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FEATURE 

APhA2004 Abstracts of Contributed Papers 

The following are abstracts of original research being presented at 

APhA2004, March 26–30, 2004, Seattle, Wash. Inquiries specific to the 

research should be directed to the principal author, indicated in the abstracts by 

underlined name. The abstracts are organized according to sections of the 

APhA–Academy of Pharmacy Practice and Management (APhA–APPM), 

APhA–Academy of Pharmaceutical Research and Science (APhA–APRS), and 

other organizations, as follows: 

• APhA–APPM Administrative & Management Practice: Abstracts 1–19 

• APhA–APPM Clinical & Pharmacotherapeutic Practice: Abstracts 20–51 

• APhA–APPM Community & Ambulatory Practice: Abstracts 52–105 

• APhA–APPM Hospital & Institutional Practice: Abstracts 106–112 

• APhA–APPM Nuclear Pharmacy Practice: Abstracts 113-119 

• APhA–APPM Specialized Pharmaceutical Services: Abstracts 120–126 

• APhA–APPM Miscellaneous: Abstracts 127–129 

• APhA–APPM Pharmacy Residents: Abstracts 130–179 

• APhA–APRS Basic Sciences: Abstracts 180–181 

• APhA–APRS Clinical Sciences: Abstracts 182–203 

• APhA–APRS Economic, Social, & Administrative Sciences: Abstracts 

204–283 

• American Society for Pharmacy Law (ASPL): Abstracts 284–290 

• American Institute of the History of Pharmacy (AIHP): Abstracts 291–306 

APhA is especially proud to note that 18 of this year’s presented papers 

come from current pharmacy students. In recognition of their outstanding 

achievements, students’ abstracts are noted with a special symbol () next to 

the abstract number. 

In the abstracts, “NA” denotes that the information was not available when 

the abstract was prepared. Encore presentations—papers presented previously 

at other meetings—are marked with a special symbol (). 

APhA–APPM 

Administrative & 

Management Practice 

1—A BUSINESS MODEL FOR A SELF- 

SUSTAINING PHARMACY PROGRAM IN A 

COMMUNITY HEALTH CENTER. Stubbings J, 

University of Illinois at Chicago, Talsania Patel S, 

Assam A, Mile Square Health Center. E-mail: 

jstubbin@uic.edu 

Objective: To create a self-sustaining pharmacy 

program that improves patient access to clinical 

pharmacy services and medications and reduces total 

health care costs. 

Methods: In 2002, the Bureau of Primary Health 

Care awarded a grant to an urban community health 

center for a comprehensive clinical pharmacy 

demonstration project. The focus of the clinical services 

was on diabetes and comorbidities. The business 

goal was to create a financially self-sufficient 

pharmacy program. A two-pronged business model 

was developed to generate revenue and save costs. 

The primary source of revenue came from third 

party reimbursement of clinical pharmacy services 

through incident-to-physician billing. Recognizing 

that payment for services would not generate enough 

revenue to make the program self-sufficient, we set 

out to reduce the drug budget for the community 

health center. This was accomplished by expanding 

the Medication Assistance Program that matched 

uninsured patients with medications donated by 

pharmaceutical companies. Data were collected on 

total number of patients served, revenue from clinical 

pharmacy services, and cost savings through 

donations of pharmaceuticals and other items. 

Results: After the first year of implementation, 92 

patients were enrolled in the clinical pharmacy services 

program and 554 were enrolled in the 

Medication Assistance Program. Of the patients who 

received clinical pharmacy services, 36% were uninsured, 

27% were Medicare recipients, and 21% had 

Medicaid. Payment for clinical pharmacy services 

totaled $1,682. The major impact came from cost 

reduction through the Medication Assistance 

Program. Savings to the health center’s drug budget 

totaled $283,000. Bayer Diagnostics also donated 95 

Ascensia Dex glucose monitoring systems at a total 

retail value of $6,650. 

Conclusions: The business model was successful 

in creating a self-sustaining clinical pharmacy program 

at an urban community health center, primarily 

by reducing the pharmacy budget through the 

Medication Assistance Program. This program had 

the added benefit of increasing access to pharmaceuticals 

in an uninsured population. 

2—ANALYSIS OF THE PATENT LIFE OF 

NEW MOLECULAR ENTITIES APPROVED 

BY THE FDA BETWEEN 1980 AND 2001. 

Seoane E, Ohio State University, Schondelmeyer S, 

Ronald H, Rodriguez R, Weckwerth V, University of 

Minnesota. E-mail: pharmacoeconomics@osu.edu 

Objective: The purpose of this study was to 

describe and analyze the factors affecting the life of 

the first and last patent listed in the Orange Book 

(OB) for the first NDA of the NMEs approved in the 

U.S. between 1980 and 2001. 

Methods: Summary descriptive statistics were 

computed for dependent and independent covariates. 

A linear regression analysis model was used to 

determine the impact of the characteristics of the 

drug, the sponsor of a first NDA, the drug market 

size, drug policy, and the intellectual protection policy 

on NMEs’ patent life. A total of 330 drugs 

approved between 1980 and 1999 were included in 

the regression analysis. NMEs approved during the 

period 2000–2001 were excluded from the study. 

FDA and the U.S. Patent Office were the main 

sources of data for this study. 

Results: The results of the study demonstrate an 

increase in post-NDA patent and pediatric exclusivity 

time of the NMEs included in the study by almost 

2 years from the period 1980–1989 to the period 

1990–1999. The study also shows an increase in last 

patent post-NDA time and pediatric exclusivity by 

1.5 years from the period 1980–1989 to the period 

1990–1999. These results contradict the results 

found in the literature review showing a downward 

trend in post-NDA patent time in late 1980s and 

early 1990s. 

Conclusions: Several factors explain the increase 

in patent protection including: reduction of the NDA 

review time, pharmaceutical patent extensions, pediatric 

exclusivity, and changes in patent statutory 

term. The reduction in NDA review time is the main 

factor accounting for the increase in patent post- 

NDA statutory term time. 

3—CHARACTERISTICS OF NEW INDE- 

PENDENTLY OWNED COMMUNITY PHAR- 

MACIES IN NC. Boyd J, Evans J, Robert C, 

Campbell University School of Pharmacy. E-mail: 

jboyd@mailcenter.campbell.edu 

Objective: To determine and evaluate the relative 

importance of specific services and products offered 

by newly owned independent pharmacies. A second 

objective is to distribute this information to pharmacists 

in North Carolina who are considering purchasing 

or opening an independent pharmacy. 

Methods: The North Carolina Board of Pharmacy 

provided a list of new pharmacy permits with the 

names and addresses of corresponding pharmacy 

managers. These permits were issued after January 

1, 2000. The pharmacy managers were mailed a survey. 

Exclusions included existing pharmacies with 

changes in ownership, new pharmacies owned by 

corporations and multiple pharmacies owned by the 

same individual. The survey included questions 

about clinical services offered, including: blood 

pressure monitoring, bone density screening, diabetes 

education, health screenings, immunizations 

and other clinical services. Administrative questions 

included the availability of customer charge 

accounts, delivery services, and use of technologies 

including automated dispensing. Other information 

226 Journal of the American Pharmacists Association www.japha.org March/April 2004 Vol. 44, No. 2 

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Annual Meeting Abstracts 2004 

FEATURE 

obtained includes demographics, web site availability 

and types of nonprescription medication inventories. 

A small panel of new pharmacy owners was interviewed 

for comments prior to the development of the 

pretest. Based on comments from the panel, drive 

through windows, friendly service and the availability 

of after-hours emergency medicine pickup were rated 

highly as important factors for success of the pharmacy. 

The survey was developed and pretested in 

approximately 10% of the population. The results of 

the pretest were used to refine the survey. 

Results: The importance of specific programs and 

services in starting a new community pharmacy will 

be evaluated and described using Likert scale and 

frequency analysis. 

Conclusions: Will be reported upon completion 

of the project. 

4—DRUG BENEFIT MANAGEMENT 

STRATEGIES: CONSUMERS’ ATTITUDE AND 

PERCEPTIONS REGARDING FORMULA- 

RIES. Sikri S, Kawatkar A, Sansgiry S, University of 

Houston. E-mail: ssikri@mail.uh.edu 

Objective: In recent years there has been a growing 

concern about the quality and cost of health care in 

America. Managed care has implemented drug benefits 

management strategies like formularies, which 

have evolved foremost amid cost containment strategies. 

However, most patients lack understanding of 

these drug management strategies, which may lead to 

dissatisfaction. The objective of this study was to evaluate 

consumer perceptions regarding formularies and 

to understand their knowledge regarding formularies. 

Methods: A cross-sectional study was conducted 

by administering a survey to consumers (N = 714) 

waiting to pick a prescription in community pharmacies 

(N = 72) in the Houston metropolitan area. A 

prevalidated questionnaire using an 11-item, 5-point 

Likert scale (strongly disagree, 1; strongly agree, 5) 

was used to measure consumer perceptions and 

knowledge regarding drug formularies. Data along 

with demographic information such as age, gender, 

marital status, race, education and income were collected, 

coded, and analyzed using SAS at an a priori 

significance level of .05. Descriptive and correlation 

analyses were performed on the data. 

Results: Among the surveyed population, only 

25% of patients owned a copy of the formulary and 

75% had no knowledge that their prescription plan 

used the formularies. Majority of the respondents 

were white (43%), female (52%), married (52%), and 

working full-time (64%) with a mean age of 39.58 (± 

13.96) years. Overall, consumers had negative attitude 

towards formularies 2.77 (± 0.66). The respondents 

were neutral with respect to satisfaction with drugs 

included in their formulary 3.0 (±0.9). However analysis 

indicated that consumers were motivated to seek 

information regarding formularies 3.20 (± 0.98). 

Conclusions: Consumers had negative attitude 

toward formularies, which may be attributed to their 

lack of knowledge regarding formularies. Patient 

education efforts by health plan providers may help 

change consumer attitude and perception towards 

formularies. 

5—EVALUATION OF INSULIN 

GLARGINE USE IN MEDICAID PATIENT. 

Mohamed O, Bultemeier N, Yeah C, Oregon State 

University, College of Pharmacy. E-mail: mohamedo 

@ohsu.edu 

Objective: The objective of this study is to evaluate 

the increase in use of insulin glargine in the 

Oregon Medicaid fee-for-service population. 

Methods: Design: This is a retrospective study 

utilizing a prescription claim database and manual 

chart review. Setting: Office of Medical Assistance 

Programs (OMAP) prescription claim database and 

Oregon Health & Science University (OHSU) medical 

records will be used to identify subjects. 

Participants: Subjects 18 years and older with an 

insulin glargine claim during the 18-month period of 

May 1, 2001 through October 31, 2002 and continuous 

eligibility 6 months prior to the claim will be eligible. 

Subjects receiving glargine from an OHSU 

prescriber and chronic diabetes care at OHSU will be 

identified to obtain clinical data. Subjects on chronic 

corticosteroid and/or immunosuppressant therapy 

and pregnant women will be excluded. Data collection: 

Diabetes medications before and after the sentinel 

glargine claim will be identified for all subjects. 

The following clinical data will be collected from 

chart review: weight, A1c, age, reasons for initiating 

and discontinuing glargine, type of diabetes, and prescriber’s 

specialty. All data will be de-identified. 

Analysis Plan: Descriptive statistics will be used to 

evaluate the characteristics of the sampled records. 

Furthermore, paired t-tests will be used to assess the 

change in A1c and weight at baseline versus 6- 

months and 12-months postsentinel claim. 

Results: Study findings will be presented. 

Conclusions: A conclusion will be presented 

based on study findings. 

6—EVALUATION OF MEDICATION NON- 

COMPLIANCE AT AN INDIAN HEALTH 

SERVICE HOSPITAL. Dupree M, Foster S, 

Dennewitz M, Cass Lake Indian Health Service 

Hospital. E-mail: michael.dupree@mail.ihs.gov 

Objective: The purpose of our retrospective evaluation 

was to assess improvement in medication 

compliance at an Indian Health Service Hospital 

with regard to patients picking up prescriptions. 

Methods: In October 2003, the Department of 

Pharmacy installed an Interactive Voice Response 

(IVR) Application, Bin Management, Outbound 

Calling, and Status Inquiry Solution System to 

improve medication compliance and decrease the 

number of prescriptions that were being returned to 

stock. Through retrospective review, prescriptions 

unclaimed by patients for a 10-month period from 1 

April 2003 to 31 Jan 2004 were analyzed. Pharmacy 

staff used the weekly return to stock medication 

labels and bin management return to stock reports 

before and after IVR installation. To determine 

which prescriptions were never dispensed, system 

reports were used for medication utilization review 

for data categorization and tracking purposes. 

Unclaimed prescriptions were tracked according to 

the following criteria: (1) Prevalence based on individual 

drug therapeutic classification; (2) total number 

of unclaimed prescriptions compared with the 

total number of patients with unclaimed prescriptions 

(some patients had multiple prescriptions); and 

(3) total number of unclaimed prescriptions compared 

with the total number of prescriptions filled 

during the tracking period. 

Results: Data collection ongoing, 

Conclusions: NA. 

7—MEDMARX: A MEDICATION ANALY- 

SIS TOOL FOR THE 21ST CENTURY, OR 

TEACHING AN OLD DOG NEW TRICKS. 

Shalita E, Guill J, United States Air Force, Rogers L, 

University of the Sciences in Philadelphia. E-mail: 

julie.guill@mcguire.af.mil 

Objective: Medication error analysis has become 

a mainstay of administrative pharmacy practice. 

Tying medication errors to breakdowns in process 

has been an emphasis since the early 1990s. Various 

methods have been used to determine the root causes 

of medication errors, leading to process improvement. 

Some of these methods include electronic 

spreadsheets, manual paper trail, AF form 765, 

CRAF documentation, and home-grown databases. 

A new tool, MedMarx was installed at McGuire Air 

Force Base (AFB), N.J., in December 2002. This 

program will examine the utility of this tool in root 

cause analysis of medication errors. 

Methods: McGuire AFB Pharmacy conducted 

two retrospective error analyses using 18 months of 

data. 

Results: Error analysis tied greatest risk to a single 

process step and identified new targets for opportunity. 

Conclusions: MEDMARX provides standardized 

tools for evaluating errors in an objective manner. 

Data can be analyzed using a concise reporting format 

and a standard definition of errors. Meaningful 

reports and charts present data in a way that clearly 

and easily identifies trends so that it can be acted 

upon to make valuable process improvements. 

8—OVER-THE-COUNTER MEDICATION 

LABELS FOR BLIND CONSUMERS. Pawaskar 

M, Sansgiry S, University of Houston. E-mail: 

p_manj@rediffmail.com 

Objective: To develop and evaluate the use of 

Braille and large print, over-the-counter (OTC) medication 

labels for blind and visually impaired consumers. 

Methods: The project is divided into three phases: 

development, implementation, and evaluation. In 

the first phase, OTC medication labels of analgesics 

will be developed in Braille for totally blind consumers. 

The study will also develop large print (18- 

font size) labels especially for visually impaired consumers. 

In implementation phase, these labels will 

be tested in 50 blind and 50 visually impaired consumers. 

Participants will be chosen randomly from 

organizations and institutes that provide services and 

education for blind and visually impaired population. 

An experimental study design will be conducted 

to assess the effectiveness of such labels to help 

blind consumers comprehend OTC medication 

2004 Abstracts of Contributed Papers 

Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 227 


FEATURE Annual Meeting Abstracts 2004 

information. The OTC label evaluation process 

model will be used to test labels. Variables such as 

ease of product use, product knowledge, attitude 

toward product label, product evaluations, purchase 

intention, and overall satisfaction with the product 

performance will be measured using previously validated 

and reliable scales. The test instrument will be 

provided in English and in Braille, and participants 

will have a choice as to which they would prefer to 

use. Data will be coded and analyzed using SAS statistical 

package to estimate effectiveness of labels in 

providing appropriate product use information. 

Results: Currently data collection is in progress. 

After data analysis, results will highlight consumers’ 

proficiency and satisfaction with the use of Braille 

and large print labels. 

Conclusions: Braille and large print medication 

labels are expected to be beneficial for consumers in 

making informed decisions regarding product selection 

and use. These labels may promote safe and 

effective use of OTC medications and help these 

consumers to administer medications independently. 

9—PATIENT ACCESS TO PHARMACIES 

IN HEALTH PROFESSIONAL SHORTAGE 

AREAS (HPSAS). Gadkari A, Mott D, University of 

Wisconsin–Madison. E-mail: asgadkari@wisc.edu 

Objective: To identify the characteristics of 

Health Professional Shortage Areas (HPSAs) in 

terms of access to pharmacy sites. 

Methods: Two databases will be used for this 

study. First, the HPSA database created by the 

Health Resources and Service Administration 

(HRSA) will be used to identify all Primary Medical 

Care HPSA designations in the state of Wisconsin. 

From this, we will select HPSAs identified by 

boundaries of townships, towns, villages and districts. 

Second, a database of all licensed pharmacies 

in Wisconsin containing contact information will be 

obtained from the Department of Regulation and 

Licensing in Wisconsin. Using these two databases, 

all the selected HPSAs and the surrounding pharmacies 

will be identified. A database containing HPSA 

characteristics will be created, which will describe 

access in the form of presence/absence of a pharmacy 

within a HPSA, the estimated distance of a HPSA 

from the closest pharmacy, number of pharmacies 

within a 10/20/30 mile radius of a HPSA, and types 

(i.e., clinic, hospital, chain, independent) of pharmacies 

accessible to a HPSA. 

Results: This study will help describe access to 

pharmacies for patients living in HPSAs and inform 

policy makers about access to pharmacy goods and 

services in these areas. The other chief outcome of 

this study will be the generation of a database of 

Wisconsin pharmacies that serve HPSA populations. 

This database will serve as a sampling frame for a 

future survey of pharmacies, which will help us 

obtain insight into a number of diverse issues including 

workload for these pharmacists and pharmaceutical 

services provided to HPSA populations. 

Conclusions: Given the current shortage of pharmacists 

and concern for access to health care for vulnerable 

populations, the study is expected to improve understanding 

of patients’ access to pharmacies in HPSAs. 

10—PERCEPTIONS OF HIGH SCHOOL 

STUDENTS TOWARD PHARMACISTS. 

Mattingly L, Stensland S, Jackson T, Lullo A, 

Midwestern University. E-mail: Lisa.Mattingly@ 

mwumail.midwestern.edu 

Objective: To evaluate students’ overall perception 

of pharmacists after participation in a pharmacy 

summer program. 

Methods: The Career Explorers Program provides 

an opportunity for high school students to gain 

pharmacy practice experience. A retrospective 

pre–post survey was given to students during the last 

week of the program. This 16-item survey was 

adapted from a survey used in 2002. Statements 

were restructured to assess student agreement with 

common pharmacist stereotypes. The survey was 

designed using three different Likert-type scales 

based on the nature of the question. 

Results: All participants completed this survey (N 

= 50). Each statement was evaluated using the 

Wilcoxon Signed Rank Test with a Bonferroni correction. 

Responses to 13 of the 16 statements were 

significantly changed upon posttest. Improvements in 

students’ attitude were seen toward: pharmacists’ 

knowledge of prescription (P < .001), over-thecounter 

(P < .001), and herbal (P < .001) medications. 

Upon posttest, students were more likely to agree that 

pharmacists are medication experts (P < .001), 

improve patients’ health (P < .001), have many 

responsibilities when filling a prescription (P < .001), 

are accessible to patients (P < .001), counsel patients 

(P < .001), prevent medication problems (P < .001), 

and make drug therapy recommendations (P < .001). 

Perceptions of pharmacists’ career options expanded 

beyond community and hospital upon posttest (P < 

.001). Pharmacists’ education to practice (P < .001) 

and specialize were better understood (P = .002). 

Two statements—“pharmacists act in an ethical manner” 

and “pharmacists are trustworthy”—were not 

statistically significant because 98% of students 

agreed with these characteristics on the presurvey. 

The third statement that was not statistically significant 

concerned compensation for services; 60% 

agreed pharmacists are compensated “just right” 

before the program and 63% agreed after. 

Conclusions: The results show that students did 

not have an understanding of the expectations and 

roles of a pharmacist before entering the program, 

and the program was successful at changing students’ 

perceptions. 

11—PERSISTENCE AFTER CHOLINES- 

TERASE THERAPY CHANGE IN A MEDI- 

CAID DATASET. Bunz T, Dore D, Kogut S, 

University of Rhode Island. E-mail: 

mail@thomasjbunz.com 

Objective: The purpose of this project is to determine 

the frequency of change in cholinesterase 

inhibitor (ChEI) therapy and to determine if patients 

changing therapy are likely to persist with therapy. 

Methods: Thirty-two months of pharmacy dispensing 

records of Rhode Island Medicaid enrollees 

were examined using the SAS software package. 

The data included a unique patient identification, a 

medication description, including date dispensed and 

days supply, as well as variety of demographic information. 

We identified patients having at least 18 

months of data describing medication use, and 

excluded patients who switched to a different ChEI 

drug within 180 days of the end of the dataset. 

Patients changing repeatedly between different ChEI 

drugs, or switching between more than two medications 

were also excluded. Patients were included in 

our study only if at least 80% adherent with therapy, 

according to their medication possession ratio. The 

number of patients who were adherent and persistent 

for 6 months before switching to a different ChEI 

drug, for 6 months after the switch, and those 

patients persistent before and after change were then 

recorded. 

Results: The dataset contained records for 2,336 

patients, 1,547 of whom had 18 months of data for 

analysis. Of these patients, 217 had received a dispensing 

for more than one of the ChEIs. Sixty-seven 

patients were eligible for inclusion in the assessment. 

Of these patients, 45 (67.2%) were persistent for 6 

months after the switch, 48 (71.6%) were persistent 

before the switch, and 33 (49.3%) were persistent 

before and after the switch. 

Conclusions: The number of patients persistent 

before or after change is similar to the number of 

patients persistent throughout the rest of the population. 

This appears to support the practice of changing 

between ChEIs. More studies should be done to 

determine the variables affecting patient therapy and 

to determine the clinical and economic impacts of 

therapy changes. 

12—PHARMACY CAREER OPPORTUNI- 

TY AWARENESS AMONGST HIGH SCHOOL 

STUDENTS. Jain B, Stensland S, Jackson T, 

Midwestern University. E-mail: 

jbhav@hotmail.com 

Objective: To increase pharmacy career opportunity 

awareness of high school students enrolled in a 

pharmacy summer program. 

Methods: The Career Explorers Program engaged 

students in activities that consisted of both experiential 

and didactic components designed to introduce 

them to the world of pharmacy. Ten pharmacy career 

descriptions were selected and compiled in a handout. 

A paired pre–post survey was created with questions 

regarding these pharmacy career opportunities, 

factors influencing their decision in choosing a certain 

career opportunity, and other issues. The presurvey 

was completed in class, while the postsurvey and 

job description handouts were completed at home. 

The postsurvey additionally asked students to 

explain why responses changed from the presurvey. 

Results: All students completed the paired surveys 

(N = 50). Respondents indicated the most interesting 

option presented was Industry-Based Pharmacist 

(30% pretest, 24% posttest). On pretest, the number 1 

pharmacy career respondents indicated a desire to 

learn more about was Nuclear Pharmacy (76%), 

while on postsurvey respondents most often wanted 

additional information on Pediatric Pharmacy (52%). 

Respondents chose Industry-Based Pharmacy as the 

option they were most likely to pursue on pretest 

(26%), but this preference changed to Pediatric 




FEATURE 

Pharmacy (28%) on postsurvey. The career choice 

students were least likely to pursue was Military 

Pharmacy (30% pretest, 20% posttest). The most 

influential factor in pursuing a career was genuine 

interest in the field (72% pretest, 68% posttest). The 

least influential factor was family pressure (70% 

pretest, 66% posttest). Overall, 74% (N = 37) of students 

changed their career option choices, while 88% 

(N = 44) did not change the factors influencing their 

decision in a pharmacy career choice. 

Conclusions: The Career Explorers Program 

raised awareness about pharmacy career opportunities. 

This research helped to establish where students 

interests lies and what may influence their decision 

to pursue certain pharmacy-based careers. 

13—POTENTIAL COST SAVINGS AT AN 

INDIGENT CARE CLINIC BY MAXIMIZING 

PATIENT ASSISTANCE PROGRAMS. Lindsey 

C, Sutherland J, University of Missouri–Kansas 

City. E-mail: lindseyca@umkc.edu 

Objective: To evaluate the cost of medications 

used in an indigent care clinic dispensary and determine 

the potential cost savings if patient assistance 

programs were optimized. 

Methods: This was a retrospective review of 

medication invoice purchases that took place at the 

Jackson County Free Health Clinic between August 

2002 and August 2003. All purchases were recorded 

by medication, dose, drug class, date of purchase, 

and cost. Medication purchases were summated and 

evaluated based on the ability to access these products 

through assistance programs and therapeutic 

substitutions. 

Results: A total of $5,168.13 was spent to purchase 

38 different medications for the dispensary 

over a 12-month time frame. Majority of medications 

were antihypertensives, antidepressants, and 

hypoglycemics. Of all of the maintenance medication 

purchases, 79.5% of our dispensary expenses 

could have been saved by ensuring the patient assistance 

program was optimized. 

Conclusions: Medication cost to the clinic could 

be potentially reduced by $4,107.93 annually by 

ensuring that each drug order is evaluated for its ability 

to be acquired through assistance programs. 

14—THE DEFENSE SUPPLY CENTER: 

PHILADELPHIA’S COLD CHAIN MANAGE- 

MENT PROGRAM FOR THE INFLUENZA 

VIRUS VACCINE. Dallas D, Defense Supply 

Center Philadelphia. E-mail: dana.dallas@dla.mil 

Objective: To identify and improve problem 

areas associated with the distribution and storage of 

Influenza Virus Vaccine for Department of Defense 

(DoD) personnel and beneficiaries. 

Methods: The Pharmaceutical Commodity 

Business Unit of the Medical Directorate at the 

Defense Supply Center Philadelphia (DSCP) is 

responsible for the distribution of the Influenza 

Virus Vaccine for the Department of Defense. 

DSCP’s Cold Chain Management program was 

established to ensure product integrity following 

losses of hard to replace vaccine due to freezing during 

shipment. The program benchmarked off the 

United States Army Medical Materiel Agency’s 

Anthrax Cold Chain Management Program. It 

includes three packaging protocols: warm, moderate, 

and cold. These packaging protocols, using 

endothermic containers and temperature monitors, 

have been third party tested, and permit DSCP to 

ship and track Influenza Virus Vaccine in any ambient 

temperature to DoD medical facilities and 

deployed units worldwide. The temperature monitors 

enable DSCP to monitor the temperature of the 

vaccine during shipment by recording temperature 

readings every 15 minutes for up to 20 days. 

Results: Over the past 3 years, DSCP’s Cold 

Chain Management Program has dramatically 

improved the reliability of shipping temperature sensitive 

vaccines through training end users, increasing 

in transit visibility, established set shipping schedules 

with commercial carriers, and allowed DSCP to 

monitor 100% of the shipments from manufacturer 

to customer receipt. 

Conclusions: The Defense Supply Center 

Philadelphia’s Cold Chain Management program 

has been highly successful in ensuring more timely 

deliveries and most importantly, product integrity. 

15—THE EVOLVING ROLE OF PATIENT 

ADVOCACY GROUPS IN IMPROVING 

HEALTH AND HEALTH CARE. Lee S, Amgen, 

Ascione F, McKercher P, University of Michigan. E- 

mail: run_so_run@yahoo.com 

Objective: The primary purpose of this study was 

to better understand the role of patient advocacy 

groups’ efforts to raise disease awareness and 

improve access to appropriate modern therapies. 

Methods: In-depth telephone interviews were 

commissioned by the University of Michigan’s 

Center for Medication Use, Policy & Economics and 

conducted by Market Strategies, Inc. Key representatives 

within selected patient advocacy organizations 

dedicated to serving patients in two different 

disease categories, kidney disease and breast cancer, 

were interviewed. In kidney disease advocacy 

groups, members at the National Kidney Foundation 

(NKF) and American Society of Nephrologists 

(ASN) were interviewed. In breast cancer, members 

at the American Cancer Society (ACS) and Susan G. 

Komen Foundation were interviewed. The targeted 

subjects for each organization were staff members at 

the national office as well as the state affiliates in 

California, Florida, Michigan, New Jersey, and 

Texas. Interviews lasted approximately 45–60 minutes 

and were conducted during April and May 

2003. In total, 18 interviews (9 nephrology and 9 

oncology) were conducted. 

Results: Differences were noted between the 

patient advocacy groups within each of two disease 

states. The NKF is focused on educating the general 

public and health care professionals, while ASN is 

heavily focused on nephrologists. Both organizations 

play a role in legislative issues. NKF tends to 

be more involved in areas of primary interest to 

patients, whereas ASN tends to be more involved in 

issues affecting the health care system as a whole. In 

terms of breast cancer, ACS is more involved in 

working with and educating health care professionals, 

whereas the Komen Foundation concentrates 

more of their efforts with the general public. 

Activities that appear to be the most effective are 

educational activities directed toward both consumers 

and health care professionals. Outreach 

activities are extremely successful in reaching the 

general public, especially the health fairs, and wellpublicized 

and -organized walks and runs. 

Conclusions: The role of patient advocacy groups 

has evolved from charitable public champions for 

disease victims to facilitating and enhancing early 

and progressive care. Our research suggests that 

patient advocacy groups play a growing and important 

role in dissemination of disease and treatment 

information and providing a forum for individuals 

seeking additional insight into their disease. 

16—DRUG THERAPY FOR 

ALZHEIMER´S DISEASE: PERSISTENCE ON 

CHOLINESTERASE INHIBITORS MEA- 

SURED USING MEDICAID PHARMACY 

CLAIMS DATA. Dore D, Bunz T, Kogut S, 

University of Rhode Island. E-mail: dave@ 

daviddore.com 

Objective: To measure and compare persistence 

with the three commonly used cholinesterase 

inhibitors (ChEIs). 

Methods: A retrospective cohort analysis was 

completed using de-identified Rhode Island 

Medicaid pharmacy claims data between January 1, 

2000 and August 31, 2003. Inclusion criteria were all 

Rhode Island Medicaid patients whom received 

newly initiated therapy on donepezil, rivastigmine, 

or galantamine between June 1, 2000 and August 31, 

2002 and had at least 12 months of data for followup. 

