Research in Social and Administrative Pharmacy - Articles in Press

Labor supply functions of working male and female pharmacists: In search of the backward bend - Corrected Proof

Manuel J. Carvajal, Lisa Deziel, Graciela M. Armayor — 2012-05-04

Abstract: Background: Previous research has shown that U.S. pharmacists experience negative elasticities along a backward-bending labor supply function. The presence of a backward bend in the labor supply curve may cause a decrease in the amount of work at a time of labor shortage. Therefore, the determinants of pharmacists’ labor supply functions should be explored to assess the impact of this backward bend.Objectives: To determine whether female and male pharmacist work inputs are influenced by the same factors and estimate where the backward bend occurs, if at all, in their labor supply functions.Methods: Data were collected using a survey questionnaire mailed to registered pharmacists in South Florida. Labor supply functions were formulated and tested separately for 558 men and 498 women. The wage rate, other household income, human capital stock, job-related preferences, and opinion variables were hypothesized to explain labor supply differentials. Human capital stock variables included professional experience, holding a specialty board certification, and number of children; job-related preference variables included urban-rural location of work site and main role as a practitioner; and opinion variables included stress, autonomy, fairness in the workplace, flexibility, and job security.Results: Men and women responded differently to identical stimuli, and their supply functions were influenced in different ways by the explanatory variables. Both genders exhibited positive labor supply elasticities greater than those reported in other studies. Both genders’ backward bend in their labor supply functions occurred several standard deviations to the right of the mean.Conclusion: The backward bend in the labor supply functions of male and female pharmacists is not likely to affect in the near future the labor market’s ability to regulate shortages of practitioners via increases in the wage rate. A more thorough understanding of pharmacists’ labor supply functions must address gender issues and differences in response to identical stimuli.

Pharmacists’ provision of information to Spanish-speaking patients: A social cognitive approach - Corrected Proof

2012-05-04

Abstract: Background: Hispanics with limited English proficiency face communication challenges that affect medication use and outcomes. Pharmacists are poised to help patients’ use medications safely and effectively; however, scant research has explored factors that may impact pharmacists’ communication with Spanish-speaking patients (SSPs).Objective: Guided by social cognitive theory (SCT), the purpose of this study was to examine the relationships between pharmacy environmental factors, pharmacists’ cognition, and pharmacists’ communication with SSPs.Methods: A cross-sectional survey used a vignette to quantify the amount of information pharmacists would provide to an SSP. Pharmacy environmental factors (language-assistance resources, Spanish-speaking staff, and number of SSPs) and pharmacists’ cognition (self-efficacy beliefs and cultural sensitivity) that may influence communication also were assessed. The relationships between environmental factors, cognition, and pharmacists’ communication with SSPs, including indirect relationships, were examined using composite indicator structural equation (CISE) modeling.Results: Of the 183 respondents, most were white (91%) and male (63%) with a mean age of 47 years (SD = 12.77). The CISE modeling revealed that the number of SSPs served by the pharmacy and the pharmacist’s self-efficacy in communicating with SSPs were significantly directly associated with pharmacist’s provision of information to SSPs. Two environmental factors (presence of interpreter services and Spanish-speaking staff) operated indirectly through self-efficacy to significantly impact the provision of information.Conclusions: Study findings identify both environmental factors and cognition that could contribute to pharmacists’ communication behavior with SSPs. Thus, future interventions to improve pharmacists’ communication with SSPs may include training pharmacists to integrate interpretative services and Spanish-speaking staff into service delivery and strengthening pharmacists’ self-efficacy beliefs.

