The pharmacist provides the final check on the original
prescription with the medication bottle and label before
counseling the patient.
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Evolution of the Pharmacy
Technician’s Role
• Without pharmacy technicians, pharmacists would
not have sufficient time for the duties involved in
“pharmaceutical care.”
– counseling patients
– reviewing medication profiles
– monitoring for side effects and adverse reactions
– screening patients for disease
– discussing cost-effective drug therapy options with the
prescriber
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Evolution of the Pharmacy
Technician’s Role
Pharmacy technicians play a valuable role in
reducing the risk of medication errors.
Safety Note!
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Evolution of the Pharmacy
Technician’s Role
• Originally, many pharmacy techs were trained as
medics in the military.
– returned after service to take positions in hospitals
• In community pharmacy the pharmacy tech
evolved from clerk or cashier to a pharmacist’s
assistant.
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Evolution of the Pharmacy
Technician’s Role
• A pharmacy technician assists the pharmacist with routine functions.
– leaves professional decision making and judgment calls to the pharmacist
• Technician activities may range from ordering, stocking, and inventorying drugs to preparing the IV order to assisting in the dispensing process.
– the pharmacist must always check his or her work
– the pharmacist is responsible for patient counseling
– the technician functions in strict accordance with standard written procedures and guidelines
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Evolution of the Pharmacy
Technician’s Role
The pharmacy technicians works under the
direction of the supervising pharmacist.
Safety Note!
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Evolution of the Pharmacy
Technician’s Role
• Central defining feature of the technician’s job is
accountability to the pharmacist for the quality
and accuracy of his or her work.
• The essential differences in the duties of a
pharmacist and a technician involve:
– accountability
– making decisions about the patient’s healthcare
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Education and Licensing Requirements
• Most state boards of pharmacy recognize the
existence and importance of the pharmacy
technician.
• Each state board of pharmacy regulates:
– the activities of pharmacy technicians
– sometimes the ratio of pharmacy techs to pharmacists
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Education and Licensing Requirements
• In the past, on-the-job training was sufficient for
the tech working in a pharmacy.
• Now formal technician training programs train
pharmacy technicians for their expanded roles.
– Initially centered in hospitals to train staff in the
necessary functions of the hospital pharmacy.
– Now many programs are offered by community
colleges and technical schools.
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Education and Licensing Requirements
• ASHP developed a model curriculum to meet the
needs of all practice settings.
• In some states pharmacy technicians must be
certified to practice.
– Academic programs help to prepare the student to pass
the certification exam
For an up-to-date list of states requiring certification of pharmacy
technicians, see the Pharmacy Technician Certification Board Web site
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Discussion
• What is the relationship between the
duties of the pharmacy technician and
those of the pharmacist?
• How do the education and licensure of
technicians and pharmacists relate to
those duties?
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Work Environments and Conditions
• Pharmacy technicians are employed in most
of the same settings as pharmacists
– community pharmacies (i.e., drugstores)
– hospital pharmacies
– home healthcare and long-term care facilities
– specialized area of practice (e.g., nuclear
pharmacy) with additional training
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Work Environments and Conditions
• Pharmacy technicians usually work in clean, well-lighted, and well-ventilated environments.
• To ensure a sterile environment and minimize infectious disease, many techs in the hospital and other practice settings work either in a “clean room” or under specialized ventilation cabinets called laminar flow hoods when they prepare infusions, total parenteral nutrition, or cancer chemotherapy.
• Gowns, masks, hairnets, foot booties, and gloves are often needed in this environment.
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Work Environments and Conditions
• Pharmacy tech work requires standing, often for
long hours.
• Pharmacists and pharmacy technicians may be on
call or work days, nights, weekends, and holidays.
– At any time, 24 hours a day, some number of the
estimated 250,000 pharmacy technicians currently
employed are on the job.
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Characteristics
• broad knowledge of pharmacy practice
• dedication to providing a critical healthcare service to customers and patients
• high ethical standards
• willingness to follow instructions
• eagerness to learn
• an eye for detail
• manual dexterity
• facility in basic mathematics
• excellent communication skills
• good research skills
• ability to perform accurately and calmly in hectic or stressful situations
• ability to multi-task or work on several projects at the same time
A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.
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Discussion
What makes each of the listed
characteristics of a pharmacy technician
important?
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Terms to Remember
•Pharmacy technician
•Multi-task
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Pharmacy Workplace of Today
• Pharmacists work primarily in community and hospital pharmacies
• Some go on to pursue further education and higher degrees, residencies, or fellowships
• Other fields include managed care, mail-order pharmacy, home healthcare, long-term care, nuclear pharmacy, academia, drug information, sales, marketing, or research.
• The need for both pharmacists and pharmacy technicians is expected to continue.– new life-saving drugs
– increase in the aging population in the United States
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Community Pharmacy
• Three fifths of all pharmacists in the United
States work in a community pharmacy
(retail pharmacy).
