ing),10 or that use bottle-filling machines; others are experimenting with decentralized systems that rely on prefilled bottles and manufacturer-packaged items (Cohen, 2000).

Patient counseling in a pharmacy provides an opportunity for the pharmacist to inform the patient about his/her medications, encourage medication adherence, and answer any questions the patient may have. In the OBRA of 1990 (P.L. 101-508), Congress required that pharmacists counsel Medicaid patients. Since then, boards of pharmacy in most states have come to require some type of counseling for all patients (NABP, 2004). For many reasons (e.g., low patient demand, lack of cost-effectiveness data, time constraints, lack of reimbursement), however, pharmacies often offer counseling only as requested by a consumer. A study of 100 prescription orders dispensed in 1994 in community pharmacies in New Jersey, New York, and Florida found that oral counseling had been provided to 64 patients, covering on average 3 of the 14 categories11 (i.e., dosage, frequency of administration, drug or food interactions) of drug information required by OBRA 1990 (Allan et al., 1995). Similar results were observed in a more recent, larger eight-state study. In this study, about two-thirds of consumers had been given oral information—on average 2.3 items from a 5-item list (Svarstad et al., 2004). The study also found that higher levels of pharmacist counseling were associated with younger pharmacists, less busy pharmacies, and more demanding state regulations. In terms of mail order pharmacies, counseling is generally available as requested by telephone.

Dispensing errors account for an estimated 6–12 percent of all medication errors (Buchanan et al., 1991; Allan et al., 1995; Flynn et al., 2003). Research suggests that the main causes of such errors are issues concerning workload and staffing, distractions during processing, suboptimal packaging and labeling, poorly designed work areas, and outdated or incorrect drug reference information (Cohen, 2000; Phillips et al., 2001). A review of the literature reveals that:

  • Failure to double-check orders, medication, and labels is a common cause of dispensing errors.

10

With strip and envelope packaging, instead of a 30-day bottled prescription containing 30 tablets (1 per day), a 30-pack “compliance strip” contains 1 pill per pack. Each pack contains the patient’s name, the drug and its dose, and the date and time it is to be administered.

11

The 14 categories for pharmacy counseling established by the Omnibus Budget Reconciliation Act of 1990 are drug name; use of medication; dosage (how much); route of administration; frequency of administration; duration of therapy; special directions, procedures for administration; side effects; drug or food interactions; disease state effects; storage; refills; directions if dose missed; and self-monitoring techniques (Allan et al., 1995).



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