The impact of patient knowledge of patient-centered medication label content on quality of life among older adults - Corrected Proof

Song Hee Hong, Jing Liu, Sunghee Tak, Varun Vaidya — 2012-05-04

Abstract: Background: Prescription drugs have made great contributions to health and quality of life (QOL). However, inappropriate use of drugs may result in just the opposite effect. Older adults often take multiple medications simultaneously and thus are more vulnerable to inappropriate drug use. Knowledge of important aspects of medication use might reduce the risk of inappropriate utilization and improve QOL.Objective: To determine the extent of patient knowledge concerning patient-centered contents of medication labels (PCCMLs) and whether level of patient knowledge is associated with health outcomes.Methods: A survey was administered to members of 6 senior centers in Memphis, TN, USA. Surveys from older adults (65 or older) who were taking at least 1 medication were included in the current analyses (N=287). QOL was measured using the Euroqual EQ-5D and the Visual Analog Scale (EQ-VAS). Older adults reported their knowledge of PCCML on a set of 4 Likert-type scale items concerning the PCCMLs. Statistical analyses included descriptive statistics, analysis of variance, correlation analysis, and linear regression.Results: Study participants scored on average 16.20 (standard deviation [SD]=3.41) for knowledge of PCCML. Patient knowledge of PCCML was associated with age (rs=−0.1469, P=.0127), race/ethnicity (F=4.40, P=.0131), education (rs=0.1984, P=.0007), and household income (rs=0.1539, P=.0159). Study participants had an average EQ-5D score of 0.82 (SD=0.16) and EQ-VAS score of 77.80 (SD=15.07). Multivariate linear regression results showed that 1 unit increase in patient knowledge resulted in 0.62 unit increase (P=.017) in EQ-VAS QOL scores after adjusting for the impact of other variables. However, patient knowledge of PCCML did not significantly predict EQ-5D QOL scores (=0.002, P=.4633) when all other variables were controlled.Conclusion: Patient knowledge of medication use was associated with QOL among older adults. New standardized labels should be designed to improve patient knowledge of PCCML information. Furthermore, providers of medication therapy management should ensure that older adults have a complete knowledge of the PCCML information.

Application of system-level root cause analysis for drug quality and safety problems: A case study - Corrected Proof

Brian C. Sauer, Charles D. Hepler — 2012-05-04

Abstract: Background: Automated surveillance indicators are used to identify problems with drug therapy. A previous study automated 39 indicators of possible drug-related emergency department visits and hospitalizations. These indicators were used to investigate the quality and safety of drug use in a large health care coalition in Florida. This study describes a method of capturing this input with an aim of applying it to a root cause analysis (RCA), which may be useful for improving system-level flaws and weaknesses in medication use.Objective: To apply results of a computerized surveillance system containing selected indicators of potential drug-related emergency department and hospital admissions to an RCA for evaluation. Such evaluation might prove effective in determining criteria useful in improving the quality and safety of systemic responses to individual types of drug therapy problems.Methods: This was a case study that brought together a study group of 6 coalition stakeholders to evaluate findings from 4 indicators. The indicators represented problems in the prescribing, adherence, and monitoring steps in the ambulatory care medication use system. The RCA included the following procedures: brainstorming of possible system failures, organizing proposed system failures into groups and corresponding system levels, voting to prioritize proposed system failures, tree diagramming to illustrate how the system failures are interconnected among system levels, and determining whether system conditions or failure sequences are common among indicator types.Results: The group judged 3 themes to be important contributors to drug-related problems identified by the 4 indicators, including lack of patient knowledge, patient nonadherence to medical recommendations, and lack of medication management systems. The group believed that these barriers were interconnected and the result of subsystem influences.Conclusion: Drug therapy problems represented by the indicators have certain system failures, flaws, or defects in common, allowing them to occur and persist. RCA may be a useful method for evaluating population-level indicator findings to identify potential failures with the medication use system and develop interventions.

