PHARMACY What It Is and How It Works Third Edition WILLIAM N. KELLY CRC Press PHARMACY What It Is and How It Works Third Edition Pharmacy : What It Is and How It Works, Third Edition William N. Kelly Essentials of Law and Ethics for Pharmacy Technicians, Third Edition Kenneth M. Strandberg Essentials of Human Physiology for Pharmacy, Second Edition Laurie Kelly McCorry Pharmaceutical Dosage Forms and Drug Delivery Ram I.
Mahato Basic Pharmacokinetics Mohsen A. Hedaya Basic Pharmacology: Understanding Drug Actions and Reactions Maria A. Hernandez and Appu Rathinavelu Managing Pharmacy Practice: Principles, Strategies, and Systems Andrew M. Peterson Essential Math and Calculations for Pharmacy Technicians Indra K.
Reddy and Mansoor A. Khan Pharmacoethics: A Problem-Based Approach David A. Gettman and Dean Arneson Pharmaceutical Care: Insights from Community Pharmacists William N. Tindall and Marsha K.
Millonig Essentials of Pathophysiology for Pharmacy Martin M. Zdanowicz Quick Reference to Cardiovascular Pharmacotherapy Judy W. Cheng Essentials of Pharmacy Law Douglas J. Pisano Pharmacokinetic Principles of Dosing Adjustments: Understanding the Basics Ronald D.
Schoenwald Pharmaceutical and Clinical Calculations, Second Edition Mansoor A. Khan and Indra K. Reddy Strauss’s Federal Drug Laws and Examination Review, Fifth Edition Revised Steven Strauss Inside Pharmacy: Anatomy of a Profession Raymond A. Gosselin and Jack Robbins Understanding Medical Terms: A Guide for Pharmacy Practice, Second Edition Walter F.
Holt, and Steven Strauss PHARMACY What It Is and How It Works Third Edition WILLIAM N. KELLY Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor and Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U. Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-13: 978-1-4398-5307-8 (Ebook-PDF) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use.
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For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.com and the CRC Press Web site at http://www.com To all the student pharmacists required to read this book: May you learn much and enjoy the profession of pharmacy as much as I. xxxiii About the Author.xxxv Chapter 1 What Is Pharmacy?.1 What Is a Profession?.
2 Study and Training.2 Measure of Success.3 The Business of Pharmacy. 3 A Brief History of Pharmacy. 3 Community Pharmacy in Early America.4 Hospital Pharmacy in Early America.6 What Is the Purpose of Pharmacy?. 8 What Controls Pharmacy?.8 State Pharmacy Laws.8 State Pharmacy Rules and Regulations.9 What Shapes Pharmacy?.9 Scope of Practice.
9 House of Delegates. 10 Standards of Practice. 10 Conference Proceedings and White Papers. 14 The Value of Pharmacy.
16 Discussion Questions and Exercises. 17 Web Sites of Interest. 18 vii viii Contents Chapter 2 The Pharmacist. 21 Who Are Pharmacists?.
21 Education and Training.28 Characteristics of Pharmacists.28 Skills and Traits.28 Character and Virtues. 31 What Pharmacists Do.34 Manager, Supervisor, and Leader. 36 Titles and Career Paths. 36 Expectations of Pharmacists.
36 Supply and Demand for Pharmacists. 37 The Rewards of Being a Pharmacist.40 Lifelong Learning and Career Planning. 42 Discussion Questions and Exercises. 42 Contents ix Challenges.
43 Web Sites of Interest.44 Chapter 3 Pharmacists and the Health Care System. 48 Overview of the Health Care System in the United States. 48 Access to Care. 49 Quality of Care.
52 Private-Sector Funding. 52 Public-Sector Funding. 55 Affordable Health Care Act. 55 The Delivery of Care.
56 Patient-Centered Care. 56 The Health Care Team. 57 The Place of Drugs in the Health Care System. 58 The Role of Pharmacists in the U.
Health Care System. 59 Societal Purpose of Pharmacy.60 Accountable Care Organizations and the Medical Home. 61 Discussion Questions and Exercises. 61 Web Sites of Interest.
62 Chapter 4 The Drug Use Process. 65 What Is the Drug Use Process?. 65 Part I—Drug Products and Distribution.66 Distribution of Drugs from Pharmaceutical Manufacturers. 68 Distribution from Drug Wholesalers.
68 Distribution from Distribution Centers and Repackagers. 69 x Contents Self-Care and the Role of OTC Medication. 70 Over-the-Counter Medication. 70 Complementary and Alternative Medications.
