Research in Social and Administrative Pharmacy - Articles in Press

Medicare part D information seeking: The role of recognition of need and patient activation - Corrected Proof

2012-02-02

Abstract: Background: In 2006, Medicare beneficiaries had the opportunity to choose from multiple newly available Medicare prescription drug plans (PDPs). Many beneficiaries reported difficulty in finding helpful information, whereas others reported they never looked for information.Objectives: This study examines antecedents of beneficiary information-seeking behaviors when learning about Medicare part D and choosing a PDP by using the Wilson Model of Information Behavior as a conceptual framework.Methods: A cross-sectional analysis of 7008 Medicare beneficiaries from the 2004 to 2005 Medicare Current Beneficiary Surveys was used to predict whether a beneficiary sought Medicare part D information and the number of information sources used among those who sought information. A negative binomial hurdle model was used to estimate the determinants of these outcomes. Particular attention was given to the roles of information need and patient activation in predicting the outcomes.Results: The results show that beneficiaries stating a need for information were more likely to seek information (odds ratio [OR]=2.02) and use multiple information sources (incidence rate ratio [IRR]=1.13). Beneficiaries with low patient activation were less likely to seek information (OR=0.97) and use multiple information sources (IRR=0.98).Conclusions: Information need and patient activation are antecedents of both the decision to seek Medicare part D information and how beneficiaries seek information. Interventions aimed at improving Medicare part D-related information seeking and decision making should focus on helping beneficiaries identify their need for information accurately and increasing their level of activation.

Healthy children’s identification and risk perception of medicines in England - Corrected Proof

Ben Whately, Sian E. Williams, Paul R. Gard, Angela B. MacAdam — 2012-01-20

Abstract: Background: Children’s understanding of medicines has an impact on their behavior toward those medicines, and yet there has been a paucity of studies exploring this area.Objectives: To assess children’s ability to identify and to explore their risk perceptions of medicines.Methods: One hundred eighty-two children aged 4 to 11 years at 2 primary schools in England completed a worksheet containing photos of foods and pharmaceutical products. Children were asked to identify what the picture showed and classify it as “good for them,” “bad for them,” or “sometimes good/sometimes bad for them.” Responses were marked as correct if they identified an item without the need for exact identification. Where an item was correctly identified, risk perception was analyzed.Results: Children correctly identified 5 of the 7 pictures as a form of medicine (mean=5.10, standard deviation=1.51), and identification was positively correlated with age (ρ=0.59, P<.001). A greater percentage of children correctly identified bicolored capsules (86.3% correct, 95% confidence interval [CI]=81.3-91.3) as medicines than either white (71.4% correct, 95% CI=64.9-78) or pink tablets (33.5% correct, 95% CI=26.7-40.4). There was a significant shift with age in the perceptions of the children as they changed from reporting that medicines were good for them to reporting that they were sometimes good and sometimes bad for them. This held for all medicines (χ2 tests, P<.05) except for the cream and the inhaler.Conclusions: As children get older, they become better at identifying medicines, and they become more likely to see their potential risks.

Analysis of pharmacists’ interventions on electronic versus traditional prescriptions in 2 community pharmacies - Corrected Proof

2012-01-20

Abstract: Background: Relatively little is known about how e-prescribing impacts outpatient prescribing errors. Comparing these data with problems identified with other prescription conveyance methods will help researchers identify system problems and offer solutions.Objectives: The objectives of this study were to (1) measure the incidence of prescription problems that required pharmacist intervention, (2) determine the types and relative frequencies of prescription conveyance that contain problems that require pharmacist intervention, and (3) estimate the pharmacy personnel time and related practice expenses for prescriptions requiring intervention.Methods: This study used an observational prospective design examining data from 2 community chain grocery store pharmacies. The primary outcome was number of interventions for each prescription conveyance type. Variables of interest included (1) the type of medication(s) involved in the intervention, (2) how the pharmacist was alerted to the potential problem, (3) reason for the intervention, (4) pharmacists’ actions based on the intervention, (5) time spent during the resolution of the intervention, and (6) costs based on pharmacy personnel time. Chi-square analysis with a Bonferroni correction was used to compare percentage intervention rates between prescription conveyances. E-prescribing was used as the reference group to compare across interventions. A Kruskal-Wallis rank test was used to compare the time on task values for the interventions.Results: Pharmacists reviewed 1678 new prescriptions and intervened on 153 (9.1%) during 13 days of data collection. A total of 11 hours and 58 minutes were required to perform all interventions for an overall average of 4.9 (standard deviation=0.34) minutes per intervention. The most common reasons for pharmacists’ intervention on e-prescriptions were excessive quantity/duration (18.2%) and violating legal requirements (18.2%). The percentages of interventions were significantly different between e-prescribing (11.7%) and both faxed (3.9%) and verbal (5.1%) orders (P<.0001 and P<.01, respectively), with faxed and verbal interventions occurring less frequently. The difference in the intervention rates between e-prescribing (11.7%) and handwritten (15.4%) prescription conveyances were not statistically significant.Conclusion: When comparing e-prescribing with handwritten prescriptions requiring interventions, no significant differences existed. Results suggest that pharmacists must intervene on e-prescriptions as at the same rate as handwritten prescriptions.

Exploring patient experiences with prescription medicines to identify unmet patient needs: Implications for research and practice - Corrected Proof

2012-01-06

Abstract: Background: Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients’ unmet needs when taking prescribed medications.Objective: To identify and characterize patients’ unmet needs related to using prescribed medication for chronic conditions.Methods: Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis.Results: Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved.Conclusion: The results were consistent with Dowell’s therapeutic alliance model (TAM) and Leventhal’s common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients’ desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients’ perceptions of illness and desired coping strategies.

Characterizing healthcare quality in the community pharmacy setting: Insights from a focus group study - Corrected Proof

Devina Halsall, Peter R. Noyce, Darren M. Ashcroft — 2012-01-06

Abstract: Background: There is currently no common frame of reference defining community pharmacy quality. It can therefore be difficult to know whether the provision of care meets minimum standards and how to improve quality of care.Objective: The aim of this research was to develop a conceptual framework characterizing healthcare quality in the community pharmacy setting.Methods: Ten focus group discussions with 47 participants were conducted across the northwest of England, United Kingdom. All participants had experiences of health care provided by community pharmacies and included patients and their carers, pharmacists and pharmacy staff, and National Health Service staff who commissioned pharmacy services. Constant comparative analysis was used to analyze the verbatim transcripts.Results: Community pharmacy quality can be conceptualized as dynamic with 3 interdependent dimensions. Each dimension was associated with structures, processes, and outcomes. The first dimension (accessibility) emphasized that in addition to patients requiring access to the available services, medicines, and health care advice, it was equally important for pharmacy personnel to have access to adequate structures to provide quality health care. The second dimension (effectiveness) highlighted a shift away from simply supplying medicines to supplying medicines appropriately, from passively providing services and information to individualizing advice to achieve intended outcomes, and from having structures available to using them purposefully to achieve outcomes. The third dimension (positive perceptions of the experience) enabled patients and carers to better care for themselves and for others, and it influenced future access. At the same time, when pharmacy personnel believed themselves to be valued and that they had done a good job, they felt motivated to continue to provide high-quality care.Conclusions: All 3 dimensions should be considered when the term quality is used in the context of community pharmacy. This research can be used as a springboard for similar studies in other sectors or jurisdictions wishing to characterize quality for their health care services. In particular, this research provides a common frame of reference for those interested in the provision and assessment of quality health care from community pharmacies.