Exclusion criteria were having received a dispensing 

for more than one ChEI product, having 

received any dispensing for a greater than 60-day 

supply, or having a greater than 90-day interval 

between any two dispensings. Persistence was 

defined as continuous therapy for at least 180 days. 

Patients were identified as not persistent if he or she 

did not receive a dispensing for a ChEI on days 180 

through 365. The patient population included a total 

of 2,336 individuals; 1,802 supplied 12 months of 

follow-up data, and 1,612 did not switch between 

agents. 

Results: Persistence was measured in 888 individuals 

whom received any ChEI, 556 whom 

received donepezil, 193 whom received rivastigmine, 

and 139 whom received galantamine. 

Persistence at 6 months was estimated to be 75% 

overall and 76%, 74%, and 75% for donepezil, 

rivastigmine, and galantamine respectively. 

Conclusions: Approximately 1 in 4 patients did 

not persist to 6 months with ChEI therapy. In addition, 

persistence did not differ between ChEIs. 

Further research should be conducted to identify 

characteristics of individuals likely to fail therapy 

and to subsequently decrease prescribing in that population. 

Optimizing use of ChEIs may improve 

patient care and reduce expenditures on ineffective 

therapy. 





17—EVALUATION OF CARDIOPUL- 

MONARY RESUSCITATION CERTIFICA- 

TION AMONG PHARMACY STUDENTS. Patel 

S, Eap N, Blodgett B, Onamade A, University of 

Illinois at Chicago. E-mail: opatel1@uic.edu 

Objective: The morbidity and mortality of cardiac 

arrest are costly in the United States. Research has 

demonstrated that immediate cardiopulmonary 

resuscitation (CPR) improves survivability in 

patients who experience cardiac arrest and respiratory 

failure. Even though they are future health professionals, 

pharmacy students are often minimally 

trained in CPR. Because patients at increased risk of 

cardiovascular and pulmonary events regularly visit 

health care settings, pharmacy students should have 

adequate CPR training before entering the workforce. 

The purpose of this study is to assess the 

knowledge and attitude regarding CPR certification 

among pharmacy students and to evaluate the effectiveness 

of their training. Developing confidence 

through repetition enhances students’ ability to perform 

these skills. Currently, CPR training is offered 

to students during the fourth (experiential) year. This 

study will investigate whether students perceive a 

benefit to CPR being offered earlier in the curriculum. 

Specifically, the investigators will assess student 

knowledge and confidence regarding their ability 

to perform CPR as a health care professional. 

Methods: Students in their fourth year at a college 

of pharmacy who have completed CPR training will 

be asked to complete a self-assessment instrument. 

The instrument will measure students’ perceived 

knowledge and attitudes about their ability to use 

CPR in immediate response situations. Additionally, 

first- through third-year students will be surveyed 

about their perceived need for obtaining CPR training 

earlier in the curriculum and their willingness to 

participate in these programs if offered. 

Results: Data will be analyzed using Rasch rating 

scale model to measure hierarchically responses provided 

by the two instruments. 

Conclusions: Students are expected to perceive 

value in having CPR offered earlier in the curriculum 

and in repeated participation in these training 

sessions that allow students to demonstrate their 

ability, willingness to initiate immediate response, 

and develop confidence in performing CPR. 

18—PHARMACY STUDENTS’ ATTI- 

TUDES ABOUT MEDICALLY UNDER- 

SERVED POPULATIONS. Langridge S, Jackson 

T, Lurvey P, Midwestern University. E-mail: 

Sarah.Langridge@mwumail.midwestern.edu 

Objective: To determine the extent to which 

experience and knowledge gained regarding medically 

underserved populations affects pharmacy students’ 

attitudes about community health centers 

(CHCs), clinicians, and patients. BACKGROUND: 

Approximately 40 million Americans are medically 

uninsured or underinsured. Poor health outcomes 

occur more frequently in these patients when compared 

with insured populations. Clinicians in collaboration 

with pharmacists in CHCs have been successful 

in improving patient health outcomes. 

However, many are unaware of these resources. To 

introduce these resources to fourth professional year 

pharmacy students, an elective class was developed, 

“Bringing Pharmaceutical Care to Underserved 

Populations.” 

Methods: A retrospective pre–post attitudinal survey, 

comprising three different sections, was developed 

and administered to students in the course. 

Section 1 used a four-point Likert-type scale to 

assess students’ perceived knowledge of CHCs, services 

they offer, patients who use these services, and 

characteristics of clinicians who provide them. 

Section 2 evaluated responses about the perceived 

frequencies of services provided, barriers encountered, 

and duties of CHC pharmacists. Section 3 

assessed students’ intentions to provide pharmaceutical 

care services in a CHC environment and their 

confidence level regarding their ability to develop a 

pharmaceutical care services plan for a CHC. 

Results: Students who completed the class participated 

in the pilot study (N = 2). Students believed 

this elective class increased their awareness of the 

services CHCs provide and that these services are 

not exclusive to indigent populations. Students 

viewed pharmaceutical care in a CHC as a viable 

career option and indicated their confidence level in 

their ability to implement these services increased. 

The effectiveness of this elective will be evaluated 

with the same instrument in winter 2003, and the 

final poster will reflect these data. 

Conclusions: Overall, the perceptions about services 

provided in CHC environments and the 

patients who use these services improved after taking 

this elective. 

19—RETURN ON INVESTMENT ANALY- 

SIS FOR BONE MINERAL DENSITY (BMD) 

SCREENING. Patel H, Shenandoah University, 

Skelton J, US Wellness, Inc., Ahrens R, Stolte S, 

Shenandoah University. E-mail: Hpate3@su.edu 

Objective: To estimate the number of new antiosteoporosis 

prescriptions generated for patients with 

low BMD upon screening, and to estimate the potential 

return on investment (ROI) in terms of new 

antiosteoporosis prescriptions for a pharmaceutical 

manufacturer–sponsor of BMD screenings. 

Methods: A total of 262 patients were screened 

for osteoporosis using the Hologic Sahara Clinical 

Bone Sonometer. Screenings were conducted at four 

physician offices and six employer groups. All 

patients were 40 years or older and were not currently 

taking any antiosteoporosis prescription medications. 

Patients were placed into either a low-, moderate-, 

or high-risk fracture group based on their T 

scores from the BMD screening. A follow-up survey 

was performed within 60 days after initial screening 

to determine whether the patient scheduled a followup 

appointment with their physician. Patients were 

also asked whether an antiosteoporosis medication 

was prescribed. 

Results: A total of 98 patients were identified as 

low risk were excluded from the follow-up and ROI 

analysis, and 2 other patients were lost to follow-up. 

Among the remaining 162 patients, the fracture risk 

at initial screening was 76% for physician office 

patients and 58% from employer group patients. A 

total of 78% of patients initiated a follow-up 

appointment with their physicians, and 69% of 

patients in the high-risk category received a prescription 

antiosteoporosis medication. The return on 

investment for the BMD screenings was 256%, 

assuming the patients’ average medication adherence 

was 6 months. 

Conclusions: The BMD screening program 

demonstrated that 9.8% of patients screened 

received an antiosteoporosis prescription. 

Screenings appear to be beneficial to both patients 

and a pharmaceutical manufacturer–sponsor. 

APhA–APPM Clinical & 

Pharmacotherapeutic 

Practice 

20—A RANDOMIZED, DOUBLE-BLIND 

TRIAL OF LOW-DOSE OXYMORPHONE 

IMMEDIATE RELEASE (5 MG) FOR MILD 

TO MODERATE PAIN IN AMBULATORY 

PATIENTS. Walker D, Granger Medical Clinic, 

Inc. Gimbel J, Arizona Research Center, Ma T, 

Zagorski A, Ahdieh H, Endo Pharmaceuticals, Inc. 

E-mail: livinginpa135@aol.com 

Objective: To assess the safety and efficacy of 

low-dose (5 mg) oxymorphone immediate release 

(IR) in patients with mild to moderate pain following 

outpatient knee arthroscopy. 

Methods: A double-blind, randomized, placebocontrolled 

study will include patients 18 years of age 

and older following ambulatory arthroscopic knee 

surgery. To enter the study, patients must have initial 

postsurgical pain between 30 and 70 mm on a 100- 

mm visual analog scale (VAS) and a pain rating of 

mild or moderate on a categorical scale. Patients will 

be instructed to take the study medication (5 mg oxymorphone 

IR or placebo) as needed for pain for up to 

8 hours, and not more frequently than 1 dose per 

hour. Pain will be assessed at 30 minutes after the 

first dose and every hour thereafter. Patients requiring 

rescue medication will be discontinued from the 

study. Patients will record in diaries pain intensity, 

relief, and use of study medication and rescue medication. 

Efficacy measures are hourly pain intensity 

scores (VAS), pain intensity and relief scores (Brief 

Pain Inventory), frequency of remedication, time to 

rescue medication or discontinuation, and patient 

global assessment of pain relief. Records of adverse 

events will measure safety. 

Results: Data will be presented for approximately 

100 patients (50 patients per group). 

Conclusions: Conclusions will be presented 

based on the trial results, and the implications for 

pharmacists will be discussed. 

21—ANALGESIC EFFICACY OF OXY- 

MORPHONE IMMEDIATE RELEASE IN 

POSTSURGICAL ORTHOPEDIC PAIN: 

RESULTS OF A RANDOMIZED, DOUBLE- 

BLIND, PLACEBO-CONTROLLED, DOSE- 

RANGING COMPARISON WITH OXY- 

CODONE. Gimbel J, Lee W, Arizona Research 

Center, Ma T, Zagorski A, Ahdieh H, Endo 

Pharmaceuticals, Inc. E-mail: vrisman@hotmail.com 




FEATURE 

Objective: To evaluate the analgesic efficacy and 

safety of three dose levels of oxymorphone immediate 

release (IR) compared with oxycodone IR and 

placebo in patients with moderate to severe postoperative 

pain following total hip or knee replacement 

surgery. 

Methods: This Phase III, double-blind, parallelgroup 

study included single- and multiple-dose 

parts. Opioids were terminated the day following 

surgery and patients developing moderate to severe 

pain within 9 hours were randomized to one of five 

groups: oxymorphone IR 10 mg, 20 mg, or 30 mg; 

oxycodone IR 10 mg; or placebo. Single-dose efficacy 

measures included total pain relief (TOTPAR) 

up to 8 hours or until remedication. Patients requiring 

remedication after 3 hours received drug every 4 

to 6 hours for 48 hours for multiple-dose evaluation; 

placebo patients were rerandomized to active treatment. 

Multiple-dose efficacy was based on worst 

pain and global evaluations. 

Results: During the single-dose phase (N = 258), 

all oxymorphone doses were statistically superior to 

placebo for most end points including TOTPAR 0–8 

scores (P = .05 for 10 mg and P = .001 for 20 and 30 

mg) and a statistically significant dose-response was 

observed (P < .001). The median time to meaningful 

pain relief was significantly shorter in all oxymorphone 

groups (1 hour) than in placebo (1.5 hours; P 

= .05). Treatment with oxycodone 10 mg was not 

significantly different than placebo. Adverse events 

were typical of opioid medication. During the multiple-dose 

phase (N = 161), analgesia was maintained 

in all groups over 48 hours. The median dosing 

interval was more than 9.5 hours for oxymorphone 

IR 30 mg and between 7 and 8 hours for the other 

groups. Opioid-related adverse events were similar 

between groups. 

Conclusions: Oxymorphone IR provides significant 

pain relief with the first dose of 10 mg, 20 mg, 

or 30 mg and maintains analgesia over consecutive 

days with multiple doses. Adverse events were mild 

to moderate and dose related. 

Original Citation: Poster Presentation: American 

Pain Society Annual Meeting; March 18–23, 2003; 

Chicago, Illinois. 

22—LONG-TERM EFFECTIVENESS AND 

SAFETY OF A NEW ORAL OPIOID, OXY- 

MORPHONE EXTENDED RELEASE, FOR 

MODERATE TO SEVERE CANCER PAIN. 

Slatkin N, City of Hope National Medical Center, 

Amy F, Ma T, Ahdieh H, Endo Pharmaceuticals, 

Inc. E-mail: noellecurry@excite.com 

Objective: To evaluate the long-term effectiveness, 

safety, and dosing requirements of oxymorphone 

extended release (ER), a new formulation of 

oxymorphone, in cancer patients with chronic pain. 

Methods: Cancer patients with moderate to 

severe chronic pain who completed a previous randomized 

controlled trial and met study criteria 

entered a 2-year, open-label, extension study of oxymorphone 

ER every 12 hours. Patients began openlabel 

treatment with the oxymorphone ER dose 

attained in the previous study and were allowed to 

titrate to achieve acceptable pain relief. 

Oxymorphone immediate release was available as 

rescue medication throughout the study. 

Effectiveness was assessed by pain intensity scores 

and patient global assessment of study medication. 

Results: Of 44 enrolled patients (mean age = 54 

years), 16 completed 52 weeks of treatment, with a 

median time to discontinuation of 249 days. 

Concomitant disease progression and other serious 

adverse events unrelated to study medication caused 

the most withdrawals over the 2 years. Patient pain 

was well controlled throughout the first year with 

every-12-hour doses of oxymorphone ER (approximate 

weekly average score of 30–35 mm on 100 mm 

visual analog scale). The mean dosage was 125 

mg/day during days 0–30 and 150 mg/day during 

days 331–360. The mean dose of oxymorphone IR 

rescue medication was low (23 mg/day) during the 

same time period. At each study visit, 90% or more 

of patients rated study medication as “excellent,” 

“very good,” or “good” at relieving pain. Adverse 

events associated with opioid use included nausea, 

vomiting, constipation, and sedation. 

Conclusions: Oxymorphone ER is safe and effective 

in cancer patients with moderate to severe 

chronic pain when used long-term. Stable pain 

scores were maintained with little change in scheduled 

medication and with minimal rescue medication. 

Patients reported overall “excellent” to “good” 

satisfaction with oxymorphone. Oxymorphone ER 

provides a new, effective, and safe opioid treatment 

for moderate to severe chronic cancer pain. 

23—LONG-TERM EFFECTIVENESS AND 

SAFETY OF A NEW ORAL OPIOID, OXY- 

MORPHONE EXTENDED RELEASE, FOR 

MODERATE TO SEVERE OSTEOARTHRI- 

TIS PAIN. Mcilwain H, Tampa Medical Group 

Research, Ahdieh H, Endo Pharmaceuticals, Inc. E- 

mail: vrisman@hotmail.com 

Objective: To evaluate the long-term effectiveness, 

safety, and dosing requirements of oxymorphone 

extended release (ER) in patients with moderate 

to severe chronic osteoarthritis (OA) pain uncontrolled 

by nonopioid analgesics. 

Methods: OA patients with moderate to severe 

chronic pain who previously completed a randomized 

double-blind trial and met study criteria entered 

a 2-year open-label extension trial of oxymorphone 

ER. Patients were either on active drug in the previous 

study and began open-label treatment at their 

prior stabilized dose, or had previously received 

placebo and began open-label treatment at oxymorphone 

20 mg every 12 hours. Least, worst, and average 

pain intensity scores and dosage amounts were 

recorded. Effectiveness was assessed by pain intensity 

scores and patient global assessment of study 

medication. 

Results: The study included 153 patients with a 

mean age of 60 years. Of these, 61 patients completed 

52 weeks, and 16 of 29 patients (55%) enrolled in 

year 2 completed the study. After an initial decrease 

from baseline, the mean recall scores of the least and 

worst pain remained stable during the first year, and 

the median daily dose of medication stabilized at 40 

mg. More than 80% of patients rated oxymorphone 

as “excellent,” “very good,” or “good” at each visit. 

Most withdrawals (n = 49, year 1) were caused by 

adverse events typically associated with opioid medications, 

but 47% of these patients (23) had received 

placebo in the prior study. 

Conclusions: Oxymorphone ER presents a new 

alternative for the treatment of moderate to severe 

chronic OA pain, and tolerability in clinical practice 

can likely be improved by initiating opioid-naive 

patients with doses lower than 20 mg every 12 hours. 

Long-term use of oxymorphone ER was safe and 

effective in patients with OA with moderate to 

severe chronic pain, and patients maintained control 

of pain with a stable twice-daily doses of medication 

for 1 year. 

24—TOLERABILITY AND EFFECTIVE- 

NESS OF OXYMORPHONE EXTENDED 

RELEASE IN OPIOID-NAIVE PATIENTS 

WITH CHRONIC PAIN. Hale M, Gold Coast 

Research, L.L.C., Nagle B, Photivihok G, Endo 

Pharmaceuticals, Inc., Drass M, Center for Pain 

Management. E-mail: noellecurry@excite.com 

Objective: To assess the tolerability and effectiveness 

of oxymorphone extended release (ER) following 

titration from a low dose (5 mg every 12 

hours) in opioid-naive patients with moderate to 

severe chronic pain. 

Methods: This open-label nonrandomized study 

is being conducted in patients 18 years of age or 

older with an initial pain intensity score of 40 or 

more on a 100-mm Visual Analogue Scale and a 

pain rating of moderate or severe on a categorical 

scale. Patients must be opioid-naive (no prior opioid 

use within the past 3 months) and suboptimally 

responding to nonopioid analgesics. Patients initiate 

2 days of therapy with oxymorphone ER 5 mg every 

12 hours. Starting on day 3, patients will be titrated 

to a stable dose of oxymorphone ER that provides 

meaningful pain relief (4 or more on a 0 to 10 scale 

for 3 of 5 consecutive days). The titration period is 

not to exceed 21 days. No changes are made in concomitant 

nonopioid analgesics during this period. 

Following titration, patients are maintained with the 

stabilized dose of oxymorphone ER therapy for up to 

6 months. Oxymorphone immediate release 5 mg is 

available as rescue medication during the maintenance 

period only. Concomitant nonopioid analgesics 

can be decreased or discontinued but not 

increased, and no new nonopioid analgesics can be 

added during the maintenance period. Tolerability 

will be assessed by the rate of discontinuations 

because of adverse events. Additional assessments 

will include average daily pain intensity, average 

daily dose of oxymorphone ER, rescue medication, 

time to stabilization, and patient and physician global 

assessments. 

Results: Data will be presented for approximately 

100 patients. 


based upon the trial results, and the implications for 

pharmacists will be discussed. 





25–A REPRODUCIBLE MODEL FOR DIS- 

EASE STATE MANAGEMENT AND PHAR- 

MACEUTICAL ACCESS FROM A FEDERAL- 

LY FUNDED URBAN COMMUNITY HEALTH 

CENTER. Talsania S, University of Illinois at 

Chicago, Assam A, University of Illinois at Chicago, 

Mile Square Health Center. E-mail: stalsa1@uic.edu 

Objective: To develop an effective model for expanded 

clinical pharmacy services and increased access to 

pharmaceuticals in an underserved community. 

Methods: The Bureau of Primary Health Care 

provided grant funding for clinical pharmacy 

demonstration projects to meet the needs of underserved 

communities. One of the 2002 recipients was 

a federally qualified urban community health center 

with an in-house pharmacy. To achieve the goals of 

the grant, the pharmacy created three integrated processes: 

diabetes disease state management, 340B 

drug program utilization, and manufacturer assistance 

program expansion. Before the grant was funded, 

pharmacists provided disease state management 

on a sporadic basis depending on pharmacy staffing 

needs. Funding from the grant enabled the pharmacy 

to hire a pharmacotherapist to implement structured 

clinical pharmacy services on a consistent basis. The 

focus was on patients who had type 2 diabetes mellitus 

with or without comorbidities. Patients were 

seen in a one-on-one session, and drug therapy was 

adjusted through a collaborative practice agreement 

and established protocols. An educational assessment 

was performed, and education was tailored to 

meet individual patient needs. Increased access to 

pharmaceuticals was achieved through the 340B 

drug program and expansion of manufacturer assistance 

programs. Clinical indicators measured included 

change from baseline in glycosylated 

hemoglobin, blood pressure, and serum lipid levels. 

Data on economic, education, and humanistic outcomes 

are also being collected, and validated instruments 

will be used to analyze this information. 

Results: Analysis for year 1 data has started and 

will be completed by the APhA annual meeting. 

Conclusions: Based on preliminary data analysis, 

this model will demonstrate improvement in diabetic 

patient outcomes and cost savings for the health 

center’s drug budget. The hope is that pharmacists 

will implement this model in their practice settings. 

26—A SURVEY OF PHARMACISTS’ 

ACTIVITIES SUPPORTING MEDICATION 

ADHERENCE. Possidente C, Pfizer, Inc, Anzisi L, 

Pfizer, Algozzine T, Buckley T, Weathermon R, 

Pfizer, Inc. E-mail: carl.possidente@pfizer.com 

Objective: Nonadherence to prescribed drug therapy 

is a common and serious health care problem. 

The study objectives were to determine what activities 

were provided by pharmacists to improve medication 

adherence and to review pharmacists’ attitudes 

related to medication adherence. 

Methods: A 15-question written survey was distributed 

to pharmacists attending educational programs 

conducted in New York, Connecticut, New 

Hampshire, and Vermont from February through 

June 2003. The survey response rate was approximately 

65%. 

Results: The majority of the 937 respondents 

were men (65%) who had been in practice for more 

than 20 years (58%) and were working in community 

practice (60%). A total of 73% of pharmacists 

stated they performed adherence activities. 

Activities most commonly provided included: verbal 

counseling for new prescriptions, verbal counseling 

not related to prescriptions, telephone consultations, 

and distributing written materials. Community pharmacists 

(86.4%) provided more activities to improve 

adherence than did hospital pharmacists (50.8%), (P 

< .0001); however, they had less time available. 

Hospital pharmacists tended to target patients with 

specific diseases more than community pharmacists. 

Time spent performing adherence activities did not 

vary between independent and chain community 

pharmacists. Pharmacists in practice less than 5 

years provided activities to improve adherence more 

frequently than their peers. Time spent performing 

these activities decreased as years in practice 

increased. The most common barrier was limited 

time, reported by 78% of pharmacists. Some 76% of 

respondents agreed pharmacists have a responsibility 

to improve medication adherence, but 17% of 

pharmacists stated improving medication adherence 

was not their responsibility, an attitude more common 

with men in community practice for longer than 

10 years. Overall, 92% of respondents were interested 

in learning more about adherence. 

Conclusions: Pharmacy organizations and the 

pharmaceutical industry have an opportunity to educate 

pharmacists and the public on the importance of 

optimizing medication adherence. 

27—A UTILIZATION REVIEW OF OAB 

AGENTS IN A WISCONSIN MEDICAID POP- 

ULATION. Conner C, Cherayil G, Pfizer, Inc. E- 

mail: christopher.conner@pfizer.com 

Objective: Current estimates suggest that 17 million 

Americans are affected by overactive bladder 

(OAB). The available agents for the treatment of 

OAB differ with respect to formulation (immediate 

versus extended-release), selectivity for the bladder, 

and adverse effect profile. Our objective was to 

describe the costs and explore the use patterns of 

specific OAB agents in the Wisconsin Medicaid 

population. 

Methods: The claims data used for analysis 

included all Wisconsin Medicaid paid prescription 

claims data from January 1, 2002 to December 31, 

2002. These data were obtained directly from the 

Centers for Medicare & Medicaid Services Web site. 

National Drug Codes were used to extract use data 

for tolterodine immediate and extended-release, oxybutynin 

immediate and extended-release, and 

flavoxate. Descriptive analysis of claims included 

calculation of total expenditures, number of claims 

reimbursed, and mean cost per claim across products 

and formulations. 

Results: In 2002, the Wisconsin Medicaid program 

reimbursed for OAB agent claims totaling 

$3,423,458.30, representing 55,864 claims. Within 

the OAB category, oxybutynin extended-release 

(14,899 claims), tolterodine extended-release 

(14,852 claims) and oxybutynin immediate-release 

(13,343 claims) represented the most frequently used 

products. Extended-release products constituted 

47% of total prescription claims expenditures in 

2002. Cost per claim values within the extendedrelease 

OAB agents were $77.67 for tolterodine and 

$82.44 for oxybutynin. 

Conclusions: In the Wisconsin Medicaid population, 

the top three most frequently used OAB agents 

in 2002 were oxybutynin (extended-release), tolterodine 

(extended-release), and oxybutynin (immediate-release). 

Among extended-release OAB products 

tolterodine exhibits a more favorable cost per claim 

ratio than did oxybutynin. 

28—ADHERENCE MEASURES OF PSY- 

CHOSTIMULANTS USED IN THE TREAT- 

MENT OF ATTENTION-DEFICIT/HYPERAC- 

TIVITY DISORDER IN CHILDREN AND ADO- 

LESCENTS. Sanchez R. E-mail: rjsrph@yahoo.com 


examine adherence measures of various psychostimulants 

in school-aged children with attentiondeficit/hyperactivity 

disorder (ADHD). 

Methods: Paid prescription claims from May 1, 

2001 to May 31, 2002 were extracted from the Texas 

Medicaid prescription claims database. Adherence 

measures included persistence, medication possession 

ratio (MPR), and consistence. Adherence was 

evaluated based on drug, age, and gender. 

Results: Subjects initiated on Concerta performed 

better on all three adherence measures. Mean persistence, 

MPR, and consistence were 0.50, 0.76, and 

0.81, respectively. Subjects aged 5–9 years exhibited 

better persistence and consistence than did those 

aged 10–14 years and 15–18 years. Mean persistence 

and consistence were 0.45 and 0.78, respectively, for 

subjects aged 5–9 years. No gender-related adherence 

differences were found among the groups. 

Conclusions: Separation between Concerta and 

the other stimulants was statically significant. 

However, this significance may not be clinically 

meaningful. Younger children tended to perform 

better on adherence measures than older children. As 

medical advances continue to improve, physicians, 

pharmacists, managed care organizations, and other 

health care-related workers should develop strategies 

to identify and improve adherence to medications. 

Further investigation into the clinical relevance of 

these findings should be explored. 

29—AN EVALUATION OF THE MANAGE- 

MENT OF HYPERLIPIDEMIA IN COMMUNI- 

TY BASED OUTPATIENT CLINICS WITH A 

CENTRALLY BASED CLINICAL PHARMA- 

CIST (“VIRTUAL CLINICAL PHARMA- 

CIST”). Evanko T, Jones W, Southern Arizona VA 

Health Care System. E-mail: tara.evanko@med.va.gov 

Objective: The objective of this project was to 

evaluate the impact of a clinical pharmacist in a 

hyperlipidemia disease state management program 

using telephone contact and follow-up for a Veterans 

Affairs (VA) Community Based Outpatient Clinics 

(CBOCs). 

Methods: This was a prospective open study of 

patients with hyperlipidemia approved by the local 




FEATURE 

Institutional Review Board. All patients were cared 

for by one of five CBOCs, with nurse practitioners or 

physicians being the primary care providers. Patients 

entering the study were referred to a clinical pharmacist 

via E-mail or telephone communication. The 

clinical pharmacist reviewed the medical records of 

the patient and made recommendations for drug therapy 

and adjustments to therapy based upon laboratory 

results. Patients agreeing to this program had their 

lipid lowering drugs adjusted according to the 

Pharmacologic Management of Hyperlipidemia clinical 

practice guidelines published by the Department 

of Veterans Affairs. Follow-up laboratory testing 

was scheduled by the clinical pharmacist and medication 

changes were suggested to the primary care 

provider and implemented when approved. The target 

LDL cholesterol was less than 130 mg/dL for primary 

and less than 100 mg/dL for secondary prevention. 

All contact between the clinical pharmacist, 

primary care provider, and patients was via the telephone, 

E-mail, or electronic progress notes. The primary 

endpoint was to determine the change in the 

lipid profile before and after enrollment in the hyperlipidemia 

project. 

Results: A total of 47 adult patients (44 men/3 

women) enrolled in the study. The respective mean 

total and LDL cholesterol concentrations were 251 

and 164 mg/dL at the time of enrollment. After 

enrollment, these respective values decreased to 191 

and 114 mg/dL. Follow-up was completed for 44 

patients (94%). The three who did not complete the 

study did not have laboratory testing (1) or died of 

causes unrelated to hyperlipidemia (2). 

Conclusions: These results show that having 

hyperlipidemia patients managed by a “virtual clinical 

pharmacist” who recommends, implements, and 

monitors therapy can be very successful. Many VA 

medical centers are operating CBOCs but may not 

have clinical pharmacist involvement in drug therapy 

management. Further evaluation of alternative 

practice models needs to be undertaken. 

30—ANALYSIS OF A MEDICAID COX-2 

PRIOR AUTHORIZATION PROGRAM. 

Hermansen E, Gunning K, University of Utah. E-mail: 

erica.hermansen@hsc.utah.edu 

Objective: (1) To examine criteria used for denial 

or acceptance in determination of Medicaid prior 

authorization for COX-2 inhibitors and to evaluate 

appropriateness of these requests. (2) To evaluate 

costs shifts and use of nonselective NSAIDs in 

response to the implementation of the prior authorization 

program. 

Methods: All patients whose physicians submitted 

requests for prior authorization for COX-2 

inhibitors from July 1, 2003 to December 31, 2003 

will be examined. Baseline demographic data will be 

collected. Medication profiles will be compared with 

patients’ profiles before implementation of the prior 

authorization program (January 1, 2003 to May 31, 

2003). 

Results: NA. 

Conclusions: Based on these results, the prior 

authorization process may be able to be improved 

such that quality care is provided while costs within 

Medicaid are contained. 

31—COLLABORATIVE PRACTICE 

AGREEMENTS: PERCEPTIONS OF PHAR- 

MACISTS AND PHYSICIANS. Causey L, 

Causey’s Rx Solutions, Ramsey L, University of 

Mississippi. E-mail: lcausey@causeyrx.com 

Objective: To determine provider perceptions and 

barriers to implementation of pharmacy disease 

management programs using physician–pharmacist 

collaborative practice agreements (CPAs). 

Methods: Nonexperimental, descriptive-correlational 

design using surveys mailed to 4,991 

Mississippi-licensed pharmacists and physicians. 

Primary outcome measures included perceived barriers 

and benefits to CPAs, support level of CPAs, and 

interest level in establishing CPAs. 

Results: Response rate was 13.5%; 70% of 

respondents were men; respondents were between 30 

and 60 years of age; most were private practice physicians 

or independent community pharmacists. A total 

of 95% of pharmacists and 74% of physicians supported 

CPAs. Similarly, 94% of pharmacists and 

68% of physicians felt CPAs were within a pharmacist’s 

scope of practice. Age of individuals surveyed 

had no impact on pharmacist’s support level; however, 

support differed in varying age groups of physicians. 