– an independent or chain pharmacy that
dispenses prescription medications to
outpatients
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Community Pharmacy
• Most community pharmacies are divided into
– a back prescription area offering prescription
merchandise and related items
– a front area offering over-the-counter (OTC) drugs,
toiletries, cosmetics, and greeting cards
• Community pharmacies may be
– independently owned small businesses
– part of large retail chains
– franchise operations
• The recent trend is toward fewer independent
pharmacies
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Community Pharmacy
A chain pharmacy is a community pharmacy that
consists of several similar pharmacies in the region
(or nation) that are corporately owned.
• May be national or regional– in department stores (e.g., Wal-Mart, Target)
– grocery stores (e.g., Kroger, Publix)
– typical corner drugstores (e.g., Walgreens, Eckerds, CVS, Rite-Aid).
• Located to allow for large-volume dispensing with
heavy use of both pharmacy techs and automation
• Administrative decisions are made at the corporate
level
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Community Pharmacy
An independent pharmacy is a community
pharmacy that is privately owned by the pharmacist.
• May be owned and operated by a group of
pharmacists (rather than a corporation)
• A pharmacist owner makes his or her own
decisions regarding the practice of pharmacy
– more attention and time spent to keep customers
• Most compounding of prescriptions is done in this
type of pharmacy
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Community Pharmacy
A franchise pharmacy is member of a small chain of professional community pharmacies that dispense and prepare medications but are independently owned; sometimes called an apothecary.
• Combines characteristics of independent business and large retail chain
• A large retail company, the franchiser grants exclusive use of the company name and rights to sell company products to a store owner/operator, the franchisee
• Most sell only medication and health-related products/services
Visit The Medicine Shoppe
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Community Pharmacy
Pharmacy technicians employed in a community pharmacy typically
• aid the pharmacist in the filling, labeling, and recording of prescriptions
• operate and are responsible for the pharmacy cash register
• stock and inventory prescription and over-the-counter (OTC) medications
• maintain computerized patient records
• prepare insurance claim forms
• order and maintain parts of the front-end stock
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Community Pharmacy
A mail-order pharmacy is a large-volume centralized pharmacy operation that uses automation to fill and mail prescriptions to the patient.
– somewhat related to retail pharmacy
Run by a centralized operation using both automation and pharmacy techs
– dispense and mail large volumes of prescriptions every day
– more and more prescriptions are being filled by
mail-order pharmacies
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Community Pharmacy
Mail-order pharmacy
• Economies of scale allow lower acquisition costs
– savings to insurers and customers
• Limitations:
– if the patient experiences a side effect or adverse reaction, or the physician changes the medication, then the drug savings could be offset by drug wastage
– impersonal counseling, which is limited to a drug printout or calling a toll-free number
– time delay
– safety of delivery of pain medications through the mail
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Discussion
What are the advantages and disadvantages
of each type of community pharmacy
operation?
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Terms to Remember
• community pharmacy
• chain pharmacy
• independent pharmacy
• franchise pharmacy
• mail-order pharmacy
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Institutional Pharmacy
Institutional pharmacies are organized under a
corporate structure, following specific rules and
regulations for accreditation.
• A pharmacy associated with any organized
healthcare delivery system
– hospital pharmacy is the most common example
– more recent examples of places where institutional
pharmacies can be found include :
• home healthcare
• long-term care facilities
• managed-care organizations
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Institutional Pharmacy
A hospital pharmacy is an institutional pharmacy that dispenses and prepares drugs and provides clinical services in a hospital setting.
• One fourth of all pharmacists work in a hospital setting
– an institution that offers 24-hour healthcare service; that has six or more beds, a governing authority, and an organized medical staff; and that offers nursing and pharmacy services
– carries out the functions of maintaining drug treatment records and ordering, stocking, compounding, repackaging, and dispensing medications and other supplies
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Institutional Pharmacy
• The pharmacy technician in a hospital setting
– takes part in functions involving delivery, stocking, or inventorying of medications anywhere in the hospital
– may operate manual or computerized robotic dispensing machinery
• Typical hospital pharmacy staff may include:
– administrators with master’s degrees or PharmD degrees
– staff pharmacists with Bachelor of Science (BS) degrees
– staff and clinical pharmacists with PharmD degrees
– pharmacy technicians
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Institutional Pharmacy
• Hospital pharmacies (and drugstore chains) are
more likely than community pharmacies to require
that pharmacy technicians be certified.
• Some pharmacy employers encourage technicians
to become certified
– by paying for the certification exam
– by giving raises to those who pass it
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Institutional Pharmacy
A home healthcare pharmacy is a pharmacy that
dispenses, prepares, and delivers drugs and medical
supplies directly to the home of the patient.
• Spiraling hospitalization costs, regulatory changes, and
advances in parenteral therapies have created an
explosion in this field
• The home healthcare market continues to grow because
of our aging society and as an alternative to the higher
cost of hospitalizations
– Many hospitalized patients are discharged as soon as possible
to continue their recovery at home with IV solutions.