Pharmaceutical care in hypertensive patients: A systematic literature review - Corrected Proof

2012-01-06

Abstract: Background: Since the conception of pharmaceutical care in 1990, many studies have been published purported to implement and/or evaluate interventions under this aegis; however, most have been criticized in methodological approach. As such, there is a need to assess the scientific rigor of the published studies and examine the biases that may compromise the hardiness of their findings.Objectives: The aim of this review is to describe and appraise published research on the management of patients diagnosed with essential hypertension under the guise of pharmaceutical care.Methods: MEDLINE, EMBASE, Scopus, and LILACS databases from January 1990 to July 2011 were searched using the keywords “pharmaceutical care,” “hypertension,” and “blood pressure.” Included were clinical trials assessing the impact of pharmaceutical care on outcomes for hypertensive patients. Two independent reviewers abstracted data on descriptive characteristics, research design and outcomes, and study limitations.Results: The literature search identified 917 articles, of which 16 satisfied the inclusion criteria. The studies were conducted primarily in North America (8) and in ambulatory settings (9). Sample sizes ranged from 24 to 235 patients, with most studies reporting a 6-month patient follow-up period. Many studies (9) were randomized clinical trials but generally had a low-quality methods score according to the Jadad scale. Blood pressure (BP) (15), medication adherence (11), and quality of life (9) were the most common outcome measures. As expected, systolic BP was the outcome most positively impacted by the pharmaceutical intervention.Conclusions: This database search revealed that most of the included studies evaluated the impact of pharmaceutical care on clinical and humanistic outcomes and few studies showed statistically significant improvement in BP. However, a lack of hardiness and many important limitations were common in the studies analyzed. As such, recommendations are made to improve in research design and to demonstrate the effectiveness of the intervention.

U.S. publication trends in social and administrative pharmacy: Implications for promotion and tenure - Corrected Proof

Anne Kangethe, Duska M. Franic, Ming-Yi Huang, Sally Huston, Chakita Williams — 2012-01-06

Abstract: Background: There is no consensus on the preferred approach to assess journal quality. Procedures previously used include journal acceptance or rejection policies, impact factors, number of subscribers, citation counts, whether the articles were refereed or not, and journals cited in books within the discipline. This study built on the work of previous authors by using a novel approach to assess journal quality in social and administrative pharmacy (SAdP).Objectives: To determine U.S. SAdP faculty perceptions of prestigious journals for their research, SAdP faculty perceptions of prestigious journals by their promotion and tenure (P&T) committees, and current research trends in SAdP.Methods: A census of U.S. colleges and schools of pharmacy was conducted using an e-mailed survey and an open-ended approach requiring respondents to list their preferred journals.Results: Seventy-nine SAdP faculty reported that the 5 most prestigious journals were JAMA, New England Journal of Medicine, Health Affairs, Health Services Research, and Medical Care. These journals were selected because respondents wished to seek broad readership.Conclusions: Results of this study can be used as a guide by U.S. SAdP faculty and P&T committees to assess the quality of publications by pharmacy administration faculty with the caveat being that pharmacy versus nonpharmacy journals will be chosen based on the fit of the article with the audience.

Development and initial validation of the Pharmacist Frequency of Interprofessional Collaboration Instrument (FICI-P) in primary care - Corrected Proof

Connie Van, Daniel Costa, Bernadette Mitchell, Penny Abbott, Ines Krass — 2012-01-06

Abstract: Background: Existing validated measures of pharmacist-physician collaboration focus on measuring attitudes toward collaboration and do not measure frequency of collaborative interactions.Objective: To develop and validate an instrument to measure the frequency of collaboration between pharmacists and general practitioners (GPs) from the pharmacist’s perspective.Methods: An 11-item Pharmacist Frequency of Interprofessional Collaboration Instrument (FICI-P) was developed and administered to 586 pharmacists in 8 divisions of general practice in New South Wales, Australia. The initial items were informed by a review of the literature in addition to interviews of pharmacists and GPs. Items were subjected to principal component and Rasch analyses to determine each item’s and the overall measure’s psychometric properties and for any needed refinements.Results: Two hundred and twenty four (38%) of pharmacist surveys were completed and returned. Principal component analysis suggested removal of 1 item for a final 1-factor solution. The refined 10-item FICI-P demonstrated internal consistency reliability at Cronbach’s alpha=0.90. After collapsing the original 5-point response scale to a 4-point response scale, the refined FICI-P demonstrated fit to the Rasch model. Criterion validity of the FICI-P was supported by the correlation of FICI-P scores with scores on a previously validated Physician-Pharmacist Collaboration Instrument. Validity was also supported by predicted differences in FICI-P scores between subgroups of respondents stratified on age, colocation with GPs, and interactions during the intern-training period.Conclusion: The refined 10-item FICI-P was shown to have good internal consistency, criterion validity, and fit to the Rasch model. The creation of such a tool may allow for the measure of impact in the evaluation of interventions designed to improve interprofessional collaboration between GPs and pharmacists.

Medication supply and management in rural Queensland: Views of key informants in health service provision - Corrected Proof

Amy Chen Wee Tan, Lynne Emmerton, Laetitia Hattingh, Victoria Jarvis — 2012-01-06

Abstract: Background: Rural settings challenge health care providers to provide optimal medication services in a manner that is timely and of high quality. Extending the roles of rural health care providers is often necessary to improve access to medication services; however, there appears to be a lack of pharmacy-based involvement and support within the medication system.Objectives: This article explores medication supply and management issues in rural settings, based on the governance perspectives of key informants on regulatory aspects, policy, and professional practice. The specific objectives were to (1) identify the key issues and existing facilitators and (2) explore the potential roles of pharmacy to improve medication supply and management services.Methods: Semi-structured interviews were conducted with representatives within regulatory or professional organizations. The participants were key informants who held leadership and/or managerial roles within their respective organizations and were recruited to provide insights from a governance perspective before data collection in the community. An interview guide, informed by the literature, assisted the flow of interviews, exploring topics, such as key issues, existing initiatives, and potential pharmacy-based facilitators, in relation to medication supply and management in rural settings.Results: Issues identified that hindered the provision of optimal medication supply and management services in the rural areas centered on workforce, interprofessional communication, role structures, and funding opportunities. Legislative and electronic developments and support mechanisms aim to facilitate medication processes in rural areas. Potential initiatives to further enhance medication services and processes could explore extended roles for pharmacists and pharmacy support staff, as well as alternative service delivery models to enhance pharmacy workforce capacity.Conclusions: The study provided an overview of key issues with medication supply and management and highlighted the potential for increased pharmacy involvement to improve and support medication services in rural areas. The governance views of these key informants could be used to inform policy and practice related to rural medication services.

Awareness and knowledge of autism among pharmacists - Corrected Proof

Rahul Khanna, Krutika Jariwala — 2012-01-06

Abstract: Background: In the past few decades, the prevalence of autism has increased tremendously in the United States. The prevalence of autism is now higher than the combined prevalence of juvenile diabetes, pediatric cancer, and pediatric AIDS. As health care professionals with a high visibility in a community, pharmacists are likely to encounter more and more families having a child affected by this disorder.Objectives: The purpose of this study was to assess pharmacists’ awareness and knowledge of autism. The study aimed to assess pharmacists’ familiarity with autism symptoms, treatment medications, and community resources devoted to this disorder. Further, pharmacists’ knowledge of common myths associated with autism, etiology, prognosis, and treatment were assessed.Methods: Using a cross-sectional design, an online survey of pharmacists registered in the state of Mississippi (MS) was conducted, using the Qualtrics software program. Descriptive analysis of study items was conducted.Results: A total of 147 usable responses (5.8%) were received. The results indicated gaps in pharmacists’ awareness and knowledge of autism. Approximately, 23% of pharmacists did not know that autism is a developmental disorder, and 32% did not believe that genetics has a major role in autism etiology. More than 18% believed that vaccines can cause autism. Most (>90%) felt that they could benefit from autism continuing education (CE).Conclusion: Policy makers and autism agencies should consider providing educational interventions or CE programs to increase pharmacists’ awareness and knowledge of autism.