Physicians in satellite clinics expressed the 

greatest interest in establishing CPAs, while physicians 

in private groups expressed the least. The 

impact of training medical and pharmacy students 

together was evident only when the highest degree of 

co-training was achieved, with support rate increasing 

by 12%. Approximately 45% of practitioners 

deemed training beyond an entry-level pharmacy 

degree necessary. Pharmacists and physicians identified 

different disease states for which they believed 

pharmacists could play a paramount role. The majority 

of physicians (74%) were unfamiliar with pharmaceutical 

care (PC) data. Physician support 

increased by 14.9% as knowledge of PC increased. 

Pharmacists’ greatest concerns were adequate reimbursement, 

training, and time to deliver PC. 

Pharmacist competency, scope of practice, and protocol 

adherence were identified as physician’s primary 

concerns. Perceived benefits of CPAs were similar 

between both groups, but they differed in order of 

importance. 

Conclusions: Physician support for CPAs with 

pharmacists is positive. Most providers perceive 

CPAs as positively affecting patient care; however, 

concerns exist that negatively affect CPA establishment. 

Understanding provider perceptions allows 

initiatives to be pursued leading to increased CPA 

implementation and improved patient care. 

32—COMPARISON OF KNOWLEDGE 

AND ATTITUDES OF PHARMACISTS VER- 

SUS DIETITIANS REGARDING HERBS AND 

DIETARY SUPPLEMENTS. Mehta B, Ohio State 

University, Giannamore M, Pfizer, Inc. E-mail: 

mehta.6@osu.edu 

Objective: The goals of this project were to determine: 

(1) differences in knowledge between pharmacists 

and dietitians, (2) changes in attitudes toward 

the professional responsibility of patient education, 

and (3) the level of confidence within each profession 

regarding patient education. 

Methods: Pharmacists and dietitians who attended 

Ohio pharmacy association annual meetings completed 

a knowledge and attitude survey before and 

after attending a continuing education (CE) program 

on herbs and dietary supplements. Pharmacists and 

dietitians listened to the same presentation. The 

pretest included the following questions about herbal 

supplements: demographic information, access to 

information, previous CE program attendance, attitudes 

regarding use of supplements, and knowledgebased 

questions about commonly used products. The 

posttest repeated pretest knowledge-based and attitude 

questions. Data from the survey were entered 

and analyzed using Microsoft Access. 

Results: Of the 130 dietitians and 85 pharmacists 

who attended each program, 60% of dietitians and 

69% of pharmacists had attended previous herbal CE 

programs. Dietitians had a lower average baseline 

knowledge score of 5.3, compared with 7.4 for pharmacists 

(P < .01; maximum score 15). Posttest scores 

improved significantly to scores of 10.3 and 10.5, for 

dietitians and pharmacists, respectively (P < .01 for 

pretest-to-posttest comparisons within each group). 

Attitudinal scores (pretest versus posttest) regarding 

professional responsibility for patient education 

decreased from 24% to 14% for dietitians (P < .02) 

and 8% to 5% for pharmacists (P > .05). The confidence 

level (pretest versus posttest) in providing 

patient information decreased from 62% to 25% for 

dietitians (P < .01) and 43% to 21% for pharmacists 

(P < .04). 

Conclusions: Pharmacists had higher baseline 

knowledge scores, compared with dietitians. Both 

groups significantly increased their scores following 

the CE presentation. The majority of respondents 

had attended previous CE sessions on this subject, 

but they did not consider provision of patient education 

about herbal products within the realm of their 

professional responsibilities. Attitudinal scores 

regarding professional responsibility for patient education 

differed significantly between pretest and 

posttest surveys for dietitians but not pharmacists. 

Both groups were less comfortable discussing herbal 

products in the posttest versus pretest presentation 

period. Future research may identify educational 

needs of pharmacists and dietitians to increase confidence 

about patient education on herbal supplements. 

33—COMPARISON OF PHARMACY 

REFILL HISTORY VERSUS SPIROMETRY 

AS AN INDICATOR OF ASTHMA CONTROL 

IN COMMUNITY PHARMACY PRACTICE. 

Dugan B, Palm Beach Atlantic University, Buie B, 

Walgreens Pharmacy, Weitzel K, University of 

Florida, Van Riper B, Walgreens Pharmacy, Asmus 

M, Hendeles L, Chesrown S, University of Florida. 

E-mail: Dee_Dugan@pba.edu 

Objective: To determine if community pharmacist 

performed spirometry would assist in identifying 





patients with poorly controlled asthma who had a 

refill history indicative of good control and asthma 

medication adherence. 

Methods: Design: Prospective, pilot project. 

Setting: Four community pharmacies in Gainesville, 

Florida. Patients: Those identified as having a refill 

history suggestive of good asthma medication adherence 

and asthma control. Parameters defining good 

asthma control were based on NHLBI asthma guidelines 

and were: (1) receipt of not more than 12 shortacting 

beta-2 agonists or not more than 6 short-acting 

beta-2 agonists if using long-acting beta-2 agonists 

concomitantly in the past year, (2) receipt of not 

more than 12 long-acting beta-2 agonists in the past 

year, (3) receipt of inhaled corticosteroids at least 

one half as often as prescribed in the past year. 

Selected patients then underwent spirometry testing. 

Data Collection: Forced vital capacity (FVC), forced 

expiratory volume in 1 second (FEV 1 

), and the ratio 

of these two measures. Patients with a FEV 1 

/FVC 

ratio of less than 0.8 of predicted were identified as 

having poor asthma control. Analysis Plan: 

Descriptive analysis and statistics. Other Measures: 

Not applicable. 


having a refill history suggestive of good asthma 

control. Of these, seven patients met study criteria 

and underwent spirometry. The mean age of participants 

was 26.6 years. Subjects were primarily 

Caucasian and women, with a 6:1 ratio for race and 

gender. FEV 1 

/FVC ratio was less than 0.8 of predicted 

for 57% of the subjects. 

Conclusions: NHLBI guidelines recommend 

community pharmacists use patients’ refill history to 

identify those with poorly controlled asthma. This 

study tested a mechanism by which community 

pharmacists could identify patients with poor asthma 

control who would not be identified by refill history 

alone. Results indicate that spirometry may have a 

role in further identifying poorly controlled asthma 

patients in the community pharmacy setting. A larger, 

controlled analysis is warranted. 

34—EVALUATION OF PHARMACIST 

INTERVENTIONS IN DIABETIC PATIENTS 

FROM RURAL COMMUNITY HEALTH CEN- 

TERS. Pinto S, Segal R, Winterstein A, Annis L, 

Robinson D, Yates D, University of Florida, 

Pederson L, Palatka Community Health Center, 

Willis M, Trenton Medical Center. E-mail: 

sharrelpinto@gru.net 

Objective: The focus of this clinical pharmacy 

demonstration project is on improving the drug-use 

process in the management of vulnerable patients 

with chronic diseases, especially diabetes. The program 

includes the education and training of pharmacists 

in five community health centers funded by the 

Health Resources and Service Administration 

(HRSA) about specific disease therapies, monitoring, 

and management. The targeted disease is diabetes, 

but the program also addresses diabetic 

patients’ comorbidities, including hypertension and 

hyperlipidemia. The study hypotheses are (1) 

patients exposed to the intervention will have 

improved medical and patient outcomes based on 

changes in glycosylated hemoglobin, diabetic symptoms, 

LDL, blood pressure, and health related quality-of-life; 

and (2) process measures consistent with 

best practices will improve for patients exposed to 

the intervention. 

Methods: The project uses a prospective design to 

determine whether exposure to the intervention over 

a 2-year period leads to improved outcomes and processes 

of care. Patients are the unit of analysis and 

serve as their own controls. Subjects include adult 

patients who have a diagnosis of type 2 diabetes mellitus 

and whose glycosylated hemoglobin values are 

above 8 mg/dL within a 3-month period of the 

enrollment date. Subjects who meet the inclusion 

criteria were consecutively drawn from a subset of 

clinic patients. Medical outcome data are being collected 

from medical and laboratory records, pharmacy 

records, and patient self-report. Study measures 

include clinical indicators, quality-of-life, satisfaction, 

and HEDIS diabetes-related process measures. 

Outcomes and process data is collected at baseline 

and every 6 months. 

Results: Currently, 142 patients are enrolled in 

the study, with 137 at the 6-month level and 104 at 

the 12-month level. Study findings for approximately 

135 patients followed for 12 months will be presented. 


based on the analysis of data comparing baseline, 6- 

month, and 12-month results. 

35—HYPERCHOLESTEROLEMIA: A 

SURVEY OF PATIENTS’ UNDERSTANDING 

OF THE CONDITION AND ITS TREATMENT. 

Ong C, Liew S, Changi General Hospital. E-mail: 

charlene_ong@cgh.com.sg 

Objective: To determine: (1) patients’ perceptions 

of the causes and consequences of hypercholesterolemia, 

and (2) the level of understanding of 

their current pharmacological treatment for hypercholesterolemia. 

Methods: A random survey on hypercholesterolemic 

patients who consented to participate in 

completing a pharmacist-assisted questionnaire was 

conducted. These subjects were from specialist outpatient 

clinics and wards. 

Results: A total of 73 patients were interviewed 

for the survey. Only 45.2% of participants were able 

to describe briefly a physical feature of cholesterol. 

While 39.7% of patients had heard of the term “high 

cholesterol,” only 24.7% of respondents were aware 

of the differences between “high density-lipoprotein 

cholesterol” and “low density-lipoprotein cholesterol.” 

Participants most commonly associated 

hypercholesterolemia with unhealthy diets (80.8%), 

lack of exercise (58.9%), and obesity (28.8%), and 

they believed that hypercholesterolemia led mainly 

to heart attacks (58.9%) and strokes (43.8%). 

Although most respondents understood the importance 

of lowering their serum cholesterol, they were 

largely unaware of their target serum cholesterol levels. 

The results of this study also suggested that the 

patients’ degree of understanding of hypercholesterolemia 

was proportional to the level of education 

but inversely related to their age. Treatment-wise, 

patients demonstrated familiarity with the physical 

appearance and dosing regimen of their medication; 

however, few patients could accurately remember 

the names of their medication and their potential 

adverse effects. Eight patients (11%) reported experiencing 

drug-related adverse effects such as muscle 

weakness and constipation. 

Conclusions: Although patients were generally 

aware of the influence of social lifestyle on the 

development of hypercholesterolemia, overall 

knowledge about this condition was poor. More than 

one half of the patients surveyed knew how to take 

their medication, but most were unaware of potential 

adverse effects. Health professionals are well placed 

to better educate patients, especially older patients, 

in understanding their condition, treatment goals, 

and medication profile. 

36—IMPACT OF DIABETES EDUCATION 

AND MANAGEMENT ON PATIENT OUT- 

COMES. Assam A, University of Illinois at 

Chicago, Mile Square Health Center, Talsania S, Lin 

S, Jackson T, University of Illinois at Chicago, 

Ntowe F, Chessky A, University of Illinois at 

Chicago, Mile Square Health Center. E-mail: 

aassam@uic.edu 

Objective: To determine the impact of clinical 

pharmacy services on diabetes outcomes in an urban 

community health center. 

Methods: Patients 18 years of age or older with 

type 2 diabetes, with or without comorbidities, were 

enrolled in the program through physicians, pharmacists, 

or self-referral. Enrollment was on an ongoing 

basis. A total of 92 patients were evaluated by clinical 

pharmacists during year 1. Patients were seen in 

a one-to-one session by appointment or walk-in 

basis. Before the visit, the pharmacist reviewed 

patient’s medical and laboratory records via an integrated 

electronic medical record system. Initial visits 

lasted 30 minutes to 1 hour, and the patient’s knowledge, 

adherence to drug therapy, and glycemic control 

were assessed. All patients enrolled were provided 

with a free blood glucose monitor and were 

taught proper testing technique. Based on the initial 

assessment, patients were referred to a nutritionist, 

podiatrist, or optometrist/ophthalmologist, as needed. 

An individualized educational plan was also 

developed at this time. Educational sessions included, 

but were not limited to: importance of self-monitoring 

blood glucose, medication use, diet and exercise, 

complications of diabetes, and importance of 

laboratory values and patient involvement in disease 

management. A collaborative practice agreement 

with the medical providers and standards of care for 

the American Diabetes Association were used to 

adjust drug therapy and monitor disease states. 

Subsequent visits lasted 20 to 30 minutes, and 

patients were assessed for adherence to prior interventions. 

Results: Year 1 data analysis will be presented at 

APhA2004. Clinical markers collected to evaluate 

the program objective include glycosylated 

hemoglobin, blood pressure, lipid profile, and 

improvement in knowledge from baseline. 

Conclusions: We anticipate the results will 




FEATURE 

demonstrate clinical pharmacy services can improve 

patient knowledge base and diabetes outcomes. 

37—IMPACT OF PHARMACEUTICAL 

CARE: A RANDOMIZED, CONTROLLED 

TRIAL OF BLOOD PRESSURE CONTROL IN 

HYPERTENSIVE PATIENTS. Amruso N, 

Eckerd PatientCARE Network. E-mail: 

namru1@eckerd.com 

Objective: To determine the ability of pharmacists 

within community pharmacies to manage 

hypertensive patients. 

Methods: Design/Setting: Randomized, prospective, 

controlled study within community pharmacies. 

Patients: Patients were included if they had an average 

blood pressure (BP) reading above goal based on 

the sixth report of the Joint National Committee on 

Prevention, Detection, Evaluation, and Treatment of 

High Blood Pressure (JNC VI) guidelines. Patients 

were excluded if they had one or more of the following 

conditions: status-post–transplant procedure 

requiring long-term immunosuppressive therapy, 

terminal illness, end-stage renal disease, renal artery 

stenosis, or other unstable condition potentially contributing 

to hypertension. Patients were excluded if 

they were participating in another hypertension management 

program or refused to consent to the conditions 

of the study. Patients were randomized into 

high intensity (HI) or low intensity (LI) groups. HI 

patients met individually with the pharmacist for BP 

measurements, medication assessment, and education. 

Patients were scheduled for visits at 2 to 4 week 

intervals until BP was controlled, then periodically 

until the end of 12 months. LI patients were mailed 

educational materials quarterly and had their BP 

measured at 12 months. Data Collection: A progress 

note was developed to ensure complete data collection 

at each visit. The completed note was sent to the 

study coordinator for input into a database. 

Outcomes measures: Change in systolic blood pressure 

(SBP) and diastolic blood pressure (DBP), percentage 

of patients who achieved goal BP and percentage 

on first-line therapy. Analysis: A statistician 

performed the data analysis. 

Results: Overall, 109 patients were randomized 

into HI and 103 into LI, and 35 HI and 13 LI patients 

completed the study. Among HI patients, SBP 

declined by an average of 17 mm Hg, compared with 

a 1 mm Hg decrease for LI patients. Among HI 

patients, DBP declined by an average of 3 mm Hg, 

compared with a 1 mm Hg increase for LI patients. 

A total of 66% percent of HI patients and 8% of LI 

patients achieved goal BP; 57% of HI patients and 

23% of LI patients were on first-line therapy. 

Conclusions: Patients enrolled in a hypertension 

management program conducted by pharmacists in 

the community setting achieved BP control to a 

greater extent than patients not enrolled. 

38—IMPACT OF PHARMACIST INTER- 

VENTION THROUGH A TELEPHONE RUN 

SMOKING CESSATION CLINIC. Foust S, 

Porter J, Drake University College of Pharmacy. E- 

mail: sharon.foust@drake.edu 

Objective: To determine the impact of a pharmacist-run, 

telephone smoking cessation clinic on 

patient success. 

Methods: Patients were obtained based upon 

patient interest and primary care referral at the 

Department of Veterans Affairs. Inclusion criteria 

included patients at either the precontemplation or 

contemplation stages of the Transtheoretical Model. 

Duration of patient enrollment was 1 year from 

patient’s quit date. The pharmacist contacted 

patients 2 weeks and again 7 days before the quit 

day. Patients were also contacted on quit day (Day 0) 

and on days 3, 7, 14, 21, 28, 42, 56, 70, 84, 114, 144, 

174, and 365. Counseling consisted of behavioral 

and pharmacological cessation methods, such as 

proper use of nicotine-replacement therapy (NRT) 

and trigger, stress, and weight management. Data 

collected will include patient self-reported frequency 

and duration of tobacco use throughout the program 

and response to initial assessment questionnaire. The 

initial assessment questionnaire will be used to 

obtain Fagerstrom Tolerance Scores, previously 

used NRT therapy by the patient, patient-perceived 

negative effects of smoking, patient concerns, and 

planned methods to be used in smoking cessation. 

The primary outcome is participants’ abstinence rate 

1 year from quit date. Secondary outcomes include 

initial Fagerstrom Tolerance Scores compared with 

quit rate, duration of NRT or bupropion therapy, 

number of telephone calls placed to patient, and 

number of patient-reported relapses. 

Results: Preliminary results show that subjects 

were all men with a mean age of 55. Descriptive 

statistics will be used to evaluate primary and secondary 

outcomes for presentation at APhA2004. 

Conclusions: If favorable outcomes result from 

this research, this study will show that pharmacists 

can have an impact on patient success in smoking 

cessation through the use of a telephone smoking 

cessation clinic. 

39—MEDICATION UTILIZATION EVAL- 

UATION OF HMG-COA REDUCTASE 

INHIBITORS IN LIPID CLINIC. Booth H, 

Tomich D, Kassebaum P, Madigan Army Medical 

Center. E-mail: helen.booth@nw.amedd.army.mil 

Objective: (1) To identify patients in lipid clinic 

who are being treated with a 3-hydroxy-3-methylglutaryl 

coenzyme A (HMG-CoA) reductase 

inhibitor (statin) other than our formulary agent, simvastatin, 

and to document the reason behind starting 

on or switching to a nonformulary statin, (2) to identify 

trends in prescribing pattern of HMG-CoA 

reductase inhibitors, and (3) to document the rate of 

discontinuation of simvastatin and to assess for the 

opportunities for clinical interventions to improve 

patient care. 

Methods: This is a retrospective analysis of use of 

HMG-CoA reductase inhibitors in a pharmacistmanaged 

lipid clinic. A query from Access-based 

database used in the lipid clinic enabled identification 

of patients who were being treated with a HMG- 

CoA reductase inhibitor between January 1, 2002 

and September 30, 2003. A retrospective chart 

review was conducted in patients who were identified 

as being treated with a HMG-CoA reductase 

inhibitor other than simvastatin. 


being treated with HMG-CoA reductase inhibitors. 

Of these patients, 403 patients were being treated 

with simvastatin, 114 patients with atorvastatin, 42 

patients with pravastatin, and 1 patient with lovastatin. 

Retrospective analysis of prescribing pattern of 

HMG-CoA reductase inhibitors, rate and rationale 

behind discontinuation of simvastatin, and potential 

opportunities for clinical interventions will be presented. 


40—MEDICATION UTILIZATION 

REVIEW OF ALENDRONATE. Seah J, Lim W, 

Wee I, Changi General Hospital. E-mail: 

jonathan_seah@cgh.com.sg 

Objective: To determine the prescribing patterns, 

drug-related problems, range of patient monitoring, 

and daily calcium intake associated with oral alendronate 

amongst inpatients. To recommend appropriate 

measures for rational prescribing of alendronate 

and improvements in patient monitoring. 

Methods: A retrospective review of clinical case 

notes, laboratory data, and pharmacy medication 

records was performed for all ward patients prescribed 

alendronate during a 5-week study period. 

Results: A total of 44 patients receiving either 

once-daily or once-weekly alendronate were identified. 

Alendronate was prescribed most commonly to 

treat postmenopausal osteoporosis. Six patients were 

switched from alternative pharmacological treatments 

for osteoporosis to alendronate therapy. Seven 

patients were also prescribed concomitant intranasal 

calcitonin, with two being on long-term combination 

treatment. One patient was given alendronate despite 

the drug being contraindicated; two tube-fed patients 

and another patient with dysphagia received crushed 

tablets. No significant drug interactions were noted, 

though many patients were on multiple medications. 

Approximately one third of patients had their baseline 

bone mineral density (BMD) assessed, but none 

received follow-up BMD scans. Calcium levels were 

checked in 56.8% of patients, and none was hypocalcemic. 

Constipation was the most common adverse 

event; other less common adverse effects included 

esophagitis, gastric ulcers, and gastritis. None of the 

patients received the recommended 1,500 mg/day of 

elemental calcium, although almost one half of them 

had a total calcium intake (meals plus supplements) 

of 800–1000 mg/day. 

Conclusions: Alendronate was generally prescribed 

appropriately for registered indications. The 

use of long-term concomitant intranasal calcitonin 

should be reviewed as clinical evidence for this practice 

is lacking. Alendronate was generally well tolerated; 

however, its contraindications and precautions 

should be closely noted before initiating therapy. 

Increased use of BMDs, more frequent serum calcium 

level determinations, and adequate calcium 

intake should also be considered. 





41—NATIONWIDE DISSEMINATION OF 

THE RX FOR CHANGE TOBACCO CESSA- 

TION CURRICULUM: IMPACT OF A TRAIN- 

THE-TRAINER PROGRAM FOR PHARMA- 

CY FACULTY. Corelli R, Fenlon C, Kroon L, Lem 

K, Sullivan M, Hudmon K, University of California, 

San Francisco. E-mail: corelli@itsa.ucsf.edu 

Objective: Research consistently demonstrates 

that students in the health professions receive inadequate 

training for assisting patients with tobacco cessation. 

In response to this need, the California 

schools of pharmacy collaborated to develop Rx for 

Change, a 6- to 8-hour comprehensive tobacco cessation 

curriculum that is being disseminated to 

schools of pharmacy across the U.S. via a faculty 

train-the-trainer model. The purpose of this study is 

to assess pharmacy faculty members’ posttraining 

perceptions regarding adoptability of the Rx for 

Change curriculum. 

Methods: Pharmacy faculty attended one of three 

train-the-trainer conferences offered during summer 

2003. Participants completed an eight-page posttraining 

survey that assessed key factors potentially 

associated with adoption of the program. 

Participants rated their pretraining and posttraining 

ability to teach comprehensive tobacco cessation on 

a 5-point scale (1 = poor; 2 = fair; 3 = good; 4 = very 

good; 5 = excellent). 

Results: A total of 132 faculty members representing 

76 pharmacy schools participated in the trainthe-trainer 

program and completed a posttraining survey. 

Before the training, 48.5% of the faculty had 

received no formal training for treating tobacco use 

and dependence, and 82.2% had not taught students 

about this subject. Participants’ self-rated abilities to 

teach tobacco cessation to pharmacy students significantly 

increased on the posttest, compared with the 

pretest (2.77 versus 4.39; P < .001), with 25.7% and 

96.2% rating their abilities as either very good or 

excellent before and after the training, respectively. 

Nearly all participants believed the Rx for Change 

curriculum materials were either moderately (47.3%) 

or highly (50.4%) compatible for integration into 

their existing curricula, and 69.5% of the participants 

indicated they were highly likely to adopt Rx for 

Change at their school. A total of 96% of attendees 

said they would recommend the train-the-trainer program 

to other pharmacy faculty members. 

Conclusions: Participation in a train-the-trainer 

program significantly increased pharmacy faculty 

confidence to provide comprehensive tobacco cessation 

education to pharmacy students. The majority of 

participants are highly likely to adopt the Rx for 

Change curriculum at their school, which will eventually 

translate into an increased proportion of pharmacists 

who are adequately trained to treat tobacco 

use and dependence. 

42—OXYMORPHONE EXTENDED 

RELEASE PROVIDES SAFE AND EFFECTIVE 

ANALGESIA FOR CANCER PATIENTS: A 

RANDOMIZED,. Ahdieh H, Endo Pharmaceuticals, 

Inc., Dvergsten C, INC Research, Inc., Ma T, Frailey 

A, Endo Pharmaceuticals, Inc., Nashat G, not applicable. 

E-mail: livinginpa135@aol.com 

Objective: To compare the analgesic efficacy and 

tolerability of oxymorphone extended release (ER) 

and oxycodone controlled release (CR) in moderate 

to severe cancer pain. 

Methods: In this Phase III, randomized, doubleblind, 

two-way crossover study, patients were stabilized 

with oral opioid medication during a 7- to 10- 

day titration/stabilization phase, followed by 7 to 10 

days of double-blind treatment with oxycodone CR 

or oxymorphone ER (estimated conversion ratio of 

2:1 for oxycodone CR:oxymorphone ER). Dosages 

remained fixed from days 4 to 7; two rescue doses of 

morphine sulfate 15 mg/day were allowed. Patients 

then crossed over to the alternate treatment for 7 to 

10 days. Efficacy was assessed by pain intensity and 

relief (via the Brief Pain Inventory), global evaluations, 

and Karnofsky performance status. Routine 

safety evaluations were performed. During doubleblind 

treatment, the ratio of the average total daily 

dose from the last 2 days of each treatment period 

was calculated for each patient. 

Results: A total of 44 patients received at least 1 

dose of study drug. Mean pain intensity following 

double-blind treatment was 2.8 for oxycodone CR and 

2.5 for oxymorphone ER. Results of all other efficacy 

parameters were equivalent, indicating equianalgesia 

was achieved. The mean daily dose of oxycodone CR 

was 91.9 mg versus 45.9 mg for oxymorphone ER, an 

equianalgesic dose ratio of 2:1. Karnofsky scores 

were 81% for patients taking oxycodone and 82% for 

patients taking oxymorphone ER, equating to normal 

activity with effort. Rescue medication use was low in 

both groups; however, fewer patients receiving oxymorphone 

ER required rescue. Opioid adverse events 

were similar between groups. 

Conclusions: Patients taking oxycodone CR can 

convert to oxymorphone ER at one half the dose and 

rapidly achieve a stable dose that provides adequate 

pain relief with similar opioid adverse events. Nearly 

90% of patients rated oxymorphone ER as “good,” 

“very good,” or “excellent.” 

Original Citation: Poster Presentation; American 

Society of Clinical Oncology, May 28–June 3, 2003, 

Chicago, IL. 

43—PREDICTING EMETOGENICITY OF 

NEW CANCER CHEMOTHERAPY AGENTS. 

Terenzi L, Waddell J, Walter Reed Army Medical 

Center. E-mail: varoom007@hotmail.com 

Objective: Serotonin receptor antagonists are 

standard of care for prevention of acute cancer 

chemotherapy induced nausea and vomiting. To 

guide the use of serotonin receptor antagonists, 

Hesketh et al. classified cancer chemotherapy agents 

according to frequency of acute emesis. Their classification 

remains unchanged since 1997 and several 

new agents are on the market since then. Our objective 

is to classify new cancer chemotherapy agents by 

emetogenicity according to the Hesketh nomogram. 

Methods: Literature searches will be conducted to 

find emetogenicity data from the serotonin antagonist 

era for a subset of agents in the Hesketh nomogram. 

This data will be used to determine ratios of 

pre-serotonin versus serotonin era emetogenicity for 

these agents. If there is a consistent ratio for all 

agents or consistent ratios within drug classes, this 

information will be used to predict the emetogenicity 

of new agents. Literature searches and data analysis 

will be conducted by the oncology pharmacy residency 

program director and oncology pharmacy resident 

at an academic military medical center. 

Results: NA. 


44—THE CHALLENGE: ACHIEVING 

ADEQUATE ORAL ANTICOAGULATION IN 

ONCOLOGY PATIENTS WITH DEEP VEIN 

THROMBOSIS. Swenson C, Shaw D, Berry J, 

Madigan Army Medical Center. E-mail: 

claudia.swenson@nw.amedd.army.mil 

Objective: Recently published studies suggest 

higher rates of both recurrent deep-vein thrombosis 

(DVT) as well as bleeding in oncology patients treated 

with warfarin. To help assess the risk–benefit 

ratio of warfarin versus low molecular weight heparin 

or other options for this population, the rate of 

therapeutic anticoagulation in patients with DVT 

with or without an oncology diagnosis at our institution 

was needed. 

Methods: A retrospective, comparative study of 

patients receiving oral anticoagulation with a diagnosis 

of DVT and an oncology diagnosis versus no 

oncology diagnosis was undertaken. A query of the 

institutional database for the 800 active anticoagulation 

clinic patients who also carried an oncology 

diagnosis yielded 150 patients. A further screen for 

DVT diagnosed within the last 12 months yielded 27 

patients. A control group of 27 patients with DVT 

but without an oncology diagnosis was identified 

using the anticoagulation clinic database. The diagnosis 

of DVT was confirmed by usual tests (ultrasonography). 

The demographics of the groups were 

similar: Average age (years): nononcology = 66.6, 

oncology = 61.6; sex (men/women): nononcology = 

10/17, oncology = 13/14. The international normalized 

ratio (INR) values for analysis were included 

after the patient was in the 2.0–3.0 range for two values 

and the percentage of values in range calculated. 

Results: The percentage of INR values in range 

was much higher for the nononcology DVT patients 

versus oncology DVT patients: 70.7% (220 of 311 

patients) versus 42% (268 of 636 patients). The 

range and median for the percentage of therapeutic 

INRs for the nononcology DVT patients versus 

oncology DVT patients: 25–90%, median 72%; 

0–80%, median 47%. 

Conclusions: This retrospective comparative 

study of the rate of therapeutic anticoagulation in 

patients with DVT with or without an oncology diagnosis 

at our institution demonstrated results similar 

to those in the published literature. These data will 

be key in assessing other therapeutic options for 

these patients. 

45—USE OF MIXED-EFFECT MODELING 

TO DETERMINE THE INFLUENCE OF 

ALBUMIN, BILIRUBIN, VALPROIC ACID, 

WARFARIN, AND ASPIRIN ON PHENYTOIN 

UNBOUND FRACTION AND PHARMACOKI- 

NETICS. Bauer L, University of Washington. 




FEATURE 

E-mail: labauer@u.washington.edu 

Objective: Because phenytoin is a drug with a 

low hepatic extraction ratio, the unbound fraction of 

drug in the serum influences its pharmacokinetics 

and interpretation of serum concentrations. The 

objective of this study was to use NONMEM to 

determine the effects of the above characteristics on 

phenytoin pharmacokinetics. 

Methods: A total of 637 hospital inpatients taking 

phenytoin for seizures were studied; 57% of the 

patients took one or more of the other drugs, and 

32% of the patients had abnormal albumin (1.5 mg/dL). Steadystate 

phenytoin total and unbound concentrations 

were measured using the TDx assay system (coefficient 

of variation 3.841, P 4 mg/day, valproic acid >750 

mg/day, aspirin >1,300 mg/day. These patient 

covariates were statistically significant and 

decreased the maximum rate of metabolism (V max 

) 

by more than 25%: albumin 3 mg/dL, valproic acid >500 mg/day. 

