Showing papers in "Research in Social & Administrative Pharmacy in 2009"
TL;DR: Of all methods, simulated-patient methods appear to be a more reliable method of evaluating counseling practice in pharmacies, and in providing information to consumers with prescriptions, pharmacists appear to have fulfilled the minimum legislative requirements or practice standards.
Abstract: Background Counseling has become an integral part of community pharmacy practice. Previous reviews of research into pharmacists' counseling practices on prescription medicines have primarily focused on activities at a national level. None have adopted an international perspective. Objectives To review (1) verbal counseling rates and (2) types of information provided for prescription medicines in community pharmacies and (3) to compare the research methods used in evaluating counseling practice. Methods Published articles in English (1993-2007) were identified based on searches of on-line databases (International Pharmaceutical Abstracts, PubMed, Medline, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews) and cited references in the articles. Results Forty research articles met inclusion criteria for studies investigating verbal counseling rates and/or types of information provided for prescription medicines in community pharmacies. The counseling rates reported varied from 8% to 100%, depending on the research methods used. On average, lower counseling rates were found from consumer and observational studies compared with pharmacist- and simulated-patient studies. The type of prescription also influenced the rate. Higher rates were found in counseling consumers with new compared with regular prescriptions. Information on directions for use, dose, medicine name, and indications was more frequently given than information on side effects, precautions, interactions, contraindications, and storage. Most findings came from self-report and observational methods, each of which has limitations. Few studies used triangulation to overcome methodological limitations. In recent studies, simulated-patient methods have been used increasingly to evaluate counseling practice in the natural environment. Conclusions The actual counseling rates are difficult to obtain due to the differences and limitations of each research method. Of all methods, simulated-patient methods appear to be a more reliable method of evaluating counseling practice in pharmacies. In providing information to consumers with prescriptions, pharmacists appear to have fulfilled the minimum legislative requirements or practice standards.
174 citations
TL;DR: In this paper, the authors investigate whether community pharmacists' and general practitioner's perceptions of the role of community pharmacologists may be a barrier to pharmacists increasing their role in medication management.
Abstract: Background Because community pharmacists are encouraged to provide clinical services, there is a need to determine the role perceptions of both community pharmacists and general practitioners (primary care physicians). Differing role perceptions are likely to result in barriers to pharmacists expanding their roles in health care. Objectives The purpose of this study was to investigate whether community pharmacists' and general practitioner's perceptions of the role of community pharmacists may be a barrier to pharmacists increasing their role in medication management. Other potential barriers were also explored that could provide a framework for future research. Methods A postal survey to 900 and 1000 randomly selected community pharmacists and general practitioners, respectively, elicited the perceptions of these groups toward the role of community pharmacists. Likert scales were used to quantify the results. Results The results revealed a gap in perceptions regarding the role of the community pharmacist, with general acceptance of the technical roles but less acceptance of clinical roles by general practitioners. Barriers to increased involvement of community pharmacists in clinical services included a perceived lack of mandate, legitimacy, adequacy, and effectiveness by both groups. Also observed was a lack of readiness to change by community pharmacists. Conclusions This study suggests that there are significant barriers to community pharmacists increasing clinical services, both from the community pharmacists themselves and from the general practitioners. Attention to change management in a complex environment will be necessary if community pharmacists are to change their role toward more clinical services.
128 citations
TL;DR: A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients.
Abstract: Background Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization. Objectives The objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent). Methods A self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Results The level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services. Conclusions A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.
126 citations
TL;DR: Only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacist.
Abstract: Background To date there has been no published research on the link between job satisfaction and intentions to quit the profession among pharmacists. Objective To explore job satisfaction, intentions to quit the profession, and actual quitting among pharmacists on the Royal Pharmaceutical Society of Great Britain Register. Methods Job satisfaction of pharmacists was measured as part of a workforce census using a validated satisfaction scale. Pharmacists were asked about their intentions to quit pharmacy within the next 2 years and follow-up was done using secondary analysis to see if they had quit within this timescale. Mean values for the satisfaction scale items were recorded and regression techniques were used to explore factors affecting job satisfaction and intentions to quit. The workforce census questionnaire was completed by 32,181 pharmacists (response rate = 76.6%). This article considers the job satisfaction and intentions to quit of pharmacists under state pension age who were working in the community, hospital, and primary care sectors (n = 21,889). Results Overall, pharmacists appeared to be satisfied with their work, although female pharmacists were more satisfied than their male counterparts. Pharmacists working in the community sector were less satisfied than those in other sectors. Remuneration was consistently ranked as 1 of the aspects of their work that pharmacists found least satisfying, regardless of age, sex, or sector of practice. Strength of desire to practice pharmacy was a predictor of both job satisfaction and intentions to quit pharmacy. Conclusions Several factors were found to affect pharmacists' intentions to quit the profession including sex, age, job satisfaction, and strength of desire to practice pharmacy. However, only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacists.
111 citations
TL;DR: Physicians in hospitals in Jordan were more likely to accept or recognize traditional pharmacy services than newer clinical services and increasing physician awareness of these clinical pharmacy skills will be an important step in developing CWRs.