Impact of a drug-drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: A 1-year follow-up - Corrected Proof

2012-01-06

Abstract: Background: There have been many interventions aimed at improving retention of drug-drug interaction (DDI) knowledge of health care professionals. Much less is known about their retention of such knowledge for extended periods of time after an educational intervention.Objectives: To evaluate pharmacy and medical students’ knowledge retention and attitudes 1 year after participating in an educational session on DDIs.Methods: This study used a pre-post design with an assessment of DDI knowledge and attitude by pharmacy and medical students before and after the final didactic year of their professional education. The intervention was a 1-hour program.Results: A total of 74 of 193 students (38%) completed the pre, post, and final questionnaire. The median numbers of correctly identified DDIs before the program were 8 and 7 for pharmacy and medical students, respectively, out of a possible score of 15. One year after, the median identification knowledge scores were 12 and 8, respectively, for pharmacy and medical students. The median difference scores of correctly managed DDIs on this evaluation 1 year after the program were −4 and −8 for pharmacy and medical students, respectively (P<.05).Conclusion: This study found that the ability to identify important DDIs is poor among both pharmacy and medical students 1 year after being exposed to the educational session.

The use of speech disfluency as an indicant of paradigm development in pharmacy's academic subdisciplines - Corrected Proof

Erin R. Holmes, Shane P. Desselle — 2012-01-06

Abstract: Background: Paradigm development among disciplines has implications for faculty productivity, quality of work life, turnover, organizational rewards, and scholarly progress. Although studied in basic fields, paradigm development has not been measured in professional programs, such as pharmacy.Objective: The objective of this study was to compare speech disfluency rates in lectures of entry-level pharmacy courses within 5 subdisciplines of pharmacy as a measure of paradigm development.Methods: Disfluency rates were observed in randomly selected courses in 4 schools of pharmacy. Disfluency rates among course faculty in personal interviews controlled for subjects' inherent disfluency rates. Lecturers completed a modified version of the Brief Fear of Negative Evaluation survey and a self-rated anxiety measure. Correlates of disfluency patterns were determined using analysis of covariance procedures.Results: The overall mean disfluency rate in lectures was 2.11 disfluencies per minute. Average disfluency rates among the 5 subdisciplines ranged from 1.28 to 2.74. The subdiscipline under study, the lecturers' self-rated anxiety, fear of negative evaluation, or any alternative factors were not associated with disfluency rates in the classroom.Conclusions: Although study results corroborate previous evidence that pharmacy's academic subdisciplines exhibit similar paradigm development, the use of speech disfluency as a measure of paradigm development may have limited utility in the study of disciplinary progress within professional domains.

A pilot study assessing the frequency and complexity of methadone tapers for opioid abstinence syndrome in children discharged to home - Corrected Proof

Peter N. Johnson, Donald L. Harrison, Christine H. Castro, Jamie L. Miller — 2012-01-06

Abstract: Background: Methadone is often prescribed as a taper schedule to prevent/treat opioid abstinence syndrome (OAS) or neonatal abstinence syndrome (NAS).Objective: The objective of this study was to determine the percentage of children discharged home on methadone tapers and to develop, assess, and implement an instrument for measuring the complexity of the methadone regimens.Methods: This study used a descriptive retrospective design to examine patients younger than 18 years from January 1, 2008, to December 31, 2008, administered methadone for prevention/treatment of OAS/NAS and discharged home on a methadone taper. Data collection included demographics and characteristics of methadone regimen. The primary objective was to determine the percentage of children discharged on methadone. Secondary objectives included characterization (ie, number of dosage and interval changes), duration, and complexity of the methadone taper. Descriptive statistics were performed using Stata v10 (StataCorp LP, College Station, TX). Complexity was evaluated using the medication taper complexity score (MTCS) between 4 raters. Reliability of the MTCS was established using interrater correlation analyses of the regimen complexity scores.Results: Thirty-three patients (41.8%) were discharged on methadone. The median (range) age was 0.42 (0-12) years, with most patients (75.8%) initiated on methadone for prevention of OAS. Thirty-one patients were included for further analysis of medication complexity. The median (range) duration of the home taper was 8 days (2-48), which included a median (range) of 4 (1-11) dose changes and at least 1 (0-2) change in the interval. MTCS ranged from 7 to 42, with the tool demonstrating 95% interrater reliability.Conclusions: More than one-third of patients were discharged home on methadone. The median taper duration was 8 days and included a median of 5 adjustments in either the dose or interval. The MTCS demonstrated very good interrater reliability to measure wide variability in the complexity of individual tapers. Future studies should determine the construct validity of the MTCS and the applicability of this tool for further research and clinical application.

Validating a Hospital Medicines Formulary Survey in the Western Pacific Region—A global hospital pharmacy initiative based on the Basel Statements - Corrected Proof

Jonathan Penm, Betty Chaar, Rebekah Moles — 2011-12-12

Abstract: Background: In 2008, the Basel Statements were developed to reflect the future of hospital pharmacy worldwide. Included were a key set of statements regarding the expanding role of hospital pharmacists' influence on prescribing from the management of medicines formularies to being an active member of the therapeutic decision-making process.Objectives: This study aimed to validate a survey to measure Basel Statement 26 regarding the role of medicines formularies and the factors that affect its use in the Western Pacific Region (WPR).Methods: The survey was developed in consultation with a WPR advisory group and current literature. The survey was translated using the forward-backward method into Chinese (simplified) and Vietnamese. The instrument was pilot tested in a stratified random sample of 260 hospital pharmacy directors in the WPR. Principal components analysis (PCA) was applied to the data to assess construct validity of the Medicines Formulary Scale that assessed responders’ perceptions of their formulary and impact on utilization.Results: The Medicines Formulary Survey was completed by 107 hospital pharmacy directors or equivalent. The survey contained the Medicines Formulary Scale in addition to questions regarding the content and review process of the hospital’s formulary as well as demographic questions. Application of the PCA procedures resulted in a parsimonious 2-factor solution in which 33.8% of the variance was explained. The Cronbach alpha for the 17-item scale was found to be 0.70. The Cronbach alpha values for the first and second factor/subscales were 0.76 and 0.68, respectively.Conclusion: The Medicines Formulary Survey appears reliable and valid for assessing hospital pharmacy directors’ perceptions of hospital medicine formularies in the WPR. Further development of validated instruments to assess other areas of hospital pharmacy practice will help track the progression of hospital pharmacy and aid in globalization of the profession.

The association between functional health literacy and patient-reported recall of medications at outpatient pharmacies - Corrected Proof

Andrea C. Backes, Grace M. Kuo — 2011-12-02

Abstract: Background: Published literature on assessing the functional health literacy (FHL) level of patients in pharmacy practice is lacking.Objectives: To assess FHL in an outpatient pharmacy setting and the associations between FHL and patient recall of medications.Methods: In a cross-sectional study of 79 English-speaking adults recruited from 3 outpatient pharmacies, patients were given the Short Test of Functional Health Literacy in Adults and asked to recall their medication names, dosages, frequencies, and indications. Patients’ responses were compared with pharmacy records (medication name, dosage, frequency) and Facts and Comparisons (indication).Results: Of the 79 patients, 27 had inadequate FHL. Correct medication names were recalled less frequently by patients with inadequate FHL compared with patients with adequate FHL (60% vs 84%, P<.001). Similarly, correct dosages (71% vs 83%, P=.03) and frequencies (62% vs 85%, P<.001) were reported less often by patients with inadequate FHL. There was no significant difference in the frequency of correct indications for medications between the 2 groups.Conclusions: Inadequate FHL is associated with poor recall of correct medication name, dosage, and administering frequency. Future research to evaluate the effect of pharmacists on improving patients’ recall of medication name, dosage, and frequency is warranted.