Conclusions: Unbound concentrations and 

unbound fractions of phenytoin should be measured 

in patients with characteristics that alter protein 

binding. When patients have more than two covariates 

present, the unbound fraction can be as high as 

30% to 40%. Phenytoin doses should be reduced by 

25% or more in patients with characteristics that 

decrease V max 

values. 

46—USING THE OUTCOMES PHARMA- 

CEUTICAL HEALTH CARE CASE MANAGE- 

MENT SYSTEM AS A DATA COLLECTION 

TOOL FOR RESEARCH. Zillich A, Purdue 

University, Kumbera P, Outcomes Pharmaceutical 

Health Care, Carter B, University of Iowa. E-mail: 

azillich@purdue.edu 

Objective: To describe a system for collecting 

research-based data from community pharmacy programs. 

Methods: The Outcomes Case Management 

System (OCMS) is a Web-based patient care system. 

The system assists payers in implementing disease 

management programs while simultaneously offering 

pharmacists a method to bill for services provided. 

For pharmacists, patient-specific information can 

be captured, enabling pharmacists to maintain 

progress notes and document patient care services. 

OCMS identifies patients who qualify for services 

and reminds pharmacists about the types of assessments 

needed at each visit. A variety of reporting 

capabilities track clinical and service data for individual 

patients or groups. For payers, researchers 

and program managers, OCMS captures service data 

for quality assurance monitoring. Advanced administrative 

features of OCMS offer customized patient 

care protocols that detail patient visit frequency, 

types of services needed, and specific monitoring 

parameters (i.e., blood pressure, blood glucose, 

cholesterol). Pharmacist fees are calculated using a 

unit rate set by the payer for various services and 

clinical assessments. Fees can also be adjusted based 

upon percent or fixed dollar patient copayments. 

These data can be used for research purposes to evaluate 

pharmacy-based services. No additional data 

entry is required, and the system interfaces with a 

relational database. Data are captured via an encrypted 

and password-protected hyperlink. Recently, 

OCMS was tailored for use during a clinical research 

study conducted in 12 community pharmacies. The 

study evaluated a pharmacist-based home blood 

pressure monitoring program. The program consisted 

of four face-to-face visits with a trained pharmacist. 

In general, the visits lasted 15 to 60 minutes. 

Pharmacists were required to document all patient 

care activities and submit data via OCMS. As data 

were submitted, a claim was generated by the pharmacist 

to receive reimbursement for the service. 

Pharmacists were paid a set fee for each service visit. 

All claims data were instantly transferred to a relational 

database. The database was queried to provide 

researchers with the data collected in the pharmacies. 

Results: A total of 398 visit claims were submitted. 

Appropriate data, without specific patient identifiers, 

were transferred to researchers for analysis. 

Research personnel reported that the data were clean 

and easy to manage for analyses. 

Conclusions: OCMS can be used effectively for 

collection of research-based data. 

47—VALUE OF SPECIALTY CERTIFICA- 

TION IN PHARMACY. Pradel F, Palumbo F, 

Flowers L, Mullins C, Haines S, Roffman D, 

University of Maryland at Baltimore. E-mail: 

fpradel@rx.umaryland.edu 

Objective: The purpose of this project was to 

develop a white paper addressing the value of Board 

of Pharmaceutical Specialties (BPS) certification. 

Our work primarily focused on the value of pharmacy 

specialty certification as perceived by different 

stakeholders (pharmacists, employers, government, 

and academia). We also examined specialization and 

certification in medicine to draw a parallel between 

the two disciplines. 

Methods: We searched electronic databases 

(Medline, International Pharmaceutical Abstracts, 

Sociological Abstracts), association/health care 

organization Web sites, and outside reports. Finally, 

clinical pharmacists involved in certification processes 

were consulted. 

Results: Board certification is perceived as valuable 

in a number of instances. Certified pharmacists 

report enhanced feelings of self-worth, improved 

competence, and greater marketability. Other values 

of certification include increased acceptance by 

health care professionals, salary increases, and job 

promotion. Employers acknowledge board-certified 

pharmacists through public recognition, increases in 

responsibility, and some type of monetary compensation. 

In a few governmental organizations, certified 

pharmacists receive salary raises and are granted 

prescribing authority. About one third of colleges 

of pharmacy in the United States also consider board 

certification as a criterion for promotion and tenure, 

and, to a lesser extent, for salary increases. In contrast, 

the overall value of specialty certification in 

pharmacy as perceived by the public or payers lags 

behind when compared with the status of specialty 

certification in medicine. 

Conclusions: The Board of Pharmaceutical 

Specialties needs to, in collaboration with pharmacists, 

further document and promote the value of certification 

to various stakeholders. 

48—WOMEN’S USE OF INFORMATION 

SOURCES IN THE TREATMENT OF 

MENOPAUSE. Jackowski R, Kirking D, Huston S, 

University of Michigan. E-mail: jackowsk@umich.edu 

Objective: Recent studies regarding hormonereplacement 

therapy (HRT) have caused women to 

rethink decisions regarding its use. In light of the 

controversy surrounding HRT use, we sought to 

explore what sources women use for information 

regarding their decision to treat menopause. Thus, 

the objectives of this study were to (1) identify 

sources women use, ascertain their understanding of 

those sources, and assess how helpful sources were 

in influencing decisions to use HRT and (2) determine 

how these factors vary by patient characteristics, 

including HRT user status and presence of diabetes 

mellitus. 

Methods: A cross-sectional mail survey was used. 

Data were collected from women with and without 

diabetes mellitus aged 45 to 60 years who met specified 

inclusion criteria and were enrolled in a southeastern 

Michigan health-maintenance organization. 

Results: A total of 765 usable responses were 

obtained from 1,812 eligible, deliverable surveys 

(42.2%). The most frequent information source was 

physicians, followed by magazines/print publications, 

friends, and family, (80%, 57%, 48% and 43%, 

respectively). Pharmacists were used as an information 

source by 17% of respondents. The most trusted 

sources were physicians, pharmacists, and other 

health care professionals (82%, 59%, and 56%, 

respectively), with similar results for the most knowledgeable 

and helpful sources. Least trusted were print 

ads, television ads, television programs and the 

Internet (34%, 34%, 25%, and 13%, respectively). 

These sources were also most thought to be biased or 

to have a vested interest in promoting a particular 

view. Results show differences in trust among 

sources by various personal characteristics, including 

diabetes status. Three distinct groups were shown to 

be trusted differently by respondents: health 

providers, family and friends, and various media. 





Conclusions: Except for physicians, sources used 

most frequently by women were not always considered 

to be the best sources of information regarding 

treatment of menopause. 

49—WORK AND COST ANALYSIS OF 

PHARMACEUTICAL CARE DELIVERED BY 

PHARMACISTS IN PRIMARY CARE CLIN- 

ICS. Helou L, Sorensen T, University of Minnesota. 

E-mail: helou002@umn.edu 

Objective: (1) Identify the amount of revenue 

generated by clinical pharmacists in primary care 

settings and compare this amount with the pharmacy 

personnel cost of service delivery and (2) model 

potential patient-care revenues using a resourcebased 

relative value scale (RBRVS) for reimbursement 

of pharmaceutical care. 

Methods: Clinical pharmacists practicing in four 

Minnesota primary care clinics will record workload 

and clinical data for patients evaluated during a 4- 

week period in October and November 2003. Billing 

in these clinics is accomplished via cash payment, 

“incident-to” billing, and/or institutional provider 

fees. Data collected will include but are not limited 

to: reason for pharmacist assessment, time committed 

to encounter, number of drugs and medical conditions 

reviewed during assessment, and number of 

drug therapy problems identified. Revenue collected, 

as cash or from third-party payers, from each 

encounter will be identified and compared with 

workload data. Workload and clinical data collected 

will be used to model projected revenues using a 

RBRVS for pharmaceutical care reimbursement that 

models the RBRVS applied to medical reimbursement 

for medical care. 

Results: Results of this project will allow determination 

of the cost–revenue differential for the 

delivery of pharmaceutical care in a primary care 

setting. Data collected will allow for a prospective 

modeling of the cost–revenue differential using a 

RBRVS for pharmaceutical care. 

Conclusions: The mechanism by which pharmacists 

will be reimbursed for pharmaceutical care, 

should these services be included in Medicare insurance 

plans, is unknown. Reimbursement may model 

the RBRVS of medical provider reimbursement. 

This project will allow prospective evaluation of one 

proposed RBRVS for pharmaceutical care. 

50—EMERGENCY CONTRACEPTION 

PILLS—EDUCATING PHARMACISTS UTI- 

LIZING A CONTINUING EDUCATION PRO- 

GRAM. Morawiec K, Northeastern University, 

Dougherty T, Presbyterian Medical Center, Penn 

Family Care. E-mail: kmorawiec@hotmail.com 

Objective: To develop, conduct, and assess the 

effectiveness of an interactive, multidisciplinary 

continuing education (CE) program about emergency 

contraception pills (ECPs). 

Methods: A unique CE program about ECPs, 

practice guidelines and state/federal legislation was 

created for pharmacists practicing in Massachusetts. 

Pharmacists were invited to attend through pharmacy 

associations, E-mails, faxes, and site visits. A 

variety of learning methods were used: lecture, casebased 

discussions, and video-counseling sessions. 

Pamphlets in English and Spanish were developed 

and distributed to participants to facilitate patient 

counseling in their practice settings. The presenters 

panel consisted of a physician, faculty pharmacist, 

and assistant director for the Massachusetts Health 

Department family planning program. Participants 

completed a voluntary pretest survey to assess 

knowledge, medical practices, attitudes, and patient 

encounters. A posttest survey was mailed 3 months 

later. A comparison of the pretests and posttests were 

used to assess the program’s effectiveness. 

Results: The program was attended by 21 pharmacists—12 

community, 6 hospital, and 3 faculty 

pharmacists. Of 19 participants, 37% felt confident, 

56% felt unconfident, and 5% felt very unconfident 

in the accuracy of ECP information they were providing. 

Of the 12 community pharmacists, 67% 

rarely or never discussed ECPs when counseling 

patients receiving prescription contraceptives. 

Among all participants, 81% knew ECPs were most 

effective when used within 72 hours after unprotected 

sex, and 43% did not know that progestin-only 

ECPs are more effective than combined ECPs. 

Results of the posttest survey will be presented and 

compared. 

Conclusions: The program may be an effective 

method of education as measured by the increased 

number of pharmacists counseling patients about 

ECPs and improved confidence in knowledge accuracy 

about ECPs. 

51—PRESCRIPTION ASSISTANCE AND 

MEDICATION MANAGEMENT FOR 

SENIORS. Herndon A, School of Pharmacy, Roth 

M, University of North Carolina at Chapel Hill. E- 

mail: tig41ger@yahoo.com 

Objective: Senior Care, a prescription drug program 

for North Carolina seniors, covers 60% of the 

first $1,000/year for select prescription drugs. This 

includes medications used to treat cardiovascular 

disease, chronic obstructive pulmonary disorder 

(COPD), and diabetes. The program also funds 23 

Medication Management Centers across the state to 

assist seniors in appropriate medication use. One of 

these centers, the University of North Carolina 

(UNC) School of Pharmacy, is responsible for providing 

medication assistance by telephone to seniors 

in 41 counties not covered by a local Medication 

Management Center. 

Methods: Senior Care eligibility requirements are 

age 65 years or older; annual income less than 

$17,720 (single individuals) and $23,880 (couples); 

medications used to treat cardiovascular disease, 

COPD, and diabetes; Medicaid ineligible; and no 

third-party prescription coverage. Interested individuals 

submit an application to Senior Care headquarters. 

Approved applications are mailed to the 

Medication Management Center in the senior’s 

respective county or to UNC. Upon receiving an 

application, UNC initiates patient contact. The 

senior is given an opportunity for a telephone interview 

to determine prescription assistance eligibility 

and learn more about his or her medications from a 

pharmacist. After completing the interview, a pharmacist 

documents the medication history in a letter 

to the patient. Additionally, a prescription assistance 

coordinator searches for prescription assistance programs 

for which the patient may qualify. The pharmacist’s 

letter along with applications for assistance 

programs are mailed to the patient. This concludes 

the patient encounter. 

Results: To date, 354 individuals have been contacted. 

Of these, 162 (46%) have been interviewed, 

and 98% of interviewed individuals received a pharmacist’s 

letter and applications. Some 2% were ineligible 

for prescription assistance, but received a 

pharmacist’s letter. The remaining 54% were 

unreachable or declined participation. 

Conclusions: Although 50% of Senior Care-eligible 

individuals are reached and the majority receive 

application packets, the program has limited ability 

to reach those in need and to detect meaningful outcomes 

because of lack of follow-up. 

APhA–APPM Community & 

Ambulatory Practice 

52—ADHERENCE TO ANTIDEPRESSANT 

MEDICATIONS. Krueger M, Asher C, Mancuso 

L, U.S. Army Medical Department, Chou C, Pfizer, 

Inc. E-mail: mark.krueger@na.amedd.army.mil 

Objective: To assess medication adherence rates 

in an ambulatory setting. 

Methods: Design: A convenience sample of 98 

patients completed a four-question validated survey 

(Adhere Rx). As a follow-on study, we conducted a 

retrospective analysis of antidepressant prescription 

data using the Standardized Therapy Adherence 

Research Tool (START). Participants: Military 

health care beneficiaries receiving new prescriptions 

during the pilot study and 5,830 patients receiving 

16,800 prescriptions in the follow-on study. 

Analysis: After being stripped of patient identifiers, 

antidepressant (bupropion, citalopram, fluoxetine, 

mirtazapine, nefazodone, paroxetine, sertraline, trazodone, 

venlafaxine) prescription data from January 

2002 through June 2003 were placed into a 

Microsoft Access 97 database. We employed a 

washout period to avoid bias and to be reasonably 

certain that all first instances of prescriptions included 

in the transformed database were new starts, leaving 

a population of 2,571 patients. 

Results: During the pilot study, the majority of 

respondents (84.7%) self-reported adherence scores 

in the medium or high categories. There was no correlation 

between medication adherence score and the 

number of medical conditions. There was, however, 

a correlation between medication adherence score 

and the type of medical condition, namely depression, 

anxiety, allergy, and asthma. Having a concern 

with antidepressants, we decided to examine general 

population results using START. The average length 

of therapy for SSRIs was 130.3 days, compared with 

111.1 days for non-SSRIs. There was a higher median 

gap (44.8) for SSRIs versus non-SSRIs (30.7). 

Persistence on SSRI therapy at 3, 6, and 12 months 

was 74, 63, and 42 percent, respectively, while persistence 

on non-SSRI therapy at 3, 6, and 12 months 




FEATURE 

was 58, 41, and 18 percent, respectively. Fluoxetine, 

trazodone, and nefazodone had higher switch rates. 

A limitation is that our database likely did not 

include solely those with depression since some of 

these medications were being used to treat insomnia, 

migraine headache prophylaxis, or anxiety. 

Conclusions: Medication adherence is the use of 

the right drug in the correct dose at the right interval. 

Brief questionnaires can help pharmacists target 

individual patients for additional counseling. 

START is a powerful statistical tool to examine 

pharmacy claims databases to determine rates of 

medication adherence. Assessment of adherence 

rates uncovers opportunities for improvement in 

pharmaceutical care. 

53—AN EVALUATION OF THE IMPACT 

OF A PHARMACY BASED LATENT TUBER- 

CULOSIS INFECTION COMPLIANCE CLIN- 

IC ON COMPLETION RATES OF ISONIAZID 

IN A COLLEGE STUDENT POPULATION. 

Goad J, Johnson K, University of Southern 

California, Milani H, Longs Drug Stores. E-mail: 

goad@hsc.usc.edu 

Objective: To determine if a pharmacist-managed 

latent tuberculosis infection (LTBI) clinic in a university 

community pharmacy improves the completion 

rate of isoniazid (INH) therapy for students. 

Methods: Data were retrospectively collected 

from pharmacy and medical records at the campus 

pharmacy and student health center. Using pharmacy 

records, all students receiving INH between January 

1999 and May 2003 were identified. Those patients 

on antituberculosis medications other than INH were 

excluded. The resulting set of patients was matched 

to student health center medical records. Students 

were excluded if they did not meet CDC guidelines 

for low INH toxicity risk. A community pharmacybased 

LTBI compliance clinic for INH therapy had 

been initiated in August 2000. The pre-LTBI pharmacy 

clinic group A (January 1999 to July 2000) was 

managed completely by student-health clinicians, and 

the pharmacy-managed group B (August 2000 to 

May 2003) was referred by student health for all follow-up 

care at the pharmacy. Before June 2000, 

LTBI in non-HIV patients was treated with a 6- 

month course of INH, while later patients received 

the currently recommended 9 months of therapy. 

Results: A total of 86 patients were included in 

group A, while 118 patients were in group B. The 

average age in both groups was 25 years, and the ethnicity 

of group B was primarily Asian. The completion 

rate in group A (6 months or 180 doses in 9 

months) was 36%, compared with 65% in group B (9 

months or 270 doses in 12 months). The rate of 

adverse drug reactions to INH in group A was 1.2%, 

while in group B it was 11%, most likely reflecting 

the infrequent visits with clinicians in group A. 

Conclusions: A community pharmacy-based 

compliance clinic may significantly increase the rate 

of INH completion for LTBI treatment. 

54—BILINGUAL OVER-THE-COUNTER 

PRODUCT LABELS TO ENHANCE PROD- 

UCT USE. Sansgiry S, University of Houston. 

E-mail: ssansgiry@uh.edu 

Objective: The objective of this study was to 

develop and evaluate bilingual (Spanish and 

English) product information labels (PILs) for overthe-counter 

(OTC) medication products to enhance 

comprehension of product-use information. 

Methods: A randomized experimental study 

design was developed using three different label formats: 

new OTC labels, old OTC labels, and PILs. 

Data were collected from consumers in the process 

of selecting OTC medications from the pharmacy 

stores in the Houston area. Participants were classified 

into three groups—English monolinguals, 

Spanish monolinguals, and English/Spanish bilinguals. 

Each participant evaluated three label designs 

in random order after which they completed a questionnaire 

that measured dependent variables such as 

ease of use, product knowledge, attitude toward 

product label, product evaluation, and purchase 

intention. The questionnaire was provided in both 

English and Spanish languages. Demographic variables 

measured include age, gender, marital status, 

race, income, education, employment status, and 

prior medication use. Data were coded and analyzed 

to evaluate the effect of PILs as compared with other 

label designs. 

Results: A total of 336 subjects participated in the 

study. Participants had a mean age of 38.7 (± 12.2) 

years with a higher distribution of women (59.2%) 

and Hispanics (69%). The multivariate analysis of 

variance (MANOVA) test showed significant effect 

of label design on all dependent measures (P < .001). 

Scheffé post-hoc tests showed that PILs were significantly 

superior to the current OTC label formats, 

and the results were consistent across all dependent 

variables measured. 

Conclusions: This study highlights the need for 

better information sources for OTC medications, 

especially for the growing Hispanic population. PILs 

provide a valuable solution to the concerns of the 

Spanish-speaking communities who may have difficulty 

reading or understanding current OTC labels. 

55—BLOOD PRESSURE CONTROL OF 

ELDERLY HYPERTENSIVE PATIENTS 

WITH PHARMACEUTICAL CARE INTER- 

VENTION AND HOME BLOOD PRESSURE 

MONITORING. Christian M, Johnson & Johnson. 

E-mail: mchris2785@aol.com 

Objective: To assess the effectiveness of pharmaceutical 

care intervention, medication-use review, 

and home blood pressure monitoring for blood pressure 

control in elderly hypertensive patients. 

Methods: Eligible patients were entered into this 

prospective, controlled 4-month, two-phase study. 

Blood pressure was recorded and quality of life 

(QOL) assessments made using the 36-item short 

form (SF-36). During the initial (control) phase, 

blood pressure was monitored monthly by a trained 

health care professional without pharmaceutical care 

interventions. Weight and pulse were measured 

monthly. Patients were maintained on their medication 

regimen, adjustments only made as per standard 

of care. At the start of the second (intervention) 

phase of the trial, patients were administered the 

QOL survey. Monthly, patients received medication 

counseling, disease education, lifestyle modification 

counseling, and instruction on using a home blood 

pressure monitor. Monthly, patients had blood pressure 

monitored by a health care professional. Weight 

and pulse were measured monthly. At the conclusion 

of the trial, the QOL assessment was administered 

once again. 

Results: During the control phase, patients exhibited 

a mean elevation in both systolic and diastolic 

blood pressure from baseline. Heart rate remained 

virtually unchanged, and weight was reduced an 

average of 2 pounds, corresponding to a mean reduction 

of BMI. QOL assessment, using SF-36, showed 

an improvement in six of eight categories in the 

intervention group over the control group. General 

health category scores were improved 31.7% over 

baseline in the intervention group, compared with a 

17.8% decline in general health score for the control 

group. During the intervention phase, systolic and 

diastolic blood pressures were reduced by an average 

of 3.25 and 0.4 mm Hg, respectively. Heart rate 

remained stable, and weight loss was observed in 7 

of 12 patients for a mean reduction of 3 pounds (a 

mean reduction in BMI of 3.8%). 

Conclusions: Data presented demonstrate that 

active, monthly pharmaceutical care intervention 

along with home blood pressure monitoring was 

effective in blood pressure control of elderly hypertensive 

patients. Patient QOL can be significantly 

improved after pharmaceutical care intervention. 

Weight reduction was also enhanced with active 

pharmaceutical care intervention. 

56—CHANGING BEHAVIOR TOWARDS 

OSTEOPOROSIS PREVENTION: DOES 

SCREENING LOCATION MATTER? Scolaro 

K, Stamm P, Lloyd K, Auburn University. E-mail: 

scolakl@mail.auburn.edu 

Objective: To determine if adherence to pharmacist 

recommendations for osteoporosis prevention 

differs by screening setting. 

Methods: Nonrandomized prospective analysis 

conducted in two chain community pharmacies (CP) 

and one nondispensing pharmaceutical care center 

(PCC) in suburban Alabama. The sample consists of 

200 adult men and women. CP recruitment efforts 

include flyers, pharmacy staff referrals, and patient 

self-referrals. PCC patients are recruited during routine 

visits. Eligible patients complete an intake form 

collecting demographic data, basic medical information, 

osteoporosis risk factors, and current preventative 

behaviors (calcium and vitamin D use and exercise). 

Patients are then screened using the Achilles 

Express Ultrasound, educated about their results, and 

given recommendations to reduce osteoporosis risk. 

Follow-up surveys are mailed to each patient 

screened. Surveys are used to determine patient 

adherence to recommendations and patient satisfaction. 

Results will be compared to see if adherence or 

satisfaction differs according to screening setting. 

Nominal data (e.g., gender) will be analyzed using 

descriptive statistics. Differences in nominal data 





will be assessed using chi square analysis. Interval 

data will be analyzed using means, standard deviations, 

and Student’s t test for paired data. 

Results: Screenings are ongoing; the following 

data are aggregate. A comparison by setting will be 

presented. A total of 92 patients (81 CP, 11 PCC) 

have been screened, including 88 (96%) women. 

Mean (± SD) age is 48 ± 18 years. Patients average 

2.7 ± 1.6 risk factors for osteoporosis, and the mean 

(± SD) T score is –0.2 ± 1. A total of 221 osteoporosis-specific 

recommendations have been made: 67 to 

increase calcium, 53 to increase vitamin D, 50 to initiate 

or increase weight-bearing exercise, 25 to 

obtain a diagnostic scan, 6 to reduce modifiable risk 

factors, and 20 miscellaneous. Some 54 (59%) 

patients returned evaluable surveys, and 16 of 37 

(43%) responders had followed calcium recommendations, 

and 14 of 30 (47%) responders followed the 

exercise recommendations. On a scale of 1 to 10 (1 

= very dissatisfied; 10 = very satisfied), patients 

rated the screening service at 8.9 ± 2.5, and all 

reported that they would recommend the service to a 

friend. 

Conclusions: Preliminary results indicate patients 

do change behavior, are highly satisfied with osteoporosis 

screenings conducted by pharmacists in the 

community setting and in nondispensing pharmaceutical 

care centers, and would recommend the service 

to others. 

57—COMPARING THE RISK FOR OSTEO- 

POROSIS IN HISPANIC AND CAUCASIAN 

WOMEN BASED UPON BONE DENSITY 

MEASUREMENTS OBTAINED FROM COM- 

MUNITY HEALTH SCREENINGS. Alvarez G, 

Nova-Southeastern University, Marsh W, Hunter T, 

Droege M, Nova Southeastern University. E-mail: 

galvarez@nova.edu 


determine whether Caucasian–Hispanics are at a significantly 

lower risk than are non-Hispanic 

Caucasians for development of osteoporosis. 

Osteoporosis, a debilitating bone disease defined by 

decreased mass and altered bone micro-architecture, 

results in increased bone fragility and increased risk 

of fracture. The World Health Organization defines 

osteoporosis as a T score 2.5 standard deviations 

below the mean for young adult controls. All 

women, regardless of race, are at risk of developing 

osteoporosis; however, Caucasian or Asian women 

are commonly considered being at higher risk. 

Hispanics in the United States are of Mexican, 

Puerto Rican, Cuban, Dominican Republic, Central 

American, or South American descent; many 

Hispanics in South Florida are of Caucasian heritage. 

Whether osteoporosis risk differs based upon 

heritage within the Hispanic population is unknown. 

If health care providers mistakenly believe that some 

are not at risk for this disease, opportunities for 

appropriate prevention may be forfeited. 

Methods: Bone density measurements were used 

to assess the osteoporosis risk in 627 men and 

women in South Florida. Each subject self-reported 

gender, age, and race. Bone density measurements 

were obtained using a Hologic Sahara Bone 

Sonometer and T scores were calculated. Data are 

presented for 353 (209 Hispanic and 144 Caucasian) 

women over the age of 55. 

Results: The overall mean T score for the group 

was –1.229 with a standard deviation of 1.0385. The 

mean T score obtained for Hispanic women was 

–1.194, compared with –1.280 for Caucasian 

women. An independent Student’s t test for paired 

data confirmed that there was no statistically significant 

difference between the groups (t = 0.76, P = 

.47). As expected, the correlation between the 

obtained T score and age was negative (r = –.36), 

reflecting bone loss with increasing age. 

Conclusions: This study indicates that Hispanic 

women of Caucasian heritage are at equal risk of 

developing osteoporosis as Caucasian women. 

58—CONSUMER ATTITUDES TOWARD 

THE OVERALL VALUE OF THE PHARMA- 

CIST AS A DRUG INFORMATION SOURCE. 

Rollins B, Sullivan D, Ohio Northern University. E- 

mail: b-rollins@onu.edu 

Objective: Consumers consistently view the pharmacist 

as one of the most trusted and respected professionals, 

but do they truly view the pharmacist as a 

valuable source of drug and medical information? 

The pharmacist, especially in the community setting, 

is the one of the most accessible and reliable sources 

of drug information for the consumer. However, are 

there barriers preventing consumers from seeking 

the pharmacist’s advice? The purpose of the study is 

to assess consumer attitudes toward the overall value 

of the pharmacist as a drug information source. The 

researchers will attempt to answer the following 

research questions: (1) Consumer attitudes toward 

the availability and approachability of the pharmacist; 

(2) is the pharmacist seen as a true patient advocate; 

(3) who do consumers seek to answer their drug 

information questions; and (4) do consumers prefer 

written drug information or pharmacist counseling? 

The fourth research question is based on the results 

of a previous study in which consumers slightly to 

moderately agreed they would rather have a voluntary 

package insert versus personal instruction from 

the pharmacist regarding the use of a corticosteroid 

nasal spray (mean = 4.49 ± 1.268; scale: 1 = strongly 

disagree to 6 = strongly agree). 

Methods: Consumers were selected for inclusion 

in the study from a database of Ohio residents 

between the ages of 18 and 70. A sample size of 

approximately 140 consumers was calculated based 

on a priori alpha of .05, beta of .20, and power of .80. 

Based on an estimated response rate of 35%, 400 

consumers will be randomly selected through simple 

random sampling from this database. The survey 

instrument is a self-administered mailed questionnaire. 

The questionnaire uses approximately 35 questions 

to assess the four research questions. Data will 

be analyzed using descriptive statistics and Student’s 

t test for paired data. Demographic differences (gender, 

age, education level) will also be analyzed. 

Results: Data collection ongoing. 

Conclusions: Data collection ongoing. 

59—CREATING THE CAPACITY FOR 

CASE MANAGEMENT IN A COMMUNITY 

PHARMACY. McDonough R, Doucette W, 

Musick J, Klepser D, McCarthy R, University of 

Iowa. E-mail: randal-mcdonough@uiowa.edu 

Objective: Main at Locust Pharmacy Clinic 

developed and implemented a process to provide 

case management services for the Iowa Medicaid 

Pharmaceutical Case Management (PCM) Program. 

The objective of this report is to describe the patient 

care processes and forms that were developed to provide 

case management services for eligible patients. 

Methods: Design: A descriptive overview of the 

patient care processes developed and implemented at 

the pharmacy to provide efficient and effective care 

to eligible Medicaid patients. Setting: An independent 

community pharmacy Patients: Medicaid recipients 

who were taking four or more long-term oral 

medications and had one or more of the 12 disease 

states that are costly to Iowa Medicaid (heart failure, 

coronary artery disease, diabetes mellitus, hypertension, 

hyperlipidemia, asthma, depression, atrial fibrillation, 

osteoarthritis, gastroesophageal reflux disease, 

peptic ulcer disease, and chronic obstructive 

pulmonary disease) Data Collection: A description 

of the patient care process that evolved over the 2- 

year period is provided. Patient care forms and 

physician communication tools that were developed 

to improve the efficiencies of the patient care process 

are discussed and shared. The number of 

patients enrolled, the number of drug therapy problems 

found, and the physician response to pharmacists’ 

recommendations is described. Analysis Plan: 

Description of the patient care process 

Results: Over a 2-year period, 259 patients met 

eligibility criteria. The clinic enrolled 153 patients 

into the program. Patient care processes were developed 

and patient care forms created. Communication 

forms were developed that improved the physician 

response rate to the pharmacists’ recommendations. 

Pharmacists found 901 drug therapy problems over 

the 2-year period. Physicians responded to pharmacists’ 

recommendations approximately 60% of the 

time. In 48% of the cases, pharmacists’ recommendations 

led to a documented change in patients’ medications. 