Application of the nonlinear Blinder-Oaxaca decomposition to study racial/ethnic disparities in antiobesity medication use in the United States - Corrected Proof

Hemalkumar B. Mehta, Suja S. Rajan, Rajender R. Aparasu, Michael L. Johnson — 2012-05-04

Abstract: Background: The nonlinear Blinder-Oaxaca (BO) decomposition method is gaining popularity in health services research because of its ability to explain disparity issues. The present study demonstrates the use of this method for categorical variables by addressing antiobesity medication use disparity.Objective: To examine racial/ethnic disparity in antiobesity medication use and to quantify the observed factor contribution behind the disparity using the nonlinear BO decomposition.Methods: Medical Expenditure Panel Survey data, 2002-2007, were used in this retrospective cross-sectional study. Adults with body mass index (BMI) >30, or BMI ≥27 and comorbidities such as hypertension, cardiovascular diseases, diabetes, or hyperlipidemia were included in the cohort (N=65,886,625). Multivariable logistic regression was performed to examine racial/ethnic disparity in antiobesity medication use controlling for predisposing, enabling, and need factors. The nonlinear BO decomposition was used to identify the contribution of each predisposing, enabling, and need factors in explaining the racial/ethnic disparity and to estimate the residual unexplained disparity.Results: Non-Hispanic Blacks were 46% (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.35-0.83) less likely to use antiobesity drugs compared with non-Hispanic Whites, whereas no difference was observed between Hispanics and non-Hispanic Whites. A 0.22 percentage point of disparity existed between non-Hispanic Whites and Blacks. The nonlinear BO decomposition estimated a decomposition coefficient of −0.0013 indicating that the observed disparity would have been 58% higher (−0.0013/0.0022) if non-Hispanic Blacks had similar observed characteristics as non-Hispanic Whites. Age, gender, marital status, region, and BMI were significant factors in the decomposition model; only marital status explained the racial/ethnic disparity among all observed characteristics.Conclusions: The study revealed that differences in the predisposing, enabling, and need characteristics (except marital status) did not successfully explain the racial/ethnic disparity in antiobesity medication use. Further studies examining racial/ethnic differences in individual beliefs, behavioral patterns, and provider prescription patterns are vital to understand these disparities.

A randomized trial evaluating 2 approaches for promoting pharmacy-based referrals to the tobacco quitline: Methods and baseline findings - Corrected Proof

2012-05-04

Abstract: Background: Despite the fact that individuals who smoke are at an increased risk for disease and therefore require frequent visits to pharmacies for medications, most community pharmacies do not integrate tobacco cessation activities into routine practice.Objective: The objective of this report is to describe the methods and baseline findings for a 2-state randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline.Methods: Participating community pharmacies in Connecticut (n=32) and Washington (n=32) were randomized to receive either (1) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline or (2) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians).Results: Pharmacists (n=124) and pharmacy technicians (n=127), representing 64 participating pharmacies with equal numbers of retail chain and independently owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were not at all familiar with the tobacco quitline. During the baseline (preintervention) monitoring period, the quitline registered 120 patients (18 in Connecticut and 102 in Washington) who reported that they heard about the quitline from a pharmacy.Conclusion: Novel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.

Pharmacoeconomics and outcomes research degree-granting PhD programs in the United States - Corrected Proof

2012-05-04

Abstract: Background: Evidence is missing on showcasing current practices of degree programs specific to the field of pharmaceutical outcomes research.Objectives: To measure current practices of pharmacoeconomics and outcomes research PhD programs in the United States and synthesize recommendations for improving the success of programs and prospective students.Methods: A 23-question online survey instrument was created and distributed to 32 program directors identified in the International Society for Pharmacoeconomics and Outcomes Research educational directory. Descriptive statistics summarized both the program characteristics (including observed and desired number of faculty and students) and training recommendations (traits of program and student success).Results: Of 30 eligible programs that conferred a PhD in pharmacoeconomics, pharmaceutical outcomes research, or a related field, 16 respondents (53%) completed the survey. Seventy-five percent of respondents were located in a school of pharmacy. The average observed number of faculty (7.5) and students (11.5) was lower than the average desired numbers (8.1) and (14.7), respectively. Reputation of faculty research and a collaborative environment with other disciplines were rated highest for a program’s success. Faculty’s mentoring experience and reputation and student funding opportunities were rated highest for prospective students’ success.Conclusions: Existing and emerging programs as well as prospective students can use these findings to further their chances of success.

