RESUMEN
This study attempted to define the characteristics and process components of pharmaceutical care, and to quantify the extent to which they compare in community pharmacists' perception of practice. Published literature and personal interviews were synthesized into a 75-question, cross-sectional, self-evaluated survey that was sent to all in-state members of the Virginia Pharmacists Association. A Community-based Pharmaceutical Care Index (CPCI) was developed to categorize and compare respondents. Individuals with scores greater than 1 standard deviation above (CPCI > or = 72.6, 14%, n = 91) and below (CPCI < or = 44.3, 16%, n = 106) the mean (CPCI = 58.4) were defined as high- and low-CPCI pharmacists, respectively. The response rate for the survey was 58% (972/1672). The high-CPCI pharmacists practiced predominantly in independently owned pharmacies in rural Virginia and appeared to have good rapport with their patients and local physicians. The presence of high-CPCI pharmacists working in chain-owned pharmacies indicated that the setting was not the only factor determining the decision to practice pharmaceutical care. As the prescription volume increased beyond 150/day, the number of high-CPCI pharmacists able to maintain their practice style rapidly declined. The CPCI allows differentiation and comparison of individual pharmacists along the spectrum of patient care.
Asunto(s)
Servicios Comunitarios de Farmacia/normas , Adulto , Servicios Comunitarios de Farmacia/organización & administración , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos , Encuestas y Cuestionarios , VirginiaRESUMEN
Hypersensitivity adverse drug reactions, characterized by fever and multi-organ involvement, are the most severe adverse reactions to sulphonamides. Although there is evidence that these reactions are initiated by metabolic events, these reactions appear to be propagated on an immune basis. We investigated the effect of a sulphonamide reactive metabolite, the hydroxylamine of sulphamethoxazole (SMX H/A), on the ability of T-lymphocytes to respond to stimulation with mitogens. Peripheral blood mononuclear cells (PBMCs) were collected and incubated with SMX H/A in increasing concentrations. PBMCs were then incubated with phytohaemagglutinin (PHA) and phorbol myristate acetate (PMA) or with PHA and ionomycin. T-lymphocyte proliferation was then determined by tritiated thymidine uptake. The hydroxylamine of sulphamethoxazole produced a concentration-dependent decrease in T-lymphocyte proliferation; this decrease was significant even at concentrations of hydroxylamine that were not associated with a decrease in cell viability. PBMCs incubated with SMX H/A that were washed and then added to fresh PBMCs failed to inhibit the proliferation of fresh PBMCs. The hydroxylamine of sulfamethoxazole produces profound suppression of T-lymphocyte proliferation. This suppression appears to be a direct event and does not involve the activation of suppressor cells. These findings may explain the infectious complications contributing to mortality associated with sulphonamide hypersensitivity reactions.