Identifying iatrogenic depression using confirmatory factor analysis of the Center for Epidemiologic Studies Depression Scale in patients prescribed a verapamil-sustained-release-led or atenolol-led hypertension treatment strategy - Corrected Proof

Debbie L. Wilson, L. Douglas Ried — 2011-12-02

Abstract: Background: β-blockers and calcium channel blockers are highly effective medications indicated for treatment and prevention of hypertension. However, the literature regarding the potential depressive effects of β-blockers and calcium channel blockers is equivocal regarding whether one or both are associated with depression.Objectives: To determine whether self-reported depressive symptoms of older persons with hypertension and coronary artery disease and who were randomly assigned to a verapamil-sustained-release-led (Ve-led) or atenolol-led (At-led) hypertension treatment strategy were similar using confirmatory factor analytical models of the Center for Epidemiologic Studies Depression Scale (CES-D).Methods: This study used a mail survey of patients enrolled in a substudy of an international randomized controlled clinical trial. Complete data on the CES-D after 1 year of treatment were obtained from 1019 study subjects. Multiple group confirmatory factor analysis (CFA) procedures were used to test for differences in the fit of the data to the initial 4-factor CES-D model among patients assigned to the 2 treatment groups after 12 months of therapy. A test of configural invariance was conducted by sequentially constraining various matrices to be equal across groups. The convergent validity of the model was tested by examining the standard errors of the lambda-X parameter estimates of the configural model. The factor loadings for like items were investigated across the 2 groups using a test of strong factorial invariance. Finally, the 2 treatment groups were compared on the 4 factors to detect differences in the model's parameters.Results: Overall, the data fit the CFA models across the 2 treatment groups based on the 4-factor model. However, 3 items differed slightly, including appetite, depressed, and crying. The data suggested significant differences across groups on the positive affect, interpersonal relations, and somatic and retarded activity latent variables.Conclusions: The domains indicating less happiness and more depressive symptoms were most likely to be unfavorably impacted by the At-led treatment strategy. Given a choice between these equally effective high blood pressure treatment strategies, it may be prudent to use the Ve-led strategy. This is especially true if the risk of the occurrence of a mood-related side effect of the β-blocker outweighs its other benefits in comparison.

Pharmacist earnings by gender: A small gap or a big issue? - Corrected Proof

Linnea A. Polgreen — 2011-10-28

The article “The gender earnings gap among pharmacists” by Carvajal et al in this issue of the Research in Social and Administrative Pharmacy addresses an important topic: gender-based pay differentials among pharmacists. Over the last few decades, the gender composition of pharmacists has changed dramatically. In 1990, 31% of licensed pharmacists were women. In 2004, 46% were women. In addition, in 2004, 67% of pharmacy graduates were women. The profession is appealing to women, perhaps more so than any other profession, for a number of reasons including flexible and family-friendly work schedules. Women also may be drawn to pharmacy because they are able to find work in a wide range of locations, including rural areas and small towns. Additionally, the relatively high level of compensation that pharmacists receive attracts women as well as men. Thus, as more women enter the profession of pharmacy, equitable compensation becomes that much more critical, particularly because it relates to available labor supply, organizational culture, role modeling and decision making as a profession. The authors find that female pharmacists earn 7.9% less income than males, and even after controlling for potential confounders, female pharmacists, on average, still earn 6% less income than their male counterparts.

The association of race, comorbid anxiety, and antidepressant adherence among Medicaid enrollees with major depressive disorder - Corrected Proof

Chung-Hsuen Wu, Steven R. Erickson, John D. Piette, Rajesh Balkrishnan — 2011-09-28

Abstract: Background: Depressed patients often have comorbid anxiety. African Americans with depression are less likely to adhere to antidepressant treatment. Knowledge of the association between race, comorbid anxiety, and adherence among Medicaid enrollees with depression is limited.Objective: The objective of this study was to evaluate the association of race, comorbid anxiety, and antidepressant adherence, and persistence among Medicaid enrollees with major depressive disorder (MDD).Methods: The MarketScan® Multi-State Medicaid Database (Thomson Reuters, Ann Arbor, MI) was used in this retrospective cross-sectional study. Medicaid enrollees aged between 18 and 64 years, with MDD but without bipolar disorders, and with a newly initiated antidepressant between January 1, 2004 and December 31, 2006 were identified. An index date was assigned corresponding to the newly initiated antidepressant. Patients having claims for any antidepressant refills during the 12 months before the index date were excluded. Eligible patients were then followed-up for 12 months after the index date. Adherence was measured by a modified medication possession ratio. Adherence was evaluated using multivariate logistic regression. Persistence was assessed based on treatment discontinuation and examined by Kaplan-Meier survival curves and Cox-propositional hazard regression models.Results: A total of 3083 Medicaid patients with MDD were included. Approximately, 25% of patients had comorbid anxiety. The odds of adhering to antidepressants were 40% lower among African Americans than Caucasians, adjusting for covariates (AOR [adjust odds ratio]=0.60; 95% confidence interval [CI]=0.51-0.72, P<.001). MDD patients with comorbid anxiety were more likely to adhere to antidepressants than patients with MDD alone (AOR=1.55, 95% CI=1.27-1.90, P<.001). African Americans had a higher hazard of not persistently taking antidepressants (hazard ratio=1.47, 95% CI=1.30-1.65, P<.001). The interaction between race and comorbid anxiety was not associated with adherence or persistence.Conclusions: Among Medicaid enrollees with MDD, race and comorbid anxiety disorders are significantly associated with antidepressant adherence and persistence. Physicians need to recognize comorbid anxiety and race as 2 important determinants of antidepressant use behaviors when they encounter Medicaid patients with MDD.

Challenges to counseling customers at the pharmacy counter—Why do they exist? - Corrected Proof

Susanne Kaae, Janine Morgall Traulsen, Lotte Stig Nørgaard — 2011-09-28

Abstract: Challenges to engage pharmacy customers in medicine dialogues at the counter have been identified comprising a new and extended clinical role for pharmacists in the health care system. This article seeks to expand understanding of factors involved in successful interaction at the pharmacy counter between customers and pharmacy staff to develop their relationship further. Practical challenges to customer encounters experienced by community pharmacists are discussed using theory from the field of mainly inter-relational communication and particular studies on pharmacy communication. Preconceived expectation of customers, the type of question asked by pharmacy staff, and differences in perception of illness and medicines between staff and customers are discussed. Both staff and customer influence the outcome of attempts by pharmacy staff to engage customers in dialogue about their medicine use through a complex mechanism of interaction. It is recommended that practitioners and researchers begin to distinguish, both theoretically and practically, between the content of a conversation and the underlying relationship when exploring and further developing the therapeutic relationship between pharmacy personnel and customers.

Self-reported responses to medication therapy management services for older adults: Analysis of a 5-year program - Corrected Proof

Daniel M. Cook, Paula V. Moulton, Teresa M. Sacks, Wei Yang — 2011-09-28

Abstract: Background: Medication therapy management (MTM) services provide essential reviews of drug regimens and are increasingly recognized as beneficial to patient safety, improved health outcomes, and cost savings.Objective: To assess patient behavioral outcomes from an MTM service, including actions following receipt of a pharmacist report.Methods: A retrospective analysis of an MTM program at the Sanford Center for Aging (NV, USA) was conducted. Outcome measures included whether the patient discussed the review with the physician, whether any changes in the client’s drug regimen occurred, and whether the client feels more knowledgeable about his or her medications. Predictor variables included basic demographics, prescription insurance status, number of prescriptions taken, self-reported health status, and use of medications considered to be high risk. The analysis plan involved the use of multivariate logistic regression models.Results: The odds of discussing the medication review with physicians, making changes recommended in the report, and both discussing and making a change were 65%, 60%, and 67%, respectively, lower among those below poverty level than among those above poverty level; 95% confidence intervals (CIs): 0.15, 0.80; 0.18, 0.85; and 0.15, 0.73, respectively. The odds of those using high-risk drugs of making changes in drug regimens, and of discussing with physicians and making changes together, were 2 times higher than the odds of those not using these drugs, 95% CIs: 1.02, 4.31 and 1.20, 4.87, respectively. The likelihood of those reporting good or excellent health of doing the combination of discussing the MTM report with physicians and to make a drug regimen change was 2 times greater than for those reporting poor to fair health, 95% CI: 1.08, 3.65. Gender, ethnicity, age group, rural status, prescription drug insurance, and high polypharmacy were not significant factors for acting on the medication review in the adjusted model.Conclusion: MTM services are associated with enhanced patient self-advocacy, but like other interventions, they are constrained by social disparities. Greater attention to the resources of target populations to respond to pharmacy services is merited.

