Research in Social and Administrative Pharmacy - Articles in Press

Evaluating pharmacists’ views, knowledge, and perception regarding generic medicines in New Zealand - Corrected Proof

2010-08-06

Abstract: Background: Generic medicines are commonly used in New Zealand; however, Pharmaceutical Management Agency of New Zealand (PHARMAC) has indicated a need for better information to the public. Studies on consumers’ perceptions suggest that pharmacists play an important role in consumers’ choice; hence, “quality use of generic medicines” can be promoted with a better understanding of pharmacists’ views, knowledge, and perception.Objectives: (1)To evaluate pharmacists’ perceptions, views, and knowledge of and willingness to recommend generic medicines. (2) To explore pharmacists perceptions of the safety, quality, and efficacy of generic medicines. (3) To assess pharmacists’ views on current policy with respect to substitution of generic medicines.Methods: A cross-sectional survey using a postal questionnaire was conducted, and questionnaires were sent to 625 randomly selected pharmacists from a list of 1594 pharmacists who had agreed to release their details for research purposes.Results: Three-hundred and sixty pharmacists responded to the questionnaire (a response rate of 58%). Seventy percent of pharmacists stated there is no difference in safety between original brand and generic medicines. However, 65% stated that original brand medicines were of higher quality than their generic counterparts, and half stated that generic medicines and original brand medicines are equally effective. A large number of pharmacists reported concerns regarding brand substitution and offered suggestions, such as the need for advertising campaigns, patient pamphlets, updating prescribers’ software, and distinct packaging for generic medicines. It was found that pharmacists’ perceptions of generic medicines are primarily driven by PHARMACs policies and their experiences with consumers.Conclusions: About one-third of pharmacists correctly defined the term “generic medicines,” suggesting discrepancies in pharmacists’ knowledge and perceptions of generic medicines. Concerns were raised regarding: quality, safety, and effectiveness; however, most of the pharmacists acknowledged the economic benefits to the health care system.

Research funding expectations as a function of faculty teaching/administrative workload - Corrected Proof

Christopher K. Surratt, Khalid M. Kamal, Peter L.D. Wildfong — 2010-07-26

Abstract: Background: Persistent faculty shortages at US pharmacy schools make faculty recruitment and retention a perennial priority. The literature indicates that a key retention issue is whether the faculty member's scholarship is compromised because of a heavy teaching or service workload.Objective: Assess US pharmacy faculty perceptions concerning their views of appropriate expectations of research grant support given their teaching/administrative workloads.Methods: Data and opinions were collected using a multiple-choice, cross-sectional survey instrument (SurveyMonkey®; Menlo Park, CA), e-mailed to 1047 faculty members, randomly selected from all Accreditation Council of Pharmacy Education (ACPE)-accredited US pharmacy schools. Statistical analyses were performed using SPSS® (Chicago, IL) for Windows, Version 17.0.Results: Of the researcher respondents, a majority felt that the amount of teaching expected was too much to be a competitive researcher. Teaching commitment was found more likely to increase than decrease after achieving tenure. Reported new faculty start-up funding was well below that typically found at nonpharmacy research schools.Conclusions: This information is anticipated to help pharmacy faculty members gauge their workload and productivity relative to a national peer group, and to help pharmacy schools improve in faculty recruitment and retention. The survey findings may assist pharmacy schools in clarifying reasonable teaching and funding expectations for pre- and post-tenure faculty, which in turn may help attract more pharmaceutical scientists to academic pharmacy positions.

Pharmacist supplementary prescribing: A step toward more independence? - Corrected Proof

Dalia Dawoud, Peter Griffiths, Jill Maben, Larry Goodyer, Russell Greene — 2010-07-26

Abstract: Background: Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP).Objective: To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation.Methods: A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis.Results: Three typologies of pharmacists' experiences were identified: “a blind alley”, “a stepping stone” and “a good fit”. Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role.Conclusions: Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a “stepping stone” to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists regarding the adoption of such an innovative role.

Physician-pharmacist collaborative care in dyslipidemia management: The perception of clinicians and patients - Corrected Proof

2010-07-26

Abstract: Background: Collaborative practices allow physicians and pharmacists to comanage pharmacotherapy to maximize the benefits of medication regimens. The Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia (TEAM) study compared the efficacy of a physician-pharmacist collaborative primary care (PPCC) intervention, where pharmacists requested laboratory tests and adjusted medication dosage, to the usual care (UC) for patients under treatment with lipid-lowering medication.Objective: In a qualitative study nested within the TEAM study, the perceptions of physicians, pharmacists, and patients regarding the PPCC model, interprofessional collaboration, and the clinicians' willingness to implement the model in their practice were explored.Methods: In the area of Montreal (Quebec, Canada), TEAM study participants assigned to the PPCC group were invited to participate. Individual semistructured interviews with physicians (n=7) and 2 six-member focus groups with pharmacists (n=12) and patients (n=12) were analyzed using a phenomenological approach.Results: The vast majority of participants reported PPCC was more structured and systematic than the UC they had received previously, wherein physicians prescribe and adjust pharmacotherapy and pharmacists provide the counseling and dispense medications. Many patients felt they received better follow-up and reported being reassured and well informed, making them more inclined to care for themselves better. These feelings were attributed largely to the pharmacists' accessibility and ability to communicate with them easily. Given the physician shortage, physicians perceived interprofessional collaboration as almost inevitable. They considered PPCC to be safe and effective. However, obstacles were also identified. Physicians were concerned that it might alter their special relationship with patients and threaten their overall medical follow-up. Pharmacists felt enthusiastic about their new role, but found PPCC time consuming and thought it might not be applicable to all the patients.Conclusions: PPCC model was highly appreciated by patients, and clinicians saw it as beneficial to patients. However, several obstacles still have to be overcome before the model can be implemented in the current health care context.