72 Tips for Consumers. 73 Parts of a Prescription. 73 Types of Prescriptions. 75 Writing the Prescription.
76 Types of Retail Pharmacies. 76 Independent Community Pharmacies. 77 Chain Store Pharmacies. 77 Mass Merchandiser Pharmacies.
77 Food Store Pharmacies. 77 Mail-Order Pharmacies. 77 Outpatient Pharmacies in Hospitals. 78 The Dispensing Process.
78 Drug Distribution in Organized Health Care Settings. 79 Drugs Are Big Business. 79 Why Costs for Drug Prescriptions Are Rising.80 Part II—Medication Use. 81 Medication Use in the United States.-Made Drugs in Other Countries.
83 Buyers and Sellers of Prescription Drugs.84 Third-Party Contracts. 85 Gross Margin, Reimbursement, and Making a Profit. 86 Contents xi Projecting Drug Costs. 88 Part III—Patients.
88 Economic Value of Pharmaceuticals. 88 Compliance with Taking the Medication as Prescribed.90 Quality Drug Therapy. 91 How Drug Therapy Is Monitored and Reviewed. 93 Adverse Drug Reactions.
93 Allergic Drug Reactions.94 Drug–Drug Interactions.94 Control of the Drug Use Process.94 Current Issues in the Drug Use Process. 95 Nutriceuticals and Herbal Medicines. 95 Direct-to-Consumer Advertising of Prescription-Only Drugs. 95 Importing of Drugs from Other Countries.
95 Rising Number of Prescriptions and Not Enough Pharmacists.96 Discussion Questions and Exercises.97 Web Sites of Interest.97 Chapter 5 Pharmacy Supportive Personnel. 101 The Pharmacy Technician. 102 Why Pharmacy Technicians Are Important. 102 What Pharmacy Technicians Do.
103 Functions of Pharmacy Supportive Personnel. 103 What Pharmacy Technicians Need to Know. 105 How Pharmacy Supportive Personnel Are Trained. 105 xii Contents Technician Certification and Competency.
108 Pharmacy Technician Organizations. 108 Supervision of Pharmacy Technicians. 109 Being a Professional Pharmacy Technician. 111 Advancement and Expanded Roles.
112 White Paper on Needed Changes. 112 Discussion Questions and Exercises. 113 Web Sites of Interest. 114 Additional Pharmacy Technician Texts and Resources.
114 Chapter 6 Pharmacy Informatics. 117 Information Technology, Automation, and Informatics. 118 Improved Patient Care. 119 Improved Documentation of Care.
119 Pharmacy Informatics in the Drug Use Process. 120 Computerized Prescriber Order Entry. 124 Benefits of Pharmacy Automation. 124 Challenges of Pharmacy Automation.
125 Selecting Pharmacy Automation. 126 Contents xiii The Market for Pharmacy Automation. 126 Types of Pharmacy Automation. 127 Safety of Automated Devices.
128 Automating the Pharmacy. 129 Freeing Pharmacists for Pharmaceutical Care. 130 Discussion Questions and Exercises. 131 Web Sites of Interest.
131 Blog Sites of Interest. 133 Chapter 7 Pharmaceutical Care. 137 Theory of Practice. 137 A Brief History of Pharmacy Practice in the United States.
138 Drug Dispensing and Distribution. 139 From Clinical Pharmacy to Pharmaceutical Care. 140 What Is Pharmaceutical Care?. 141 Elements of Pharmaceutical Care.
141 Responsible Provision of Care. 141 Direct Provision of Care. 143 Achieving Positive Outcomes. 143 Improving the Patient’s Quality of Life.
144 Resolution of Medication-Related Problems. 144 Pharmaceutical Care versus Clinical Pharmacy. 146 Learning about Pharmaceutical Care. 146 Providing Pharmaceutical Care.
149 Selecting Patients to Monitor. 150 Identifying, Resolving, and Preventing Medication-Related Problems. 150 Identifying Medication-Related Problems. 150 xiv Contents Resolving Medication-Related Problems.
150 Preventing Medication-Related Problems. 151 Patient Problem List. 151 Pharmaceutical Care Plan. 152 Making Cents of Pharmaceutical Care.
153 Why Perform Pharmaceutical Care?. 154 Problems in the Drug Use Process. 155 Drug-Related Morbidity and Mortality. 155 Pharmaceutical Care Works.