Abstract: Background To initiate a collaborative working relationship (CWR) between physicians and pharmacists, current physicians' perceptions, expectations, and experiences with pharmacists should be determined. Objective The purpose of this study was to investigate physicians' perceptions, expectations, and their actual experiences with pharmacists in hospital settings in Jordan. Methods A self-administered questionnaire was delivered to 284 physicians selected randomly from 4 main hospitals in northern Jordan. The questionnaire was composed of 4 parts investigating physicians' expectations, experiences, and perceptions of the pharmacists. Results Two hundred and forty-five questionnaires were completed (response rate, 86.3%). More than half of the physicians were comfortable with pharmacists providing patient education. Similarly, just fewer than half (48.2%) were uncomfortable with pharmacists suggesting the use of prescription medications to patients. Most physicians (62.5%) expect the pharmacist to educate their patients about safe and appropriate use of drugs; however, approximately one third (33.9%) of them do not expect the pharmacist to be available for consultation during rounds. Approximately, 54% of the physicians agreed that pharmacists were always a reliable source of information. Nevertheless, only 28.2% agreed that pharmacists frequently inform them that their patients have experienced some problem with their medications. Conclusions Physicians in hospitals in Jordan were more likely to accept or recognize traditional pharmacy services than newer clinical services. Increasing physician awareness of these clinical pharmacy skills will be an important step in developing CWRs.
99 citations
TL;DR: Pharmacists found that the integration into team-based primary health care provided both challenges and fresh opportunities and their professional identities evolved in relation to valued role models, emerging practice-level opportunities, and their patient-related contributions.
Abstract: Background Multidisciplinary team development generates changes in roles, responsibilities, and identities of individual health care providers. The Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) project introduced pharmacists into family practice teams across Ontario, Canada, to provide medication assessments, drug information, and academic detailing and to develop office system enhancements to improve drug therapy. Objective To analyze pharmacists' narrative accounts during early integration to study identity development within emerging team-based care. Method Qualitative design using 63 pharmacist narrative reports of pharmacists' experiences over a 9-month integration period. Four independent researchers with varied professional backgrounds used immersion and crystallization to identify codes and iterative grounded theory to determine and debate process and content themes relevant to identity development. Results The pharmacists' narratives spoke of the daily experiences of integrating into a family practice setting: feeling valued and contributing concretely to patient care; feeling underutilized; feeling like a nuisance, or feeling as though working too slowly. Pharmacist mentors helped deal with uncertainty and complexity of care. Pharmacists perceived that complementary clinical contributions enhanced their status with physicians and motivated pharmacists to take on new responsibilities. Changes in perspective, clinic-relevant skill development, and a new sense of professionalism signaled an emerging pharmacist family practice identity. Conclusion Pharmacists found that the integration into team-based primary health care provided both challenges and fresh opportunities. Pharmacists' professional identities evolved in relation to valued role models, emerging practice-level opportunities, and their patient-related contributions.
88 citations
TL;DR: There is high prevalence of self-medication in Assendabo town, Jimma, southwestern Ethiopia and lack of drug information and accessibility to over-the-counter drugs without any health professional guide contributed to the high incidence.
Abstract: Background The actions taken for the treatment of illness or symptom of an illness vary depending on the perceptions and experiences of individuals and other factors. A significant portion of all care in illness is self-care. In many cases, self-medication is an important initial response to illness. Although some health-care providers attach negative connotations to it, the World Health Organization acknowledges the existence of a valid role of self-medication. Objective This study was aimed at assessing the magnitude, type, and factors of self-medication in Assendabo town, Jimma, southwestern Ethiopia. Methods A community-based cross-sectional study was conducted in Assendabo town during February and March 2006. Open-ended questionnaire was used to collect data by interviewing heads of households in the study population. The data collected were properly screened before they were analyzed. Results A total of 242 households with 1257 individuals were visited, of which 143 (11.4%) reported at least 1 episode of illness and of whom 56 (39%) used self-medication using both modern pharmaceuticals and traditional medicines. Low severity of illness was a major reason for practicing self-medication; 80.6% of self-medicating individuals had no information on potential drug adverse effect. About 55% of ill persons who treated themselves reported improvement in their condition. Conclusions There is high prevalence of self-medication in Assendabo town. Lack of drug information and accessibility to over-the-counter drugs without any health professional guide contributed to the high incidence of self-medication. Enforcement of regulations in drug distribution and provision of appropriate health education to the community at large is critical.
77 citations
TL;DR: Results of this study show that the educational intervention led to an increase in the participants' levels of knowledge about hypertension and a positive influence on their beliefs about medicines, despite adequate time required before anticipated behavioral changes, such as increased adherence, can be observed.
Abstract: Background The burden of chronic noncommunicable diseases continues to rise in South Africa, leading to high rates of morbidity and mortality. The control of hypertension is far from optimal because of factors such as inadequate patient understanding of the condition and its therapy, as well as poor adherence to prescribed regimens. Objective This study investigated the effect of an educational intervention on selected hypertensive participants' levels of knowledge about hypertension, their beliefs about medicines, and adherence to antihypertensive therapy. Method Participants took part in an educational intervention that provided them with information about hypertension and its therapy through presentations, monthly meetings, and a summary information leaflet. The participants' levels of knowledge about hypertension and its therapy as well as their beliefs about medicines were measured using interviews and/or self-administered questionnaires. Levels of adherence were assessed using pill counts, self-reports, and punctuality in collecting medication refills. Paired t tests for dependent samples were performed to compare the participants' levels of knowledge about hypertension and its therapy, beliefs about medicines, and levels of adherence to antihypertensive therapy before and after the educational intervention. Results There were significant increases in the participants' levels of knowledge about hypertension and its therapy ( P P P P Conclusion Results of this study show that the educational intervention led to an increase in the participants' levels of knowledge about hypertension and a positive influence on their beliefs about medicines. Despite these positive changes, adequate time is required before anticipated behavioral changes, such as increased adherence, can be observed.