The gender earnings gap among pharmacists - Corrected Proof

Manuel J. Carvajal, Graciela M. Armayor, Lisa Deziel — 2011-09-28

Abstract: Background: A gender earnings gap exists across professions. Compared with men, women earn consistently lower income levels. The determinants of wages and salaries should be explored to assess whether a gender earnings gap exists in the pharmacy profession.Objectives: The objectives of this study were to (1) compare the responses of male and female pharmacists' earnings with human-capital stock, workers' preferences, and opinion variables and (2) assess whether the earnings determination models for male and female pharmacists yielded similar results in estimating the wage-and-salary gap through earnings projections, the influence of each explanatory variable, and gender differences in statistical significance.Methods: Data were collected through the use of a 37-question survey mailed to registered pharmacists in South Florida, United States. Earnings functions were formulated and tested separately for male and female pharmacists using unlogged and semilog equation forms. Number of hours worked, human-capital stock, job preferences, and opinion variables were hypothesized to explain wage-and-salary differentials.Results: The empirical evidence led to 3 major conclusions: (1) men's and women's earnings sometimes were influenced by different stimuli, and when they responded to the same variables, the effect often was different; (2) although the influence of some explanatory variables on earnings differed in the unlogged and semilog equations, the earnings projections derived from both equation forms for male and female pharmacists were remarkably similar and yielded nearly identical male-female earnings ratios; and (3) controlling for number of hours worked, human-capital stock, job preferences, and opinion variables reduced the initial unadjusted male-female earnings ratios only slightly, which pointed toward the presence of gender bias.Conclusion: After controlling for human-capital stock, job-related characteristics, and opinion variables, male pharmacists continued to earn higher income levels than female pharmacists.

Organizational factors influencing pharmacy practice change - Corrected Proof

2011-09-28

Abstract: Background: Some pharmacists have changed the focus of their practice from solely dispensing. Emerging services they have added include medication therapy management and other pharmacy services.Objective: To assess the effect of entrepreneurial orientation, resource adequacy, and pharmacy staffing on pharmacy practice change.Methods: A total of 1847 licensed U.S. pharmacists received 2 mail surveys as part of a larger national pharmacist survey. The core survey collected information about practice setting, prescription volume, and staffing. The supplemental survey assessed how the pharmacy had changed over the past 2 years to enable the delivery of pharmacy services. The amount of change was assessed by 12 items, which were summed to provide an aggregate change index. Five variables from organizational change literature were assessed as influences on practice change: proactiveness, risk taking, autonomy, work ethic, and adequacy of resources. In addition, the associations of pharmacist and technician staffing with practice change were assessed. A multiple linear regression analysis was performed with the aggregate change index as the dependent variable and the 7 potential influences on change as the independent variables.Results: Four hundred usable surveys were analyzed. At least some level of practice change was reported in 60% of pharmacies surveyed. The linear regression analysis of the model was significant (P<.001) with an R-square value of 0.276. Significant influences on change were 2 dimensions of entrepreneurial orientation—proactiveness and autonomy—as well as adequacy of resources and pharmacy technician staffing.Conclusions: Many pharmacies reported that some aspects of their practice have changed, such as collecting patient information and documenting care. Few reported changes in asking patients to pay for pharmacy services. These findings support previous results, which show that the capacity for organizational change can be augmented by increasing proactiveness, autonomy among employees, and the availability of adequate and appropriate resources.

Using critical realism as a framework in pharmacy education and social pharmacy research - Corrected Proof

Carmen Oltmann, Chrissie Boughey — 2011-09-28

Abstract: This article challenges the idea that positivism is capable of representing the complexity of social pharmacy and pharmacy education. It is argued that critical realism provides a framework that allows researchers to look at the nature of reality and at mechanisms that produce, or have the tendency to produce, events and experiences of those events. Critical realism is a framework, not a method. It allows researchers to make observations about phenomena and explain the relationships and connections involved. The researcher has to look for mechanisms and structures that could explain why the phenomena, the connections, and the relationships exist (or do not) and then try to show that these mechanisms do exist.This article first contextualizes critical realism, then briefly describes it, and lastly exemplifies the use of critical realism in a discussion of a research project conducted in pharmacy education. Critical realism may be particularly useful in interdisciplinary research, for example, where practitioners and researchers are working together in a social pharmacy or pharmacy education setting. Critical realism requires the practitioners and the researchers to question and make known their assumptions about their own realities and to think of a complex problem or phenomenon in terms of a stratified reality, generative mechanisms, and tendencies. Critical realism may make research more rigorous and also allow researchers to conceive of a greater breadth of research designs for their work.

The Value Prescription: Relative Value Theorem as a Call to Action - Corrected Proof

Greg L. Alston, Joseph C. Blizzard — 2011-08-31

Abstract: The Joint Commission of Pharmacy Practitioners Future Vision of Pharmacy Practice 2015 (2005) and Project Destiny (2008) clearly defined a vision for transforming community practice pharmacy from a culture of dispensing drugs to the provision of services. Several viable service offerings were identified. Pharmacy has not yet fully capitalized on these opportunities. Pharmacy must demonstrate value in providing these services to remain viable in the marketplace. Many pharmacists do not understand how value is created and lack sufficient marketing skills to position their practice for long-term success. The relative value theorem (RVT) describes in simple terms the key elements that drive purchase decisions and thus marketing decisions: (P+S)×PV=RV (P, price; S, service; PV, perceived value; RV, relative value). A consumer compares the P, extra S, and PV of the purchase against all potential uses of their scarce resources before deciding what to buy. Evidence suggests that understanding and applying the principles of RVT is a critical skill for pharmacy professionals in all practice settings to master if they plan to remain viable players in the health care marketplace of the future.

Rurality and other factors associated with adherence to immunosuppressant medications in community-dwelling solid-organ transplant recipients - Corrected Proof

2011-08-19

Abstract: Background: Data on immunosuppressant adherence of community-dwelling adult solid-organ transplant recipients (SOTRs) from rural populations in the United States are limited. Therefore, understanding the association of rurality and other factors of immunosuppressant adherence will help providers design and deliver patient-centered adherence enhancing interventions.Objectives: The objective was to examine factors associated with a previously validated 4-item Immunosuppressant Therapy Adherence Scale (ITAS) score in community-dwelling adult SOTRs who received a transplant from an academic center in the Midwestern United States.Methods: For this observational study, cross-sectional survey data (patient demographic, medical condition, immunosuppressant therapy, and self-reported ITAS) received from adult SOTRs aged 19 years or older with other data from an academic transplant center’s database were merged. Using multivariate logistic regression, significant SOTR characteristics associated with being adherent (ITAS score=12) versus nonadherent (ITAS score <12) were examined.Results: The survey response rate was 30% (n=556/1827). Those SOTRs responding (n=556) had a kidney (48%), liver (47%), or other (4.5%) transplant. They were more likely to be 50- to 64-year olds (52%), men (55%), white (90%), metroresident (59%), with an annual income less than $55,000. The SOTRs were living with a transplant for 6.3 years (median), reported excellent-to-good health status (77%), and received different immunosuppressant regimens. More than half of the SOTRs (58%) were adherent. In multivariate analyses, compared with patients aged 65 years or older, younger patients, nonmetro rural- versus metroresident, and those having more (≥6) versus less (<6) comorbidities were significantly less likely to report adherence. SOTRs receiving tacrolimus-based combination immunosuppressant versus tacrolimus alone were more likely to report adherence.Conclusions: When designing and delivering patient care-centered interventions including those that use technology to increase immunosuppressant adherence, providers need to consider rural residence besides other well-established patient factors (younger age, immunosuppressant drug, and comorbidities) of nonadherence.