An organizational culture gap analysis in 6 New Zealand community pharmacies - Corrected Proof

Shane L. Scahill, Peter Carswell, Jeff Harrison — 2010-07-26

Abstract: Background: The barriers to moving forward and meeting the expectations of policy makers and professional pharmacy bodies appear to relate to the organizational culture of community pharmacy. Despite the importance of cultural change for business transformation, organizational culture has largely gone unnoticed in community pharmacy practice research.Objectives: To perform an organizational culture gap analysis in 6 New Zealand community pharmacies.Methods: Mean scores from a cultural rating survey (n=47) were calculated for 8 cultural clusters and mapped onto a typical and a beneficial pattern match (ladder diagram) for each case site. These ladder diagrams provide an understanding of the gap between the 2 ratings based on the gradient of the lines joining cultural clusters—the rungs of the ladder. Software can be used to generate a Pearson correlation describing the strength of the relationship between the typical and beneficial ratings.Results: Eight cultural clusters were mapped: “leadership and staff management”; “valuing each other and the team”; “free-thinking, fun and, open to challenge”; “trusted behavior”; “customer relations”; “focus on external integration”; “provision of systematic advice”; and the “embracing of innovation.” Analysis suggested a high level of correlation between the means of the typical and beneficial ratings. Although the variance between average ratings might be quite small, the relative difference can still be meaningful to participants in the cultural setting. The diagrams suggest a requirement for external integration, the provision of systematic advice, and the embracing of innovation to become more typical in most pharmacies. Trusted behavior is the most typical and most beneficial cultural dimension in most pharmacies, whereas valuing each other and the team is the least beneficial.Conclusions: Gaps in organizational culture have been identified through the use of a rating survey. The dimensions of focus on external integration, providing systematic advice, and embracing innovation require further exploration through interviews in case site pharmacies.

Key determinants of hospital pharmacy staff's job satisfaction - Corrected Proof

Cicely S. Liu, Lesley White — 2010-06-30

Abstract: Background: The level of job satisfaction among pharmacy personnel is of importance because it may affect performance and retention.Objectives: The objectives of this study were to (1) examine the level of job satisfaction among pharmacists and pharmacy support personnel practicing in Australian hospitals, (2) compare the level of job satisfaction with career satisfaction, (3) investigate the key factors determining hospital pharmacy staff's job satisfaction and their relative importance, and (4) identify the influential factors on their perceptions related to the ideal job.Methods: A cross-sectional survey was sent to 350 pharmacy staff in Australia. Participants had the option of returning the completed survey by means of mail or online. Previously validated 5-point scales measured each of the study variables. Data analyses included descriptive statistics, analysis of variance, factor analysis, and multiple linear regression.Results: Responses were received from 188 subjects (53.7%). Job satisfaction was 3.62±0.77, which was significantly higher than career satisfaction 3.38±0.85. Different job satisfaction mean scores were seen among age groups (F=2.718, P<.05). Percentage of time spent in dispensing was negatively correlated to job satisfaction (β=−0.202, P<.01). Sex, job positions, education levels, size and location of the hospitals, and work experience were not significant factors in determining job satisfaction. Job-related predictors of job satisfaction were ability utilization and recognition. Ability utilization was the most important factor in their perception of the ideal job.Conclusion: The primary determinants of job satisfaction were intrinsic aspects of the job; that is, what makes people satisfied is the work that they do or the way they are used. Hospital pharmacy staff need to feel certain about their future, so managers should strive to secure the pharmacist's role in the provision of health care. It is suggested that pharmacy managers focus on altering the job to provide greater use of skills and abilities and to provide increased challenge in the work. Further research should focus on other predictors of job satisfaction and possible ways to enhance satisfaction level.

Perception and knowledge of patients with type 2 diabetes in Malaysia about their disease and medication: A qualitative study - Corrected Proof

2010-06-30

Abstract: Background: Diabetic patients' experience and knowledge about their medication play an important role in determining the success of long-term adherence in their disease management.Objective: This study aimed to explore diabetic patients' experience and knowledge about diabetes and its medication and to understand the factors contributing to medication adherence in Malaysian population.Methods: A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by diabetic patients. Twelve patients were interviewed using a semi-structured interview guide. Saturation point of the interview was reached after the 10th interview, and no more new themes emerged from the subsequent 2 interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework.Results: A total of 4 themes were identified from the interview analysis: knowledge about diabetes and its medication, experiences of adverse effects of medication, issues related to adherence, and the impact of medical and family relationships on well-being. Most of the patients were aware of the disease known as diabetes but unaware which type of diabetes they were suffering from. None of the participants knew the adverse effects of their medication, and most of them considered it to be safe. Financial barriers, forgetfulness, self-medication, and quality of relationships with doctor and family members seem to be the factors that challenge adherence in our sample of diabetic patients.Conclusion: This study identified a number of key themes that might be useful in enhancing the awareness of experiences, knowledge, adherence, and attitudes of Malaysian patients with diabetes. More efforts should be taken to estimate how diabetic patients take their medication, and a well-planned educational program is also required to educate and encourage patients to practice a healthy lifestyle.