71 citations
TL;DR: In addition to known corruption in some of the least developed countries, the trail through developed countries was detected and means to detect faulty products are identified and efforts toward resisting and ending these corrupt practices are described.
Abstract: Background Counterfeiting and the sale of substandard pharmaceutical products can no longer be ignored. At 10% of global trade, counterfeiting is affecting many countries, causing serious downstream expenses and resource shortages. Objective To describe the nature and impact of drug product counterfeiting and substandard product sale and to present strategies that may have value in ameliorating these phenomena. Methods A literature review was conducted, supplemented by interviews of key leaders/experts in the field and the search of relevant web sites. All of the data were combined, integrated, and coordinated to present the complete picture of this problem. Results In addition to known corruption in some of the least developed countries, the trail through developed countries was detected. This report identifies means to detect faulty products and describes efforts toward resisting and ending these corrupt practices. Conclusions Counterfeit drugs, if not stopped, can be responsible for a macroeconomic pandemic where major portions of some populations may be too ill to work and where the health sector resources are completely overwhelmed, as with the case of HIV/AIDS.
62 citations
TL;DR: The generally favorable attitude of community pharmacists toward depression is promising with regard to their role in depression care, and training programs are needed to further improve unfavorable attitudes.
Abstract: BACKGROUND: Pharmacists' expanding roles may be witness to greater involvement in mental illnesses, of which depression is the disorder with the highest prevalence. Little, however, is known on pharmacists' attitude toward depression, although it may affect pharmacists' service provision and lead to stigmatization of patients. OBJECTIVE: This study is intended as a pilot to explore community pharmacists' attitude toward depression, components in the attitude, and factors related to it. METHODS: A random sample of 200 community pharmacists in Belgium was surveyed on the attitude toward depression. To measure this attitude, we used a modified version (adapted to the specific context of pharmacists) of the Depression Attitude Questionnaire (DAQ), which covers several aspects of the attitude toward depression. RESULTS: Pharmacists' attitude toward depression was generally favorable, but some opinions about depression treatment were not. This attitude could be summarized by 4 components (the attitude toward the treatment of depression, toward the course of depression, toward pharmacists' role in depression care, and toward patients with depression), although several limitations in the component solution were observed. Older pharmacists and those with a more pessimistic attitude toward the course of depression endorsed a more negative attitude toward patients with depression. CONCLUSIONS: The generally favorable attitude of community pharmacists toward depression is promising with regard to their role in depression care. Training programs, preferably including patients with depression themselves, are needed to further improve unfavorable attitudes. Further work is needed to refine the pharmacists' adapted DAQ.
56 citations
TL;DR: These studies provide a macroscopic look at the linguistic services offered in pharmacies, gaps in services, and their subsequent impact on pharmacists and patients.
Abstract: Background Spanish-speaking people represent more than 12% of the total population in the United States and are poised to become the largest minority group in the United States by 2015. Although researchers have studied pharmacist-patient communication for approximately 30 years, little emphasis has been placed on the interactions between pharmacists and Spanish-speaking patients. Objectives The objectives of this review are (1) to describe empirical studies on Spanish-speaking patient/pharmacist communication examined relative to patient factors, pharmacist factors, and environmental factors that may influence Spanish-speaking patient/pharmacist communication and (2) to integrate medical and nursing literature to generate a research agenda for future study in this area. Methods We compiled articles from a systematic review of (1) CINAHL, International Pharmacy Abstracts, PubMed, and Web of Knowledge databases using “Hispanic limited English proficiency,” “Latino limited English proficiency,” “language-assistance services,” “Spanish-speaking patients,” “Latino patients,” “Spanish-speaking health literacy,” “pharmacy health literacy,” “patient-provider communication,” “pharmacy language barriers,” and (2) bibliographies of selected articles. Results This search generated 1174 articles, 7 of which met the inclusion criteria. We categorized the results into 4 topic areas: “Spanish-speaking patient literacy,” “pharmacists knowledge of/proficiency in the Spanish language,” “pharmacy resources to overcome language barriers,” and “pharmacists' attitudes toward communicating with Spanish-speaking patients.” Conclusions These studies provide a macroscopic look at the linguistic services offered in pharmacies, gaps in services, and their subsequent impact on pharmacists and patients. Future research should investigate Spanish-speaking patients' literacy issues, pharmacy staff language skills, factors that influence pharmacists' counseling, and language-assistance programs for pharmacists and patients. Furthermore, these studies need to be conducted in large Hispanic/Latino populated areas where positive service models are likely to be present. Addressing these issues will provide pharmacists and pharmacies with information to overcome language barriers and provide Spanish-speaking patients with quality care.