Conclusions: Pharmacists at Main at Locust 

Pharmacy Clinic were successful in developing and 

implementing case management services in a patient 

population considered at high risk for drug therapy 

problems. 

60—DETERMINING THE EFFECT OF 

MEDIA RELATIONS ON PHARMACISTS. 

Ferreri S, University of North Carolina at Chapel 

Hill, Coffey C, Mercer University Southern School 

of Pharmacy. E-mail: ferreri@E-mail.unc.edu 

Objective: (1) To address if pharmacists have 

interacted with media. (2) Report if pharmacists 

receive communication or media training. (3) 

Identify how pharmacists could improve their interaction 

with the media. 

Methods: The members of the OTC Media 

Advisors network were chosen based on the criteria 

of knowledge of OTC medications, availability to 




FEATURE 

partake in media relations, and prior media relations 

experience. Since the first charge of the media network 

was the switch of Prilosec from prescription to 

OTC status, the advisors were chosen from market 

areas with high incidence of heartburn sufferers. The 

OTC Media advisors were media- and messagetrained 

at the American Pharmacists Association 

headquarters in Washington, D.C. by two seasoned 

reporters. The training focused on message development 

and interaction with the print media via phone 

and during live and taped television interviews. The 

network of pharmacists were trained how to express 

their intended message while maintaining their 

integrity. The intention of this network is to introduce 

society to the pharmacists who serve their community 

and present their roles in health care. Active 

participation of pharmacists in the media can 

increase consumer awareness of pharmacists’ abilities 

to manage medication therapies. Pharmacists are 

the medication experts, so use them! The survey 

used in this study will be dispersed to licensed practicing 

pharmacists throughout the United States to 

determine the extent of media training or experience 

that pharmacists have with the media. This will help 

guide continuing education programs in the future to 

help better prepare pharmacists to reach-out to their 

consumers. The survey contains 15 questions that 

assess past media relations of pharmacists, perceived 

satisfaction of how they were portrayed, and how 

they can better prepare to discuss topics of expertise 

with the media and the community. 

Results: Results in progress. 


61—DIABETES, BODY WEIGHT, AND 

LIPID ABNORMALITIES: AN EVALUATION 

OF OUTPATIENTS WITH SEVERE MENTAL 

DISORDERS RECEIVING CLOZAPINE. Olson 

D, Lamberti J, Maharaj K, Crilly J, University of 

Rochester, Costea O, Columbia University. E-mail: 

Steven_Lamberti@urmc.rochester.edu 

Objective: The purpose of this study is to determine 

the actual prevalence of diabetes in patients of 

an outpatient mental health clinic taking clozapine. 

This study involves physical and laboratory assessment 

to confirm the absence of diabetes and any 

clinical correlates with diabetes in this population. 

Methods: An initial retrospective chart review 

identified all patients taking clozapine (N = 141). All 

were patients of Strong Ties Community Support 

Program, an outpatient clinic of the University of 

Rochester Department of Psychiatry serving approximately 

1,000 patients. Physical assessments include 

blood pressure, body weight, body mass index (BMI), 

body fat percentage, and hip and waist circumferences. 

Laboratory assessments done for patients without 

diagnosed diabetes include fasting blood glucose, 

serum cholesterol, and serum triglycerides. 

Results: The point prevalence for type 2 diabetes 

was 18.4% for 141 patients whose charts were 

reviewed. Demographics for an initial group of 93 

patients completing assessments included a mean (± 

SD) age of 40.9 ± 9.7 years, 63% were men, and 

78.7% were Caucasian. Mean (± SD) duration of 

clozapine treatment was 6.0 ± 3.5 years. Chi-square 

analysis demonstrated a statistically significant 

effect for the family history of diabetes (P = .003), 

but not for age, race, or gender. Preliminary analysis 

of the physical assessments of 93 patients revealed a 

mean (± SD) BMI of 32.9 ± 8.1 kg/m 2 , with 60.6% 

having BMIs greater than or equal to 30 kg/m 2 . For 

patients without prior diagnosed diabetes (N = 68), 

elevated measures included 42.6% with total cholesterol 

above 200 mg/dL, 38.2% with triglycerides 

above 200 mg/dL, and 11% with systolic blood pressure 

greater than 140 mm Hg. 

Conclusions: Patients receiving clozapine are at 

significant risk for developing type 2 diabetes. 

Further study is needed to establish the relative risk 

of developing diabetes while taking clozapine versus 

other antipsychotic medications. 

62—DIABETIC PATIENTS’ AWARENESS 

OF THE AMERICAN DIABETES ASSOCIA- 

TION’S GUIDELINES CONCERNING 

ASPIRIN THERAPY. Steiner G, Rowe S, 

Musgrave R, Cain J, Wilkinson W, Childress S, 

Campbell University. E-mail: gsteiner@quixnet.net 

Objective: This study examines diabetic patients’ 

knowledge of the American Diabetes Association 

(ADA) guidelines concerning aspirin therapy in 

patients with diabetes. A secondary objective seeks 

to identify the source(s) of information concerning 

the ADA recommendations. 

Methods: This study consisted of a survey administered 

in five different community pharmacies in 

North Carolina, during clinical rotations of five of 

the authors. Each of the doctor of pharmacy candidates 

collected data during a 1-month rotation in 

community pharmacy beginning in June 2002 

through March 2003. Each candidate collected surveys 

from the first 25 diabetic patients presenting to 

the pharmacy with a refill or new prescription for a 

drug used in the treatment of diabetes. Criteria for 

inclusion into the study included age over 30 years, 

presence of diabetes mellitus type 1 or type 2, and 

ability to read and write English. 

Results: A total of 92 patients completed the survey, 

including 45 men and 47 women with a mean 

age of 54.96 years. The mean weight of participants 

was 197.6 pounds, and the mean body mass index 

(BMI) was 31.58 kg/m 2 . Overall, 63% of participants 

indicated that they were taking daily aspirin. 

Of the 92 participants, 88 answered the question pertaining 

to the ADA’s recommendation of daily 

aspirin therapy, with 55% of them aware of the recommendation 

to take an aspirin daily. Of those who 

responded to the question that asked the source of 

their knowledge of the recommendation, 69% indicated 

their physician. The second most common 

source of this information was their pharmacist, 

accounting for 13% of responses. 

Conclusions: The results of this survey are from a 

wide sample area of North Carolina. Data collection 

took place in the eastern, central, and western areas of 

the state. Several socioeconomic categories of patients 

were included. This leads us to believe that this is a 

good representative sample of patient’s knowledge of 

the current ADA recommendations concerning 

aspirin therapy in North Carolina, and may have 

applicability to a large portion of the United States as 

well. Approximately one third of patients with diabetes 

are unaware of ADA aspirin guidelines and 

could benefit from routine education concerning these 

guidelines by community pharmacists. 

63—EFFECT OF A PHARMACIST EDUCA- 

TIONAL INTERVENTION ON PATIENT 

KNOWLEDGE ABOUT ANTIBIOTIC RESIS- 

TANCE AND APPROPRIATE USE IN 

ADULTS. Rodis J, Green C, Pedersen C, Ohio State 

University. E-mail: rodis.2@osu.edu 

Objective: (1) To assess the effect of a pharmacist-mediated 

educational intervention on patient 

knowledge about antibiotic resistance and appropriate 

antibiotic prescribing in patients with adult upper 

respiratory tract infections (URTIs), (2) to determine 

patient satisfaction with the pharmacist intervention, 

and (3) to evaluate changes in managed care antibiotic 

costs associated with implementation of an 

antibiotic resistance intervention. 

Methods: Included in this study were 130 adult 

patients presenting to a multidisciplinary urgent care 

clinic in November 2002 through February 2003 and 

identifying any URTI symptom. Each participant 

completed an initial survey assessing knowledge 

about antibiotic resistance and appropriate prescribing. 

Each participant then received written educational 

materials and an intervention with a pharmacist. 

Two weeks following the pharmacist intervention, 

a postintervention survey reassessed main endpoints 

and evaluated patient satisfaction with the 

pharmacist intervention. The data for comparison of 

managed care antibiotic costs of November 2001 to 

February 2002 (year 1) with November 2002 to 

February 2003 (year 2) was gathered from managed 

care system records. 

Results: Patient understanding of antibiotic resistance 

improved from preintervention to postintervention 

survey; agreement with all three antibiotic 

resistance statements increased from 54% to 78% 

(P = .026). Patient knowledge of appropriate antibiotic 

prescribing showed significant improvement (P 

= .023, P = .016). Patients were satisfied with the 

pharmacist-mediated intervention. An overall cost 

reduction of $4.02 per URTI diagnosis from year 1 

to year 2 was identified. 

Conclusions: A pharmacist-mediated educational 

intervention does improve patient knowledge about 

antibiotic resistance and appropriate prescribing of 

antibiotics. A patient-focused antibiotic resistance 

education program in an urgent care setting can 

reduce managed care antibiotic costs. 

64—EFFECT OF EDUCATION AND 

COUNSELING PROVIDED BY A CLINICAL 

PHARMACIST ON OUTPATIENTS WITH 

CANCER. Wongwiwatthananukit S, 

Chulalongkorn University, Sakchinabut S, Paolo 

Memorial Hospital, Dhumma-Upakorn R, 

Chulalongkorn University, Laohavinij S, Rajavithi 

Hospital. E-mail: supakit.w@chula.ac.th 

Objective: To evaluate the effects of education 





and counseling provided by a clinical pharmacist on 

outpatients receiving cancer chemotherapy. 

Methods: A two-way mixed-design experimental 

study was conducted during September 2002 to 

February 2003 at Oncology Unit, Department of 

Internal Medicine, Rajavithi Hospital, Bangkok, 

Thailand. A total of 44 subjects were randomly stratified 

and assigned into experimental and control 

groups based on the number of cycles of chemotherapy 

and educational levels. An experimental group 

of 23 patients received education and counseling, 

while a control group of 21 patients did not. 

Outcomes variables were evaluated in terms of: (1) 

knowledge about disease and treatment, adverse 

drug reactions, and self-care of patients receiving 

chemotherapy; (2) clinical changes in the severity of 

adverse drug reactions and the effectiveness of selfcare 

when patients had adverse drug reactions; and 

(3) changes in the quality of life. Data were collected 

using standardized survey interview and selfassessment 

questionnaire at baseline and during the 

first and second follow-up visits while receiving 

chemotherapy. Two-way ANOVA with repeated 

measure on one factor and chi-square test were used 

to analyze data. 

Results: No statistically significant differences 

were observed in demographic data, cancer types, 

and chemotherapy treatment regimen between 

experimental and control groups at baseline. Results 

indicated that providing education and counseling 

had significant effects on knowledge of patients (P < 

.05), especially concerning knowledge of adverse 

drug reactions and self-care. The effectiveness of 

self-care in the experimental group was higher than 

in the control group significantly (P < .05). However 

no significant differences in severity of adverse drug 

reactions and the quality of life emerged between the 

groups (P > .05). 

Conclusions: Providing education and counseling 

by a clinical pharmacist can significantly improve 

patients’ knowledge and effectiveness of self-care of 

adverse cancer chemotherapy reactions. 

65—EFFECT OF PHARMACIST EDUCA- 

TION ON PATIENT KNOWLEDGE OF NOSE- 

BLEED MANAGEMENT: AN ANTICOAGU- 

LATION CLINIC INTERVENTION. Hassenplug 

K, Burkiewicz J, Jackson T, Peppers L, Midwestern 

University. 

E-mail: 

karen.hassenplug@mwumail.midwestern.edu 

Objective: To assess patient knowledge of management 

of nosebleeds of patients receiving anticoagulation 

therapy at an ambulatory care clinic in a 

managed care setting. Our objectives are to determine 

if pharmacist intervention improves proper 

management and to decrease risks of complications 

among patients. 

Methods: Studies have documented the 

widespread unawareness of patient management of 

nosebleeds. Few studies document the improved 

response in patient management after pharmacist 

education of patients. Further, these studies did not 

specifically study higher-risk anticoagulation 

patients. Paired evaluations of patient knowledge 

were conducted before and after patient education by 

a pharmacist. The survey included approximately six 

demographic-based and four knowledge-based questions. 

Included patients were receiving anticoagulation 

therapy at the time of presurvey administration 

(July–August 2003). Patients unable to communicate 

written or verbally and those who discontinued therapy 

were excluded. Postsurvey evaluation began 

approximately 6 weeks after a pharmacist education. 

The Wilcoxon Signed Rank Test and Bonferroni 

Correction were used to evaluate data. 

Results: Of 264 patients in the anticoagulation 

clinic, 171 patients completed the presurvey (65%), 

and 148 post surveys have been completed to date. 

Demographic data reveal that 60% of the patients 

surveyed were women. The mean (± SD) age of the 

patients was 71 ± 12.03 years. Significant improvement 

occurred in the before and after surveys in the 

following knowledge-based areas: pinching nose (P 

< .001), placement of pinch (P < .001), plugging nostrils 

(P < .001), and tilting head forward (P = .01). 

Final results will be presented at APhA2004. 

Conclusions: Patient education by a pharmacist 

increases patient knowledge of proper nosebleed 

management. Pharmacist intervention has been successful 

in improving proper compliance of nosebleed 

management. 

66—ESTABLISHMENT OF PHARMACIST 

CONSULTATION SERVICES AND COLLAB- 

ORATION BETWEEN HIV CLINICS AND A 

NONPROFIT PHARMACEUTICAL CARE 

CENTER SPECIALIZING IN HIV CARE IN 

ORANGE COUNTY CALIFORNIA. Sherman M, 

Gotterer H, Center for Advanced Pharmaceutical 

Care. E-mail: michrx@earthlink.net 

Objective: To improve therapeutic outcomes and 

quality of life for individuals with human immunodeficiency 

virus (HIV) infections through specialized 

pharmaceutical care services provided through a collaboration 

between HIV clinics and a nonprofit pharmaceutical 

care center. 

Methods: The Center for Advanced 

Pharmaceutical Care (CAPC) is a unique, innovative 

nonprofit facility, specializing in pharmaceutical care 

services for patients with HIV. The HIV specialist 

pharmacist collaborates and works with providers at 

HIV clinics, providing services that have improved 

outcomes such as: improved adherence, decreased 

drug–drug interactions, improved understanding of 

HIV medications and complex regimens, improved 

health and better quality of life. The collaboration is 

funded by Ryan White Title I and Title III funding. 

CAPC is also a rotation site for pharmacy student 

clerkships from the University of California–San 

Francisco and University of Southern California 

pharmacy schools. Future plans include collaboration 

with an HIV clinic in Long Beach, California, and the 

University of the Western Cape Pharmacy School in 

South Africa, to educate pharmacists about HIV and 

HIV drug therapies and to create a pharmacist consultation 

program similar to that at the Center for 

Advanced Pharmaceutical Care in Khayamandi, a 

township of about 25,000 people near Stellenbosch, 

South Africa, where 40% of the residents in this 

township are unemployed. One half of the township 

is composed of women, and most individuals are 

from 29 to 49 years of age. Of those with tuberculosis, 

an estimated 35% are HIV positive. 

Results: During 2002 the HIV pharmacist had 

792 face-to-face patient contacts and 931 other contacts 

(physicians, nurses, and case managers). The 

collaboration between the pharmacist and health care 

team has resulted in improved patient outcomes. 

Specific outcomes include: improved adherence 

with drug therapies, improved health, and better 

quality of life. 

Conclusions: Pharmacist involvement in the care 

of HIV-infected individuals is critical especially in 

the areas of drug therapy counseling, drug interaction 

monitoring, and adherence. Pharmacist collaboration 

with the HIV health care team has completed 

the continuum of care for patients and allowed for 

effective management of HIV drug therapies, which 

is the key component to successful outcomes for 

HIV patients. 

67—EVALUATION OF A COMMUNITY 

PHARMACY NUTRITIONAL EDUCATION 

PROGRAM FOR PATIENTS WITH DIA- 

BETES. Dinh Q, Zgarrick D, Cornell S, Midwestern 

University. E-mail: quangdinh77@yahoo.com 

Objective: To evaluate the effect of a diabetes 

education program on patient knowledge of the 

impact of nutrition on their diabetes and their desire 

to self-manage their disease. 

Methods: All patients with diabetes who were 

enrolled in an American Diabetes Association 

(ADA) recognized Diabetes Education Program at a 

grocery store pharmacy were invited to participate. 

Two Certified Diabetes Educator pharmacists (one is 

also a licensed dietitian) instructed small groups of 

patients on how nutrition affects their disease in an 

hour-long session. A quiz was developed to evaluate 

patient knowledge of the impact of nutrition on their 

diabetes and their desire to self-manage their disease. 

The quiz was administered to patients immediately 

before, immediately after, and 6 months after the 

educational session. A total of 39 patients were 

enrolled into the study. 

Results: Student’s t tests for paired data showed 

significant increases in patient diabetes knowledge 

both immediately after and 6 months after their educational 

session (P < .05). Patients’ ability to pick 

out carbohydrate-containing foods improved after 

their session. Patient motivation to self-manage their 

condition also increased after their session. 

Conclusions: We conclude that this pharmacistmanaged 

diabetes education program significantly 

improve patient knowledge and willingness to selfmanage 

their condition. 

68—EVALUATION OF A MEDICAID 

PHARMACEUTICAL CARE PROGRAM 

WITHIN AN INDEPENDENT COMMUNITY 

PHARMACY IN RURAL IOWA. Belger A, 

University of Iowa, Osterhaus M, Bullock T, 

Osterhaus Pharmacy, Currie J, Farris K, University 

of Iowa. E-mail: akbelger@uwalumni.com 

Objective: We plan to: (1) identify processes 

required to expand the Pharmaceutical Case 




FEATURE 

Management (PCM) program within an independent 

pharmacy; (2) evaluate patient satisfaction with this 

program; and (3) evaluate cost effectiveness of this 

program for this pharmacy. 

Methods: The Iowa PCM program was implemented 

in 2000 to serve Medicaid patients with at 

least four maintenance medications and one of 12 

disease states. Pharmacists and physicians collaborate 

to maximize patients’ care. A 2002 evaluation of 

the program found improvement in the quality of 

care patients received and in medication safety. It 

found no net increase in health care costs. Design: 

Program implementation and evaluation. Subjects: 

All individuals receiving PCM in the pharmacy. 

Program implementation: Participation in PCM will 

be expanded within a community pharmacy. 

Program evaluation: An impact and cost-effectiveness 

evaluation will be conducted. Patient satisfaction 

surveys using validated questions will be mailed 

to all PCM patients seen between September 2003 

and February 2004. The 15-item survey will use a 5- 

point Likert response scale. Patients will be provided 

a return envelope and a reminder postcard to 

obtain high response rates. Costs will be determined 

using pharmacist salary and benefit expenses for 

pharmacist time delivering and documenting care. 

Fees received for care provision will be compiled. 

Results: Methods used to expand care provision 

will be described. Satisfaction results will be analyzed 

using t tests and ANOVA statistics as appropriate. 

The cost-effectiveness evaluation will 

describe all revenues generated and expenses 

incurred in the provision of PCM. Fees received for 

care provision will be compared with costs and evaluated 

to determine cost effectiveness. 

Conclusions: Patient satisfaction and cost effectiveness 

results will be evaluated to determine where 

improvements can be made in patient care and if 

continuation of effort in the program is beneficial. 

69—EVALUATION OF BENZODIAZEPINE 

UTILIZATION IN A FAMILY MEDICINE 

OFFICE. Santee J, Howell J, University of 

Missouri-Kansas City. E-mail: santeej@umkc.edu 

Objective: This study was performed to determine 

whether benzodiazepines are commonly misused, 

abused, or underprescribed and whether a 

patient–physician contract changes benzodiazepine 

utilization in a family medicine office. 

Methods: The investigators queried a billing 

database to identify patients of a family medicine 

office who had been diagnosed with generalized 

anxiety disorder, insomnia, and/or panic disorder. 

The charts of identified patients were retrospectively 

reviewed to gather information on patient characteristics 

and benzodiazepine utilization since 2001. 

Patients were classified as misusing if at least twice, 

they requested a refill for benzodiazepines more than 

5 days early. Abuse was defined as sufficient documentation 

to meet DSM-IV criteria for substance 

abuse. Underutilization was assessed by identifying 

patients who had not received benzodiazepine prescriptions 

despite being appropriate candidates. 

Impact of the patient–physician contract was determined 

by comparing the frequency of early refills 

before and after the contract was signed. 

Results: A total of 147 patients were identified 

through the billing database. None could be classified 

as abusing benzodiazepines, while seven (22%) were 

identified as misusing these agents. The mean daily 

dose in terms of diazepam equivalents was 8 mg 

overall and 26 mg for those who were classified as 

misusing. Impact of the patient–physician contract 

could not be assessed as only two of five patients who 

signed the contract did so after 2001. Some 114 

patients had not received a benzodiazepine prescription 

despite being diagnosed with one or more of 

these conditions, but only one patient was an appropriate 

candidate for benzodiazepine therapy. 

Conclusions: The percentage of patients classified 

as misusing benzodiazepines was higher than 

that reported in other studies. The doses of benzodiazepines 

used, however, were well within the recognized 

dosing range for these indications and lower 

than what was seen in the before-mentioned studies. 

Misuse may therefore be more reflective of an ineffective 

dose rather than abuse. Underuse of benzodiazepine 

prescriptions was not common, but the criteria 

for what was an appropriate candidate for benzodiazepine 

therapy was strict. 

70—EVALUATION OF CARDIOVASCU- 

LAR RISK AMONG PARTICIPANTS OF A 

VIETNAMESE HEALTH AWARENESS PRO- 

GRAM. Wong N, Merrigan D, Pfizer. E-mail: 

Noreen.Wong@Pfizer.com 

Objective: Coronary heart disease (CHD) is the 

leading cause of death in the United States. Major 

risk factors for the development of CHD are elevated 

blood pressure, elevated total (TC) and LDL 

cholesterol, low serum HDL cholesterol, diabetes 

mellitus, cigarette smoking, and obesity. The objectives 

of this evaluation were to assess control of 

blood pressure according to the sixth report of the 

Joint National Committee on Prevention, Detection, 

Evaluation, and Treatment of High Blood Pressure 

(JNC VI) guidelines; assess management of hyperlipidemia 

according to the National Cholesterol 

Education Program (NCEP) guidelines; and identify 

participants with undiagnosed hypertension and 

hyperlipidemia. 

Methods: Methods included offering cholesterol 

(TC, LDL-C, HDL-C, TG), blood pressure and glucose 

screenings to participants at a Vietnamese 

health awareness program. A questionnaire was used 

to collect information regarding health plan, treatment 

for hypertension and hypercholesterolemia and 

risk factors such as smoking, diabetes and prior history 

of CHD. Values were recorded in CHD Risk 

Calculator using scanner technology. 

Results: A total of 54 participants were screened. 

The majority of participants (74.1%) described their 

ethnicity as Asian/Pacific Islander. Results of the 

screenings showed that 54.4% of participants had a 

systolic blood pressure greater than 120 mm Hg and 

25.9% had a diastolic blood pressure greater than 80 

mm Hg, yet only 3.5% reported receiving treatment 

for hypertension. Cholesterol screenings revealed 

that 83.3% of participants had a TC greater than 200 

mg/dL and 40.7% had a TC greater than 240 mg/dL. 

LDL-C level of 130 mg/dL or higher was found in 

55.7% of participants. However, only 5.4% of participants 

reported receiving lipid-lowering therapy. 

Conclusions: The American Heart Association 

statistics report the median percentage of 

Asian/Pacific Islander adults who have been 

informed by a health professional that they have high 

blood pressure is 16.3% and the median percentage 

of those informed that they have high blood cholesterol 

is 27.3%. Findings of the Vietnamese Health 

Awareness Program suggest a possible gap between 

disease prevalence and diagnosis and treatment. The 

results demonstrate a need for improvement in diagnosis 

and treatment of CHD risk factors among the 

Asian/Pacific Islander population. 

Original Citation: American Society of Health- 

System Pharmacists Midyear Clinical Meeting, New 

Orleans, La., December 7–11, 2003. 

71—EVALUATION OF MEDICATION 

ADHERENCE IN A LOCAL COMMUNITY 

PHARMACY. Rosiak B, Pfizer, Akinsowon W, 

Howard University. E-mail: bonnie.jean.rosiak@ 

pfizer.com 

Objective: To review general medication adherence 

taking behavior in patients at a community 

pharmacy. To determine the relationship between 

adherence level and other factors (age, sex, payment 

method, number of prescriptions, costs and adverse 

effect). 

Methods: Patients were asked to complete a selfassessment 

survey tool that included de-identified 

data on patient’s demographics (sex and age), the 

Morisky scale, and questions on medication cost. 

Four patients were excluded from the study due to 

incomplete data. Descriptive statistics were performed 

using Microsoft Access and Minitab 12 for 

Windows. 

Results: The population includes 65 women and 

35 men, ranging in age from 18 to 75 years (mean = 

43.5 years). According to the Morisky scale, 19% of 

patients had low medication adherence, 37% had 

medium adherence, and 44% had high adherence. 

About 21% of women had low adherence, compared 

with 14% of men. Older adults (aged 50 years and 

older) who were on more than four medications 

scored higher for adherence to medications than 

those younger than 38 years of age and on one or two 

medications. Of all patients, 25% said they stopped 

taking their medications when they feel worse. 

Adherence level did not differ by payment type. Of 

26 patients not filling their medications because of 

cost, 39% scored as highly adherent according to the 

Morisky scale. 

Conclusions: The Morisky scale can help assess 

medication-taking behavior but has limitations related 

to cost issues (e.g., not filling a prescription 

because of costs). Pharmacists have an opportunity 

to play an active role to help improve patient’s 

adherence by assessing patients’ medication-taking 

behavior and addressing cost-related issues. 





72—EVALUATION OF REIMBURSEMENT 

METHODS UTILIZED BY PHARMACISTS 

PERFORMING DISEASE STATE MANAGE- 

MENT SERVICES. Beatty S, Mehta B, Rodis J, 

Ohio State University. E-mail: beatty.52@osu.edu 

Objective: For pharmacists performing disease 

management services: (1) determine billing and reimbursement 

techniques being used, (2) assess the 

amount pharmacists are being reimbursed, and (3) 

propose an effective billing and reimbursement technique. 

Methods: After performing a literature review of 

pharmacist-based billing and reimbursement techniques, 

a comprehensive survey will be created to 

determine geographic location, practice setting, disease 

management services, billing techniques, and 

amount of reimbursement for each service. Following 

survey development, local pharmacists performing 

disease management services will beta-test the survey 

and appropriate adjustments will be made. 

Approximately 1,000 surveys will be sent to all pharmacists 

with mailing information available through 

the following lists: APhA Community Pharmacy 

Residency Preceptors, Anticoagulation Forum, and 

ACCP Ambulatory Practice and Research Network. 

Data entry into Microsoft Access will assure avoidance 

of duplicate mailings. In October, pharmacists 

will receive an introductory postcard, the survey and 

postage-paid self-addressed envelope 2 weeks later, 

and a reminder postcard 2 weeks after that. All surveys 

will be returned by December 31, 2003. As surveys 

are returned, responses will be recorded into the 

Microsoft Access database. 

Results: Statistical analysis will be performed to 

assess which practice settings are billing, what type 

of billing techniques are being used, what disease 

management services are receiving reimbursement, 

who is paying for the services, and the approximate 

amount of reimbursement being received. 

Conclusions: Results from this survey will provide 

an overall assessment of the billing techniques 

currently being used and the approximate amount of 

reimbursement being received by pharmacists performing 

disease state management services. It is 

anticipated that these results will be presented in a 

publication that proposes an effective way for pharmacists 

to bill for services to receive reimbursement. 

73—HEALTH SCREENING: THE ROLE 

OF PHARMACISTS IN ASSESSING HEART 

DISEASE RISK. Glosner S, Pfizer Inc, Tynan S, 

Lee M, Midwestern University. E-mail: scott. 

glosner@pfizer.com 

Objective: Coronary heart disease (CHD) is the 

number 1 killer in the United States. Illinois has a 

higher heart disease death rate than the national average. 

A health care center in Chicago wanted to help 

promote preventive cardiovascular disease management. 

We evaluated patient CHD risk factors (e.g., 

blood pressure [BP], cholesterol profile, glucose 

level, tobacco utilization, family history and age) 

and determined 10-year CHD risk. 

Methods: Each participant attended an ambulatory 

care health fair on September 13, 2003. The health 

fair took place in a southwestern Chicago community. 

They completed a survey, which captured their 

CHD risk factors. Their values were scanned into 

CHD Risk 2001 Software. A health care professional 

(e.g., pharmacist, physician) reviewed each participant’s 

CHD risk factors and his or her 10-year CHD 

risk. All patients received a printed CHD risk health 

report. A copy of each de-identified health survey 

was captured into a Microsoft Access database and 

aggregately analyzed. 

Results: BP and cholesterol levels were collected 

on 38 participants. Of the attendees 47% were 

African American, while 45% and 8% were 

Caucasian and Hispanic, respectively. The average 

age was 69.3 years. Body mass index of greater than 

25 mg/k 2 was noted in 82% of participants. Nearly 

8% of those screened smoked tobacco. Three participants 

had CHD, while six had diabetes. Elevated 

BP, as defined in the seventh report of the Joint 

National Committee on Prevention, Detection, 

Evaluation, and Treatment of High Blood Pressure 

(JNC VII) guidelines, was present in 42% of participants, 

while 45% were in the new JNC VII classification 

of prehypertension. The average BP was 

133/76 mm Hg. Total cholesterol level of greater 

than 200 mg/dL was documented in 82% of participants, 

and 53% did not meet their NCEP goals. A 

majority (89.5%) of participants were considered 

“unhealthy,” with a relative CHD risk higher than 

standard risk for their age and gender. 

Conclusions: A majority of the participants 

(89.5%) were deemed “unhealthy” because of elevated 

BP, elevated cholesterol, and/or concomitant 

disease states (e.g., diabetes, CHD). Participants 

were counseled on lifestyle changes and appropriate 

BP and lipid-goal attainment by a pharmacist or 

physician. In addition, patients received their own 

personalized health report, which contained CHD 

risk factors and their risk of developing CHD over 

the next 10 years. Preventive follow-up and education 

are paramount to controlling and treating 

patients at risk for CHD. 