The decision to continue or discontinue treatment: Experiences and beliefs of users of selective serotonin-reuptake inhibitors in the initial months—A qualitative study - Corrected Proof

2010-06-07

Abstract: Background: Little is known about patients' views on taking selective serotonin-reuptake inhibitors (SSRIs) and their decision-making processes regarding either continuation or discontinuation within a few months of initiating therapy.Objective: To explore the experiences and beliefs of SSRI users in relation to initiation and execution of treatment, with the intention to identify patterns leading to discontinuation or continuation of treatment.Methods: Semistructured qualitative interview study. Eighteen patients, older than 18 years, were interviewed 3 months after starting SSRI treatment prescribed by a general practitioner (GP), 9 of whom had discontinued (discontinuers) and 9 of whom continued treatment (continuers).Results: Two main patterns lead to either discontinuation or continuation of use. Continuers were satisfied with the GP's role during initiation and execution of SSRI treatment and fully trusted their decision. Continuers' attitudes toward treatment were predominantly positive; they seemed to have little doubt about the necessity of using an SSRI and hardly considered discontinuing for fear of relapse. Discontinuers, on the other hand, seemed to be less involved in decision making and often appeared to have little confidence in their GPs. Most discontinuers felt that they lacked knowledge, and their attitude toward taking SSRIs was rather negative. Discontinuers often were unconvinced about the necessity of using an SSRI and appeared to have a strong desire to discontinue treatment.Conclusion: Lack of shared decision making between patient and GP, limited counseling during treatment, lack of knowledge, and patients' negative attitudes toward SSRI use and the disease itself, hampered the acceptance of the SSRI and brought on the decisional conflict to discontinue treatment. Health care professionals could be more supportive during the initial months of SSRI treatment by eliciting patients' considerations for continuing or discontinuing treatment.

New Zealand community pharmacists' views of their roles in meeting medicine-related needs for people with mental illness - Corrected Proof

2010-06-01

Abstract: Background: Mental illness is common among the New Zealand population. Several roles have been identified for community pharmacists in providing care to people with mental illness; however, the specifics of these roles have not been studied in New Zealand.Objectives: To explore the services currently provided by community pharmacists, the barriers that may be encountered, and possible solutions when providing care to people with mental illness.Methods: Community pharmacists across the North Island of New Zealand, who expressed a special interest in mental health or had a clozapine-dispensing contract, were invited to participate. Eleven participants were interviewed using a semistructured format guided by principles of inductive analysis. Using a thematic approach, transcripts from the interviews were analyzed with the assistance of NVivo 7® (QSR International Pty Ltd 2007).Results: Four major themes were identified: provision of care, relationships, challenges within the health care system and resources, and future roles for pharmacists. Provision of care was associated with the type of services pharmacists provided, patient-focused care, family involvement, education, psychological support, referrals, and culturally appropriate practice. Building effective relationships was described by participants as adopting a nonjudgmental and culturally sensitive manner, respecting patient privacy, spending more time with patients, and using varied communication techniques. Significant challenges involved working at the end of the health care chain, inadequate patient information and contact time, prescription and payment issues, and difficulties ensuring compliance with medication. Participants identified education, support, and funding as resources that needed to be improved. Their perspectives about future roles of the pharmacists included providing more education and acting as medicine managers for patients.Conclusions: Pharmacists provided a variety of services to people with mental illness despite the barriers they encountered. If the roles of community pharmacists within mental health were to be expanded, solutions to these barriers would need to be identified and implemented.

Primary care physicians' perceptions of medication errors and error prevention in cooperation with community pharmacists - Corrected Proof

Tuula Teinilä, Kirsi Kaunisvesi, Marja Airaksinen — 2010-06-01

Abstract: Background: Physicians and community pharmacists play a major role in safe use of medication in primary outpatient care. Still, little is known about primary care physicians' perceptions of medication errors and error prevention and how they would like to cooperate with community pharmacists in error prevention and management.Objectives: To explore primary outpatient care physicians' perceptions of medication errors and error prevention and to examine physicians' perceptions and expectations of cooperation with community pharmacists in error prevention and management.Methods: A national mail survey containing structured and open-ended questions to a random sample of 15% of Finnish public health care physicians and occupational health physicians (n=639) was carried out.Results: A total of 179 responses were entered into the study (29% response rate). The potential causes of medication errors were most often related to physicians (39%), followed by the causes related to the organization (23%) and patient (19%). The factors concerning physicians' unawareness of patients' comedication arose as the major causes of medication errors. The respondents considered workload as a primary cause for medication errors. The most frequently mentioned actions to prevent medication errors were related to the physician (31%), organization (28%), and information technology (22%). The respondents expected more contacts from community pharmacists than actually occurred, particularly in the cases of potential drug abuse and problems in drug use.Conclusions: Problems related to polypharmacy because of physicians' unawareness of patients' entire current medication were considered as most challenging in medication safety. Many of the problems were contributed to communication and coordination issues, which could be ameliorated by appropriate use of information technology. The study also indicated a need to develop the cooperation between primary care physicians and community pharmacists to enhance medication safety.

Evaluation of online consumer medication information - Corrected Proof

Karissa Y. Kim, Anne Metzger, Patricia R. Wigle, Pearl J. Choe — 2010-06-01

Abstract: Background: Millions of Americans search the Internet for health-related information; however, the readability and comprehensiveness of consumer medication information (CMI) on the Internet has not been widely studied.Objective: The purpose of this study was to evaluate the readability and comprehensiveness of online CMI.Methods: The readability and comprehensiveness of consumer drug information found on 3 well-known Web sites (Medline Plus, Yahoo Health, and WebMD) was evaluated; in particular, information related to 10 commonly prescribed medications. Readability was assessed using the Simple Measure of Gobbledygook (SMOG) and Fry Readability Graph (FRG) tools; comprehensiveness of information was evaluated using the Keystone action plan criteria.Results: Using SMOG, the mean reading level of each Web site was 13th grade level or higher. Using the FRG, the mean reading level was 10th grade or higher. Out of the 24 points in the Keystone action plan criteria, information found on each of the Web sites was deemed accurate with mean score of 21, 21, and 19 for Medline Plus, Yahoo Health, and WebMD, respectively.Conclusions: For the medications reviewed, CMI found on Web sites was accurate when assessed using the Keystone action plan criteria. The readability levels were higher than the recommended sixth grade level.