TL;DR: In this article, the authors explored US pharmacists' perceived preparedness, willingness, and challenges toward providing medication therapy management (MTM) services, and found that a majority of the respondents agreed that pharmacists should provide MTM and have the ability to do so.
Abstract: Background Changes in US Medicare legislation could benefit pharmacy's attempt to make medication therapy management (MTM) practice more commonplace; however, little is known about pharmacists' capabilities and preferences to do so Objectives The purpose of this study was to explore US pharmacists' perceived preparedness, willingness, and challenges toward providing MTM services Methods A brief purpose of the survey and its website link were included in the electronic weekly newsletter of the National Community Pharmacists Association (NCPA) in January 2007 The web-based survey consisted of 8 demographic questions, 8 questions examining preparedness and willingness of the respondents regarding MTM, 2 questions regarding reimbursement to pharmacists, and 2 checklists for challenges in establishing MTM services Results Most of the 143 respondents indicated that they were aware of MTM, and 92 (65%) reported that they were currently practicing MTM A majority of the sample agreed that pharmacists should provide MTM and have the ability to do so Major challenges reported by the sample include the different specification of MTM by each health plan, time, staffing, and reimbursement issues Respondents selected valid measures of program effectiveness but revealed that they needed help with documentation and billing Expected reimbursement range was $1-10/minute Conclusion Community independent pharmacists reported being ready, willing, and able to provide MTM services, but need assistance in the process, that is, standardized MTM protocols, documentation and billing
TL;DR: Pharmacists in West Virginia are interested in and open to their pharmacists receiving education and training for implementation of MTMS, and had a favorable view of the value of services to patients, but reported that lack of time tended to be a barrier.
Abstract: Background The Medicare Modernization Act of 2003 recognizes the challenges associated with drug therapy in elderly patients with multiple chronic diseases, and requires the development of medication therapy management services (MTMS) for such beneficiaries. Objective To assess pharmacists' perception of educational and training needs necessary to implement MTMS in community pharmacies in West Virginia, USA. Methods Self-administered mail surveys with an explanatory cover letter were mailed to the designated pharmacist-in-charge (PIC) of each licensed community pharmacy (506) in West Virginia. Main outcome measures included pharmacists' comfort level, perceptions of value to patients, barriers to provision of services, and pharmacists' interest in receiving education and training related to MTMS. Results Of the 503 surveys that were deliverable, 203 (40.4%) usable responses were received. Fifty-five (27.1%) PICs reported that MTMS are currently being provided in their pharmacy. Respondents were likely to use services that aid in the development of MTMS and disease-state management, felt relatively comfortable in providing MTMS, and had a favorable view of the value of services to patients, but reported that lack of time tended to be a barrier. Conclusion PICs in West Virginia are interested in and open to their pharmacists receiving education and training for implementation of MTMS.
TL;DR: The findings of the study suggest substantial variability among pharmacists in their perception of the need for pharmacy leadership across 16 clinical and managerial activities.
Abstract: Background Patient-focused care provided by an interprofessional team has long been presented as the preferred method of primary care delivery. Community pharmacists should and can provide leadership for many clinical and managerial activities within the primary care team. Objective To determine the extent to which community pharmacists are prepared to be members of the health care team, and to assess their support for general expansion of clinical responsibilities. Methods A mail questionnaire (in either English or French) was sent to 1500 community pharmacists between February and April 2004. Respondents were asked to indicate the necessity of pharmacy leadership for a range of clinical and managerial services associated with a primary care team. Respondents were also asked to indicate the extent to which they should be more involved in drug therapy selection and monitoring, as well as assuming greater responsibility for treating both minor and chronic illnesses. Results The response rate was 35.2% (470/1337) with the highest response rate in the Prairie provinces (40.6%) and the lowest in Quebec (24.4%). Most pharmacists in the study did not advocate a strong leadership role for non-discipline-specific clinical and managerial activities. Most of them indicated that community pharmacists should be more involved in selecting (69.9%) and monitoring (81.0%) drug therapy, and be more responsible for treating minor illnesses (72.0%). Support for more responsibility declined to 50% for chronic illnesses. Conclusions The findings of the study suggest substantial variability among pharmacists in their perception of the need for pharmacy leadership across 16 clinical and managerial activities.
TL;DR: If African countries are to institute price-sensitive procurement agencies, or multinational buying cooperatives, to negotiate steep discounts off global list prices for medicines, this may not lead to expanded access in the presence of inefficient and ineffective drug supply chains.
Abstract: Access to medicines has no single clear definition, but it may be considered as a collection of different interrelated dimensions: accessibility, affordability, acceptability, and availability. These interrelated dimensions underscore the essence for differentiated yet simultaneously operating medicine access policies as depicted by the easily recognizable WHO access framework. If African countries are to institute price-sensitive procurement agencies, or multinational buying cooperatives, to negotiate steep discounts off global list prices for medicines, this may not lead to expanded access in the presence of inefficient and ineffective drug supply chains. Because pharmaceuticals play a vital role in the
TL;DR: The TRA is a useful model in identifying the factors that are associated with physicians' intentions to measure BMI and differences between family physicians and pediatricians on theoretical constructs are assessed.