74—IMPACT OF PHARMACEUTICAL 

CARE INTERVENTION ON PATIENT 

ADHERENCE. Mutha N, Unterwagner W, Coffey 

C, Mercer University, Thurman S, Eckerd Drug 

Company, Norton A, Mercer University. E-mail: 

uncangelnupe@yahoo.com 

Objective: (1) To define reasons for nonadherence; 

(2) to perform pharmaceutical care intervention 

to improve patient adherence; (3) to assess 

improvement in patient adherence before and after 

pharmaceutical care intervention; and (4) to compare 

glycosylated hemoglobin A1C (A1C) levels, blood 

pressure (BP), and number of refills before and after 

intervention. 

Methods: Study participants will be selected from 

Eckerd’s central computer database system. Subjects 

will be contacted via telephone and asked to participate 

in the study. Patient will be considered as a nonadherent 

to their therapy if they have not filled 30-day 

supply of their medication within last 3 months. All of 

the participants will be asked to come into the 

Eckerd’s pharmacy or schedule a visit at another 

Eckerd location for initial assessment and baseline 

A1C and BP checks. The initial assessment will consist 

of a complete medical history and a survey to 

define patient’s reasons for being nonadherent. The 

program will consist of defining the reasons for nonadherence 

(cost, poor education, adverse effects, 

accessibility, forgetfulness, difficult regimen, multiple 

pharmacies/samples) as well as finding a pharmaceutical 

care intervention (cost improvement, education, 

prevent/treat adverse effects, convenience, memory 

aid, simplifying regimen, contacting pharmacist) for 

each individual. The pharmacist will have performed 

pharmaceutical care interventions for each individual 

within a period of 3 months. Patients may be followed 

further to determine improvement in compliance by 

telephone or bringing them back to Eckerd. At a 6- 

month follow-up visit, the participants will be asked to 

complete the initial survey assessing improvement in 

adherence, and their A1C and BP will be measured. 

At this time, evaluation will be made based on A1C 

and BP levels before and after the intervention. 

Improvement in number of refills will be evaluated 

via rerunning Eckerd’s central computer database by 

each participant name. The A1C and BP readings will 

be provided to the patient and to their physicians. The 

research study will involved approximately 500 participants 

who have met the criteria. 

Results: All of the data accumulated will be evaluated 

via STATISTIX analytical software. 

Conclusions: Research study in progress. 

75—IMPLEMENTATION OF A BREAST 

CANCER RISK ASSESSMENT AND EDUCA- 

TION SERVICE IN A COMMUNITY PHAR- 

MACY. Bumgardner M, University of Minnesota, 

Duluth College of Pharmacy, Giles J, University of 

Colorado Health Sciences Center. E-mail: mbumgar2 

@d.umn.edu 

Objective: This project evaluated the impact of a 

community pharmacy-based service for breast cancer 

risk assessment, education, and risk communication 

on knowledge of and adherence to American Cancer 

Society (ACS) guidelines for mammograms and clinical 

breast exams (CBE). 

Methods: Design: Women were invited to receive a 

free breast cancer risk assessment at select community 

pharmacies and health fairs. Subjects provided 

informed consent, knowledge of current ACS breast 

cancer screening guidelines, and a description of current 

screening practices. Risk assessment was performed 

using the National Cancer Institute Breast 

Cancer Risk Assessment software program. Results 

were discussed with each subject and education regarding 

2002 ACS screening guidelines and breast cancer 

risk was provided. Results were then communicated to 

the subjects’ health care providers. Subjects completed 

a telephone interview 6 months later to assess changes 

in screening behaviors. Setting: Five Denver community 

pharmacies and four community health fairs. 

Participants: 103 women age 25 to 78 years completed 

the risk assessment, 62 completed the follow-up telephone 

interview. 

Results: Knowledge of ACS screening guidelines 

for mammogram and CBE increased 5% (P = .61) and 

9% (P = .36), respectively, after the initial encounter. 

Adherence to guidelines for mammogram in subjects 




FEATURE 

older than 40 years increased by 5% (P = .61). 

Conclusions: This community pharmacy-based 

breast cancer education program increased knowledge 

of and adherence to ACS guidelines, and may 

serve as a model for other programs. However, these 

improvements were not statistically significant, possibly 

because of a high baseline knowledge of and 

adherence to ACS guidelines, lack of control for outside 

factors influencing screening behavior, and the 

brief follow-up period. 

This project was supported by an APhA Foundation 

Incentive Grant for Practitioner Innovation in 

Pharmaceutical Care. 

76—IMPLEMENTATION OF A LIPID 

MANAGEMENT PROGRAM IN A COMMU- 

NITY PHARMACY. Nesbitt K, Ferris State 

University/Pfizer/Meijer, Durst S, Ferris State 

University, Detloff R, Pfizer, Ruhlman B, Vanlente 

H, Meijer, Inc.. E-mail: nesbittk@meijer.com 

Objective: Approximately one in five Americans 

have one or more types of cardiovascular disease 

(CVD), including stroke, myocardial infarction 

(MI), angina pectoris, and congestive heart failure 

(CHF). Risk factors for CVD include: dyslipidemia, 

age, family history, cigarette smoking, hypertension, 

obesity, diabetes mellitus, and physical inactivity. 

High blood cholesterol is strongly related to 

the risk of CVD. The recommendations for screening 

for CVD include a fasting lipid profile consisting 

of high-density lipoprotein cholesterol (HDL- 

C), low-density lipoprotein cholesterol (LDL-C), 

total cholesterol (TC), and triglycerides (TGs). 

Measuring blood pressure and fasting blood glucose 

levels is also important when screening for cardiovascular 

disease. This study investigates the impact 

of a community pharmacy-directed lipid management 

program (LMP) on the clinical outcomes associated 

with lipid management. The LMP will be 

offered each year in January and July over a 6- 

month timeframe. Monthly group sessions will be 

conducted that will provide the patient with intense 

education. Topics discussed will include risk factors 

for cardiovascular disease, diet, therapeutic lifestyle 

changes, and lipid-lowering drug therapy. 

Individual consultations will take place during refill 

visits to the pharmacy. The pharmacist will be notified 

when the patient picks up the refill and will 

keep track of when the refills are due. The patient 

will also be afforded the opportunity to call and 

schedule a visit with the pharmacist on an as-needed 

basis to allow the patient the opportunity to discuss 

issues with the pharmacist in private. 

Methods: Following approval by an investigational 

review board, the LMP will enroll patients by 

physician referral or patient interest. Recruitment will 

take place during monthly cholesterol screenings 

held at the Meijer Pharmacy. During these screenings 

risk assessment will be performed for every patient 

using coronary heart disease risk calculator software. 

Physicians in the area will be educated about the program 

for patient-referral purposes. 

Results: Data collection at baseline will include a 

patient self-knowledge survey of cholesterol and 

CVD, self-reported patient medication adherence 

survey, and full lipid profile to assess LDL-C goal 

attainment. These outcomes will be re-measured at 

the month 6 completion visit and compared with 

baseline to determine the effectiveness of the lipid 

management program. 


77—IMPLEMENTING MOTIVATIONAL 

STRATEGIES TO EMPOWER PATIENTS IN 

DIABETES MANAGEMENT. Heller K, Palm 

Beach Atlantic University, Greck B, Kerr Drug and 

Campbell University. E-mail: katherine_heller 

@pba.edu 

Objective: The best way to improve treatment 

adherence among patients with diabetes is unclear. 

This preliminary study investigated the development 

of a motivationally focused program empowering 

patients with diabetes who were previously 

uncontrolled to achieve therapeutic goal. 

Methods: Design: Qualitative, cross-sectional 

descriptive study. Setting: Asheville Project 

Diabetes Wellness Program in Asheville, N.C. 

Patients: The sample frame included all patients 

enrolled in the Diabetes Wellness Program who had 

not achieved two consecutive glycosylated 

hemoglobin values of 8.0% or lower. Data 

Collection: Patients were identified by retrospective 

chart review or by referral. After patient identification, 

the intervention pharmacist met with the 

provider pharmacist to review the following: (1) 

patient’s perspective regarding value of glycemic 

control, (2) provider pharmacist’s perception of 

patient’s self-efficacy and locus of control, (3) areas 

of need for referral, (4) patient’s short- and longterm 

health goals, (5) plan of action for achieving 

these goals, and (6) identify barriers to achieving 

glycemic goals. Analysis Plan: Qualitative and 

descriptive analysis of these reviews 

Results: Reviews of five patients were studied. 

External locus of control was identified in two of four 

patients. Pharmacist provider short- and long-term 

health goals were clearly outlined in three of four 

charts, with patient-identified goals outlined in all four 

charts from enrollment data but identified in recent 

visits in only 2 charts. A pharmacist provider plan of 

action was apparent in 4:4 cases while a patient plan 

of action was apparent in 2:4. Areas of need for referral 

were primarily psychological (n = 3) but also nutrition 

(n = 2) and fitness (n = 1). The predominant barrier 

identified was psychological (n = 3). 

Conclusions: For patients who have not achieved 

goal control of their diabetes, pharmacists will need 

to better assess and enhance their patients’ psychological 

readiness for change. Pharmacy training will 

need to include an individualized approach to using 

motivational strategies. 

78—IMPROVING HEALTH AMONG 

RURAL MONTANANS: MOBILE PHARMA- 

CIST-CONDUCTED DISEASE SCREENING 

IN FRONTIER COMMUNITIES. Stratton T, 

University of Minnesota, Williams R, Meine K, 

University of Montana. E-mail: marimbafan@ 

yahoo.com 

Objective: To describe the provision of pharmacist-conducted 

disease screening services in remote 

frontier and rural Montana communities. 

Methods: A federal telehealth grant was awarded 

to this unique demonstration project, Improving 

Health Among Rural Montanans (IPHARM) in 

which a motor home was converted into a mobile 

office, and a recent doctor of pharmacy graduate was 

hired to use it in providing disease screening to residents 

of frontier and rural Montana counties. A satellite 

transmitting/receiving dish on the motor home 

provides wireless Internet access for researching 

drug information questions. The motor home also 

contains an ultrasound unit for testing heel bone density, 

a spirometer for testing lung function, and 

CLIA-waived devices to measure glycosylated 

hemoglobin and serum lipid levels. Pharmacist-conducted 

screening clinics are held in conjunction with 

county health departments, tribal health authorities, 

community pharmacies, county agricultural extension 

agents, community health centers, and migrant 

health centers. Employee wellness clinics are also 

conducted for public and private sector employers. 

Pharmacy students in advanced practice experiences 

assist with the screenings when the motor home is 

nearby. Descriptive statistics are generated for each 

clinic, and nonparametric statistical analyses are 

conducted for each screening test to compare results 

from rural and nonrural communities. 

Results: During the project’s first 6 months, the 

IPHARM pharmacist logged almost 6,000 miles, 

conducting 1,830 tests for 944 patients, 85% of 

whom live in rural communities. More than 34% of 

patients were referred to their primary-care 

providers for follow-up concerning out-of-normalrange 

test results. The age-corrected prevalence of 

low bone density was found to be statistically 

greater among rural residents tested than among 

nonrural residents tested. Some 40 pharmacy students, 

including more than one half of all students 

engaged in advanced practice experience rotations, 

participated in the clinics. In excess of $27,000 has 

been generated by the project in operating revenue 

and donations. 

Conclusions: Pharmacists and pharmacy students 

are capable of providing disease-screening 

services in remote frontier and rural communities. 

Obtaining sufficient payment for these services in 

rural communities to cover operational costs 

remains a challenge. 

79—IMPROVING INDIGENT PATIENT 

MEDICATION ADHERENCE THROUGH 

PHARMACIST INTERVENTIONS USING 

MANUFACTURER PATIENT ASSISTANCE 

PROGRAMS. Hoyt C, Ohio State University. E- 

mail: hoyt.46@osu.edu 

Objective: Despite rising costs and complexity of 

medication regimens, pharmacists are the key professionals 

to improve access to medications. The 

primary goal of this project is to increase medication 

adherence by decreasing drug costs to low 

income patients through the use of pharmacist-managed 

manufacturer assistance programs (MAPs). 





Secondary goals are to encourage patients to proactively 

manage their medications by decreasing prescription 

drug coverage through continued MAP use 

and to decrease cost burden on the health center. 

Methods: Adult indigent patients on five or more 

medications will be recruited to the study from 

Columbus Neighborhood Health Center, Inc. 

(CNHC) through two methods, either patient selfreferrals 

or if patients are deemed unable to pay 

their copayments for medications by health centers 

or providers. These patients are “waived” copayments 

with CNHC paying the cost and will be asked 

to make a pharmacist appointment to assess their 

medications. Patients will complete a preintervention 

Morisky adherence survey. At the initial 

appointment, patient eligibility for MAPs will be 

determined and MAP education and paperwork provided. 

Patients will be responsible to complete 

forms and bring back for physician signatures. The 

pharmacist will also assess medication regimens for 

simplification, therapeutic substitution, and other 

potential interventions. Medication change recommendations 

will be left in the chart for provider 

approval if not available during the patient appointment. 

A follow-up chart review will be completed 3 

months after the initial appointment to reassess 

whether the patient has refilled their next MAP 

order. At this time, a patient satisfaction questionnaire 

and post-Morisky adherence survey will be 

distributed to study participants. 

Results: Data analysis will include: before and 

after number of MAPs used, number of medications 

per patient, changes in adherence survey, and cost 

savings to the patient and CNHC per month. 

Pharmacist intervention acceptance rate, pharmacist 

time and salary versus cost to CNHC, and patient 

refills of next MAP orders will also be evaluated. 

Conclusions: By increasing MAP usage and 

decreasing patients cost burden, we anticipated that 

this program will improve medication adherence. 

Further research will need to be performed to assess 

long-term impact on savings to the health care system 

and medication adherence. 

80—INCORPORATION OF ANIMAL 

THERAPY INTO THE PHARMACY SCHOOL 

CURRICULUM: ANIMAL THERAPY AS AN 

ADJUNCT TO PHARMACOTHERAPY IN 

CLINICAL PHARMACY PRACTICE. Coffman 

R, Allison W, Nevada College of Pharmacy. E-mail: 

rcoffman@nvcp.edu 

Objective: To expose pharmacy students to 

adjunctive therapies, and raise pharmacy students’ 

awareness of the importance of treating not only the 

disease, but the psychological and emotional manifestations 

of disease through an elective course that 

combines animal-assisted therapy with the tenets of 

the pharmaceutical care model (PCM). 

Methods: Students who sign up for the elective 

follow trained therapy dogs providing adjunctive 

therapy to patients in hospitals and hospices. 

Students are assessed on their ability to articulate 

tenets of the pharmaceutical care model and their 

knowledge of the use of animal-assisted therapy in 

various diseases. Students make a formal presentation 

on their observations of the impact on animalassisted 

therapy in patients followed during the 4- 

week elective. 

Results: Students taking the elective demonstrated 

a more complete understanding of the pharmaceutical 

care model as well as the positive impact 

that animal-assisted therapy can have on therapeutic 

outcomes for patients. 

Conclusions: Bringing together the pharmaceutical 

care model and animal-assisted therapy as a 

component of pharmacy education is logical and 

can be of great benefit to the practicing clinical 

pharmacist as well as their patients. By incorporating 

this novel and innovative elective into the 

Nevada College of Pharmacy curriculum, the college 

raises student awareness of adjunctive therapies 

and can serve as a resource for the increasing 

number of undergraduate and graduate students who 

are interested in both research and applied clinical 

aspects of the field of animal-assisted therapy and 

clinical pharmacy practice. 

81—MORBIDITY AND MEDICATION 

PREFERENCES OF HEADACHE PATIENTS 

IN A COMMUNITY PHARMACY. Wenzel R, 

Diamond Headache Clinic Inpatient Unit, 

Schommer J, University of Minnesota, Marks T, 

Martin Avenue Pharmacy. E-mail: rwenz@ 

hotmail.com 

Objective: A complaint of headache has always 

been among the foremost reasons people have 

sought the help of a pharmacist. In 2000 and 2001 

the number 1 over-the-counter (OTC) product recommendation 

pharmacists performed was for a 

“headache product,” more than 53,000 times daily. 

This project quantified the degree of morbidity (via 

Migraine Disability Assessment, or MIDAS, a validated 

disability assessment tool) and the treatment 

views of headache patients presenting to a community 

pharmacy. 

Methods: Pilot project of 22 self-administered 

surveys of individuals presenting to a community 

pharmacy with a complaint of headache and seeking 

a pharmacist’s recommendation 

Results: A total of 13 patients had MIDAS scores 

of Grade III or Grade IV (highest levels). Of the 

sample population, a substantial minority (41%) did 

not believe their headaches can be effectively managed 

with OTC medications, 72% did not feel OTC 

agents are safer than prescription products, 96% did 

not indicate that OTC drugs are more effective than 

prescription items, and 50% disagreed that a physician’s 

evaluation was not necessary. Only one half 

of the population was satisfied with their current 

therapy, and patients overwhelmingly (91%) wished 

they could prevent their headaches. 

Conclusions: The majority of headache patients 

presenting to a community pharmacy had high levels 

of morbidity and are in need of education regarding 

the proper role of OTC products, the advantages 

of prescription agents, and the benefits of a physician’s 

referral. These preliminary results indicate 

that community pharmacies are potentially important 

locations of headache patient identification, 

education, and referral. 

82—PATIENT AND PHYSICIAN 

RESPONSE TO BONE MINERAL DENSITY 

MEASUREMENT IN COMMUNITY PHAR- 

MACY. Mcfee J, University of Illinois at Chicago. 

E-mail: jennifer.mcfee@walgreens.com 

Objective: Osteoporosis contributes to more than 

1.3 million fractures in the United States each year. 

Early detection of low bone mineral density (BMD) 

is the best fracture risk predictor. In recent years, the 

early detection of low BMD has become more 

accessible through use of portable units. Few studies 

have focused on low BMD detection in community 

pharmacies using portable ultrasound technology. 

Also, little tracking of the impact of pharmacist 

intervention on outcomes has been completed. The 

purpose of this study is to identify and enroll women 

at risk for osteoporosis in a pharmacist-managed 

intervention that aims to improve awareness and 

patient health in these subjects. 

Methods: Women will be recruited through marketing 

strategies available at approximately 20 

chain pharmacies in the Chicagoland area. Subjects 

will complete a questionnaire, and their BMD will 

be assessed by quantitative ultrasound of the calcaneus. 

Pharmacist recommendations will be made 

regarding calcium intake, weight-bearing exercise, 

fall prevention, and further follow up with diagnostic 

technology. BMD results and pharmacist recommendations 

will be mailed to each subject’s physician. 

Physicians will be asked to complete a survey 

instrument that asks them to evaluate and assess the 

services provided by the osteoporosis monitoring 

program. Study subjects will be contacted by telephone 

6 months after the intervention and asked 

questions from a survey designed to evaluate patient 

adherence with pharmacist recommendations and 

follow-through with their physicians. 

Results: Responses to the two instruments will 

be analyzed using the Rasch rating scale model. 

Conclusions: Increased patient and physician 

awareness and positive attitudes about the community 

pharmacists’ role in osteoporosis management 

are anticipated. 

83—PHARMACEUTICAL CARE EVALU- 

ATION OF NON-ENGLISH SPEAKING 

PATIENTS. Westberg S, Sorensen T, University of 

Minnesota. E-mail: biebi001@d.umn.edu 

Objective: (1) Identify and publicize foreign language 

services available at pharmacies near a medical 

clinic serving a large immigrant population; and 

(2) determine whether the type of drug therapy 

problems experienced differ between English and 

non-English speaking patients. 

Methods: Language services were identified by 

contacting pharmacies in the neighborhood served 

by the clinic via telephone survey. A pharmacist 

provided pharmaceutical care to clinic patients, 

working with interpreters when necessary. Patientspecific 

data and the results of the pharmacist’s 

assessment were recorded in a patient management 

database. 

Results: Of the six primary languages spoken by 

clinic patients, written or verbal information was 

available for five languages in one or more area 




FEATURE 

pharmacies. A reference card outlining available 

foreign language services was prepared in multiple 

languages and disseminated to patients and clinic 

staff. The clinic pharmacist completed comprehensive 

assessments for 91 patients via 230 patient 

encounters, identifying 186 drug therapy problems 

(DTPs). Problems related to adherence were more 

prevalent in non-English speaking patients compared 

with English speaking patients (69% versus 

23%). Of adherence-related DTPs, 54% resulted 

from lack of understanding instructions in non- 

English speaking patients, compared with 14% in 

English speaking patients. Adherence DTPs related 

to a patient’s desire to not take a medication were 

twice as frequent for non-English speakers versus 

English speakers (14% versus 7%). In these 91 

patients, the number achieving desired drug therapy 

outcomes improved by 24% after a pharmacist 

joined the team of clinic providers. Similar outcomes 

were recognized in both English and non- 

English speaking groups. 

Conclusions: Despite the availability of clinicbased 

interpreters and foreign language services in 

pharmacies, compliance-related problems are substantially 

more common in non-English speaking 

patients. Pharmacists committed to providing pharmaceutical 

care must consider the impact of language 

barriers when working to optimize drug therapy 

outcomes. 

84—PHARMACIST AND PHARMACY 

STUDENT KNOWLEDGE AND ATTITUDES 

REGARDING EMERGENCY CONTRACEP- 

TION. Maniscalco M, Daniel K, Marsh W, Nova 

Southeastern University. E-mail: maniscal@ 

nova.edu 

Objective: To assess general knowledge, attitudes, 

and beliefs of Florida pharmacists and pharmacy 

students concerning the administration and 

provision of emergency contraception (EC). 

Background: The American College of Obstetricians 

and Gynecologists supports EC as a safe and efficacious 

method for prevention of unintended pregnancy. 

Effective use of EC could prevent 2 million unintended 

pregnancies per year in the United States; 

however, many patients and providers are unaware 

of the availability of EC or have misconceptions 

concerning the use of EC. Provision of EC is based 

on a time-sensitive protocol. Pharmacists maintain 

working hours when physicians are typically 

unavailable and are ideal providers for consulting 

patients who may be in need of EC. Several states 

have passed legislation that authorizes trained pharmacists 

to consult patients and prescribe EC, and at 

the time this abstract went to press, FDA was considering 

a petition that would make EC available 

without a prescription. 

Methods: A confidential two-page survey was 

administered to pharmacists during continuing education 

programs in south Florida and to pharmacy 

students attending classes at Nova Southeastern 

University. Questions addressed knowledge of EC 

administration as well as ethical and social issues 

regarding its use. Descriptive statistics and chisquare 

cross analysis were used to analyze the data. 

Results: A total of 719 surveys were completed 

by 319 practicing pharmacists and 400 pharmacy 

students. In general, 59% responded that they 

believed they were somewhat informed on the topic 

of EC. When asked whether EC is a public concern, 

48% indicated EC was a major public concern. The 

majority of responders (68%) indicated a positive or 

neutral attitude towards the use of EC for prevention 

of unintended pregnancy. Approximately 50% 

believed EC was not safe and efficacious. Overall, 

86% responded they would be willing to prescribe 

and/or dispense EC. 

Conclusions: Florida pharmacists and pharmacy 

students who participated in this survey viewed 

themselves as somewhat informed concerning the 

topic of EC, and most indicated they would be willing 

to be providers of EC. 

85—PHARMACY PARTICIPATION IN AND 

NATURE OF CLAIMS SUBMITTED TO THE 

WISCONSIN MEDICAID PHARMACEUTICAL 

CARE PROGRAM. Hermansen–Kobulnicky C, 

University of Wyoming, Kreling D, Mott D, University 

of Wisconsin–Madison. E-mail: cjhkobul@uwyo.edu 

Objective: The study objectives were to examine 

(1) pharmacy participation and intensity of claims 

submission and (2) characteristics of claims submitted 

in the Wisconsin Medicaid Pharmaceutical Care 

Program, an ongoing program initiated in 1996 that 

reimburses pharmacies for patient-care activities. 

Methods: Pharmaceutical care claims data for the 

first 6 years of program operation were analyzed to 

examine the number of pharmacies submitting a 

claim and the number of claims submitted by each 

pharmacy. We also examined the characteristics of 

claims submitted overall and for each year of the 

program, including the reason for providing pharmaceutical 

care, the action taken by the pharmacist, 

the result of action, and the level of time required to 

provide the intervention. 

Results: A total of 16,557 claims were submitted 

and paid. Except for 1998 and 1999, the number of 

claims submitted increased every year from 1,438 in 

1996 to 4,667 in 2002. The number of pharmacies 

participating annually has varied; 154 pharmacies 

submitted at least one claim in 1996 (averaging 9.3 

claims per pharmacy) and 88 pharmacies submitted 

claims in 2002 (averaging 53.0 claims per pharmacy). 

In 2002, 10 pharmacies submitted more than 

80% of all claims. Between 1996 and 2003, the most 

common reason, action, and result were late refill (n 

= 3,035), patient education (n = 5,165), and instructions 

understood (n = 6,881), respectively. The most 

common level of time required was 6 to 12 minutes 

(n = 6,554). 

Conclusions: Although the number of claims has 

increased over time, a consolidation of pharmacies 

responsible for the vast majority of claims has 

occurred, suggesting that some pharmacies have 

incorporated the program into their routine of practice. 

Although more than 40% of reasons for pharmaceutical 

care interventions dealt with compliance 

issues, pharmacists are detecting and solving a variety 

of problems with therapy. 

86—PREDICTING AND UNDERSTAND- 

ING THE INTENTION TO USE HERBAL 

MEDICINES AMONG HISPANIC AND NON- 

HISPANIC OLDER ADULTS.. Abhyankar U, 

Gupchup G, Worley–Louis M, University of New 

Mexico, Raisch D, VA Cooperative Studies 

Program, Marfatia A, Namdar R, University of New 

Mexico. E-mail: uabhyankar@salud.unm.edu 

Objective: (1) Identify predictors of intention to 

use herbal medicines for health problems in the next 

6 months among Hispanic and non-Hispanic older 

adults using the Theory of Planned Behavior and (2) 

to compare the beliefs underlying the significant 

predictors of intention to use herbal medicines for 

health problems in the next 6 months between these 

two ethnicities. 

Methods: Design: Cross-sectional survey. 

Setting: Senior Health Clinic and the Veterans 

Affairs Hospital outpatient pharmacy. Patients: 251 

ambulatory patients; age 65 years and above 

(Hispanics = 80; non-Hispanics = 171). Data 

Collection: Self-administered questionnaire. 

Outcome Measure: Intention to use herbal 

medicines in the next 6 months. Analysis Plan: 

Multiple regression analysis was used to identify the 

significant predictors of intention to use herbal 

medicines in the Theory of Planned Behavior within 

each ethnicity. Independent t tests were used to 

compare the beliefs underlying the significant predictors 

of intention to use herbal medicines across 

the two ethnic groups. 

Results: For both Hispanic and non-Hispanic 

patients, attitudes towards using herbal medicines 

was the only significant predictor of the intention to 

use herbal medicines in the next six months 

(Hispanics, adjusted R 2 = .59, β = .78, P < .001; 

non-Hispanics, adjusted R 2 = .57, β = .66, P < .001). 

Using the method suggested by Netter et al., magnitude 

of the beta coefficients did not differ significantly 

between the two ethnicities. Behavioral 

beliefs underlying attitudes towards the use of 

herbal medicines differed significantly by ethnicity. 

Compared with non-Hispanics, Hispanics believed 

that herbal medicines are cheaper, have fewer side 

effects, work better, and are more convenient to use 

than other medicines. 

Conclusions: Understanding ethnic differences in 

behavioral beliefs underlying attitudes towards the 

use of herbal medicines can help pharmacists in educating 

and formulating appropriate counseling strategies 

specific to older patients of different ethnicities. 

87—RECOMMENDATIONS FROM IOWA 

PRIORITY’S BROWN BAG MEDICATION 

REVIEWS: A COMPARISON OF STUDENT 

PHARMACISTS AND PHARMACISTS. Freml 

J, Farris K, Currie J, Fang G, University of Iowa. E- 

mail: jfreml@blue.weeg.uiowa.edu 

Objective: In the Iowa Priority Brown Bag 

Medication Reviews: (1) Determine the percentage 

of drugs that could have been generically substituted 

or therapeutically interchanged and (2) compare 

types of recommendations (i.e., cost saving versus 





therapeutic) made by pharmacists or student pharmacists. 

Methods: Design. A retrospective cohort study 

of the Iowa Priority Brown Bag Medication 

Reviews was completed. Subjects. A random sample 

of 100 reviews performed by pharmacists and 50 

by student pharmacists was drawn from a pool of 

2,060 reviews. Data collection. To calculate the percentage 

of medications that could be generically 

substituted or therapeutically interchanged, all medications 

from the 150 brown bag reviews were identified 

and each medication was coded based upon 

availability for generic substitution or therapeutic 

interchange. Determining generic availability was 

done via the Multum Lexicon database updated as 

of March 2003 and through use of DrugStore.com. 

To be considered for therapeutic interchange, drugs 

needed to be in the same medication class and available 

generically. The total number of brown bag 

medications for each patient was the denominator. 

For objective 2, each of eight recommendation types 

was counted for each patient. Recommendation 

types were also classified as cost saving or therapeutic. 

Analysis. Comparability of the study groups 

was determined. Student’s t test was used for comparisons 

of mean data, and the Chi-square test was 

used to compare nominal data. 

Results: No differences were identified by study 

groups in the demographic, disease, or medicationuse 

variables. Student pharmacists made significantly 

more total, cost saving, generic substitution, 

alternate brand, and stop-prescription medication 

recommendations than did pharmacists. More than 

50% of all medications identified in the medication 

reviews could have been generically substituted or 

therapeutically interchanged. 

Conclusions: This study showed student pharmacists 

make a significant number of recommendations 

to decrease health care expenses, a finding that 

should encourage other pharmacists and pharmacy 

settings to use student pharmacists. 

88—REDUCTION OF PRESCRIBING 

ERRORS IN COMMUNITY PHARMACY. 

Cottrell J, Cerulli J, Albany College of Pharmacy. 

E-mail: cottrelj@acp.edu 

Objective: To determine the impact of a pharmacy-initiated, 

systems-based reporting tool on the percentage 

of prescribing errors and the perception of 

the tool among prescribers in the community setting. 

Methods: During January to May 2002, potential 

prescribing errors that occurred in community pharmacies 

during four collection periods lasting 2 

weeks each were documented by pharmacy students. 

All data collected was reviewed by the investigators 

and if determined to be a prescribing error, 

the information was entered into an Access 

database. After each collection period, a newsletterstyle 

report with the most common errors for that 

period and methods to reduce errors was distributed 

to the most common prescribers of each participating 

pharmacy. A survey assessing the perception of 

the newsletter was sent to the participating prescribers 

at the end of the study. 