Relationship between diet, exercise habits, and health status among patients with diabetes - Corrected Proof

Heather M. Campbell, Nasreen Khan, Catherine Cone, Dennis W. Raisch — 2010-05-10

Abstract: Background: The American Diabetes Association recommends that people with diabetes should engage in physical activity and healthy eating. Similarly, diets rich in fruits or vegetables (5-13 servings) have been found to lower the risk of stroke, cardiovascular conditions, cancer, and diabetes.Objectives: To examine the associations between eating fruits and vegetables and exercising on physical/mental health among diabetes patients. A secondary objective was to describe the relationship between socioeconomic status and physical/mental health. Finally, we used the Health Belief Model (HBM) to help providers understand how they can work best with their patients to implement healthy lifestyle.Methods: The 2005 Centers for Disease Control's Behavioral Risk Factor Surveillance System was used to determine the relationship between eating fruits/vegetables and exercise on physical and mental health. The sample was restricted to individuals who self-reported being diagnosed with diabetes (N=33,320) in 2005. Eating fruits and vegetables was categorized by the number of fruit and vegetable servings consumed daily (0, 1-2, 3-4, and ≥5). Poisson regression was used to assess these associations.Results: Only 26% of individuals ate 5 or more servings of fruits and vegetables, whereas only 33% met exercise recommendations. Individuals who ate 5 or more servings of fruits and vegetables reported better mental health but poor physical health. Compared with meeting exercise recommendations, no exercise was associated with more days of poor physical/mental health.Conclusions: Reinforcement of daily exercise is helpful to patients with diabetes (PWDS); meeting exercise recommendations was associated with better outcomes of physical and mental health. Pharmacists and other public health providers should focus on interventions that incorporate the promotion of healthy lifestyles. The HBM can be used to improve health behavior among PWDS. Pharmacists are in a unique position to advocate change with consistent access to care.

Consumer perception on generic medicines in Basrah, Iraq: Preliminary findings from a qualitative study - Corrected Proof

Adheed Khalid Sharrad, Mohamed Azmi Hassali — 2010-04-26

Abstract: Background: The use of generic medicines has been increasing steadily internationally, primarily because of cost concerns. Knowledge and use patterns of generic medicines in Iraq have not yet been measured.Objective: This study aimed to explore consumers' perception and knowledge on issues relating to generic medicine use in Basrah, Iraq.Methods: A qualitative approach was used to gather information from consumers in Basrah, Iraq. A purposive sample of 14 consumers in Basrah was interviewed face-to-face using a semistructured interview guide.Results: Thematic analysis of the interviews identified 5 major themes: understanding of the term “generic medicine,” preference for generic medicine, refusal of generic medicine, generic substitution, and education on the use of generic medicines. Not all the consumers were familiar with the term “generic medicine;” they were familiar with the term “commercial medicine.” Most of the participants understood that generics cost less compared with their branded counterparts. Most of the consumers said that their physicians and pharmacists had given them information on generics.Conclusion: Knowledge of generic medicines may be lacking among consumers in Iraq. Development of consumer education on generics by health care providers is required to support the implementation of the policy on generic medicines in Iraq.

Influence of ownership type on role orientation, role affinity, and role conflict among community pharmacy managers and owners in Canada - Corrected Proof

Jason Perepelkin, Roy Thomas Dobson — 2010-04-12

Abstract: Background: Ownership of community pharmacies is increasingly being controlled by a relatively small number of corporate entities. The influence of this ownership type should not be ignored, because ownership has the ability to impact pharmacy practice.Objectives: To examine the relationship between ownership type and community pharmacy managers with regard to role orientation, role affinity, and role conflict.Methods: This study consisted of a cross-sectional survey of community pharmacy managers in Canada by means of a self-administered postal questionnaire sent to a stratified sample of community pharmacies. Statistical analysis consisted of exploratory factor analysis with reliability testing on identified constructs. Frequencies, 1-way analyses of variance, and Scheffe post hoc tests were used to determine significant differences among groups, including ownership structure, on each of the constructs.Results: A total of 646 completed questionnaires were received (32.9% response rate). Most of the respondents were males (60.8%), with slightly less than half of the respondents identifying their practice type as an independent pharmacy (44.6%). There were 5 multi-item scale constructs (professional orientation, business orientation, professional affinity, business affinity, and role conflict) arising from the data, which were analyzed against the pharmacy ownership structure (independent, franchise, corporate) independent variable. Analysis revealed significant differences for 3 of the 5 constructs; however, no differences were seen regarding the 2 professionally focused constructs.Conclusions: Community pharmacy managers/owners are generally oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role when compared with those working in an independent or franchise pharmacy environment. Further research is needed to identify different practice cultures that may exist in various practice settings and the extent to which these cultures attract or define the managers working in them.

Measuring organizational flexibility in community pharmacy: Building the capacity to implement cognitive pharmaceutical services - Corrected Proof

Eleonora Feletto, Laura Kate Wilson, Alison Sarah Roberts, Shalom Isaac Benrimoj — 2010-04-12

Abstract: Background: Community pharmacy is undergoing transformation with increasing pressure to build its capacity to deliver cognitive pharmaceutical services (“services”). The theoretical framework of organizational flexibility (OF) may be used to assess the capacity of community pharmacy to implement change programs and guide capacity-building initiatives.Objective: To test the applicability of an existing scale measuring OF to the industry of community pharmacy in Australia.Methods: A mail survey was used to test a preexisting scale measuring OF amended from 28 items to 20 items testing 3 underlying factors of operational, structural, and strategic flexibility in the Australian community pharmacy context. The sample was 2006 randomly-stratified community pharmacies. A confirmatory factor analysis was conducted to assess the validity and reliability of the 1-factor models for each underlying construct and the full measurement model.Results: Responses were received from a total of 395 (19.7%) community pharmacies. The 1-factor models of operational, structural, and strategic flexibility fit the data with appropriate respecification. Overall, the favorable fit of the individual factor constructs suggested that the multiple-factor measurement model should be tested. However, this model did not yield an interpretable response. Operational flexibility covaried negatively to the other factors, whereas structural and strategic flexibility shared covariance. Despite this, the results highlighting the individual factor fit suggest the constructs have application to pharmacy.Conclusions: The individual OF constructs were useful in the development and initial testing of a scale adapted for community pharmacy. When further developed and validated, the scale could be used to identify group of pharmacies that require individualized assistance to build capacity and integrate services and other new endeavors.

