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National survey of community pharmacies examines workload, available technology, and perceptions of drug alert systems

Community pharmacists are often expected to provide innovative patient care services and optimize complex therapeutic regimens. At the same time, community pharmacies are facing a 35 percent larger prescription volume. Researchers at the Arizona Center for Education and Research on Therapeutics recently surveyed pharmacy managers at 736 chain and independent metropolitan community pharmacies. The 34-item survey collected data about each pharmacy, including demographics, workload issues, available technology, and perception of computerized drug-drug interaction (DDI) alerts. Two survey-related studies were supported by the Agency for Healthcare Research and Quality (HS10385) and are summarized here.

Skrepnek, G.H., Armstrong, E.P., Malone, D.C., and others (2006, March). "Workload and availability of technology in metropolitan community pharmacies." Journal of the American Pharmacists Association 46(2), pp. 154-160.

The pharmacists surveyed reported an average volume of 1,340 prescriptions per week processed at a rate of nearly 17 prescriptions per hour. Independent pharmacies processed about 3 prescriptions per hour more than chain pharmacies, even though a similar or slightly lower proportion of independent pharmacies had automated technologies and chain pharmacies were open significantly more hours per week. On average, community pharmacies operated 80 hours per week. Staffing consisted of 96.4 hours for pharmacists, 10.5 hours for pharmacy interns, and 110.5 hours for technicians per week; other personnel were employed for 28.3 hours per week.

Over 85 percent of pharmacies possessed at least one type of technology, with the most predominant type being the countertop tablet/capsule-counting device (62 percent of pharmacies). Pharmacies that processed more than 1,700 prescriptions per week were significantly more likely to report having Baker cells or similar counting/filling devices, computerized control of an automated filling device, and bar code scanners for medication verification/identification. Nearly half of all chain pharmacies had two or more devices available (49 percent) compared with only 15 percent of independent pharmacies.

Overall, 85 percent of pharmacies could accept new prescriptions by fax machine. Only 20 percent of independent pharmacies had automated telephone systems for either new or refill prescriptions compared with the 71 percent (new prescriptions) and 96 percent (refill prescriptions) of chain pharmacies. Also, 16 percent of independent pharmacies had Internet capability for refill prescriptions compared with 75 percent of chain pharmacies. All 24-hour pharmacies could accept refill prescriptions via the Internet or an automated telephone system. Overall, a mean of 3.5 computer terminals were present in each pharmacy (with more at chain pharmacies), equating to almost 400 prescriptions processed per terminal per week.

Abarca, J., Malone, D.C., Skrepnek, G.H., and others (2006, March). "Community pharmacy managers' perception of computerized drug-drug interaction alerts." Journal of the American Pharmacists Association 46, pp. 148-153.

As a result of new drugs entering the market, the number of known drug-drug interactions (DDIs) is increasing. About 55 percent of community pharmacists surveyed in this study believed that more than 70 percent of the computerized DDI alerts encountered in the previous week were clinically insignificant. Despite this, community pharmacists did not consider DDI alerts to be meaningless or a waste of time. On the other hand, they were not completely convinced that their computer systems provided meaningful DDI alerts or provided these alerts in a user-friendly format that allowed them to distinguish between important and unimportant drug interactions.

Community pharmacy managers who could customize DDI alerts on their computer system and whose system provided detailed DDI information (for example, mechanisms of drug interaction and alternative medications) were more likely to express confidence in the pharmacy's computer system to provide meaningful alerts. They were also more likely to agree that DDI alerts were easily differentiated from other types of alerts and less likely to agree that DDI alerts were a waste of time.

Yet half of pharmacists surveyed stated that their computer software did not allow customization of DDI alerts. Another 20 percent did not know whether this option was available on their computer system. Little more than half (56 percent) stated that their pharmacy software provided detailed information about DDIs.

Incorporating features that streamline DDI alerts may improve the ability of pharmacists to detect and appropriately manage potentially life-threatening DDIs, suggest the researchers. They caution that desensitization of pharmacists as a result of being bombarded with mostly unimportant alerts remains a concern.

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