Abstract: Background Over the past few decades, childhood obesity has become a major public health issue in the United States. Numerous public and professional organizations recommend that physicians periodically screen for obesity in children and adolescents using the body mass index (BMI). However, studies have shown that physicians infrequently measure BMI in children and adolescents. Objectives The purpose of this study was to use the theory of reasoned action (TRA) to explain physicians' intentions to measure BMI in children and adolescents. The study objectives were to (1) determine if attitude and subjective norm predict physicians' intention to measure BMI in children and adolescents; (2) determine if family physicians and pediatricians differ in terms of theoretical factors; and (3) assess differences in behavioral beliefs, outcome evaluations, normative beliefs, and motivation to comply among physicians based on their level of intention to measure BMI. Methods A cross-sectional mailed survey of 2590 physicians (family physicians and pediatricians) practicing in 4 states was conducted. A self-administered questionnaire was designed that included items related to the TRA constructs. The association between the theoretical constructs was examined using correlation and regression analyses. Student's t test was used to determine differences between family physicians and pediatricians on theoretical constructs and to compare the underlying beliefs of nonintenders with intenders. Results The usable response rate was 22.8%. Less than half (44%) of the physicians strongly intended to measure BMI in children and adolescents. Together, the TRA constructs attitude and subjective norm explained up to 49.9% of the variance in intention. Pediatricians had a significantly ( P P Conclusion The TRA is a useful model in identifying the factors that are associated with physicians' intentions to measure BMI.
TL;DR: The results support the validity and reliability of the DDSM-Q as an instrument to measure patient satisfaction with diabetes disease state management services in community pharmacy.
Abstract: Background Disease state management (DSM) programs for chronic conditions such as type 2 diabetes delivered by community pharmacists are a developing trend in health care service delivery. Although patient satisfaction with DSM services is an important indicator of service quality from the consumers' perspective, to date there is no valid and reliable instrument to enable its measurement in the context of a community pharmacy delivered service. Objective To develop and validate an instrument to measure patient satisfaction with diabetes disease state management (DDSM) services delivered by community pharmacists. Methods The DDSM questionnaire (DDSM-Q) was developed on the basis of 14 in-depth, semi-structured interviews with consumers who had received diabetes care services in community pharmacy. Thirty-one questionnaire items were developed from the qualitative interview findings and also incorporated 16 modified items from an existing instrument, the Diabetes Measurement and Evaluation Tool. The DDSM-Q was sent to 160 participants of pharmacy diabetes care projects. Higher-order factor analysis was performed to extract factors of patient satisfaction. Results One hundred and fourteen questionnaires were returned, thus yielding a 71.3% response rate. Data from 108 out of 114 questionnaires were used to validate the DDSM-Q. Respondents had a mean age of 62 years and 61% were male. The 3 factors of patient satisfaction were interpreted as (1) satisfaction with the pharmacist's service ("Service"), (2) satisfaction with self-management ("Self-management"), and (3) satisfaction with knowledge and understanding of diabetes ("Knowledge"). The model fitted the data at moderate level (relative χ 2 =1.58, n=108, adjusted goodness-of-fit index=0.77, comparative fit index=0.89, root mean-square error of approximation=0.07). The model was shown to have construct validity ( χ 167 2 = 235.62 , Bollen-Stine bootstrap P =.27). Reliabilities of the 3 factors were 0.92, 0.88, and 0.86, respectively. Conclusion The results support the validity and reliability of the DDSM-Q as an instrument to measure patient satisfaction with DDSM services in community pharmacy. Further research will be needed to validate the instrument in different populations.
TL;DR: The nature of multimethod studies is explained and their role in pharmaceutical policy research is illustrated and four of the most important issues encountered in carrying them out are identified: The importance of doing research in context, challenges of comparison and questions of Compatibility.
Abstract: This article aims to explain the nature of multimethod studies and to illustrate their role in pharmaceutical policy research. In the field of pharmaceutical policy research, methodological and theoretically sound evaluation is the main goal. Reflexive learning is required in order to address and resolve one of the important paradoxes of late modern societies, which is that while the increasing complexity of social systems progressively undermines notions of certainty in social knowledge, it simultaneously raises the stakes in relation to rational guidance of those systems. By reflecting over our own research processes, we identified the strengths and weaknesses of multimethod research. We present our research methods and the experiences of pharmaceutical policy changes from two separate evaluation studies, one from Iceland and the other from Denmark. In addition, examples from a third study in progress are included: a multimethod international comparison of recent changes in pharmaceutical policy in Iceland, Denmark and Norway. Based on our experiences and reflections, we identified four of the most important issues we encountered in carrying them out: The importance of doing research in context; Challenges of comparison and questions of compatibility of data - both qualitative and quantitative; The importance of doing these studies with a multi- disciplinary team; Research in pharmaceutical policy is a fluid, ongoing process.
TL;DR: With the use of concomitant antipsychotic therapy as a quality of care measure, there is a need to optimize prescribing of these potent combinations.