Results: Two independent and four chain participated 

in at least one data collection period. Four 

participated during every interval. A total of 397 

errors (1.6%) were detected during the study. The 

most common errors identified were incorrect dosing 

(22%), incomplete order (20%), and suboptimal 

dosage form (15%). The total number of errors 

decreased from 110 (2.2%) to 69 (1.3%) during the 

study (P = .42). A total of 25 (17%) surveys were 

returned; 83% of respondents stated that the 

newsletter was either very useful or useful, and 65% 

stated they either acted upon the newsletter or 

shared it with colleagues. 

Conclusions: Increasing awareness of prescribing 

errors in community pharmacy via a newsletter 

is one proposed mechanism to reduce the error rate. 

Because of a small response rate and sample size, 

this study was unable to demonstrate significant 

improvement, however, a trend toward error reduction 

was evident. Pharmacists need to more actively 

communicate with prescribers about medication 

errors that occur in this setting to prevent drug misadventures. 

89—RETROSPECTIVE REVIEW OF 

HYPERTENSIVE PATIENTS IN A POPULA- 

TION WITH A HIGH RATE OF DIABETES 

ACCORDING TO THE NEW JNC-7 GUIDE- 

LINES. Feldman L, Zuni Comprehensive 

Community Health Center, Binning R, Christensen 

K, University of Wisconsin–Madison. E-mail: lfeldman@abq.ihs.gov 

Objective: To assess the treatment of hypertension 

at the Zuni Comprehensive Health Center, 

using the seventh report of the Joint National 

Committee on Prevention, Detection, Evaluation, 

and Treatment of High Blood Pressure (JNC VII) 

guidelines to interpret proper therapy. 

Methods: At the Zuni Comprehensive Health 

Center, 173 patients with a diagnosis of hypertension 

between January and March 2003 were 

reviewed to categorize them into special populations, 

review medication usage, and assess blood 

pressure goals. Monitoring of therapy, laboratory 

values, glomerular filtration rate (GFR), pregnancy, 

compliance, medication allergies, and pulse was 

also performed. 

Results: The majority of the patients (120 

patients, or 69%) received an ACE inhibitor. 

Thiazide diuretics were used in 42 (26%) patients. 

Some 78 (45%) patients were only taking one medication, 

while 52 patients (30%) were taking two 

medications. Most of the patients (128 or 74%) were 

diabetic, and 64 (37%) patients had chronic kidney 

disease. Some patients were in both groups. Only 24 

(23.5%) of the patients had blood pressure monitored 

monthly until their goal was reached, but 84 

(98.8%) of those patients at goal were checked again 

in the next 6 months. Electrolytes and serum creatinine 

were monitored in 162 (94.2%) of the patients, 

and no medications were given to any patient with a 

contraindication. Only 1 patient (2.2%) on a thiazide 

diuretic had a GFR less than 30 mL/min. A total of 

119 (70.4%) patients were noncompliant with their 

medication regimen. Finally, blood pressure goals 

were reached in 70 (40%) of the patients and 108 

(62.4%) of the patients were within 10 mm Hg of 

their goal systolic blood pressure. 

Conclusions: A higher percentage of patients 

(40%) reached their goal blood pressure compared 

with the national percentage listed in the JNC-7 

guidelines (34%). Diabetic patients receiving an 

ACE inhibitor may benefit from the addition of a 

thiazide-type diuretic to help reach the blood pressure 

goal. 

90—SCREENING PATIENTS FOR RISK 

OF NONSTEROIDAL ANTI-INFLAMMATO- 

RY DRUG INDUCED COMPLICATIONS IN 

COMMUNITY PHARMACY SETTINGS. 

Anzisi L, Lee A, Algozzine T, Brady G, Pfizer Inc. 

E-mail: lisa.anzisi@pfizer.com 

Objective: The study objective was to identify 

patients at risk for gastrointestinal (GI) and cardiovascular 

complications receiving a nonspecific nonsteroidal 

anti-inflammatory drug (NSAID). Up to 

50% of patients have intolerance to nonspecific 

NSAIDs, and more than 100,000 patients are hospitalized 

annually with NSAID-associated GI complications. 

NSAID use in the elderly is an independent 

risk factor for developing hypertension and may 

contribute to poor blood pressure control in those 

receiving antihypertensive medications. 

Methods: A questionnaire consisting of 13 questions 

was developed and administered to patients in 

community pharmacies who presented with a prescription 

for an NSAID. The questionnaire assessed: 

age; need for help with self-care; previous stomach 

upset, ulcer, or bleeding from NSAIDs; concomitant 

use of antiplatelet agents, gastroprotective medications, 

corticosteroids, or nonprescription NSAIDs; 

cigarette and alcohol consumption; and presence of 

hypertension. Patients were classified as having 

mild, moderate, or severe risk for GI complications 

based upon their responses, and pharmacists recorded 

any interventions made after assessing the 

patient’s risk level. 

Results: More than 200 patients were screened in 

community pharmacies in Maine, New York, and 

New Hampshire. Preliminary results estimate that 

56% of patients screened were at moderate or severe 

risk for GI complications. A total of 25% of patients 

were over 60 years of age, placing them at moderate 

or severe risk. Regardless of age, 31% of patients 

had a history of GI upset or bleeding, and 30% were 

receiving gastroprotective medications. Of hypertensive 

patients 57% were receiving nonspecific 

NSAIDs, and 27% were receiving both prescription 

and over-the-counter NSAIDs. 

Conclusions: The use of this screening tool 

enabled pharmacists to identify NSAID users at 

greatest risk for GI and cardiovascular complications 

and should be incorporated into more community 

pharmacy practice settings. 

91—SERVING CHRONIC PAIN PATIENTS 

IN THE MILLENNIUM. Guilherme A, 

Humphrey J, Kaiser Permanente, Northwest 

Region, Vancouver, Washington. E-mail: 

AngelaMGuilherme@kp.org 

Objective: To improve the efficiency of serving 




FEATURE 

chronic pain patients by establishing a collaborative 

project via pharmacy and primary care providers. 

Methods: The Kaiser Permanente Cascade Park 

clinic is one of 22 ambulatory care locations in the 

Pacific Northwest Region. In the past years, 

improvements were needed to provide a more 

methodical approach to serve chronic pain patients 

who required therapy with controlled substances. 

The collaborative project created set out to decrease 

workload of providers and increase patient satisfaction. 

The new system operates on patient lists. One 

week before medications are due, a pharmacist sends 

a message to the provider stating the following: date 

medication is due, the last fill of the medication, the 

quantity that the prescription was filled for, last 

patient appointment, and any special requests or concerns. 

An order for the patient’s medication is also 

created. Once the provider receives the message, the 

order can be approved if continued therapy is intended, 

and a signed prescription is sent back to the pharmacy. 

Pharmacy staff then files the prescription for 

the date that the patient is due for medication and 

then on date in question, the prescription is processed 

by pharmacy staff. 

Results: All clinic providers who care for chronic 

pain patients on controlled substances have been 

participating in this project, and more than 250 

patients have been enrolled. 

Conclusions: Since this project began, provider, 

patient, and pharmacy satisfaction with the method 

of processing controlled substances for chronic pain 

patients has been overwhelming. A need for change 

was identified and satisfied with a technological 

update on method of service. 

92—STUDYING THE PROFESSIONAL 

INTERRELATIONSHIP BETWEEN COMMU- 

NITY PHARMACISTS AND PHARMACY 

TECHNICIANS. Akiyode O, Bullard W, Karodeh 

Y, Cao T, Howard University. E-mail: oakiyode@ 

howard.edu 

Objective: To understand the professional relationship 

between pharmacists and pharmacy technicians. 

To identify the supporting and inhibiting factors 

toward the professional behaviors demonstrated 

by the two entities. 

Methods: Community pharmacists and pharmacy 

technicians will complete a survey tool that 

assesses their interaction with each other. The survey 

tool is designed to evaluate the attitudes, behaviors, 

perceptions, and expectations among the aforementioned 

entities. A total of 50 surveys will be randomly 

distributed to local community pharmacies. 

Pharmacists will receive one half of the surveys, 

while pharmacy technicians will receive the other 

half. Upon completion of the surveys, a pair of fivemember 

focus groups (one involving pharmacists, 

the other technicians) will convene to discuss the 

survey results and ways to improve the professional 

relationship. The participants of the focus group discussions 

will be randomly selected from the pool of 

the study participants. Upon completion of the focus 

group discussions, all participants will be asked to 

complete a postdiscussion questionnaire to assess 

what they have learned from the discussion session, 

and how they plan to improve their own professional 

relationships. 

Results: The outcome of the surveys, focus 

group discussions, and postdiscussion questionnaires 

will be analyzed using descriptive statistics. 

The study is expected to educate participants and 

generate ideas to improve further the relationship 

between pharmacists and technicians, hopefully 

improving the efficiency of the pharmacy and overall 

patient care. 

Conclusions: NA 

93—SURVEY OF PHARMACISTS DESIRE 

AND READINESS FOR DISEASE STATE 

MANAGEMENT IN OHIO. Dorsch M, Riverside 

Methodist Hospital, Kier K, Mraz S, Ohio Northern 

University. E-mail: MDORSCH@OhioHealth.com 

Objective: Prescription drugs remained the 

fastest growing health expenditure, increasing by 

15.7%. The state of Ohio follows a similar trend. 

Currently medications account for 15.1% of the 

Ohio Medicaid budget, while physician billing only 

comprises 6%. Due to the increasing cost of health 

care and medications, the Ohio Pharmacists 

Association (OPA) started discussions with the state 

about the concept of disease state management 

(DSM). The objective was to determine pharmacists 

desire and readiness to start DSM programs within 

the state. 

Methods: OPA put together a task force to discuss 

issues relevant to starting a statewide program 

in DSM. Based on task force discussions, a survey 

was designed and pilot tested to look at DSM issues. 

The survey was sent to a random selection of 

licensed pharmacists within the state of Ohio. The 

survey asked questions relating to demographics, 

current practice settings, current DSM practices, and 

preparation and desire to provide DSM services. 

Descriptive statistics will be used to analyze the data. 

Results: Initial results from the survey provided 

interesting feedback, especially in the area of pharmacist 

training and preparation for DSM. In general, 

pharmacists were most comfortable with the area 

of diabetes management. Most pharmacists indicated 

a willingness to take more training or certification 

in areas of DSM. Data analysis is ongoing. 

Conclusions: The results will be used by the task 

force to make decisions relating to pharmacist interest, 

training, and potentially areas for reimbursement. 

94—THE DEVELOPMENT OF A PAIN 

SERVICE BY THE PHARMACY DEPART- 

MENT IN A UNIVERSITY MEDICAL CLIN- 

IC. Jacobson S, Massachusetts College of 

Pharmacy and Health Sciences, Debay G, 

Massachusetts Institute of Technology. E-mail: 

deba@med.mit.edu 

Objective: To provide pain management education 

and reference information to health care 

providers and patients in an outpatient ambulatory 

clinic and inpatient unit. 

Methods: A pharmacist was identified to lead an 

educational initiative helping pharmacists, nursing 

staff, physicians and other health care providers 

learn about effective pain management. All pharmacists 

were required to read and successfully complete 

posttests associated with journal articles. Case 

study discussions were also an integral part of their 

pain management competency training. Ongoing 

education for the pharmacists helped to ensure consistent 

communication in their clinical assistance to 

the medical staff and in patient counseling. Health 

care practitioners were provided pain management 

information and guidance on how to identify and 

refer patients to the pain service. Assessment tools 

such as flow sheets and narcotic conversion charts 

were developed by the pharmacy for use in both the 

inpatient and outpatient setting. Frequent meetings 

with the inpatient and outpatient clinical staff 

regarding up-to-date pain management information, 

assistance on the proper use of pain management 

assessment tools, approved formulary medications 

for pain, appropriate prescribing, outpatient prescription 

and inpatient order writing for medications, 

and documentation in the medical chart were 

imperative for the success of this service. The pharmacy 

department is beginning to collect data in both 

the inpatient and outpatient records to monitor the 

proper use of pain assessment tools, appropriate prescribing, 

and patient compliance. 

Results: The medical and nursing staffs have 

reported a positive outcome for patients involved 

with the pharmacy pain service. The pharmacists are 

finding that providing clinical information to health 

care providers and counseling patients receiving 

pain medications is a rewarding experience. 

Conclusions: A pharmacy-centered pain management 

program is beneficial to the university 

health system. 

95—THE PHARMACIST’S ROLE IN PUB- 

LIC HEALTH: A SURVEY OF HEALTH 

DEPARTMENT OFFICIALS. Cottrell J, Albany 

College of Pharmacy, Blumenschein K, University 

of Kentucky, Paavola F, None. E-mail: 

cottrelj@acp.edu 

Objective: To examine services provided by state 

and local health departments, determine areas into 

which health departments would like to expand, and 

examine the public health officials’ perceptions of 

partnering with community pharmacists. 

Methods: In December 1999, 25 state health 

department Web sites were reviewed to determine 

the areas of focus that public health agents were 

attempting to address. From this assessment, a 

three-page survey was developed and sent to directors 

of 300 health departments, randomly selected 

from the National Association of County and City 

Health Officials (NACCHO) mailing list. Each 

packet contained a cover letter, a survey, and a selfaddressed 

stamped envelope. Surveys were 

approved under expedited review by the University 

of Kentucky Medical Institutional Review Board 

and contained 13 questions: 4 addressing staff composition 

and responsibilities, 4 addressing current 

and future programs, and 5 concerning perceptions 

of partnering with pharmacists and pharmacy ser- 





vices. Surveys were anonymous and were collected 

from January to March of 2001. 

Results: A total of 153 surveys were returned for 

a response rate of 49%. Nurses were the most common 

health care provider on staff at health departments, 

and the most frequently additional personnel 

requested. The most common service offered by 

health departments was immunizations. Most 

respondents desired to establish preventive services 

such as disease management, indigent care clinics, 

and health information libraries. Only 13% had a 

pharmacist on staff, and an additional 11% partnered 

with their local pharmacist. Approximately 

60% had not considered partnering with their local 

pharmacists; most stated that cost was the barrier 

preventing an alliance. Officials identified indigent 

care clinics, dispensing medications, and drug-use 

review as the main services they would like to see 

provided by pharmacists. 

Conclusions: Pharmacists appear to be underused 

in public health plans for meeting goals of 

Healthy People 2010. 

96—MOTIVATION AND JOB SATISFAC- 

TION OF COMMUNITY PHARMACISTS 

INVOLVED WITH PHARMACEUTICAL 

CARE. Swensgard L, Ohio State University. E- 

mail: slswens@yahoo.com 

Objective: Community pharmacists are becoming 

increasingly involved with direct patient care 

services as a way to expand their role as health care 

professionals. The future success of these services 

depends in part on the ability of community pharmacies’ 

corporate management to keep the participating 

pharmacists motivated to continue their roles 

as pharmaceutical care providers and motivate other 

community pharmacists to become involved. The 

purpose of this study is to assist Kroger corporate 

management in identifying what motivational factors 

contribute to the decision of central Ohio 

Kroger pharmacists to become involved in or 

abstain from pharmaceutical care services. Also, the 

study will identify what barriers central Ohio 

Kroger pharmacists perceive to becoming involved 

in pharmaceutical care. Factors contributing to job 

dissatisfaction and job satisfaction will also be 

assessed. 

Methods: Mail surveys will be sent to two groups 

of central Ohio Kroger pharmacists, those actively 

providing patient care services and those involved 

solely in dispensing activities. The survey will compare 

and contrast both groups of pharmacists’ motivations 

to perform patient care services. Job satisfaction 

will also be assessed in both groups of pharmacists. 

The data collected from the survey will be 

used to implement new recruitment and advancement 

strategies to increase Kroger community pharmacist 

involvement in pharmaceutical care services. 

In addition, the information will be disseminated to 

other community pharmacies for use in increasing 

pharmacist involvement with pharmaceutical care. 

Results: Data collection began in November 

2003. 

Conclusions: This project will enable corporate 

management of community pharmacy establishments 

to identify motivational forces that contribute 

to a pharmacist’s decision to perform pharmaceutical 

care services and factors that contribute to job 

satisfaction. Also, this project is expected to provide 

information regarding how best to reward pharmacists 

for their participation in pharmaceutical care 

services. 

97—USING ADVANCED PRACTICE COM- 

MUNITY CLERKSHIP STUDENTS TO PRO- 

VIDE CONTINUING EDUCATION FOR 

RURAL PHARMACISTS. Hastings J, University 

of Arkansas for Medical Sciences College of 

Pharmacy, West D, University of Arkansas for 

Medical Sciences. E-mail: jkhastings@uams.edu 

Objective: The goal of this project is to describe 

how senior pharmacy students are used in the delivery 

of live continuing education (CE) to pharmacists 

in a remote region of a small southern state. 

Methods: The community clinical clerkship is a 

cooperative rotation taught by the college of pharmacy 

in conjunction with 24 pharmacies located 

throughout Arkansas. One of the assignments that 

senior students enrolled in this advanced community 

practice clerkship must complete is a clinical or 

management project. The board of pharmacy in this 

state requires pharmacists to obtain 12 hours of live, 

disease-related CE over a biennial licensing period. 

One preceptor in a rural area of the state requires 

each student who rotates through his site to deliver 

a CE presentation related to drug-therapy to pharmacists 

in the southeast region of the state. 

Results: NA. 

Conclusions: This unique use of students to help 

pharmacists comply with licensing requirements 

benefits everyone involved. The students have an 

opportunity to complete an assignment for their 

rotation while at the same time benefiting from the 

experience of researching, preparing and presenting 

a CE program. Pharmacists in the region benefit 

from the information presented by the student about 

the selected drug topic, are able to obtain live CE 

credit in a convenient manner and have the opportunity 

to network with their local peers on a regular 

basis. 

98—ANALYSIS OF HYPERTENSION 

CONTROL IN A MIDWESTERN CARDIOLO- 

GY CLINIC. Glosner S, Pfizer Inc, Tynan S, Alsip 

D, Cline K, Midwestern University, Konczal M, 

Faaborg J, Marcinkowski L, Midwestern 

University. E-mail: scott.glosner@pfizer.com 

Objective: Coronary heart disease (CHD) 

remains the number 1 killer in the United States. 

CHD also costs more than $100 billion a year to 

treat. CHD is both financially and clinically important. 

Risk factors for developing CHD are elevated 

blood pressure (BP), tobacco use, low HDL cholesterol, 

family history, and age. Our purpose was to 

assess BP control, treatment options and comorbidities 

that increase CHD risk in hypertensives 

patients. 

Methods: A retrospective, chart review was performed 

at an Illinois cardiology practice during 

October 2002. The study population consisted of 

patients taking either antihypertensives alone (N = 

401) or those taking antihypertensive agents in conjunction 

with medications for heart failure (N = 

359). A total fo 120 patients were randomly selected 

and evaluated from the study population. Patient 

demographics, blood pressures, laboratory test 

results, and medications were collected. 

Results: Overall, 56% of participants were 

women. The average age for the overall population 

was 68 years. More than 75% of patients had a body 

mass index of greater than 25 kg/m 2 . Some 70% of 

the population had a dyslipidemia, 29% had CHD, 

23% had arrhythmias, and 15% had diabetes mellitus 

(DM). Beta blockers (24%) and calcium-channel 

blockers (23%) were the most frequently used medications. 

BP control was noted in 47.1% of men and 

51.5% of women. BP control was observed in less 

than 50% of each drug class except for diuretic medications 

(52%). A total of 62% of CHD patients had 

elevated BPs, and 42% of patients with CHD or DM 

were not at their LDL cholesterol goal of less than 

100 mg/dL. Within the last year, 15% of reported 

patient hospitalizations were cardiac related. 

Conclusions: Cardiologists generally treat more 

complicated cardiovascular patients, yet nearly 50% 

of patients in this study had BPs that were uncontrolled 

while on medications. Practitioner education 

by pharmacists on national guideline attainment 

should help improve health outcomes (e.g., BP and 

cholesterol control). 

99—ASSESSMENT OF MEDICATION 

NONADHERENCE AND DISEASE STATE 

KNOWLEDGE IN A COMMUNITY PHAR- 

MACY. Self T, University of Kentucky, Chou C, 

Pfizer, Inc. E-mail: tdself@hotmail.com 

Objective: The purpose of this project was to (1) 

identify patients at risk for medication nonadherence 

using a validated scale and to report any trends; 

(2) determine the need for further counseling in 

patients with risk behaviors for nonadherence on the 

benefit of prescription medications, and (3) evaluate 

disease knowledge and awareness of their personal 

laboratory values in patients indicating a history 

of hypertension, hyperlipidemia, or diabetes. 

Methods: Surveys were randomly distributed to 

patients 18 years of age and older at a local Kroger 

Pharmacy. Collected information included demographics 

(age and gender), chronic disease states, 

and self-reported medication-taking behaviors. The 

survey consisted of four questions (Morisky scale) 

in a validated tool that is used to identify and 

address barriers to medication adherence. Patients 

were considered nonadherent if one or more questions 

on the Morisky scale was answered “yes,” and 

they were then counseled on ways to increase 

adherence as well as the benefit of prescription medication. 

In addition, halfway through the survey, the 

method was improved by asking patients that indicated 

a history of hypertension, hyperlipidemia, or 

diabetes if they knew their current laboratory values 

and goals for their blood pressure, cholesterol, or 

blood glucose. Patients were then counseled appropriately 

about their diseases and goals of therapy. 

Results: All data will be analyzed using 




FEATURE 

Microsoft Access. 


100—BRANDING PHARMACEUTICAL 

CARE SERVICES USING THE BRAND 

CLARITY PYRAMID. Abraham J, Bircea E, 

Stubbings J, University of Illinois at Chicago. E- 

mail: jabrah7@uic.edu 

Objective: (1) To alter the public image of pharmacy 

from the traditional dispensing role to the current 

patient-focused role, (2) to develop an image 

for pharmaceutical care using a proven professional 

tool used in the marketing and advertising industry, 

and (3) to help the public understand the role of 

pharmaceutical care in health care. 

Methods: To better represent the population, participants 

who interact with various types of pharmacy 

settings will be used. There will be multiple 

focus groups, each containing six to eight participants 

from a wide variety of backgrounds in each 

group. The brand clarity pyramid is the marketing 

tool chosen to create a new image of pharmaceutical 

care. Each session will last about 60 to 90 minutes 

and, with the permission of the participants, will be 

tape-recorded; the facilitator will ask the participants 

a series of questions to build a brand clarity 

pyramid for each session. After all the focus groups 

have done their brand clarity pyramids, a fifth focus 

group will be used to analyze the previous groups’ 

results and to develop a cohesive brand image. 

Results: Each brand pyramid from the focus 

groups will be presented. The results from the last 

focus groups will be used to determine if an effective 

image for pharmaceutical care has been developed; 

patient demographics from all focus groups 

will be included as well. 

Conclusions: This project is expected to promote 

an increased public understanding of pharmaceutical 

care. 

101—DEVELOPMENT OF A HELICOBAC- 

TER PYLORI RAPID SCREENING PROGRAM 

IN THE COMMUNITY PHARMACY SET- 

TING. Kurpius M, University of Iowa, Sommers 

Hanson J, Dominick’s Pharmacy. E-mail: mollykurpius@uiowa.edu 

Objective: To implement a Helicobacter pylori 

screening program in the community pharmacy setting 

to (1) identify patients with untreated H. pylori 

infection, (2) initiate appropriate drug therapy for 

treatment of H. pylori infections, and (3) evaluate 

patient symptom improvement as the result of the 

interaction with the pharmacist. 

Methods: Patients for program participation 

were identified through patient prescription profile 

review for antisecretory medications and patient 

requests for nonprescription medication recommendations 

for the treatment of ulcer symptoms. 

Exclusion criteria included: patients younger than 

18 years of age, pregnant, older than 50 years with 

new onset of symptoms, patients with gastroesophageal 

reflux disease-like symptoms, alarm 

symptoms, long-term use of nonsteroidal antiinflammatory 

medications, and previous infection or 

treatment of H. pylori. Those patients who did not 

meet the exclusion criteria were screened for H. 

pylori using a rapid whole blood test. Patients who 

tested negative were provided with drug therapy 

recommendations, suggestions for lifestyle modifications, 

and educational handouts. Patients who 

tested positive had a letter sent to the physician stating 

the patient’s symptoms, test results, and pharmacist’s 

recommendations for drug therapy. 

Follow-up with both groups of patients was made 1 

month later via telephone call. 

Results: The pharmacist used a gastrointestinal 

symptom survey to assess the resolution of symptoms, 

outcomes of the pharmacist’s interventions, 

and implementation of recommendations made to 

the patient and the physician. 

Conclusions: This program is expected to benefit 

patient care as a result of pharmacist identification 

of patients requiring screening and treatment of 

H. pylori, and relieving symptoms associated with 

this infection. 

102—NATIONAL PATTERNS OF ASPIRIN 

PROPHYLAXIS IN PATIENTS WITH DIA- 

BETES. Holness P, Lee E, Hogue V, Lombardo F, 

Howard University. E-mail: pholness@yahoo.com 

Objective: To describe the patterns of aspirin 

prescription in diabetic population using the 2000 

National Ambulatory Medical Care Survey 

(NAMCS) and to evaluate the need for intervention 

by community pharmacists. 

Methods: Design: Cross-sectional descriptive 

study. Setting: Standalone office-based physician 

visits in ambulatory care settings. Participants: 

22,224 NAMCS visit records made by patients 21 

years of age and older. 

Results: Mean (± SD) age of the population was 

54.3 (± 18) years. About 5% of the visits (1,046) 

were made by patients with diabetes. Mean age of 

patients making the diabetes visits (62.9 ± 13.8 

years) was higher than that of the total population. 

Of the diabetes visits, 7.2% involved recommendations 

for aspirin were noted in the record. Visits 

made by diabetic patients were highly associated 

with aspirin record (odds ratio [OR], 3.6; 95% CI, 

2.8–4.7). Although women patients were less likely 

to have aspirin records in the general population 

(OR, 0.4; 95% CI, 0.4–0.5), no gender difference 

was observed in the diabetic population (OR, 0.8; 

95% CI, 0.5–1.3). Patients who were 65 years and 

older were approximately 4 times as likely to have 

aspirin record than patients who were younger than 

65 years of age (OR, 3.7; 95% CI, 3.1–4.4). In addition, 

certain visit characteristics were associated 

with aspirin records among diabetic population. 

Cardiovascular specialists were more likely to be 

associated with aspirin records than were other 

physician specialties (OR, 5.2; 95% CI, 3.1–8.8). 

Physicians located in the Midwest were less likely 

to prescribe aspirin than were physicians in the 

Northeast (OR, 0.4; 95% CI, 0.2–0.9). No difference 

was observed by gender, race, metropolitan 

status, or counseling. Multivariate analyses will be 

conducted to describe factors predicting aspirin use. 

Conclusions: Status of aspirin use among 

patients with diabetes was suboptimal in 2000. 

More educational prevention programs focusing on 

aspirin prophylaxis are needed by community pharmacists. 

103—PHARMACY STUDENTS’ EXPEC- 

TATIONS OF COLLABORATIVE WORKING 

RELATIONSHIPS (CWRS) AMONG PHAR- 

MACISTS, PHYSICIANS, AND PATIENTS. 

Stehling D, Gaebelein C, St. Louis College of 

Pharmacy. E-mail: d_stehlin@yahoo.com 

Objective: A major trend in pharmacy education 

is the promotion of a collaborative role for pharmacists 

in patient care. This effort involves the establishment 

of CWRs among pharmacists, physicians, 

and patients. Currently, however, little research is 

available on the dynamics of these relationships. 

The objective of this study was to adapt an existing 

survey tool, the Health Role Expectations Index 

(HREI), to study pharmacist–physician–patient 

interactions. The success was measured in terms of 

the statistical reliability and sensitivity of the resulting 

survey, the HREI-Pharmacist. 

Methods: The HREI, originally developed to 

study role expectations among nurses, physicians, 

and patients, was modified by substituting the term 

“pharmacist” for “nurse” in the 16-item questionnaire. 

The resulting items reflected the degree of 

collaboration expected among physicians, pharmacists, 

and patients in the health care setting. The survey 

also provided a general index of egalitarianism. 

The statistical reliability and sensitivity of the 

HREI–Pharmacist were assessed with a convenience 

sample of 55 students in their second year of 

professional studies at St. Louis College of 

Pharmacy. Survey data were analyzed using the 

Statistical Package for the Social Sciences (SPSS), 

release 10.0, and Microsoft Excel. An alpha level of 

.05 was used for all statistical decisions. Effect size 

estimations were calculated according to Cohen. 

Results: The statistical reliability of 

HREI–Pharmacist was determined by calculating a 

Generalizability Coefficient according to the principles 

of Generalizability Theory. A value of 0.68 was 

obtained, indicating that the HREI displayed adequate 

statistical reliability. The sensitivity of the 

HREI–Pharmacist was assessed by dividing respondents 

into two groups based upon the median egalitarianism 

score, and then comparing responses on 

the three collaborative dimensions. Students with 

high CWR scores expected much collaboration with 

physicians, while those with low CWR scores did 

not. However, both groups expected much collaboration 

with patients. Based on effect size estimations, 

the group difference in collaboration among 

physicians was large, and that among pharmacists 

was moderate. 

Conclusions: The HREI–Pharmacist is a reliable 

and sensitive tool for the study of the health role 

expectations of pharmacists, physicians, and 

patients. Current work with the tool involves benchmarking 

the CWR attitudes of pharmacy students 

and rural pharmacists. 





104—PROVIDING MEDICATIONS TO 

UNDERSERVED POPULATIONS UTILIZING 

340B. Reid C, Jackson T, Langridge S, Midwestern 

University. E-mail: aleeza77@aol.com 

Objective: To increase awareness of the 340B 

program by educating pharmacist and other health 

care professionals in a community health care 

(CHC) setting. 

Methods: This is a two-hour continuing education 

(CE) program that is designed to educate health 

care professionals about 340B pricing. The main 

speaker of the program, a consultant for the Office 

of Pharmacy Affairs, will discuss barriers of access 

to pharmaceutical care in the working poor, 340B 

pricing, benefits of implementing the program, entities 

eligible for 340B pricing and who to contact for 

assistance when starting 340B. The group demographics 

will differ in gender, age, health care background, 

employment experience and education 

level. Each health care provider that attends the CE 

program will be asked to respond to a retrospective 

pre/post test. The survey is designed to assess participants’ 

knowledge of 340B pricing and the intent 

to implement the 340B pricing program. 