A drug-drug interaction knowledge assessment instrument for health professional students: A Rasch analysis of validity evidence - Corrected Proof

2010-04-12

Abstract: Background: It is essential that current and future health professionals be able to evaluate for possible clinically significant drug-drug interactions (DDIs) and when detected, determine appropriate management strategies to prevent patient harm.Objective: Assess the validity of a DDI knowledge assessment instrument in a health professional student population.Methods: This study recruited health professional students (medical, nurse practitioner, and pharmacy) beginning experiential training at the University of Arizona. Students were given a knowledge assessment instrument that included 15 medication pairings selected on the basis of clinical importance and were asked to select the most appropriate DDI management strategy for each pair by selecting “avoid combination,” “usually avoid combination,” “take precautions,” or “no special precautions.” Data were analyzed in 2 ways because of the subjective nature of classifying DDIs into specific management categories. In the first analysis, respondents were given credit for a correct item only if they selected the management strategy deemed appropriate (management strategy analysis). In another analysis, students were given credit for an item only if they correctly identified specific DDIs (DDI recognition analysis). Rasch analysis was used to assess the validity of the knowledge instrument.Results: A total of 165 of the 226 eligible health professional students completed the DDI knowledge assessment (73% response rate). The mean score for management strategy analysis was 3.82 out of 15, whereas DDI recognition analysis produced a higher average (mean=6.55). Good reliability was demonstrated in both strategies, and no ceiling or floor effects were observed. Some construct underrepresentation occurred with both scoring strategies, and some mistargeting was identified when analyzing the management strategy.Conclusions: Although improvements in construct representation may be beneficial, the instrument used demonstrated good reliability and validity and could be used by educators to assess and improve DDI knowledge. The ability of the participants to identify DDIs and select an appropriate management strategy was low. These results support the need for additional DDI education in this institution's health curricula.

Pain, infection, and colds and flu: Samoan people's views about antibiotics - Corrected Proof

2010-04-12

Abstract: Background: Samoan people have access to and use both Western and traditional forms of healing. Little is known about their perceptions and use of healing agents.Objectives: To explore Samoan people's interpretation and use of a subset of Western medicines, namely, antibiotics, in Samoa and in New Zealand.Methods: Semi-structured interviews were held with a purposeful sample of 31 Samoans, recruited through informal networks. Thematic analysis focused on understanding participants' perspectives on antibiotics using a phenomenological approach. Results from these interviews were used to develop a questionnaire administered to 232 Samoans recruited in health care facilities in Samoa and New Zealand.Results: Participants were mostly females (57% of structured interview participants), and most (88%) were born in Samoa. Nearly half the sample had tertiary education. In Western terms, confusion about what antibiotics do and lack of clarity about which medicines are antibiotics were very common among the Samoan population. Antibiotics are commonly believed to be useful for colds and flu (75% of respondents) and were frequently used for these conditions. The distinctive features of the responses were the belief that antibiotics are pain killers (50%) and confusion between infection and pain. The confusion between antibiotics and pain killers may reflect a conflict between Samoan and Western concepts of illness. In the Samoan view, the lived experience of illness appears to be conflated with the illness itself; that is, pain is seen as an illness.Conclusions: The findings have implications for attempts to promote rational use of antibiotics either with individuals or as a part of public education campaigns. Such efforts may fail in some communities if they are based on the assumption that people share Western beliefs about what antibiotics are; what they do; and which illness have microbial, bacterial, or viral causes.

The discomfort caused by patient pressure on the prescribing decisions of hospital prescribers - Corrected Proof

Penny J. Lewis, Mary P. Tully — 2010-04-12

Abstract: Background: The influence of patient expectations and demands on the decisions of prescribers in general practice has been associated with irrational prescribing and lack of evidence-based practice. However, to our knowledge, no one has investigated patient pressure to prescribe in secondary care.Objectives: To investigate the influences on hospital prescribers' decisions by exploring what they found uncomfortable when prescribing.Methods: Qualitative interviews with 48 prescribers of varying seniority from 4 hospitals were conducted. Interviews were based on the critical incident technique, and prescribers were asked, before an interview, to remember any uncomfortable prescribing decisions that they had made; these were then discussed in detail during an interview. This approach allowed the interviewer to explore the more general influences on the decision to prescribe. Interviews were tape recorded and transcribed verbatim. A grounded theory approach to data analysis was taken.Results: Prescribers discussed various factors that could provoke feelings of discomfort when prescribing. Pressure on the prescribing decision from patients, relatives, or carers was a major theme, and more than half of interviewees discussed discomfort caused by such perceived pressure on the prescribing decision. How prescribers dealt with this pressure varied with seniority and the type of relationship that they had fostered with the patient. Nearly half of all incidents of patient pressure resulted in the patient being prescribed the medication they requested. Yet, many of these requests were deemed inappropriate by the prescriber. Their reasons for capitulation varied but included maintaining a good prescriber-patient relationship and avoiding conflict in the wider health care team.Conclusions: Pressure from patients, relatives, or carers was an uncomfortable influence on these hospital prescribers' prescribing decisions. Increasingly consumer-driven health care will intensify these issues in the future. We advocate further research, focusing on managing patient demands and improving prescribers' coping strategies.