Abstract: Background Clinicians use concomitant antipsychotic therapy for management of psychotic disorders despite a paucity of evidence for this practice. Objective To examine national patterns and determinants of concomitant antipsychotic therapy. Methods Concomitant antipsychotic therapy was defined as simultaneous use of 2 or more antipsychotic agents. Prescription data from the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey were used to characterize the prescribing of concomitant antipsychotic therapy and antipsychotic monotherapy (defined as use of a typical or atypical agent). Multiple logistic regression was applied to antipsychotic visits to examine the determinants of concomitant antipsychotic therapy based on patient and provider characteristics. Results Overall, concomitant antipsychotic therapy was documented in 9% of the visits involving antipsychotic agents, and monotherapy in 91% of the visits. The use of atypical agents, namely risperidone, olanzapine, and quetiapine, was common in both forms of therapy. Concomitant therapy was frequently used for psychoses and bipolar disorder. Logistic regression revealed that the odds of receiving concomitant antipsychotic therapy were higher for patients younger than 65 years, with greatest odds (odds ratio = 6.52) for patients 40 to 64 years old. Having a diagnosis of psychosis quadrupled (odds ratio = 4.33) the odds of receiving concomitant antipsychotic therapy. Physicians in metropolitan areas were more likely (odds ratio = 2.17) to use concomitant antipsychotic therapy than physicians in non-metropolitan areas. Conclusions Concomitant antipsychotic therapy continues to be prevalent and extensive in outpatient settings. With the use of concomitant antipsychotic therapy as a quality of care measure, there is a need to optimize prescribing of these potent combinations.
TL;DR: To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered.
Abstract: Background The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies. Objectives To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time. Methods A semistructured interview protocol was used in telephone interviews with 51 pharmacist owners of rural sole community pharmacies in 27 states who were identified through a random sampling process. Results The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities. Conclusions Actions should be considered to help sole community pharmacies deal with the ongoing administrative and financial challenges of Part D. To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered. Further study is needed to determine how existing policies and regulations can be modified to ensure reasonable access to pharmacy services for rural Medicare and Medicaid beneficiaries.
TL;DR: Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail- service utilization rates and with higher costs to plan sponsors, while absence of a co-payment incentive was associated with lower mail- Service utilization ratesand with lower costs toPlan sponsors.
Abstract: Background Little evidence has been presented to date that would either support or refute a widely held belief that mail-service pharmacy utilization routinely produces savings in drug benefit costs for prescription benefit plan sponsors Objective To present a comparative analysis of mail-service and community pharmacy service drug benefit costs for 5 employer-sponsored prescription drug benefit plans Methods A cross-sectional comparison of 17,725 matched transaction pairs of community and mail-service prescriptions from a data set comprised 484,987 prescription claims from a convenience sample of 5 employer-sponsored prescription benefit plans Differences between community pharmacy and mail-service prescription transactions were examined at the per-unit level of analysis for drug ingredient costs, dispensing fees, co-payments, dollar amounts paid by plan sponsor, and total dollar amounts Results Overall, the total cost of prescriptions was lower through mail-service pharmacies for all 5 plans studied Two of 5 plans had co-payment incentives to use mail-service, yet plan sponsors paid more for mail-service drugs; respectively, 45% and 83% more overall, 250% and 214% more for generic medications; and 30% and 70% more for brand name medications Mail-service co-payments were 489% and 517% lower Mail-service utilization rates were 152% and 315% of the total number of prescriptions dispensed in the period studied Three of 5 plans had no co-payment incentive to use mail-service and paid less for mail-service drugs; respectively, 187%, 66%, and 157% less overall; 174%, 156%, and 79% less for generic medications; and 188%, 52%, and 166% less for brand name medications Mail-service co-payments were 105% more, 52% less, and 18% more than community pharmacy co-payments, respectively Mail-service utilization rates were 08%, 12%, and 44% Conclusion Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail-service utilization rates and with higher costs to plan sponsors Absence of a co-payment incentive to use mail-service pharmacies was associated with lower mail-service utilization rates and with lower costs to plan sponsors
TL;DR: Higher rates of utilization and continued good standing within the community suggest that pharmacies are potentially well placed to make additional contributions to the evolving primary health care system in Estonia.
Abstract: Background The health care systems of Estonia and other Baltic States underwent major reforms between restoration of independence from the USSR and admittance to the European Union. These reforms included changes to the regulations regarding the ownership, location, and number of community pharmacies. Objectives The objective of this study was to analyze changes in access to, image of, and satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005. Methods A survey instrument was mailed to a stratified random sample of 713 Estonians aged 20-69 years living in Tartu in 1993 and again to 1000 Estonians aged 20-69 years living in Tartu in 2005. Completed survey instruments were returned by 448 (63%) respondents in 1993 and 386 (39%) respondents in 2005. Results Respondents in 2005 reported more frequent visits to pharmacies than respondents in 1993 (P = .012) and were more likely to indicate that pharmacies have more appropriate locations and opening hours (P Conclusion Postindependence reforms to health care and pharmacy systems in Estonia have coincided with greater utilization of community pharmacy services. Higher rates of utilization and continued good standing within the community suggest that pharmacies are potentially well placed to make additional contributions to the evolving primary health care system in Estonia.
TL;DR: Over time, QOL generally improved among patients managed in the multidisciplinary anemia clinic, with statistically significant improvements in sleep and social function.
