Chapter 4 - Community, Ambulatory Care, & Home Care Pharmacy Practice

What is an ambulatory pharmacy?

A pharmacy that serves outpatients and supports clinic-based care through convenient access, coordinated communication, and medication management.

What is the definition of “ambulatory”?

The ability to move about and not be bedridden or a patient’s status as an outpatient.

Which came first: ambulatory pharmacies or community pharmacies?

Community pharmacies

What three buildings are ambulatory pharmacies usually next to?

Clinics, hospitals, or medical centers

Why are ambulatory pharmacies usually next to clinics, hospitals, or medical centers?

They serve outpatients, not inpatients, and are conveniently placed accordingly.

Do ambulatory pharmacies primarily serve prescription drugs or OTC drugs?

Prescription drugs

Is there a limited or nonlimited supply of OTC drugs in an ambulatory pharmacy?

Limited

In the early days of America, what was the role of a pharmacist?

The pharmacist would compound medications based off of a physician’s diagnosis, and they could give patients any drug they made.

What is the Food, Drug, and Cosmetics Act?

A federal law that gives the FDA its authority to regulate the safety, labeling, and quality of food, drugs, medical devices, and cosmetics.

What year did the Food, Drug, and Cosmetics Act go into law?

1938

What 2 key things (noted in the book) did the Food, Drug, and Cosmetics Act do for drugs?

(1) Loosely regulated drugs, requiring premarket approval for new drugs based on safety and prohibited false therapeutic claims for drugs. (2) Allowed drugs to be only prescription but didn’t include specifics.

Why was the Food, Drug, and Cosmetics Act created?

The previous law, the Pure Food and Drug Act of 1906, did not require drugs to be tested for safety before marketing, which then led to the sulfanilamide tragedy of 1937.

What was the sulfanilamide tragedy of 1937?

Sulfanilamide, an antibiotic powder, used to be dissolved in diethylene glycol to make it a liquid, which we now know to be a toxic solvent that causes kidney failure.

What is the Durham-Humphrey Amendment?

An amendment to the Food, Drug, and Cosmetics Act that created the legal distinction between prescription drugs (legend drugs) and over the counter (OTC) drugs.

What year was the Durham-Humphrey Amendment created?

1951

What was another name for prescription that came from the Durham-Humphrey Amendment?

Legend

What does a drug being classified as either a prescription or OTC drug depend on?

The drug’s safety and potential for addiction.

Over time, how did the focus of a pharmacist’s role shift?

From making the drug products to repackaging and dispensing them.

During the shift in pharmacist priority, which healthcare worker was the most likely to discuss information over drugs with a patient?

The doctor

What year range did the pharmacist-patient relationship revert back to discussing medication information?

1960-1970

Why did the pharmacist-patient relationship begin to include discussing medication information once more?

Because of increased adverse reactions from overcrossing drugs.

By what year did pharmacists have a more clinical role in patient care?

1980

What is a pharmacist’s role in pharmaceutical care?

To ensure the patient is receiving proper drug therapy.

What are four examples of third-party payers?

Government employers, government programs like Medicaid, health insurance policies from employers, and private insurance.

What is the Omnibus Budget Reconciliation Act (OBRA)?

A series of several large federal laws passed by Congress to adjust federal spending and revenue so they match goals set in the annual Congressional Budget Resolution.

How many significant OBRA laws were there?

8

What five key areas did the OBRA law of 1981 change?

Social Security and disability (OASDI), Medicare, Medicaid and welfare programs, housing and community development, and education, food assistance, and other social programs.

What five key areas did the OBRA law of 1982 change?

Agriculture and food programs, Medicare and Medicaid, Social Security, veterans’ benefits, and federal retirement and employee benefits.

What four key areas did the OBRA law of 1983 change?

Medicare and Medicaid, Social Security, agriculture and food programs, and federal employee and veterans’ benefits.

What five key areas did the OBRA law of 1986 change?

Medicare and Medicaid, Social Security and federal retirement programs, tax provisions, agriculture and food programs, and veterans’ benefits and federal employee programs.

What six key areas did the OBRA law of 1987 change?

Minimum standards of care, resident Bill of Rights, comprehensive care planning, staffing and training requirements, regulation of restraints, and survey and enforcement system.

What four key areas did the OBRA law of 1989 change?

Creation of the Medicare Fee Schedule (MFS), Resource-Based Relative Value Scale (RBRVS), Volume Performance Standards (VPS), and access and utilization monitoring.

What three key areas did the OBRA law of 1990 change?

Prospective Drug Utilization Review (ProDUR), patient counseling requirements, and maintaining patient medication records.

What two key areas did the OBRA law of 1993 change?

Taxes/revenue and healthcare/Medicaid provisions.

What is prospective drug utilization review (ProDUR)?

Reviewing a patient’s medication profile to identify any potential problems with the prescribed drug.

What are three examples of problems you could run into during a ProDUR?

The appropriateness of the drug and dose for the patient, drug interactions, or drug duplications.

Does OBRA require states to come up with standards for patient counseling?

Yes

What are three examples of standards of patient counseling?

When counseling is to be offered, who may make the offer to counsel, and what types of information should be included during counseling.