Ontario family physician readiness to collaborate with community pharmacists on drug therapy management - Corrected Proof

Nedzad Pojskic, Linda MacKeigan, Heather Boon, Philip Ellison, Curtis Breslin — 2010-04-12

Abstract: Background: Empirical evidence suggests that pharmacist-physician collaboration can improve patients' clinical outcomes; however, such collaboration occurs relatively infrequently in the community setting. There has been little research on physicians' perspectives of such collaboration.Objective: To ascertain Ontario family physician readiness to collaborate with community pharmacists on drug therapy management.Methods: The survey instrument was based on the transtheoretical model of behavior change. It enquired about 3 physician behaviors that represented low-, mid-, and high-level collaboration with pharmacists. The survey was distributed by fax or mail to a random sample of 848 Ontario family physicians and general practitioners, stratified by practice location (urban/rural).Results: The response rate was 36%. Most respondents reported conversing with community pharmacists about a patient's drug therapy management 5 or fewer times per week. Eighty-four percent reported that they regularly took community pharmacists' phone calls, whereas 78% reported that they sometimes sought pharmacists' recommendations regarding their patients' drug therapy. Twenty-eight percent reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% unaware of such a service. There were no differences in physician readiness to engage in any of the 3 collaborative behaviors in urban versus rural settings. More accurate patient medication lists were perceived as the main advantage (pro) of collaborating with community pharmacists and pharmacists' lack of patient information as the main disadvantage (con). Collectively, perceived pros of collaboration were positive predictors of physician readiness to collaborate on all 3 behaviors, whereas perceived cons were negative predictors for the low- and mid-level behaviors. Female physicians were more likely than males to seek pharmacists' recommendations, whereas more experienced physicians were more likely to refer patients to pharmacists for medication reviews.Conclusions: Overall, Ontario physicians were more engaged in the low- and mid-level collaboration with community pharmacists with respect to drug therapy management. The strongest predictor of physician readiness to collaborate was perceived advantages of collaboration.

Identification of barriers to medication adherence in a Latino population - Corrected Proof

Sheryl Compton, Sally Haack, Charles R. Phillips — 2010-04-02

Abstract: Background: Barriers to medication adherence may present differently in diverse patient populations. Because of changing U.S. demographics, health care providers will be required to identify alternative strategies for managing increasingly diverse patient populations.Objectives: This pilot project identified barriers that may hinder medication adherence in a Latino population. The results of the survey may identify trends in barriers allowing for the development of interventions aimed at improving medication adherence.Methods: The study used a convenience sample of Spanish-labeled prescriptions that had not been picked up from a community pharmacy after a 2-week period to identify study subjects. Patients were contacted by phone and surveyed regarding reasons for not picking up their prescription medication. The 24-item survey instrument consisted of demographic and medication-related questions, reasons for, and associated barriers with failure to pick up medications.Results: The most common classes of medications patients failed to pick up were chronic medications. More than 90% of the patients thought that the medication in question was helpful to them, and nearly 80% thought that the medicine was still needed. Patients cited communication issues (ie, content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications, whereas nearly 40% failed to identify any barriers. Barriers identified by patients that could be improved included confusion regarding when their prescription was ready and limited hours of pharmacy operation. Most of the patients were comfortable using the American health care system.Conclusions: The barriers to medication adherence identified did not appear to be the result of cultural influences. This could be because the community pharmacy had bilingual staff and interpreters available for patient education and prescription processing. Alternative methods are needed to further identify reasons for failure to pick up medications before medication adherence programs can be designed.

Using time-series intervention analysis to understand U.S. Medicaid expenditures on antidepressant agents - Corrected Proof

Yann Ferrand, Christina M.L. Kelton, Jeff J. Guo, Martin S. Levy, Yan Yu — 2010-03-02

Abstract: Background: Medicaid programs' spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005. The National Institute for Health Care Management attributed this expenditure growth to increases in drug utilization, entry of newer higher-priced antidepressants, and greater prescription drug insurance coverage. Rising enrollment in Medicaid has also contributed to this expenditure growth.Objectives: This research examines the impact of specific events, including branded-drug and generic entry, a black box warning, direct-to-consumer advertising (DTCA), and new indication approval, on Medicaid spending on antidepressants.Methods: Using quarterly expenditure data for 1991-2005 from the national Medicaid pharmacy claims database maintained by the Centers for Medicare and Medicaid Services, a time-series autoregressive integrated moving average (ARIMA) intervention analysis was performed on 6 specific antidepressant drugs and on overall antidepressant spending. Twenty-nine potentially relevant interventions and their dates of occurrence were identified from the literature. Each was tested for an impact on the time series. Forecasts from the models were compared with a holdout sample of actual expenditure data.Results: Interventions with significant impacts on Medicaid expenditures included the patent expiration of Prozac® (P<0.01) and the entry of generic paroxetine producers (P=0.04), which reduced expenditures on Prozac® and Paxil®, respectively, and the 1997 increase in DTCA (P=0.05), which increased spending on Wellbutrin®. Except for Paxil®, the ARIMA models had low prediction errors.Conclusions: Generic entry at the aggregate level did not lead to a reduction in overall expenditures (P>0.05), implying that the expanding market for antidepressants overwhelmed the effect of generic competition.

Effects of mental demands during dispensing on perceived medication safety and employee well-being: A study of workload in pediatric hospital pharmacies - Corrected Proof

2010-02-12

Abstract: Background: Pharmacy workload is a modifiable work system factor believed to affect both medication safety outcomes and employee outcomes, such as job satisfaction.Objectives: This study sought to measure the effect of workload on safety and employee outcomes in 2 pediatric hospitals and to do so using a novel approach to pharmacy workload measurement.Methods: Rather than measuring prescription volume or other similar indicators, this study measured the type and intensity of mental demands experienced during the medication dispensing tasks. The effects of external (interruptions, divided attention, and rushing) and internal (concentration and effort) task demands on perceived medication error likelihood, adverse drug event likelihood, job dissatisfaction, and burnout were statistically estimated using multiple linear and logistic regression.Results: Pharmacists and pharmacy technicians reported high levels of external and internal mental demands during dispensing. The study supported the hypothesis that external demands (interruptions, divided attention, and rushing) negatively impacted medication safety and employee well-being outcomes. However, as hypothesized, increasing levels of internal demands (concentration and effort) were not associated with greater perceived likelihood of error, adverse drug events, or burnout and even had a positive effect on job satisfaction.Conclusions: Replicating a prior study in nursing, this study shows that new conceptualizations and measures of workload can generate important new findings about both detrimental and beneficial effects of workload on patient safety and employee well-being. This study discusses what those findings imply for policy, management, and design concerning automation, cognition, and staffing.