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Institutional Pharmacy
• Pharmacists and pharmacy technicians working in
home healthcare
– provide educational materials
– carry out traditional compounding and delivery
functions
– prepare and provide infusions and infusion equipment
– often must be available for emergencies on a 24-hour
basis
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Institutional Pharmacy
A long-term care facility is an institution that
provides care for geriatric and disabled patients.
• An extended-care facility (ECF) provides
institutional services predominantly to older adults
or disabled “residents” who unable to provide for
routine or medical care for themselves
– includes adults who suffer from chronic (long-lasting)
or such debilitating illnesses as stroke or Alzheimer’s
disease
– both medical and residential care is provided with very
few discharges
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Institutional Pharmacy
• Skilled-care facilities (SCF) are limited to patients
requiring more round-the-clock nursing care (such
as IV infusions) or recovery after a recent
hospitalization
– most patients are discharged from SCF to home when
they have adequately recovered
• Other long-term care facilities include patients
with acute or chronic psychiatric disorders or
rehabilitation facilities for those with serious
traumatic brain or spinal cord injuries
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Institutional Pharmacy
• Some long-term care facilities have an “in-house” pharmacy– others contract with a community pharmacy or allow each
resident to choose his or her pharmacy
• Licensed pharmacists– establish record-keeping systems related to controlled
substances
– review drug regimens
– monitor repackaging and storage of pharmaceuticals
– ensure that medications are uncontaminated and have not expired
– note medication errors and adverse reactions or interactions
– educate residents on drug therapies and self-medication
– provide medications to outpatients or residents on weekend leave
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Institutional Pharmacy
• The pharmacist may play a crucial role in ensuring
regulatory compliance
– a licensed pharmacist must do a monthly check
of each patient profile in a long-term care
facility
• The professional organization for “geriatric”
pharmacists is the American Society of Consultant
Pharmacists (ASCP)
Visit the ASCP Web site
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Institutional Pharmacy
A pharmacy technician in a long-term care facility may:
• log prescriptions and refill orders via computer
• prepare billings
• maintain drug boxes or trays for emergencies
• package and label medications
• deliver medications to the nursing home
• maintain records, retrieve and organize patient charts
• conduct inspections of drugs in inventory and in nursing
stations
• repackage drugs in unit doses labeled for each patient
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Institutional Pharmacy
• In-house pharmacies may provide a 7-day supply of
medication in “blister packs.”
• Community pharmacies fill medication carts or trays
with a 30-day supply of medication
– medication orders rarely change in this environment
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Managed Care
Managed care is a type of health insurance system
that emphasizes keeping the patient healthy of
diseases controlled to reduce healthcare costs.
• A relatively new form of healthcare that has grown
dramatically over the past 35 years
– One of the first managed-care organizations was Kaiser
Permanente
• Another name for managed care is health
maintenance organization (HMO)
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Managed Care
• HMOs encourage patients to take an active role in their own healthcare by:
– eating right
– exercising often
– avoiding negative life-style choices
• HMOs encourage patients to:
– have annual checkups
– get all their immunizations on schedule
– get necessary laboratory (like a cholesterol or sugar test) and diagnostic tests (like a pap smear or mammogram) to detect early diseases, which may be surgically correctible
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Managed Care
• Most HMOs have their own staff physicians who are on
salary
– Patients who need a specialist must first get a referral
• HMOs have been successful in slowing the pace of the
inflationary increases in healthcare without
compromising the quality of care
• Many employers now include an HMO option on their
health plans
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Managed Care
• Most HMOs are centralized primary-care clinics
– they serve patients with pharmacy, x-ray, and
laboratory departments under one roof
• An HMO, like a hospital, usually has an approved
drug list or formulary that has been
recommended by a drug information pharmacist
and approved by the medical staff
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Managed Care
• The formulary plus the use of low-cost generic drugs allows the organization to volume purchase select drugs to lower operational and patient cost
– unlike a community pharmacy, an HMO pharmacy does not stock every brand of drug available
• Many HMO pharmacies have a tiered pricing plan so that patients pay one price for a generic drug, a higher price for a “preferred” brand name drug, and an even higher price for a “nonpreferred” brand name product
– most patients and physicians use the lower-cost alternatives whenever possible
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Managed Care
• After the patient sees the physician, the patient may
go to the HMO pharmacy to fill a prescription
• Patients needing refills may call an automated
telephone number to expedite processing and reduce
waiting times
– this “time savings” also allows the pharmacist to spend
more time reviewing the computerized medication profile
and counseling the patient
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Managed Care
• The pharmacy technician in managed care performs
similar functions to those in the community pharmacy
– although insurance billing and cashiering are minimal
• Clinical pharmacists may work closely with the
primary-care physicians to better control chronic disease
– educating
– monitoring
– adjusting doses of medications per physician-approved
protocols
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Discussion
• What are the similarities between and
among the various institutional pharmacy
environments?
• What are the differences?
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Terms to Remember
Pharmacy Workplace:
Institutional Pharmacy
• institutional pharmacy
• hospital pharmacy
• home healthcare pharmacy
• long-term care facility
• managed care
• health maintenance organization (HMO)
• formulary