Abstract: Background Anemia is common in chronic kidney disease (CKD), and suboptimal management of anemia can lead to serious health complications and poor quality of life (QOL). Objectives (1) To describe health-related and overall QOL among patients entering a clinic focused on anemia management; (2) to compare their baseline QOL with other relevant populations; (3) to explore predictors of QOL before anemia management; and (4) to explore changes in QOL over 1 year for patients managed in the clinic. Methods The Kidney Disease Quality of Life questionnaire—short form (KDQOL-SF™, Rand Corporation, Santa Monica, CA) was used to measure kidney disease specific and overall QOL in a cohort of predialysis CKD patients (n=79) enrolled in the clinic from January 2003 to September 2004. Baseline measures were compared to previously published measurements. The influence of demographic and clinical characteristics on baseline QOL was explored. Changes in QOL were evaluated over time. Results Patients with CKD entering the clinic had lower overall QOL compared with estimates from the general U.S. population (physical composite 35.7 vs 48.4 and mental composite 46.0 vs 50.2, respectively). Clinic patients had better kidney disease-specific scores than patients with end-stage kidney disease (ESRD). General QOL scores were similar regardless of kidney disease severity, with the exception of physical functioning which was lowest for patients with end-stage disease. Hemoglobin was the only factor predictive of QOL. Over time, QOL improved among patients managed in the CKD clinic, with statistically significant improvements in sleep (change of 6.2±15.2; P P Conclusions Patients with anemia of CKD reported reduced QOL compared to populations without kidney disease, but better QOL compared to populations with ESRD on dialysis. QOL generally improved among patients managed in the multidisciplinary anemia clinic.
TL;DR: In this article, a focus group was conducted in urban and rural Iceland, with 42 participants of both genders and varying age, a fifty-fifty mix of lay and educated groups.
Abstract: Background The research project: Public Beliefs about Medicine was initiated in 2001, aiming at exploring people's views, hopes, and fears with respect to drugs/medicines, now and in the future. Objectives A part of the research project mapping public beliefs about medicines aimed at getting the public to discuss definitions of drugs/medicines to grasp their explicit and implicit definitions and understand their point of reference when using the term(s). Methods Eight focus groups were conducted in urban and rural Iceland, with 42 participants of both genders and varying age, a fifty-fifty mix of lay and educated groups. The interviews were transcribed verbatim and excerpts translated into English. Results The direct question about definition of drugs generally resulted in a consensus among the informants about drugs/medicines being used to combat diseases and/or symptoms. Some included only prescribed or physician-recommended drugs in their definitions, others also over-the-counter products. Inclusion/exclusion of vitamins, food supplements, herbal remedies, functional foods, and illicit drugs was discussed without consensus and defining drugs in chemical terms or as interfering with bodily functions also occurred. New nuances emerged spontaneously later in the discussions, like viewing drugs as profit-making products, preferably prudently marketed, wishing information about "new release" drugs for the informants' diseases, and being concerned about side effects, overuse, misuse, and abuse. Other implicit definitions included viewing drugs as a product-service package, or as a necessary evil and/or as products with increasing potency and associated future problems or considering drugs to exert unreliable minor influence. Conclusion Professionals should be aware of the variety of lay people's drug definitions when discussing drugs/medicines with them to avoid misunderstandings caused by definition discrepancies.
TL;DR: The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system, and further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces act in tertiary facilities.
Abstract: BACKGROUND: Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. OBJECTIVES: This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. METHODS: A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. RESULTS: The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. CONCLUSIONS: Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.
TL;DR: The minor tranquilizers and Prozac both reveal similar patterns of initial widespread public endorsement, followed by growing public criticism and recommendations for more restrictive usage guidelines.
Abstract: Background In the sociological context, the concept of cultural lag holds that material technologies advance more rapidly than social guidelines for their use. The result can be social conflict including liability accusations and product stigmatization that have characterized several new drugs which were widely accepted initially but then publicly criticized in the lay and scientific press. Objectives The objective was to illustrate the utility of the concept of cultural lag to technology commercialization by applying cultural lag to the social and professional environments surrounding the diffusion of the “minor tranquilizers” Librium and Valium in the United States from the 1950s to the 1970s, and the antidepressant Prozac from 1987 to 2005. The intention is to develop a perspective from which to view patterns of social acceptance followed by critique that may occur when technological advances are introduced to the marketplace. Methods This study systematically reviews academic, medical, and lay literature regarding the diffusion of the “minor tranquilizers” Librium and Valium in the United States from the 1950s to the 1970s, and the antidepressant Prozac from 1987 to 2005. Results The minor tranquilizers and Prozac both reveal similar patterns of initial widespread public endorsement, followed by growing public criticism and recommendations for more restrictive usage guidelines. Conclusions Cultural lag provides a perspective from which to anticipate, view, and avoid controversies that develop from new technologies in general and pharmaceutical technologies in particular. Market demands for rapid introduction must be balanced by public education. This requires proactive encouragement of lay and professional discussions and the establishment of marketing guidelines that aid development of social consensus regarding appropriate usage.
TL;DR: It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.
Abstract: Background Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. Objectives To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. Methods Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. Results The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. Conclusions It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.
TL;DR: Assessing beliefs in medications may help to identify unreported symptoms and subsequent ADEs, and symptom reporting to physicians and other health professionals should be encouraged so that preventable ADEs are detected.