156 Patients Are Spared Medication-Related Morbidity and Mortality. 156 Pharmaceutical Care Is Cost-Effective. 157 Patients Love Pharmaceutical Care. 157 Other Health Care Practitioners Love Pharmaceutical Care.
157 Pharmacy May Become a True and Recognized Clinical Profession. 157 When Will All Pharmacists Practice Pharmaceutical Care?. 158 Barriers and Challenges. 158 The Enemy Within.
158 Resource-Related Constraints. 158 Lack of Support. 159 Studies Documenting the Value of Pharmaceutical Care. 159 Lack of Payment.
159 Enablers to Pharmaceutical Care. 160 Changes in Pharmacy Education. 160 Certified Pharmacy Technicians. 160 Function Analysis and Workflow Redesign.
160 Collaborative Practice Agreements. 160 Pharmacy Automation and Information Technology. 161 Health Care Reform. 161 Implementing Pharmaceutical Care.
161 Changes the Profession Needs to Make Happen. 161 Freeing Pharmacist’s Time to Provide Pharmaceutical Care.161 Leadership and Teamwork in Implementing Pharmaceutical Care. 162 Pharmaceutical Care in the Community and Hospital Environments. 162 Documenting Pharmaceutical Care.
162 Progress in Establishing Pharmaceutical Care. 164 Contents xv Discussion Questions and Exercises. 165 Web Sites of Interest. 165 Chapter 8 Ambulatory (Community) Pharmacy.
169 Types of Community Pharmacies. 170 Chain Store Pharmacies. 172 Mass Merchandiser Pharmacies. 172 Mail-Order Pharmacies.
173 Patient Service and Satisfaction. 174 Extent and Growth. 174 Some Bright Spots. 177 Dispensing Procedures to Advance Pharmaceutical Care.
177 Accept the Prescription and Establish the Pharmacist–Patient Relationship. 177 Review the Prescription and Patient Information. 178 Data Entry and Review of the Patient’s Medication Profile. 178 Review of Insurance Coverage.
178 Retrieve the Drug or Ingredients from Storage. 179 Preparation or Compounding. 179 Label the Prescription. 180 Check for Proper Dispensing.
181 Drug Use Review and Dispensing. 181 Medication Delivery and Patient Counseling. 181 Whose Job Is It?. 183 Avoiding Errors in the Dispensing Process.
183 Dangerous Medication Errors. 183 Reasons for Medication Errors. 184 Errors versus Mistakes. 184 Not Enough Help.
185 Community Pharmacy Services. 186 xvi Contents Prescription Services. 186 Over-the-Counter Drugs. 187 Types of New Services.
187 Are Patients Using These New Pharmacy Services?. 188 Examples of How New Services Are Offered. 188 Payment for Community Pharmacy Care. 188 Mail-Order Pharmacies.
189 Community Pharmacist Satisfaction. 190 Positions for Pharmacists in Community Pharmacy. 190 Community Pharmacy Residents. 191 Store-Level and District Managers.
191 Future of Community Pharmacy Practice. 192 Implementing Change in Community Pharmacy Practice. 192 Discussion Questions and Exercises. 193 Web Sites of Interest.
194 Chapter 9 Health System Pharmacy.200 How Hospitals Started.200 Types of Hospitals.202 Medical Staff Structure. 203 Health Care Team.204 Mission of Pharmacy.204 Control of Drugs.204 Contents xvii Overseeing the Drug Use Process.205 Ensuring Rational Drug Use. 210 Clinical Pharmacy versus Pharmaceutical Care. 212 Focusing on Patients Needing the Most Help.
212 Avoiding Medication Misadventures. 214 Education and Training. 216 Staff Pharmacists and Clinical Pharmacists. 216 Pharmacy Supportive Personnel.
218 Checking on Progress. 219 Discussion Questions and Exercises. 219 Web Sites of Interest. 220 Chapter 10 Managed Care Pharmacy.
223 What Is Managed Care?.224 Health Maintenance Organizations. 226 Preferred Provider Organizations. 228 Point-of-Service Plans. 229 Impact of Managed Care.
229 Good Things/Bad Things. 229 Criticisms of Managed Care. 230 Pharmacy Benefits Managers. 231 Impact of Managed Care on Pharmacy.
232 Impact on Community Pharmacy. 232 Impact on Pharmacy in Organized Health Care Settings. 232 Pharmacy and Therapeutics Committee and the MCO Formulary. 233 Medication Therapy Management.
234 xviii Contents Quality Assessment and Assurance. 235 Developing Measurement Criteria. 235 Monitoring Drug Use.