Requests for emergency contraception in community pharmacy: An evaluation of services provided to mystery patients - Corrected Proof

Samantha J. Higgins, H. Laetitia Hattingh — 2012-05-04

Abstract: Background: Requests for supply of the emergency contraceptive pill (ECP) through community pharmacies require consideration of a range of factors and the application of professional judgment. Pharmacists should therefore be able to follow a structured reasoning process.Objectives: The research involved an assessment of history taking and counseling by pharmacy staff through mystery patient emergency contraception product requests.Methods: Two challenging ECP request case scenarios were developed with assessment tools. Mystery patients were trained to present the scenarios to pharmacies. A project information package and expression of interest form was posted to 135 pharmacies in the Gold Coast, Australia; 23 (17%) pharmacies agreed to participate.Results: Pharmacy staff was exposed to 1 of 2 scenarios during December 2010. Staff interactions were recorded, analyzed, and rated to evaluate the management of ECP requests. The results identified practice gaps among pharmacy staff with respect to information gathering and the provision of advice.Conclusion: Ongoing training is required to enhance the skills, competence, and confidence of pharmacy staff in managing complicated requests for nonprescription medicines, such as the ECP. The impact of time pressures and financial burdens on the provision of pharmaceutical services needs to be acknowledged.

Understanding the attitudes of hospital pharmacists to reporting medication incidents: A qualitative study - Corrected Proof

Steven D. Williams, Denham L. Phipps, Darren M. Ashcroft — 2012-03-29

Abstract: Background: The attitudes of doctors, nurses, and midwives to reporting errors in health care have been extensively studied, but there is very limited literature considering pharmacists’ attitudes to medication error reporting schemes, in particular in hospitals.Objectives: To explore and understand the attitudes of hospital pharmacists to reporting medication incidents.Methods: Focus groups were conducted with a total of 17 hospital pharmacists from 4 purposively sampled hospitals in the North West of England. The recordings of the focus groups were transcribed verbatim and subject to thematic analysis using a framework analysis approach.Results: Pharmacists agreed that the high prevalence of medication errors, especially prescribing errors of omission, has led to an acceptance of not using hospital reporting systems. There were different personal thresholds for reporting medication errors but pharmacists agreed that the severity of any patient harm was the primary reporting driver. Hospital pharmacists had specific anxieties about the effects of reporting on interprofessional working relationships with doctors and nurses, but felt more confident to report if they had previously witnessed positive feedback and system change following an error. Existing reporting forms were considered too cumbersome and time consuming to complete, as pharmacists felt the need to find and record every possible detail.Conclusions: Hospital pharmacists understood the importance of reporting medication incidents, but because of the high number of errors they encounter do not report them as often as may be expected. The decision to report was a complex process that depended on the severity of patient harm, anxieties about harming interprofessional relationships, prior experience of the outcomes from reporting, and the perceived effort required to use reporting forms.

Young adults’ medicine use for headache: The combined effect of socioeconomic position and perceived stress, and the contribution of sense of coherence - Corrected Proof

Vibeke Koushede, Ebba Holme Hansen, Anette Andersen, Bjørn E. Holstein — 2012-03-22

Abstract: Background: Over-the-counter analgesic (OTCA) use is increasingly common and may have potential harmful side effects. The primary reason for using analgesics is headache symptoms. Whether OTCA use for headache is sensitive to psychosocial and social circumstances is an understudied topic.Objectives: The purpose of this study was to examine the combined effect of socioeconomic position (SEP) and perceived stress on OTCA use for headache. An additional objective was to determine whether sense of coherence (SOC) modifies the association.Methods: Data derived from the cross-sectional “Danish Lifestyle and Medicine Use Study,” 2009. The study population consisted of men and women ages 25-44 years (n = 955). The dependent variable was OTCA use for headache within the past 14 days. The independent variables were SEP, perceived stress, and SOC. Gender, headache prevalence, and response method were included as covariates. Associations were examined by means of logistic regression analyses, and reported as odds ratios (ORs) with 95% confidence intervals.Results: The OR for OTCA use was 1.42 (0.94-2.14) (statistically nonsignificant) among participants with low SEP but no perceived stress (reference high SEP, no perceived stress), 2.09 (1.53-2.85) for participants with perceived stress and high SEP, and 2.65 (1.66-4.25) among participants with perceived stress and low SEP. In analysis, stratified by SOC associations were stronger among participants with low SOC than among those with high SOC.Conclusions: Individuals exposed to both low SEP and high perceived stress have high odds for using OTCA for headache, apparently higher than participants only exposed to 1 of these factors. SOC may act as a buffer against the harmful effects of perceived stress and low SEP on OTCA use. Health care professionals and policymakers need to be aware of the sensitivity of OTCA use to psychosocial and social circumstances.