Addressing gaps in pharmacovigilance practices in the antiretroviral therapy program in the Eastern Cape Province, South Africa - Corrected Proof

Karine Wabø Ruud, Sunitha C. Srinivas, Else-Lydia Toverud — 2010-02-12

Abstract: Background: The use of antiretrovirals (ARVs) is associated with considerable concern regarding adverse drug reactions (ADRs), including both short- and long-term complications. Currently, there is a general underreporting of ADRs in South Africa. In May 2007, the Eastern Cape regional training centre introduced a pharmacovigilance plan for antiretroviral therapy (ART) to improve reporting practices in the area.Objectives: The aim of this study was to gain insight on attitudes and experiences regarding ADR detection and reporting among health care providers (HCPs) shortly after the first formal pharmacovigilance plan for ART was introduced.Methods: Three focus-group discussions were conducted with 12 HCPs. There were 7 nurses, 3 pharmacists, 1 doctor, and 1 auxiliary staff, all recruited from public hospitals and local health authorities in 2 towns in the Eastern Cape Province, South Africa.Results: It was observed that senior HCPs knew that ADRs from ARVs should be reported formally, whereas junior staff did not demonstrate the same knowledge. The participants thought that underreporting from the primary health care level was a major problem. HCPs identified various reasons for underreporting ADRs: problems with filling out the reporting form, lack of training, high workload, lack of feedback, and fears of not being taken seriously. Lack of adequate training in pharmacovigilance led to lack of confidence among the professional nurses in managing ADRs.Conclusions: Increased focus on pharmacovigilance with adequate, continuous training, especially for nurses managing down-referred patients in primary health care on identification and management of ADRs, and practical use of the ADR form may be necessary to improve pharmacovigilance practices in the area.

Exploring successful community pharmacist-physician collaborative working relationships using mixed methods - Corrected Proof

2010-02-12

Abstract: Background: Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.Objective: To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.Methods: A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.Results: On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.Conclusions: The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.

Determinants of medication incident reporting, recovery, and learning in community pharmacies: A conceptual model - Corrected Proof

2010-02-12

Abstract: Background: Evidence suggests that the underreporting of medication errors and near misses, collectively referred to as medication incidents (MIs), in the community pharmacy setting, is high. Despite the obvious negative implications, MIs present opportunities for pharmacy staff and regulatory authorities to learn from these mistakes and take steps to reduce the likelihood that they reoccur. However, these activities can only take place if such errors are reported and openly discussed.Objectives: This research proposes a model of factors influencing the reporting, service recovery, and organizational learning resulting from MIs within Canadian community pharmacies.Methods: The conceptual model is based on a synthesis of the literature and findings from a pilot study conducted among pharmacy management, pharmacists, and pharmacy technicians from 13 community pharmacies in Nova Scotia, Canada. The purpose of the pilot study was to identify various actions that should be taken to improve MI reporting and included staff perceptions of the strengths and weaknesses of their current MI-reporting process, desired characteristics of a new process, and broader external and internal activities that would likely improve reporting. Out of the 109 surveys sent, 72 usable surveys were returned (66.1% response rate). Multivariate analysis of variance found no significant differences among staff type in their perceptions of the current or new desired system but were found for broader initiatives to improve MI reporting. These findings were used for a proposed structural equation model (SEM).Results: The SEM proposes that individual-perceived self-efficacy, MI process capability, MI process support, organizational culture, management support, and regulatory authority all influence the completeness of MI reporting, which, in turn, influences MI service recovery and learning.Conclusions: This model may eventually be used to enable pharmacy managers to make better decisions. By identifying risk factors that contribute to low MI reporting, recovery, and learning, it will be possible for regulators to focus their efforts on high-risk sectors and begin to undertake preventative educational interventions rather than relying solely on remedial activities.

The role of the community pharmacist in fulfilling information needs of patients starting oral antidiabetics - Corrected Proof

Egbert J.F. Lamberts, Marcel L. Bouvy, Rolf P. van Hulten — 2010-01-18

Abstract: Background: Community pharmacy is in the middle of a paradigm shift from provider of medication to provider of care around medication. Much of this care involves giving information to patients so as to maximize pharmacotherapy outcomes; however, this is not necessarily recognized by patients. The initiation of chronic medication for diseases, such as type 2 diabetes mellitus (T2DM), arouses much uncertainty in patients, and it is not certain how information provision roles by pharmacists are viewed.Objectives: To obtain insight in the information needs of patients who have recently started treatment with oral antidiabetics and to investigate the opportunities for pharmacy regarding the provision of information for patients with T2DM.Methods: A qualitative study with both semistructured telephone interviews and patient focus group discussions was conducted. Individual patients' comments were categorized and used in a strengths, weaknesses, opportunities, and threats (SWOT) analysis exploring the role of the community pharmacist in the field of providing information at the moment of initiation of T2DM oral medication.Results: From interviews with 42 patients and 2 focus groups, discussions emerged that the general practitioner (GP) does not fulfill all information needs. For the pharmacist, there is an opportunity, as patients feel a need for information and like to discuss drug-related issues. SWOT analysis revealed main strengths of the pharmacy as “expertise” and “service and kindness.” Together with more cooperation with GPs and nurse practitioners, these strengths give the pharmacist the opportunity to further develop pharmaceutical care activities.Conclusion: Pharmacists are challenged to increase their visibility as health care provider while keeping logistic service on a high level and improving cooperation with other health care providers.