Abstract: Background Adverse drug events (ADEs) are generally preceded by symptoms reported by patients, and understanding who reports symptoms is important in understanding ADEs. Objectives The objectives of this study were to (1) determine the prevalence of symptomatology experienced, recalled, and reported to physicians (2) quantify the extent of attribution of recalled symptoms to medicines, and (3) predict factors associated with the reporting of recalled symptoms. Methods This was an Internet-based survey administered by Harris Interactive ® . Data collected and included in the analysis were symptoms experienced, symptom attribution to medicines, number of medicines, concern and necessity beliefs in medicines, self-rated health, number of physician visits, hospitalizations and emergency room visits in the past 6 months, whether patients had to pay part of their prescription costs, number of pharmacies, self-reported medication adherence, and sociodemographics. A descriptive analysis of sociodemographic and clinical/behavioral characteristics was completed, the frequency distribution of symptoms and their attribution to medication was obtained, and independent factors that predicted who was likely to report symptoms to physicians, using a multiple logistic regression analysis, were identified. Results Sixty-two percent (n=751) reported having at least 1 of 10 symptoms in the past month. Of the 1220 Medicare enrollees, 6.0-31.1% experienced varied specific symptoms. Of those who recalled they had experienced a particular symptom, 11.7-48.8% thought the symptoms were related to the medicine they were taking. Reporting symptoms to physicians was positively related to concern beliefs, seeing physicians ≥ 2 times in the past 6 months, perceiving symptom experienced was due to medicines, using more than 3 pharmacies, and not having to pay part of prescription costs. Conclusions Assessing beliefs in medications may help to identify unreported symptoms and subsequent ADEs. In addition, symptom reporting to physicians and other health professionals should be encouraged so that preventable ADEs are detected.
TL;DR: Substitute products appear to be affected in the event of a PPMW, although drugs used to treat the same disease do not seem to be so affected, and trust is not affected.
Abstract: Background Six major pharmaceutical products were withdrawn from the market from 2000 to 2006. Little evidence exists in understanding consumer reactions to such events and the influence the withdrawal has on its competitors. Objective To explore consumers' attribution of blame after pharmaceutical product market withdrawal (PPMW) and its effect on trust. Methods Subjects were assigned randomly to 4 groups and provided a unique hypothetical PPMW scenario and asked to imagine themselves in the situation described. Each scenario represented a different “distance” from the PPMW (eg, whether subjects were asked to assume they were taking the withdrawn drug or a therapeutic substitute). Blame of and trust in several key professionals/groups were measured. Results Closer “distance” to the PPMW resulted in higher blame attributions for the Food and Drug Administration (FDA), pharmaceutical company (Pharma), and the physician. Although the pattern of trust scores did not differ based on “distance,” insurance companies and Pharma suffered from low trust, whereas pharmacists and physicians received higher trust ratings. Blaming appeared to be no different between consumers on a withdrawn product and those consumers on a product in the same therapeutic class (“substitute” product). Conclusion Substitute products (drugs in the same therapeutic class) appear to be affected in the event of a PPMW, although drugs used to treat the same disease do not appear to be so affected. The difficult-to-explain findings with respect to trust may be accounted for by the fact that trust is more downstream than blame (based on the scenario presentations) and that trust is a complex construct with multiple antecedents. Although the bonds of interpersonal trust remain stronger than those of institutional trust, the likelihood of situational trust versus overall trust may complicate this picture of understanding trust. It may be possible that trust is impervious to this one negative instance versus many positive interactions.
TL;DR: Patients with higher annual household income and those who were dissatisfied with their current insulin therapy were willing to pay for inhaled products, and determinants of patients' willingness to pay (WTP) for inhale insulin were unknown.
Abstract: Predictors of patients' willingness to pay for inhaled insulin are unknown. This study found patients with higher annual household income and those who were dissatisfied with their current insulin therapy were willing to pay for inhaled products. Background Not all diabetes patients are receptive to taking injectable insulin and may therefore be noncompliant. Inhaled insulin has been shown to be as efficacious as subcutaneous insulin, but determinants of patients' willingness to pay (WTP) for inhaled insulin are unknown. Objectives The objective of this study was to determine the relationship between various patient characteristics and patient satisfaction variables with WTP for inhaled insulin. Methods Exploratory cross-sectional study using a random sample of patients with diabetes from a national database. Data were collected using a mailed survey focusing on patient satisfaction with current insulin therapy, WTP, and general patient information. Any WTP (categorical) and the amount (continuous) patients were willing to pay were the 2 dependent variables in the study. Data were analyzed using SPSS v.15.0. Descriptive statistics as well as linear and logistic regression analyses were conducted. Results One hundred twenty-eight patients responded. The logistic regression analysis indicated that annual household income ( P =.038) and patient satisfaction ( P =.002) predict WTP. Additionally, the current cost of insulin therapy ( P =.009) and annual household income ( P =.049) were found to predict the amount patients were willing to pay. On average, patients were willing to pay $55.49 out of pocket for inhaled insulin per month. Conclusions The out-of-pocket cost that patients were willing to pay was the same as the amount patients pay presently for their insulin and syringes. Although Exubera ® is no longer on the market, the study findings can have an impact on pharmaceutical companies working on new inhaled insulin products in their efforts to care for patients with diabetes.