Monitoring Chronic Outpatient Infections: Providing Comprehensive Home Healthcare Pharmacy Services

Abstract

Spanish

Management of acute illness has been increasingly shifted to community practitioners. Expansion of community pharmacy into home healthcare has brought new opportunities and responsibilities to community practitioners. These practitioners are gaining expertise in total parenteral nutrition, intravenous infusion systems, intravenous catheters, parenteral antibiotics, and clinical pharmacokinetics—areas historically managed by hospital and long-term care facility pharmacists. This shift to community pharmacy-based care has brought with it the need for community pharmacists to develop expertise in therapeutic monitoring of chronic disease states. Dose adjustment of medications based upon careful analysis of blood concentrations is no longer limited to institutional pharmacy practice. Community pharmacists now must master basic infectious disease principles and possess internal medicine knowledge to ensure appropriate monitoring of their patients. This article discusses several disease states currently managed with community pharmacy-based home healthcare, summarizing basic monitoring parameters for comprehensive patient care, and provides sample supply lists and documentation forms for home healthcare providers.

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References

Iannini

. DRGs and outpatient antibiotics. Infect Control 1986; 7: 289–90.

Brown

. Community-acquired bronchitis and pneumonia: Presentation, pathogens, and therapy. Postgrad Med 1986; 79: 241–50.

Koecheler

Abramowitz

Swim

Daniels

. Indicators for the selection of ambulatory patients who warrant pharmacist monitoring. Am J Hosp Pharm 1989; 46: 729–32.

Penington

. Treating respiratory infections in the era of cost control. Am Fam Physician 1986; 33: 153–60.

Briceland

Nightingale

Quintiliani

Cooper

Smith

. Antibiotic streamlining from combination therapy to monotherapy utilizing an interdisciplinary approach. Arch Intern Med 1988; 148: 2019–22.

Moleski

Andriole

. Role of the infectious disease specialist in containing costs of antibiotics in the hospital. Rev Infect Dis 1986; 8: 488–93.

Fels

. Bacterial and fungal pneumonias. Clin Chest Med 1988; 9: 449–57.

Curtiss

. Recent developments in federal reimbursement for home health care services and products. Am J Hosp Pharm 1988; 45: 1682–90.

Chase

Trenholme

. Overwhelming pneumonia. Med Clin North Am 1986; 70: 945–60.

10.

Kearns

Hilman

Wilson

. Dosing implications of altered gentamicin disposition in patients with cystic fibrosis. J Pediatr 1982; 100: 312–8.

11.

Lesar

Rotschafer

Strand

Solem

Zaske

. Gentamicin dosing errors with four commonly used nomograms. JAMA 1982; 248: 1190–3.

12.

Shikuma

Ackerman

Weaver

, Effects of treatment and metabolic response to injury on drug clearance: A prospective study with piperacillin. Crit Care Med 1990; 18: 37–41.

13.

Schlenkhoff

Dalhoff

Knopf

Opferkuch

. Penetration of ciprofloxacin into human lung tissue following intravenous injection. Infection 1986; 14: 299–300.

14.

Sorenson

Cederholm

Carlsson

. Pneumonia: A deadly disease despite intensive care treatment. Scand J Infect Dis 1986; 18: 329–35.

15.

Penington

. Nosocomial respiratory infection. In: Mandell

Douglas

Jr Bennett

, eds. Principles and practice of infectious diseases. New York: Churchill Livingstone, 1990: 2200–4.

16.

Macone

Pier

Penington

Matthews

Goldmann

. Mucoid Escherichia coli in cystic fibrosis. N Engl J Med 1981; 304: 1445–9.

17.

Bergogne-Berezin

. Pharmacokinetics of antibiotics in cystic fibrosis patients with particular reference to the bronchopulmonary tree. Infection 1987; 15: 288–94.

18.

Sheagren

. Staphylococcus aureus: The persistent pathogen (in two parts). N Engl J Med 1984; 310: 1368–73, 1437–42.

19.

Couch

Cierney

Mader

. Inpatient and outpatient use of the Hickman catheter for adults with osteomyelitis. Clin Orthop 1987; 219: 226–35.

20.

Prober

. Oral antibiotic therapy for bone and joint infections. Pediatr Infect Dis 1982; 1: 8–10.

21.

Norden

. Osteomyelitis. In: Mandell

Douglas

Jr Bennett

, eds. Principles and practice of infectious diseases. New York: Churchill Livingstone, 1990: 922–30.

22.

Armstrong

. Bone and joint infections. In: DiPiro

Talbert

Hayes

Yee

Posey

, eds. Pharmacotherapy: A pathophysiologic approach. New York: Elsevier, 1989: 1247–57.

23.

Eisenberg

Kitz

. Savings from outpatient antibiotic therapy for osteomyelitis: Economic analysis of a therapeutic strategy. JAMA 1986; 255: 1584–8.

24.

Fleming

. General principles of the treatment of infective endocarditis. J Antimicrob Chemother 1987; 20 (suppl A): 143–5.

25.

Sokolow

. Heart and great vessels. In: Krupp

Chatton

Tierney

Jr , eds. Current medical diagnosis and treatment. Los Altos, CA: Lange Medical Publications, 1986: 182–273.

26.

Smith

Eng

RHK

Tecson-Tumang

. Ciprofloxacin therapy for methicillin-resistant Staphylococcus aureus infections or colonizations. Antimicrob Agents Chemother 1989; 33: 181–4.

27.

Greenwood

. Antibiotic resistance in Enterococci. J Antimicrob Chemother 1989; 24: 631–5.

28.

Bamberger

Daus

Gerding

. Osteomyelitis in the feet of diabetic patients. Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy. Am J Med 1987; 83: 653–60.