Examining the development of pharmacist-physician collaboration over 3 months - Corrected Proof

Yifei Liu, William R. Doucette, Karen B. Farris — 2010-01-18

Abstract: Background: Pharmacist-physician collaboration may result in improved patient care. The model of collaborative working relationship (CWR) synthesizes such collaboration into 5 progressive stages, which are impacted by individual, context, and exchange characteristics; however, no study has demonstrated how to distinguish the 5 collaborative stages.Objective: Using CWR, the study objective was to identify factors associated with pharmacist-physician collaboration at baseline and at 3 months.Methods: This study consisted of 2 self-administered surveys mailed to a random sample of 750 Iowa pharmacists. The first survey assessed collaborative care at baseline and individual, context, and exchange characteristics. The second survey assessed collaborative care 3 months later. The measures for CWR constructs were modified from previously validated instruments. Individual characteristics; context characteristics, including practice setting, professional interaction, current collaboration status (yes/no); and exchange characteristics, including relationship initiation, trustworthiness, and role specification were obtained. Descriptive statistics, reliability analysis, and bivariate correlations were performed. Two regressions were conducted, wherein collaborative care at baseline and at 3 months were regressed over relationship initiation, trustworthiness, role specification, professional interaction, current collaboration, practice setting, and physician specialty, wherein the data for independent variables collected at baseline were used in both regression procedures.Results: Response rates were 33% (n=239) and 79% (n=188) for the first and second surveys, respectively. In the regression analyses, 85% and 35% of the variance in collaborative care at baseline and at 3 months, respectively, were explained. Trustworthiness and role specification were 2 predictors of collaborative care at baseline, and trustworthiness and professional interaction were 2 predictors of collaborative care at 3 months.Conclusions: Different factors were associated with collaborative care at different study times, which support a dynamic model of CWR.

Variation in patients' and pharmacists' attribution of symptoms and the relationship to patients' concern beliefs in medications - Corrected Proof

Olayinka O. Shiyanbola, Karen B. Farris — 2010-01-18

Abstract: Background: The process by which symptoms are identified and characterized is related to adverse drug event reporting. Patient and pharmacist symptom attribution may differ and be related to certain patient characteristics.Objectives: (1) To compare attribution of symptoms to a cause for patients and pharmacists; (2) to quantify the association between patients' concern beliefs and patient-pharmacist agreement on patients' symptom attribution to medications; and (3) to identify any associations between patients' propensity to agree with pharmacists' assessments of symptom attribution with various clinical and/or sociodemographic characteristics.Methods: An Internet survey of Medicare beneficiaries was administered by Harris Interactive®. The survey elicited information on health symptoms that subjects experienced and to whom they reported these symptoms. If subjects did not experience symptoms and did not report them, the reasons for not reporting were elicited. A clinical expert panel reported ratings about respondents' (1) likelihood of the symptom experienced being attributed to a medication and (2) probability of the symptom being attributed to the reason the patient stated. Frequencies of unreported symptoms for each reason/category were examined. Chi-square and Fisher's exact test analyses examined the variations between patients' and pharmacists' ratings of symptom attribution to medications and associations between attribution and patient sociodemographic and clinical characteristics, such as the number of medications used. Independent sample t tests examined how attributions were related to concern beliefs.Results: Most patients thought their symptom(s) were the result of their disease, something other than medications or age. There was no statistically significant difference between patients' and pharmacists' symptom attribution (χ2=1.376, P=.24). Individuals whose symptom attributions differed from pharmacists were likely to have stronger concern beliefs in medication (t=−3.03, P<.01).Conclusions: Patients' concern about their medications may be related to their symptom attributions. Older adults may not consider these concerns when asked about their symptom attributions.

Characteristics of container labeling in a sample of commonly prescribed children's oral medications - Corrected Proof

Lorraine S. Wallace, Amy J. Keenum, Jennifer E. DeVoe — 2009-12-08

Abstract: Background: Time constraints often limit the amount of instruction pharmacists can provide to patients regarding accurate prescription medication use.Objectives: To assess the content, text point size, and reading difficulty of medication container labels and auxiliary warning labels (stickers) of 2 commonly prescribed children's medications (prednisolone and amoxicillin) dispensed by 20 US pharmacies. Secondly, to examine variability of pharmacy interpretations of electronically generated physician instructions (signatures [sigs]).Methods: All medication container labels were evaluated on the following: presence and rank order of 7 Food and Drug Administration (FDA)-required label items, presence of additional label content (eg, fill date), and whether each label content item was emphasized in some way (eg, highlighting). Presence, placement, content, and color of auxiliary warning labels (stickers) were also assessed. Text point size of pharmacy name, instructions, medication name, and instructional/warning stickers was measured to the nearest centimeter. Reading grade level (RGL) of medication label instructions and auxiliary warning labels was estimated using the Lexile Analyzer (available via the Internet [http://www.lexile.com]). Amount and timing of medication administration of pharmacy interpretations of sigs were examined.Results: All containers included the 7 FDA-required label items. Text point sizes varied widely (pharmacy name [mean ± standard deviation [SD] = 12.0 ± 3.9] versus auxiliary warning labels [mean ± SD = 6.8 ± 1.1]). Four (10%) containers did not include any additional type of warnings related to the medication, beyond the dosage amount and administration frequency. Mean Lexile score of warning stickers was 488.3 ± 316.3 (approximately third to fourth RGL), whereas that of pharmacy-generated instructions was 648.3 ± 215.9 (approximately fifth to sixth RGL). Prednisolone sig instructions were presented in 14 distinct ways by the pharmacies, whereas amoxicillin sig instructions were interpreted in 16 different ways.Conclusions: Although all prescriptions reviewed met the minimum FDA-required labeling standards, pharmacy characteristics were more likely to be prominently emphasized on the labels than were medication instructions and patient information. Systematic initiatives to standardize and call attention to key medication instructions and warnings should be considered.

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.