Contingent valuation and pharmacists’ acceptable levels of compensation for medication therapy management services - Corrected Proof

Junling Wang, Song Hee Hong — 2012-03-22

Abstract: Background: Pharmacists’ acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques.Objectives: Using contingent valuation method, determine pharmacists’ acceptable levels of compensation for MTM services.Methods: A mailing survey was used to elicit Tennessee (U.S.) pharmacists’ acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness to accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists’ WTA, and Cox’s proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA.Results: Three hundred and forty-eight pharmacists responded to the survey. Pharmacists’ WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists’ characteristics had statistically significant association with their WTA rates.Conclusions: Pharmacists’ WTA for the given MTM session is higher than current Medicare MTM programs’ compensation levels of $15-$50 and patients’ willingness to pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services.

Challenges of standardized continuous quality improvement programs in community pharmacies: The case of SafetyNET-Rx - Corrected Proof

Todd A. Boyle, Neil J. MacKinnon, Thomas Mahaffey, Kellie Duggan, Natalie Dow — 2012-03-16

Abstract: Background: Research on continuous quality improvement (CQI) in community pharmacies lags in comparison to service, manufacturing, and various health care sectors. As a result, very little is known about the challenges community pharmacies face when implementing CQI programs in general, let alone the challenges of implementing a standardized and technologically sophisticated one.Objective: This research identifies the initial challenges of implementing a standardized CQI program in community pharmacies and how such challenges were addressed by pharmacy staff.Methods: Through qualitative interviews, a multisite study of the SafetyNET-Rx CQI program involving community pharmacies in Nova Scotia, Canada, was performed to identify such challenges. Interviews were conducted with the CQI facilitator (ie, staff pharmacist or technician) in 55 community pharmacies that adopted the SafetyNET-Rx program. Of these 55 pharmacies, 25 were part of large national corporate chains, 22 were part of banner chains, and 8 were independent pharmacies. A total of 10 different corporate chains and banners were represented among the 55 pharmacies. Thematic content analysis using well-established coding procedures was used to explore the interview data and elicit the key challenges faced.Results: Six major challenges were identified, specifically finding time to report, having all pharmacy staff involved in quality-related event (QRE) reporting, reporting apprehensiveness, changing staff relationships, meeting to discuss QREs, and accepting the online technology. Challenges were addressed in a number of ways including developing a manual-online hybrid reporting system, managers paying staff to meet after hours, and pharmacy managers showing visible commitment to QRE reporting and learning.Conclusions: This research identifies key challenges to implementing CQI programs in community pharmacies and also provides a starting point for future research relating to how the challenges of QRE reporting and learning in community pharmacies change over time.

Pharmacy workers’ perceptions and acceptance of bar-coded medication technology in a pediatric hospital - Corrected Proof

Richard J. Holden, Roger L. Brown, Matthew C. Scanlon, Ben-Tzion Karsh — 2012-03-15

Abstract: Background: The safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology.Objectives: (1) To describe pharmacy workers’ perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA.Methods: Pharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital’s implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians’ self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models.Results: The BCMA system’s perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA.Conclusions: To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians’ acceptance and elucidating perceptions and other factors that shape acceptance.