Collaborative prescribing: A qualitative exploration of a role for pharmacists in mental health - Corrected Proof

2011-08-10

Abstract: Background: Collaborative prescribing has been proposed as an extension of practice for advanced pharmacist practitioners. A lack of research investigating how pharmacists might be most effective as prescribers in mental health was identified.Objective: To explore health professionals’ and consumers’ attitudes and beliefs that relate to the role of specialist mental health pharmacists working as collaborative prescribers within their advanced scope of practice in secondary care.Methods: Semistructured interviews were conducted with key informants in the New Zealand mental health sector. Participants were selected via a purposive sampling method, including health professionals (n=9) and consumers (n=3). NVivo software was used to analyze data, using a thematic analysis approach to develop a series of key themes from the interviews. Common themes were extracted, which were used to gather results and draw conclusions.Results: The key findings include a widespread acknowledgment of the role of specialist pharmacists as collaborative prescribers in mental health and as integral members of the multidisciplinary team; however, consumers were unaware of pharmacists’ role in secondary care. The role was seen to extend current practice particularly in medication management after assessment and diagnosis by a medical practitioner. Concerns regarding demonstrating competence, practitioner role/boundary confusion, insufficient training and workforce development, hesitancy by pharmacists to extend role, consumer awareness, and public perception of the traditional pharmacist role were identified. Solutions discussed included education by the profession; relationship building, training, and robust competency assessments; and a structured framework for implementing a collaborative prescribing model.Conclusions: This study suggests there was recognition and acceptance of the role that specialist pharmacist practitioners could play in contributing to the care of mental health consumers as collaborative prescribers; their medication expertise being regarded highly. Further research is necessary to investigate how current resource constraints will allow for collaborative prescribing to be implemented within the context of mental health practice.

Characterizing specialized compounding in community pharmacies - Corrected Proof

Jennifer Anne Giam, Andrew J. McLachlan, Ines Krass — 2011-08-08

Abstract: Background: Compounding is a traditional role of pharmacists that declined with the availability of manufactured medicines. Compounding is now increasingly offered by community pharmacies as a specialized service, and there are calls for regulatory and practice standard changes. However, the characteristics of specialized compounding are not well understood.Objectives: The objective of this study was to conduct an in-depth exploration of the motivations, experiences, and practices of pharmacists who deliver “specialized compounding services” in Australian pharmacies.Methods: In-depth interviews of 18 pharmacists responsible for compounding in pharmacies offering specialized compounding were conducted using a semistructured interview guide based on an organizational framework. Participants were selected using purposive sampling. Characteristics of specialized compounding practice compared with routine compounding and routine dispensing were explored. Interviews were audiotaped and transcribed verbatim, then analyzed using the method of “constant comparison” to identify emergent themes.Results: Pharmacists providing specialized compounding reported that compared with their prior routine practice, they used a greater variety of ingredients and dosage forms for more clinical conditions, used different equipment and processes, and had upgraded facilities for handling compounded products. Patient and physician interactions were more involved and in the case of physicians, more collaborative compared with routine dispensing. Participants reported feeling more empowered in their roles, with improved professional satisfaction.Conclusions: Pharmacists in specialized compounding pharmacies report greater collaboration and interaction with prescribers and patients compared with their routine compounding and dispensing. This contributed to perceptions of empowerment and increased professional satisfaction. Specialized compounding may also be an avenue for reprofessionalization. The organization of compounding as a specialized service should be considered in proposed changes to compounding regulations and practice standards.

A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach - Corrected Proof

Michelle A. Chui, David A. Mott, Leigh Maxwell — 2011-08-08

Abstract: Background: Although lack of time, trained personnel, and reimbursement have been identified as barriers to pharmacists providing cognitive pharmaceutical services (CPS) in community pharmacies, the underlying contributing factors of these barriers have not been explored. One approach to better understand barriers and facilitators to providing CPS is to use a work system approach to examine different components of a work system and how the components may impact care processes.Objectives: The goals of this study were to identify and describe pharmacy work system characteristics that pharmacists identified and changed to provide CPS in a demonstration program.Methods: A qualitative approach was used for data collection. A purposive sample of 8 pharmacists at 6 community pharmacies participating in a demonstration program was selected to be interviewed. Each semistructured interview was audio recorded and transcribed, and the text was analyzed in a descriptive and interpretive manner by 3 analysts. Themes were identified in the text and aligned with 1 of 5 components of the Systems Engineering Initiative for Patient Safety (SEIPS) work system model (organization, tasks, tools/technology, people, and environment).Results: A total of 21 themes were identified from the interviews, and 7 themes were identified across all 6 interviews. The organization component of the SEIPS model contained the most (n=10) themes. Numerous factors within a pharmacy work system appear important to enable pharmacists to provide CPS. Leadership and foresight by the organization to implement processes (communication, coordination, planning, etc.) to facilitate providing CPS was a key finding across the interviews. Expanding technician responsibilities was reported to be essential for successfully implementing CPS.Conclusions: To be successful in providing CPS, pharmacists must be cognizant of the different components of the pharmacy work system and how these components influence providing CPS.

Separation of prescribing and dispensing in Malaysia: A summary of arguments - Corrected Proof

Asrul Akmal Shafie, Mohamed Azmi Hassali, Saira Azhar, Ooi Guat See — 2011-08-08

Abstract: The role of pharmacists has transformed significantly because of changes in pharmacists' training and population health demands. Within this context, community pharmacists are recognized as important health personnel for the provision of extended health services. Similarly, in Malaysia, the need to transform community pharmacy practice has been discussed by all interested parties; however, the transition has been slow due in part to the nonexistence of a dispensing separation policy between pharmacists and medical doctors in private community practices. For decades, medical doctors in private community practices have had the right to prescribe and dispense, thus diluting the role of community pharmacists because of overlapping roles. This article explores dispensing separation in Malaysia and, by taking into account the needs of health professionals and health care consumers, suggests a mechanism for how dispensing separation practice can be implemented.

Does combining antiretroviral agents in a single dosage form enhance quality of life of HIV/AIDS patients? A cost-utility study - Corrected Proof

Arijit Ganguli, Junling Wang, Dick R. Gourley — 2011-06-29

Abstract: Background: Combining various antiretroviral agents into one single dosage form has been a strategy to reduce pill burden and enhance medication adherence among human immunodeficiency virus /AIDS (HIV/AIDS) patients.Objectives: This is a cost-utility study from a health care system’s perspective comparing coformulated fixed dose (FXD) strategy versus multiple free dose combination (FRC) in antiretroviral therapy.Method: The Medical Expenditure Panel Survey (MEPS) was used to identify HIV/AIDS patients with ≥2 active antiretroviral medications. Patients on FXD were matched in 1:1 ratio with the FRC group using propensity scores. All medical costs excluding those paid by patients and families were included. Utility was measured using SF-6D scores from the SF-12 questionnaire. Incremental cost-utility ratios (ICURs) were calculated using the mean annual estimates. A cost-effectiveness acceptability curve was determined using a Monte Carlo probabilistic simulation technique.Results: Nine FXD antiretroviral formulations approved by the U.S. Food and Drug Administration by 2005 was included in this study. One hundred seventy HIV/AIDS patients with ≥2 antiretroviral agents were identified from the MEPS database, of which 53% (n=92) were on FXD formulation. On matching, 70 patients from FXD had a match from the FRC group. No differences in sociodemographic and health status variables were observed between the matched groups. The mean annual cost was $15,766.15 for FXD patients and $11,875.21 for FRC patients. The mean utility gained by using FXD over FRC was 0.085; however, this difference was not statistically significant. The ICUR for the FXD treatment over FRC treatment was $45,540.49/quality-adjusted life years (QALYs). Probabilistic sensitivity analysis showed FXD to dominate FRC (>50% probability of being cost-effective) above the $40,000 threshold.Conclusion: Although the cost-effectiveness of a single-pill strategy was within the acceptable willingness-to-pay threshold, the QALY difference were minimal. Further research is recommended to explore the long-term impact of the strategy.