Dealing with aggressive methadone patients in community pharmacy: A critical incident study - Corrected Proof

Amy Irwin, Christianne Laing, Kathryn Mearns — 2012-03-02

Abstract: Background: Community pharmacists are an important link between methadone patients and the health service in the United Kingdom. However, many pharmacists feel ill prepared to deal with methadone patients, with aggressive behavior a particular concern.Objective: To assess the perceived impact of methadone patient aggression on pharmacy practice.Methods: Sixteen registered pharmacists with a minimum of 3 years’ work experience were recruited from within 3 Scottish health boards. Critical incident interviews were conducted to assess pharmacist behavior during an interaction with an aggressive methadone patient.Results: Factors considered by pharmacists to have a negative impact on an interaction with an aggressive methadone patient included intoxication of the patient, the presence of a new or an inexperienced pharmacist, and a restricted time frame for dispensing methadone. Positive factors when dealing with aggressive patients were authoritative behavior by the pharmacist, a separate dispensing area for methadone patients, or a solid counter and a positive relationship between pharmacist and patient.Conclusion: Aggression from methadone patients is a risk when dispensing methadone. However, action can be taken by the pharmacist to minimize the impact of that aggression on pharmacy practice. The provision of further training and support, particularly to inexperienced pharmacists, could further reduce the negative impact of patient aggression. The present study indicates that such training could be based on nontechnical skills to strengthen current leadership and teamwork behaviors.

Patients’ willingness to use a pharmacist-provided medication management service: The influence of outcome expectancies and communication efficacy - Corrected Proof

Stephen R. Carter, Rebekah Moles, Lesley White, Timothy F. Chen — 2012-03-02

Abstract: Background: Previous research has demonstrated that some patients who are at risk of experiencing medication-related problems express a lack of willingness to use pharmacist-provided medication management services. Little is known about the factors that influence willingness to use these services among patients who have not yet experienced the service.Objectives: The aim of this study was to test a model of willingness to use the Australian Home Medicines Review (HMR) service. Specifically, this study aimed to determine the influence of positive and negative outcome expectancies and communication efficacy over willingness among patients who were eligible to receive the service but have not yet experienced it.Methods: A cross-sectional survey was conducted with patients who were recruited by 264 community pharmacists throughout Australia. Patients were included in the study if they had not yet experienced HMR but were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed using exploratory and confirmatory factor analyses. Structural equation modeling was used to test the model.Results: Questionnaires received from 286 patients (15.6%) were analyzed. Multi-item measurement scales were observed to have acceptable construct reliabilities (range, 0.69-0.94). Importantly, respondents held overall neutral expectations about the personal benefits of HMR (positive outcome expectancies) but high communication efficacy. Structural equation modeling revealed that positive outcome expectancies (β=0.56, P<.001) and communication efficacy (β=0.25, P<.05) influenced willingness to use, whereas negative outcome expectancies had no significant effect.Conclusions: The extent to which patients believe that HMR would provide them with increased medicines knowledge, improve their medicines management capability, and reduce their medicine concerns had a significant influence over willingness to use the service. Because these expectancies are relatively low, there appears to be significant scope for increasing patient demand for these services. Patient-directed material about medication management services should highlight the provision of medication information.

Information sources used by parents to learn about medications they are giving their children - Corrected Proof

Miina Holappa, Riitta Ahonen, Kirsti Vainio, Katri Hämeen-Anttila — 2012-03-02

Abstract: Background: Previous studies have indicated the use of medication by children to be dependent on the attitudes of knowledge of their parents; however, little is known about sources parents might use in driving medication use decisions.Objective: The aim of this study was to describe the information sources that parents use regarding their children’s medication and their perceptions of the reliability of these information sources.Methods: This study is part of a cross-sectional population survey with a random sample of 6000 children younger than 12 years. The response rate of the questionnaire was 67%. Parents were asked about the use of information sources and their perception of reliability with a list of 16 information sources.Results: The information sources that parents reported having used were physicians (72%), patient information leaflets (PILs) (67%), public or school health nurses (52%), and pharmacists (44%). Regardless of the child’s age, physicians were the parents’ most-used information source. Physicians were the most-used information source also when the child had at least 1 of the 4 most common long-term diseases among children in Finland (asthma, diabetes, epilepsy, and juvenile idiopathic arthritis). Parents considered physicians (50%), PILs (31%), pharmacists (27%), nurses (20%), and public or school health nurses (17%) very reliable information sources.Conclusions: Finnish parents seek information from health care professionals and PILs when looking for information concerning their children’s medication. Furthermore, they find health care professionals and PILs to be reliable information sources.

Generic medications for you, but brand-name medications for me - Corrected Proof

Amy J. Keenum, Jennifer E. DeVoe, Deena J. Chisolm, Lorraine S. Wallace — 2012-02-23

Abstract: Background: Because generic medications are less expensive than brand-name medications, government and private insurers have encouraged and/or mandated the use of generics.Objective: This study aimed at evaluating perceptions about generic medications among English-speaking women of childbearing age currently enrolled in U.S. TennCare (Medicaid).Methods: We recruited a convenience sample of patients from the waiting room of a primary care/gynecology health clinic, with 80% recruitment rate among those approached. We orally administered a 25-item questionnaire to gather sociodemographic information and to assess beliefs regarding the efficacy, safety, cost, and preferences for personal use of generic medications.Results: The average age of the women (n=172) was 28.8±6.4 years, and most were white (82.0%) and currently married (58.1%). Nearly one-fifth (19.2%) had not completed high school. Most women believed that generic medications were less expensive (97.6%) and better value (60.5%) than brand-name medications, but only 45.3% preferred to take generics themselves. About a quarter (23.3%) believed that brand-name medications were more effective than generics, whereas 13.4% believed that generics caused more side effects. Few women reported that their doctor (29.7%) and/or pharmacist (35.5%) had ever talked to them about taking generics.Conclusion: Awareness of the benefits of generics did not equal preferences for personal use of generics among this sample of women enrolled in U.S. TennCare. Furthermore, women reported that providers—both physicians and pharmacists—infrequently discussed generic substitution with them.

Deregulation of nonprescription medicines in Sweden—A look at the control system - Corrected Proof

Annika Nordén-Hägg, Mariam Shamoon, Sofia Kälvemark Sporrong — 2012-02-10

Abstract: Background: Sales of nonprescription medicines (NPMs) in retail outlets in Sweden have been permitted since 2009. The conditions are that sales are reported to the Medicine Product Agency (MPA) and that the owners of the retail outlets fulfill legal requirements. The MPA has an overall supervisory function, whereas municipalities are responsible for the actual control. This is mainly executed through inspections.Objective: The aim of the study was to explore some aspects of control performed by Swedish authorities of NPM sales in retail outlets.Methods: Telephonic interviews were conducted with inspectors from a heterogenic sample of municipalities in Sweden during autumn of 2010. A semistructured interview guide was designed, which included questions on inspections and deviations found in inspections. Interviews were documented in writing, and a deductive content analysis was performed.Results: Inspectors in 15 municipalities participated. In 8 of the municipalities, at least 1 inspection had been conducted. Seven inspectors had used a checklist designed by the MPA, although a majority found it difficult to use. Deviations found were mainly minor; they included lack of signs regarding age limits and prohibition of illegal sales, unlocked/open drug cabinet doors, nonexistent self-inspection programs, erroneous display of NPMs, and broken drug packages. Two serious deviations were found and reported to the MPA; these were negligence in reporting of sales statistics of NPM and 1 case where the inspector had not been allowed to conduct any inspection.Conclusion: The restructuring of the sale of NPMs in Sweden, permitting sale outside pharmacies, has not been accompanied by satisfactory control procedures from authorities according to our findings. Work is still needed to make sure that optimal drug use and patient safety issues are kept in focus.

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 Whatley, 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 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.

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.

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.