The quality of online antidepressant drug information: An evaluation of English and Finnish language Web sites - Corrected Proof

Marjo Prusti, Susanna Lehtineva, Marika Pohjanoksa-Mäntylä, J. Simon Bell — 2011-06-29

Abstract: Background: The Internet is a frequently used source of drug information, including among people with mental disorders. Online drug information may be narrow in scope, incomplete, and contain errors of omission.Objective: To evaluate the quality of online antidepressant drug information in English and Finnish.Methods: Forty Web sites were identified using the search terms antidepressants and masennuslääkkeet in English and Finnish, respectively. Included Web sites (14 English, 8 Finnish) were evaluated for aesthetics, interactivity, content coverage, and content correctness using published criteria. All Web sites were assessed using the Date, Author, References, Type, Sponsor (DARTS) and DISCERN quality assessment tools.Results: English and Finnish Web sites had similar aesthetics, content coverage, and content correctness scores. English Web sites were more interactive than Finnish Web sites (P<.05). Overall, adverse drug reactions were covered on 21 of 22 Web sites; however, drug-alcohol interactions were addressed on only 9 of 22 Web sites, and dose was addressed on only 6 of 22 Web sites. Few (2/22 Web sites) provided incorrect information. The DISCERN score was significantly correlated with content coverage (r=0.670, P<.01), content correctness (r=0.663, P<.01), and the DARTS score (r=0.459, P<.05).Conclusions: No Web site provided information about all aspects of antidepressant treatment. Nevertheless, few Web sites provided incorrect information. Both English and Finnish Web sites were similar in terms of aesthetics, content coverage, and content correctness.

Corrected Proof

David P. Zgarrick — 2011-06-29

Research Methods for Pharmaceutical Practice and Policy is the first textbook designed specifically for graduate students in the social and administrative sciences in pharmacy. The editor, an experienced researcher and educator of both professional program and graduate students, recognized the need for this text while teaching research methods to entry-level students in a social and administrative pharmaceutical sciences graduate program. Like many educators, he had previously cobbled together resources developed to teach research methods in other fields and applied them to the social and administrative sciences in pharmacy. The editor had the vision to recognize the need for a text that focused on research methods specific to this field and identified 13 colleagues (each experienced researchers and educators in their own right) to produce a resource that will be useful to educators, students, and researchers.

Drug experts of the future, today?—Depiction of the pharmacist profession in Swedish professional and lay print media - Corrected Proof

Jenny Rubensdotter Carlsson, Tobias Renberg, Sofia Kälvemark Sporrong — 2011-04-22

Abstract: Background: The Swedish pharmacy market is presently being reregulated. The state-owned pharmacy monopoly company was divided and sold during 2009, and certain nonprescription medicines are now allowed in nonpharmacy settings. The changes will likely affect the pharmacist’s role and the image of the community pharmacist in society. This change may affect how pharmacists are seen by society at large, and therefore, a baseline showing how pharmacists are depicted before the reregulation is of great value.Objectives: The aim of this study was to describe how the pharmacist profession is depicted in print media in Sweden, with a focus on community pharmacy.Methods: A deductive qualitative content analysis with material from print media was conducted, using professional criteria as a framework. Swedish print media from October 2005 to October 2008 were searched and all relevant articles included.Results: A total of 139 articles were included. Most articles came from professional journals, that is, journals directed toward pharmacist or related professions. The results show that the pharmacist profession is not highly visible and that this lack of visibility is disappointing to pharmacists.Conclusions: Society, as reflected in print media, does not display an awareness of the pharmacist role in Sweden. Although this is disappointing for the profession, it allows pharmacists to influence the depiction and hence their position in society.

Service quality in community pharmacy: An exploration of determinants - Corrected Proof

Lesley White, Christiane Klinner — 2011-04-22

Abstract: Background: Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs’ understanding of service quality and its determinants.Objectives: This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality.Methods: Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants’ perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers.Results: From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management.Conclusions: The study indicates that the extent and quality to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers.

Effect of certain angiotensin-converting enzyme inhibitors on mortality in heart failure: A multiple-propensity analysis - Corrected Proof

Abhishek S. Chitnis, Rajender R. Aparasu, Hua Chen, Michael L. Johnson — 2011-04-22

Abstract: Background: Heart failure is a major and growing public health problem in United States. There is a substantial evidence about efficacy of angiotensin-converting enzyme inhibitors (ACEIs) in heart failure (HF); however, there is no conclusive evidence on the relative effectiveness of individual ACEIs.Objective: To evaluate the effect of individual ACEIs on mortality using multiple-propensity score analysis in a large real-world population.Methods: The study was a retrospective analysis of a national cohort of patients with HF identified from the Department of Veterans Affairs. A multiple-propensity score analysis was used to balance 47 baseline patient characteristics between different nontissue ACEIs. The effect of different ACEIs on time to death was assessed using a propensity score-weighted, multivariable Cox proportional hazard model.Results: The study included 139,994 patients with 69.50% (97,293) on lisinopril, 21.79% (30,503) on fosinopril, 8.41% (11,775) on captopril, and 0.30% (423) on enalapril. Propensity scores balanced nearly all differences between different ACEI groups. Fosinopril (hazard ratio [HR]=0.739, 95% confidence interval [CI]: 0.686-0.797) and lisinopril (HR=0.818, 95% CI: 0.766-0.874) were significantly associated with reduced mortality as compared with captopril. Similar mortality was observed with enalapril (HR=0.944, 95% CI: 0.675-1.320) as compared with captopril.Conclusions: In patients with HF, fosinopril and lisinopril were associated with lower mortality as compared with captopril. However, the results of this observational study should be interpreted with caution, and need to be replicated and confirmed in studies for which HF severity data are available.

An evaluation of the psychometric properties of the Purdue Pharmacist Directive Guidance Scale using SPSS and R software packages - Corrected Proof

Lisa R. Marr-Lyon, Gireesh V. Gupchup, Joe R. Anderson — 2011-04-01

Abstract: Background: The Purdue Pharmacist Directive Guidance (PPDG) Scale was developed to assess patients’ perceptions of the level of pharmacist-provided (1) instruction and (2) feedback and goal setting—2 aspects of pharmaceutical care. Calculations of its psychometric properties stemming from SPSS and R were similar, but distinct differences were apparent.Objective: Using SPSS and R software packages, researchers aimed to examine the construct validity of the PPDG using a higher order factoring procedure; in tandem, McDonald omega and Cronbach alpha were calculated as means of reliability analyses.Methods: Ninety-nine patients with either type I or type II diabetes, aged 18 years or older, able to read and write English, and who could provide written-informed consent participated in the study. Data were collected in 8 community pharmacies in New Mexico. Using R, (1) a principal axis factor analysis with promax (oblique) rotation was conducted, (2) a Schmid-Leiman transformation was attained, and (3) McDonald omega and Cronbach alpha were computed. Using SPSS, subscale findings were validated by conducting a principal axis factor analysis with promax rotation; strict parallels and Cronbach alpha reliabilities were calculated.Results: McDonald omega and Cronbach alpha were robust, with coefficients greater than 0.90; principal axis factor analysis with promax rotation revealed construct similarities with an overall general factor emerging from R.Conclusions: Further subjecting the PPDG to rigorous psychometric testing revealed stronger quantitative support of the overall general factor of directive guidance and subscales of instruction and feedback and goal setting.

Goal-attainment scaling: A review and applications to pharmacy practice - Corrected Proof

Minhchau Vu, Anandi V. Law — 2011-04-01

Abstract: Background: Goal-attainment scaling (GAS) might represent a breakthrough, or at least hold significant utility in pharmacy practice for program evaluation, but it has not yet been widely applied in the discipline.Objective: This study aimed to (1) review the psychometric properties of GAS—a measurement technique for the evaluation of outcomes, (2) explore the clinical utility of GAS in various settings, and (3) introduce its potential application in pharmacy practice.Methods: This systematic review included identified published literature in Pubmed electronic database with keywords/search terms: GAS, goal attainment, goal scaling, goal-attainment procedure, goal-attainment method, GAS and health outcomes, GAS and Short-Form-36 (SF-36), and GAS and quality of life. The inclusion criteria were (1) articles pertaining to GAS method; (2) psychometric data of reliability, validity, and responsiveness were reported; (3) published in Pubmed from 1968 to July 2007; and (4) research on humans. The exclusion criteria were (1) articles published in languages other than English and (2) review articles.Results: Of the 1055 articles screened, 26 articles from physical/occupational rehabilitation (17) and psychology (9) with psychometric properties evaluation met the inclusion criteria for review. Examination of the literature revealed that GAS demonstrated high reliability, variable validity, and excellent responsiveness.Conclusion: Several reasons that make GAS a useful methodology include the capability for patient-specific and cooperative goal setting; incremental goal setting toward progress; versatility of clinical utility to cover medication therapy management; and indexing of individual scores for evaluation of program effectiveness.

Immigrant pharmacists in Portugal: A qualitative exploration of their work-related attitudes - Corrected Proof

Afonso Miguel Cavaco, Nuno Brito, Diogo Lopes — 2010-12-30

Abstract: Background: There are no data about the immigrant pharmacist population in Portugal, including their perceptions on adaptation to the Portuguese professional and social context.Objective: To explore the perceptions and adaptation of the immigrant pharmacists' community in Portugal, with regards to their practice and life, in general.Method: A cross-sectional mail questionnaire was sent to all immigrant community pharmacists registered with the Portuguese Pharmaceutical Society (N=771). Descriptive statistics and an iterative reflexive coding process were used to characterize participants' perceptions and attitudes.Results: Of 36 valid questionnaires 75.0% were females, with a median age of 33 years, mostly citizens from Europe (eg, France) and South America (eg, Brazil). Immigrant pharmacists reported 61.1% overall satisfaction with their decision of coming to Portugal. However, the general perception of the immigrant pharmacists was that the attitudes of their Portuguese colleagues and managers were negative towards them. Nevertheless, positive beliefs, as compared to those in their home country (eg, strong professional bodies), were also reported.Conclusion: Portuguese pharmaceutical authorities need to consider immigrant colleagues’ concerns. Further research is needed to determine the prevalence of these and other findings.

Development of a new scale to measure self-reported medication nonadherence - Corrected Proof

Elizabeth J. Unni, Karen B. Farris — 2009-10-12

Abstract: Background: A major drawback in the medication adherence literature today is the absence of a gold standard for measuring medication adherence. Objective measures of nonadherence such as prescription claims and pill count, while quantifying nonadherence, do not provide the reasons for nonadherence, hence making it difficult to develop intervention strategies. Self-reported measures are helpful to determine reasons for nonadherence; however, widely used self-reported measures such as the Morisky scale are restricted to only few potential reasons.Objectives: The objective of this study was to develop a new scale to measure self-reported nonadherence and to compare it with the existing Morisky scale.Methods: A cross-sectional study of adult U.S. population on cholesterol-lowering and asthma maintenance medications was used. Data on nonadherence were collected using (1) the newly developed Medication Adherence Reasons Scale (MARS), (2) Morisky scale, and (3) an objective self-reported measure.Results: A total of 840 responses were collected. Factor analysis of MARS resulted in 5 subscales in cholesterol-lowering medications and 3 subscales in asthma maintenance medications. The level of agreement between both scales in identifying adherents and nonadherents as measured by kappa coefficient was 0.381 in cholesterol-lowering medications and 0.545 in asthma medications. MARS was able to identify various other significant reasons for nonadherence than that identified by the Morisky scale.Conclusion: A new subjective measure of medication nonadherence based on the frequently reported reasons of nonadherence was developed, and it showed adequate reliability when compared with the Morisky scale to warrant future study.

Prescribing trends for management of congestive heart failure from 2002 to 2004 - Corrected Proof

Tonya Crawford, Larry W. Segars, Rafia S. Rasu — 2009-09-22

Abstract: Background: The incidence and prevalence of the patients diagnosed with congestive heart failure (CHF) continues to grow in the United States. The use of prescription drugs is a vital part of the management of CHF, and pharmacological regimens may vary among patients.Objectives: To examine the CHF prescription trends in the United States and to determine present prescribing patterns.Methods: National Ambulatory Medical Care Survey and both divisions (outpatient and emergency department) of the National Hospital Ambulatory Medical Care Survey from 2002 to 2004 were used to acquire the appropriate data. All analyses used weighted data to represent national estimates. The unit of analysis was individual patient visits. Analysis of the data was accomplished using SPSS 14.0.2 and Stata/SE 9.2 statistical programs.Results: During the 3 study years, 24,213,096 weighted visits were associated with a diagnosis of CHF. More than half (56.2%) of the study population were female; over 75% of the subjects were older than 65 years. Over one-quarter (27.3%; 6,618,208 visits) of CHF-related visits were not associated with being prescribed a CHF-related medication. Loop diuretics were the most commonly used medication (35%). Cardiovascular specialists (odds ratio [OR]=5.28; 95% confidence interval [CI]: 1.82-15.3; P=.002), general/family practice physicians (OR=4.5, 95% CI: 1.69-12.0; P=.003), and internal medicine physicians (OR=3.85, 95% CI: 1.39-10.7; P=.010) were more likely to prescribe CHF-related medication compared with other medical specialties. CHF patients who reside in the Northeast were more likely to receive CHF-related medications than other regions (Midwest OR=0.24; South OR=0.20; West OR=0.23; P<.05) of United States.Conclusions: There were regional and medical specialty-related variations for prescribing CHF-related medications. The results from this study suggest a need for increased awareness of the benefit of CHF-related medications in the management of CHF. The increased implementation of the CHF management guidelines would improve overall patient care.

Patterns and predictors of antipsychotic medication use among the U.S. population: Findings from the Medical Expenditure Panel Survey - Corrected Proof

Chi-Chuan Wang, Joel F. Farley — 2009-09-22

Abstract: Background: Given the importance of pharmacological treatment in mental disorders, it is important to have a thorough understanding of predictors and variations in antipsychotic use.Objective: To provide a description of patient characteristics associated with antipsychotic use and to examine predictors of atypical antipsychotic use among antipsychotic users.Methods: Data were obtained from the 2004 and 2005 Medical Expenditure Panel Survey. Dependent variables were annual, self-reported, atypical and typical antipsychotic use. Independent variables included predisposing, enabling, and need characteristics according to Andersen's Behavioral Model. In addition to descriptive statistics, logistic regression analyses were performed to examine the determinants of antipsychotic use.Results: Patients aged 65 and older were 0.63 times as likely to use antipsychotics as patients aged 26-45. Poor and near-poor patients were 1.55 and 1.37 times as likely to use antipsychotics as middle- to high-income patients, respectively. The odds of antipsychotic use were 2.95 and 1.99 times for patients with public and prescription insurance coverage, respectively. Patients with a usual source of health care were 1.51 times as likely to use antipsychotics as those without. Compared with typical antipsychotic use, patients aged 25 and younger were 3.88 times as likely to use atypical antipsychotics as patients aged between 26 and 45. Urban residents were 1.87 times as likely as rural residents to use atypical antipsychotics. The odds of antipsychotic and atypical antipsychotic use for the poor mental health population were 8.73 and 3.87 times as patients with good to excellent mental health status.Conclusions: Predisposing and need factors play important roles in determining the use of antipsychotics. However, among antipsychotic users, the use of atypical versus typical antipsychotics appears to have been influenced primarily by need. These findings should be useful to clinicians and policy makers in directing antipsychotic treatments to patients in need.

Letter to the editor - Corrected Proof

Salah Aburuz — 2009-07-30

The Case for Evidence-Based Pharmaceutical Care: Pharmaceutical care was defined by Hepler and Strand in the early 1990s as the responsible provision of drug-related care for the purpose of achieving definite outcomes that improve patients' quality of life. Since that time, pharmaceutical care has evolved and is currently being applied in many countries around the world. Medication therapy management represents some addition to the paradigm but is based mainly on the concept and principles of pharmaceutical care.