Results: The retrospective before–after test 

answers will be analyzed using the Wilcoxon 

Singed Rank analysis to measure the difference in 

the participant’s pretest and posttest knowledge of 

the 340B pricing program. Rasch analysis will 

determine the probability of answering a question 

correctly and measure the difference between the 

participant’s intent to implement the program before 

and after the retrospective pre/post test. 

Demographic variables will be analyzed using 

descriptive statistics. 

Conclusions: This CE program is expected to 

increase knowledge of 340B pricing among participants 

and gauge the intent to implement the program. 

105—THE UNAVAILABILITY OF PRE- 

SCRIBED MEDICATIONS IN THE COMMU- 

NITY PHARMACY SETTING. Rodriguez I, 

NOVA Southeastern University, Lai L, Nova 

Southeastern University. E-mail: risis@nova.edu 

Objective: To evaluate if there is a relationship 

between the unavailability of prescribed medications 

and patients’ deserting the pharmacy. 

Methods: A convenience sampling method was 

used to recruit the study subjects at three community 

pharmacies in the Pembroke Pines and Miami 

area in Florida. The unavailability of a prescription 

is defined as a medication not available until next 

day. “patients’ deserting the pharmacy” was defined 

as a patient not returning to pick up the medication 

within the next 7 days. The patients who were not 

permanent residents of Florida or who did not agree 

to interchange the medication for one that is available 

were excluded from the study. Data will be 

obtained from the pharmacy computer database 

including: age, gender, race, type of medication prescribed, 

if the medication is used for acute or chronic 

conditions, type of insurance, and if the medication 

was picked up or not. A total of 154 study subjects 

was estimated to be the minimum sample size 

to provide results with a confidence interval of 95% 

and a power of .70. 

Results: This study is expected to identify that 

patients with new prescriptions for acute conditions 

will be less willing to wait or come back for the 

medication. Elderly patients and customers with 

insurance are expected to be less willing to order the 

medication for next day. 


APhA–APPM Hospital & 

Institutional Practice 

106—APPROPRIATE TREATMENT OF 

SYSTOLIC HEART FAILURE IN THE PRI- 

MARY CARE CLINICS. Worrall T, Ralph H. 

Johnson Veterans Affairs Medical Center, Simpson 

K, Medical University of South Carolina, Jenrette 

D, Ralph H. Johnson Veterans Affairs Medical 

Center. E-mail: tomcathyw@msn.com 

Objective: Heart failure is a common medical 

condition affecting more than five million people in 

the United States. Many experts believe that suboptimal 

pharmacological treatment contributes significantly 

to hospitalizations and deaths. This study was 

designed to quantify the percentage of patients in 

the primary care clinics receiving appropriate therapy 

for systolic heart failure (SHF) and to potentially 

improve prescribing practices in this patient population. 

Methods: Male veterans with SHF from three 

primary care teams were evaluated. Patients with 

SHF were randomly selected from the fourth quarter 

of 2001. The primary end points evaluated were 

the percentage of patients on ACE inhibitors, betablockers, 

or combination therapy. The secondary 

end point evaluated was the percentage of patients 

on spironolactone. Following an initial retrospective 

chart review, two educational interventions were 

performed to increase compliance with the SHF 

treatment guidelines. The effectiveness of this education 

was assessed through a review of SHF patient 

charts using the same methods described in the initial 

retrospective evaluation. Logistic regression 

modeling was used to assess the effect of the educational 

interventions. The Likelihood Ratio was used 

to assess overall model significance, and each variable 

was assessed using the chi-square test. The 

Wald Confidence Interval (CI) for the odds ratio 

estimates was also calculated. 

Results: A total of 148 patients were evaluated 

(75 before and 73 after education). The mean (± SD) 

age of the patients was 65 ± 11.3 years, the mean 

ejection fraction was 29 ± 9.5%, and the mean number 

of drugs prescribed per patient (other than study 

drugs) was 9.5 ± 4.8. The New York Heart 

Association (NYHA) functional class distribution 

was similar between groups. The percentages of 

patients prescribed ACE inhibitor in the before and 

after education groups were 90.7% and 89%, 

respectively. After education, beta-blocker and 

spironolactone prescribing increased by 12,8% and 

6.2%, respectively. Spironolactone prescribing 

increased 10% in NYHA class III and IV heart failure 

patients. These patients were also 3.7 times 

more likely to receive appropriate therapy (95% CI, 

1.16–11.63, P = .026). 

Conclusions: These results indicate that pharmacists’ 

educational interventions significantly 

improved the appropriate pharmacological treatment 

of SHF in primary care clinics. 

Original Citation: American College of Clinical 

Pharmacy 2003 Annual Meeting. November 5, 

2003. Atlanta, Georgia. 

107—COUNSELING MONOAMINE OXI- 

DASE INHIBITOR PATIENTS. Wenzel R, 

Diamond Headache Clinic Inpatient Unit, 

Schommer J, U. of Minnesota, Diamond S, 

Diamond Headache Clinic. E-mail: rwenz@ 

hotmail.com 

Objective: Assess whether a classroom-based 

pharmacy education service for hospitalized 

patients newly prescribed a monoamine oxidase 

inhibitor (MAOI) results in (1) higher self-perceived 

medication knowledge or (2) lower perceived 

risk of using MAOIs. 

Methods: Quasi-experimental self-administered 

patient survey given before the education service 

and repeated 24–72 hours after the service. 

Results: A total of 78 individuals completed the 

study. Paired-sample t tests showed that for each of 

the four items related to self-perceived medication 

knowledge, the scores reflected higher knowledge 

after the MAOI class compared with before the class 

(P < .05). For three of four items related to perceived 

risk of using MAOIs, the scores reflected a 

lower level of perceived risk after the MAOI class, 

compared with before the class (P < .05). One item 

did not significantly change: “The MAOI prescribed 

for me is just as good as other products available for 

treating headache.” 

Conclusions: Our results demonstrate a classroom-based 

teaching structure for newly prescribed 

MAOI patients can result in higher self-perceived 

medication knowledge and lower perceived risk of 

using MAOIs. The utility of this personnel-efficient 

method of counseling hospitalized patients prescribed 

other medications warrants further investigation. 

108—DEVELOPMENT OF A CLINICAL 

PATHWAY TO OPTIMIZE EPOETIN THER- 

APY IN THE TREATMENT OF ANEMIA IN 

CHRONIC RENAL FAILURE PATIENTS. 

Canney T, Kindred Hospital. E-mail: 

dantissa@yahoo.com 

Objective: The objective of the project was to 

increase the utilization of iron supplementation and 

of the subcutaneous administration of epoetin in 

chronic renal failure patients through the design and 

implementation of a clinical pathway. 

Methods: Protocol developed based on literature 

and practice guidelines from the National Kidney 

Foundation (approved by renal specialists and the 

Medical Executive Committee of the hospital). Data 

were collected for 30 inpatients in an acute respiratory-care 

hospital who were prescribed epoetin. 

Dialysis and nondialysis patients were included and 




FEATURE 

treated identically. Fifteen patients were evaluated 

before and after implementation of the protocol to 

assess preexisting ordering practices for laboratory 

tests, epoetin route of administration (subcutaneous 

versus intravenous) and iron supplements (yes or 

no). As per the protocol, subcutaneous injections 

were used in all patients unless the volume (>1 mL) 

required use of the intravenous route and/or the 

patient refused the subcutaneous injection. All 15 

patients in the intervention group had laboratory 

monitoring done to assess iron deficiency anemia. 

Iron supplements were ordered (iron sulfate 300 mg 

three times daily) for patients with transferrin saturation 

less than 20% and/or serum ferritin less than 

100 ng/mL. The primary end points of the project 

included: utilization of the subcutaneous route for 

epoetin, monitoring of baseline iron laboratory values, 

and increased use of iron when appropriate. 

Results: Epoetin therapy was not optimized in 

the host institution before the implementation of the 

protocol. Before pharmacist intervention, the subcutaneous 

route was not the primary route of administration, 

and the intravenous route was used routinely 

when it was not indicated. In addition, iron store 

studies were not done consistently to assess for irondeficiency 

anemia. Even when laboratory values 

were available and iron was indicated, supplementation 

was often not ordered with epoetin. In the postpharmacy 

intervention group, all epoetin orders 

were changed to subcutaneous where feasible. Iron 

stores were checked with every new order for epoetin, 

and iron supplements were consistently 

ordered if indicated. 

Conclusions: Pharmacist intervention and pharmacy-managed 

programs can help optimize drug use. 

A pharmacy-initiated protocol was shown to improve 

the use of the appropriate route for administration of 

epoetin (usually subcutaneous) in chronic renal failure 

patients. In addition, the protocol improved laboratory 

monitoring of iron stores and led to increased 

iron use in patients receiving epoetin. 

109—EXPERIENCE WITH A SYMPTOM- 

TRIGGERED ALCOHOL WITHDRAWAL 

SYNDROME PRACTICE GUIDELINE IN 

HOSPITALIZED PATIENTS. Worrall C, Padgett 

S, Medical University of South Carolina, Stanley K, 

Medical University of South Carolina. E-mail: worrallc@musc.edu 

Objective: We developed a symptom-triggered 

alcohol withdrawal syndrome (AWS) Practice 

Guideline and piloted its use in general surgery and 

medicine patients. Our primary and secondary 

objectives were to improve outcomes in hospitalized 

patients at risk for AWS and to evaluate the 

safety and efficacy of the guideline to determine 

whether hospital-wide implementation would be 

appropriate. This report summarizes our experience 

using the guideline in 106 hospitalized patients. 

Methods: An evidence-based AWS Practice 

Guideline was developed by a multidisciplinary 

team of practitioners. After appropriate staff education, 

the guideline was piloted in a general surgery 

and a general medicine group. Control data were 

collected retrospectively, while guideline data were 

collected concurrently for each group. Primary outcome 

measures included milligrams of drug administered, 

presence of AWS seizures or QTc prolongation, 

transfer to an intensive-care unit (ICU), use of 

restraints or sitters, and length of stay (LOS). 

Continuous data were assessed using a two-tailed t 

test, and proportional data were assessed using chisquare 

and Fisher‘s exact test. Multivariate logistic 

regression was used to assess LOS. Results of each 

individual analysis and a combined analysis are 

described below. 

Results: Demographics of the surgery or combined 

analysis groups were similar, but the medicine 

analysis demonstrated significantly more women in 

guideline group (P = .02). Lorazepam use decreased 

significantly across all guideline-managed patients 

(surgery P = .01, medicine P < .01, combined P < 

.01). Clonidine use increased significantly in the 

guideline-managed surgery and combined groups (P 

< .01 in both groups). There was no difference in 

haloperidol use in any group. The medicine and 

combined analyses demonstrated a significant number 

of guideline-managed patients requiring no drug 

therapy (P = .01 and P < .01, respectively). 

Withdrawal seizures, QTc prolongation, transfers to 

an ICU, restraint hours, and LOS were similar 

between groups. Sitter hours decreased significantly 

in the guideline combined analysis (P = .01), but the 

surgery and medicine analyses did not reach significance. 

Conclusions: The AWS Practice Guideline significantly 

decreased benzodiazepine use in guideline-managed 

general surgery and medicine 

patients. Many patients required no drug therapy 

when managed using this symptom-triggered 

approach. We are currently working with our hospitalists 

to expand the use of this practice guideline 

hospitalwide. 

110—GABAPENTIN: A POOLED ANALY- 

SIS OF ADVERSE EVENTS FROM THREE 

POSTHERPETIC NEURALGIA CLINICAL 

TRIALS. Parsons B, Pfizer, Tive L, Huang S, 

Pfizer, Inc. E-mail: stephens@fallonmedica.com 

Objective: Gabapentin has been shown to effectively 

and safely manage the pain of postherpetic 

neuralgia (PHN). Adverse events are often doserelated, 

with frequency and severity increasing with 

increasing dosage. Here, we assessed the relationship 

between gabapentin dose and adverse events 

using data from studies of patients with PHN. 

Methods: Data were pooled from three randomized, 

double-blind, placebo-controlled, parallelgroup 

studies (N = 599 PHN patients). Three treatment 

category groups were included in the analysis: 

patients receiving placebo (N = 243); patients 

receiving less than 1,800 mg/day (N = 356) and 

patients receiving 1,800 mg/day gabapentin or more 

(N = 321). Gabapentin was initiated at 300 mg and 

titrated to maintenance doses of 1,800–3,600 

mg/day by days 12–24. Patients receiving higher 

doses had received lower doses. An adverse event 

was scored at dose of first onset, and scored again at 

a higher dose if it worsened in severity. 

Results: The three most common adverse events 

were dizziness, somnolence, and peripheral edema. 

Patients had a higher incidence of peripheral edema 

with gabapentin in doses of 1,800 mg/day or more 

(7.5%) compared with lower gabapentin doses 

(1.4%). The incidence at the higher (P = .0014) but 

not the lower (P > .05) doses was significantly different 

from the placebo rate of 1.6%. By contrast, 

patients did not have a higher incidence of dizziness 

and somnolence with higher gabapentin doses. 

Patients receiving less than 1,800 mg/day of 

gabapentin reported dizziness (20.2%) and somnolence 

(14.9%) at a significantly greater frequency 

than the respective placebo rates of 7.4% and 5.8% 

(P = .005). However, at less than 1,800 mg/day, the 

9.7% and 6.9% rates of dizziness and somnolence 

were both comparable to placebo (P > .05). 

Discontinuation rates were comparable between 

patients receiving placebo and gabapentin. 

Conclusions: These data demonstrate that 

although a mild increase in the incidence of peripheral 

edema is observed when patients receive 

greater than or equal to 1,800 mg/day of gabapentin, 

dizziness and somnolence are transient and do not 

occur more frequently or worsen when patients are 

titrated to doses of 1,800 mg/day or more by days 

12–24. Therefore, safety concerns should not limit 

titration to achieve optimal efficacy. 

111—RAPID ONSET OF ABSORPTION 

WITH OLANZAPINE ORALLY DISINTE- 

GRATING TABLETS. Houston J, Bergstrom R, 

Mitchell M, Hill A, Taylor C, Liu-Seifert H, Yadav 

Marya R, Jones B, Witcher J, Eli Lilly and 

Company. E-mail: rich.bergstrom@lilly.com 

Objective: A clinical perception exists suggesting 

more rapid onset of action with olanzapine orally 

disintegrating tablet (ODT) versus olanzapine 

standard oral tablet (SOT). Olanzapine bioavailability 

data were evaluated to assess early plasma concentration 

time profiles for olanzapine ODT versus 

SOT. 

Methods: In three crossover bioequivalence 

studies of olanzapine ODT (5, 10, or 20 mg) versus 

SOT (1 × 5 mg, 2 × 5 mg, 4 × 5 mg), approximately 

20 healthy subjects received single-dose ODT 

and the corresponding dose of SOT (13 or more 

days between treatments). Olanzapine plasma concentrations, 

area under the serum concentration– 

time curve (AUC) and peak concentrations (C max 

) 

values were evaluated to assess bioequivalence. 

Early onset of absorption was assessed using comparative 

absorption profiles. 

Results: Olanzapine ODT and SOT are bioequivalent 

based on AUC and C max 

. Overall plasma concentration-time 

profiles and absorption rate constants 

were nearly identical between formulations. 

Nonetheless, with 5 mg olanzapine, 79% of ODT 

versus 0% of SOT patients had measurable olanzapine 

concentrations at 15 minutes. Significantly 

more subjects receiving ODT had higher plasma 

concentrations over the first hour versus SOT (e.g., 

63% versus 10% with 1 ng/mL or more at 45 min- 





utes). Small early concentration differences at 

become indistinguishable before reaching C max 

. 

Conclusions: Olanzapine ODT yields a more 

rapid onset of absorption than SOT as significantly 

more subjects given ODT achieved slightly higher 

olanzapine concentrations immediately after administration. 

The small differences are likely 

attributable to more rapid onset of ODT gastrointestinal 

absorption. These differences do not change 

the conclusion of bioequivalence. The relevance of 

earlier onset of absorption to clinical treatment has 

not been tested. 

Original Citation: U.S. Psychiatric Congress, 

November 6–9, 2003, Orlando, Fla. 

112—STANDARDIZED CHEMOTHERAPY 

ORDER FORMS. Sano H, Waddell J, Doulaveris 

P, Myhand R, Walter Reed Army Medical Center. 

E-mail: harold.sano@na.amedd.army.mil 

Objective: To develop standardized chemotherapy 

order forms (SCOFs) for our institution’s most 

commonly prescribed cancer chemotherapy regimens 

and determine if the use of these SCOFs is 

associated with a decrease in prescribing error rate 

and a decrease in antiemetic costs. 

Methods: Of the most commonly used 

chemotherapy regimens from medical and gynecologic 

oncology, 60 were identified from textbooks, 

handbooks, primary literature, and consultation with 

experts. The medication doses, schedules, routes 

and durations of administration, cycles, required 

laboratory tests, and recommended supportive measures 

were extracted from primary literature. 

Antiemetic needs were drawn from standard nomograms. 

For each regimen, all of the above data were 

incorporated into a one-page SCOF in standard 

word-processing software. Final approval of each 

SCOF was obtained from the Chief, Oncology 

Pharmacy Service, the Director, Oncology 

Pharmacy Residency Program, and the Chief, 

Hematology-Oncology Service. The 60 SCOFs 

were developed over a 4-month control period, during 

which antiemetic cost and prescribing error data 

were monitored. After the control period, all 60 

SCOFs were fielded during a 4-month intervention 

period, which is ongoing. Antiemetic cost and prescribing 

error data are being monitored. Differences 

in prescribing error rate and antiemetic cost between 

the control and intervention periods will be calculated. 

Prescribing error rate in the intervention period 

will also be compared with a historical prescribing 

error rate for this service. 

Results: NA. 


APhA–APPM Nuclear 

Pharmacy Practice 

113—ENHANCED LIVER UPTAKE OF TC- 

99M–LABELED RED BLOOD CELLS DUR- 

ING GASTROINTESTINAL BLEED 

SCINTIGRAPHY USING TRANSFUSED RBC 

COMPARED TO AUTOLOGOUS RBC. 

Melchior W, Wong K, Beauvais M, Snyder S, 

William Beaumont Hospital. E-mail: wmelchior@ 

beaumonthospitals.com 

Objective: To report two cases of altered distribution 

of Tc-99m–labeled red blood cells (RBC) to 

the liver during GI studies. 

Methods: GI bleed studies were performed on 

two occasions for a 91-year-old woman and one 

occasion for a 96-year-old man. The in vitro method 

of RBC labeling with Tc-99m was used (Ultratag, 

Mallinckrodt Medical, following the package insert 

directions). For the woman, the first study used 

autologous blood, while her second study was performed 

using cells from donor packed cells infused 

the day of the study. The study for the man was performed 

using cells from donor packed cells infused 

the day of the study. Quality control was performed 

following the package insert directions for all lots of 

labeled RBC. Binding of Tc-99m to the RBC was 

98.0% to 99.4%. 

Results: All studies were negative for a GI bleed. 

Using the heart as the reference organ, the relative 

degree of liver uptake for the woman was 45% using 

autologous blood and 97% using transfused blood, 

and 91% for the man using transfused blood. 

Conclusions: Increased liver uptake of Tc- 

99m–labeled RBC obtained from a unit of transfused 

packed RBC was demonstrated compared 

with Tc-99m–labeled autologous RBC. Liver 

uptake of Tc-99m–labeled RBC is normally 50% or 

less using the heart as the reference organ. Although 

survival of transfused RBC is normal in cells surviving 

beyond 24 hours, a small but unknown percentage 

of transfused RBC is not expected to survive 

the transfusion process. The basis of the 

increased liver uptake of Tc-99m–labeled RBC 

obtained from a unit of transfused packed RBC seen 

in these cases is unknown. When using Tc- 

99m–labeled transfused RBC for the evaluation of 

gastrointestinal bleeding increased uptake in the 

liver may be anticipated. 

114—EXPECTED QUALITY OF LIFE AND 

COST IMPLICATIONS OF R-CHOP AND 

RADIOIMMUNOTHERAPY REGIMENS FOR 

INDOLENT NON-HODGKIN´S LYMPHOMA. 

Chumney E, Kit S, Cheng K, Chris B, Hall P, 

Medical University of South Carolina. E-mail: 

chumneye@musc.edu 

Objective: The recent introduction of radiolabeled 

antibodies (radioimmunotherapy) has offered 

a promising new therapy for indolent non- 

Hodgkin’s lymphoma (NHL), though with varying 

efficacy estimates. The major objective of this study 

is to examine the effect of these varying estimates 

on patient outcomes, costs, and quality of life. 

Methods: A Markov model was used to simulate 

the experience of newly diagnosed indolent NHL 

patients treated with the conventional course of rituximab 

and cyclophosphamide/doxorubicin/vincristine/prednisone 

(R-CHOP) followed by radioimmunotherapy 

and then palliative care. The model 

comprises 10 health states including complete, partial, 

and no response to each treatment course, and 

then death. Patients transition through at 1-month 

intervals with transition probabilities based on published 

estimates; the literature searches included 

Medline, ScienceDirect, general Internet searches, 

and company information. Quality of life estimates 

were based on expert pharmacist opinion using 

visual analog scales, and cost estimates were based 

on the average wholesale price (AWP). 

Results: Our base model with a 26% complete 

response rate to radioimmunotherapy has total treatment 

costs of $212,233 per patient. Median survival 

time after diagnosis is 7.8 years, with 41% of 

patients still alive at the end of the ten-year period. 

Mean quality-adjusted life-years (QALYs) are 2.89. 

We next programmed the model with a 76% complete 

response rate and found total treatment costs 

of $211,639 per patient with mean QALYs of 3.54. 

We will also report on potential benefits if the order 

of treatment is reversed so that patients have 

radioimmunotherapy as their front-line therapy. 

Conclusions: Although the efficacy estimates of 

radioimmunotherapy vary widely in the literature, 

we found they produced only a slight difference in 

the resulting 10-year cost estimates. This is primarily 

attributed to the treatment sequence of the base 

model. The different assumptions of efficacy had a 

large effect on the patients’ overall quality of life. 

115—ORGANIZATION OF LYM- 

PHOSCINTIGRAPHY PROTOCOLS. Beauvais 

M, William Beaumont Hospital, Dobish D, William 

Beaumont Hospital, Melchior W, William 

Beaumont Hospital. E-mail: mbeauvais@ 

beaumonthospitals.com 

Objective: Various lymphoscintigraphy protocols 

are ordered by the surgical physicians in a large 

teaching hospital. To clarify the instructions of the 

physicians, a nuclear medicine department unfiltered 

Tc-99m sulfur colloid breast lymphatic mapping 

request form was developed. The purpose of 

this project was to create a simplified method for 

drawing up and dispensing the requested doses. This 

led to the creation of a nuclear pharmacy preparation 

guideline form. 

Methods: Physician requests were reviewed and 

a Tc-99m sulfur colloid breast lymphatic mapping 

request form was devised. The form describes the 

Tc-99m sulfur colloid activity required for each protocol, 

the size and number of syringes the dose 

should be dispensed in, the gauge of needle to attach 

to the syringes, the radiopharmaceutical concentration 

and volume as well as injection instructions for 

the physician. Tc-99m sulfur colloid syringes for the 

subareolar and peritumoral protocols were measured 

before and after injection to determine the 

residual activity in the syringes. The postinjection 

activity was decay corrected to the time of the preinjection 

measurement. The appropriate concentrations 

for each protocol were determined and a 

nuclear pharmacy preparation guideline form was 

developed. 

Results: A nuclear pharmacy preparation guideline 

form was devised based on preinjection and 

postinjection Tc-99m sulfur colloid syringe measurements 

to aid radiopharmacy personnel to prepare 

the necessary concentration for each lymphoscintigraphy 

protocol. 




FEATURE 

Conclusions: In a busy 1,000-bed teaching hospital, 

various physician orders for lymphoscintigraphy 

doses required organization. A nuclear pharmacy 

preparation guideline chart provides a useful 

guide to accurately dispense Tc-99m sulfur colloid 

for lymphoscintigraphy procedures. 

116—PREPARATION OF [C-11]-CFT FOR 

PET MEASUREMENT OF CEREBRAL 

DOPAMINE TRANSPORT ACTIVITY. 

Moerlein S, Perlmutter J, Patel P, Welch M, 

Washington University in St. Louis. E-mail: 

moerleins@mir.wustl.edu 

Objective: Positron emission tomography (PET) 

is used to assess changes in degenerative disorders 

such as Parkinson’s disease or Huntington’s disease. 

With the goal of developing a more sensitive tracer 

for measurement of these changes, we have optimized 

the preparation of carbon-11 labeled β-CFT 

[(-)-2-β-carbomethoxy-3-β-(4 fluoropheny)tropane] 

suitable for clinical application in human subjects. 

Methods: [C-11]Carbon dioxide was produced 

using the 16-MeV proton beam of a JSW 16/8 medical 

cyclotron. The target was emptied into a 

PETtrace MeI MicroLab. This microprocessor-controlled 

device catalytically converts [C-11]carbon 

dioxide to [C-11]methane, which is subsequently 

iodinated to yield [C-11]methyl iodide. 

Approximately 12 minutes after target emptying, 

the [C-11]methyl iodide is bubbled into a solution 

of 0.5 mg of (nor-methyl)β-CFT in 200 µL of 

dimethylformamide cooled in an ice bath. The reaction 

mixture is heated at 70º C for 3 minutes. The 

crude product mixture is diluted with 4 mL of HPLC 

solvent and purified using semipreparative HPLC 

(Partisil 10 ODS-3; acetonitrile/10 mM monobasic 

potassium phosphate (40/60); 5 mL/min). The product 

fraction is diluted with 150 mL of 4 µM sodium 

hydroxide, and passed through a SepPak C18 

extraction cartridge, which is then rinsed with 10 

mL Sterile Water for Injection, USP. The radiopharmaceutical 

is eluted from the SepPak with 1.1 

mL of Ethyl Alcohol, USP, through a 0.2 µ 

Acrodisc filter into a 10 mL sterile empty vial. The 

solution is diluted with 10 mL of Saline for 

Injection, USP to give the reformulated [C-11]β- 

CFT in a 10% ethanolic solution. 

Results: Batch yields of [C-11]β-CFT prepared 

in this manner are 28.3 ± 10.1 mCi (N = 41), with 

specific activity >1000 Ci/mmol and radiochemical 

purity >97%, and are sterile and apyrogenic. The 

overall preparation time is 60 minutes EOB. 

Conclusions: This methodology is a reliable 

method for the clinical production of [C-11]β-CFT 

for PET studies of human subjects. 

117—QUALITY CONTROL OF [F- 

18]FACBC: A NON-NATURAL AMINO ACID 

TUMOR IMAGING AGENT. Crowe R, Yu W, 

Goodman M, Emory University. E-mail: 

ronald_crowe@emoryhealthcare.org 

Objective: FACBC, anti-1-amino-3-[F-18]fluorocyclobutyl-1-carboxylic 

acid, is a non-natural 

amino acid that has shown promise for PET tumor 

imaging. An improved method of synthesis has been 

reported that demonstrates high stereoselectivity 

and possible suitability for larger scale preparation. 

Determine and develop potential quality control 

(QC) methods to ensure safe intravenous administration 

and begin data collection in anticipation of 

IND submission. 

Methods: Design: FACBC was synthesized 

using an automated chemical process control unit 

(CPCU) with a computer interface (CTI, Inc.). Upon 

completion of synthesis, the FACBC is purified by 

passage through an Ion Retard column assembly 

and 0.22-µm sterilizing filter before collection. The 

QC of FACBC included analysis for sterility, pyrogenicity, 

pH, clarity, and purity. Purity is evaluated 

using TLC with radiometric detection, GC analysis, 

and timed radioactive decay. Sterility is evaluated 

per USP guidelines, and PET is performed using the 

LAL gelclot method. Setting: All procedures performed 

in a licensed radiopharmacy laboratory. 

Patients: Limited to patients presenting probable 

metastatic brain carcinoma and referred by neurosurgery 

services of the Emory Healthcare System. 

Results: For all lots of FACBC, radiochemical 

and radionuclidic purity have been greater than 

99%. Sterility and endotoxin testing have been negative. 

pH range has been 5.5–6.0. GC analysis has 

shown only trace amounts of organic solvents. 

FACBC has been used in 12 people at Emory with 

no local, neurologic, or systemic toxicities 

observed. Additional QC testing procedures have 

been identified as potential requisites for release. 

Conclusions: QC results have exceeded established 

in-house limits of acceptability. However, 

more investigation into the characterization of 

major nonradioactive species present and evaluation 

of the potential toxicity of FACBC must be completed 

to obtain regulatory approval for extensive 

human use. The Emory FACBC study is a pilot 

study to determine subsequent broad study feasibility 

and generate pilot data and is under the oversight 

of the Emory Radioactive Drug Research 

Committee. 

118—RADIOPHARMACISTS’ SATISFAC- 

TION WITH THEIR EDUCATION/TRAIN- 

ING, JOB SATISFACTION, AND PROFES- 

SIONAL PRACTICE PATTERNS: RESULTS 

OF A NATIONAL SURVEY. Wittstrom K, 

Norenberg J, Borrego M, University of New 

Mexico. E-mail: aaaaa@unm.edu 

Objective: This study assessed radiopharmacists’ 

satisfaction with their radiopharmacy training and 

education (T&E) and job satisfaction. The study 

also identified factors that have influenced radiopharmacists’ 

decision to enter, continue, or exit this 

specialty practice. 

Methods: A 20-item, self-administered survey 

was developed and pilot-tested using a convenient 

sample of practicing radiopharmacists. The study 

sample included all U.S. radiopharmacists identified 

through databases of licensed pharmacists, radiopharmacy 

continuing education program subscribers, 

and alumni records (N = 789). Follow-up 

surveys were mailed to nonrespondents. 

Results: Overall usable response rate was 41% 

(N = 327). Of those respondents practicing radiopharmacy, 

64% were Board Certified Nuclear 

Pharmacists (BCNPs), 81% were men, 64% listed 

BS Pharmacy as their highest degree, and 54% 

received their T&E through a certificate program. 

Respondents trained in an academic setting felt 

more prepared to perform radiopharmacy practice 

functions, compared with those completing a certificate 

program. Board certification did not influence 

preparedness to perform radiopharmacy practice 

functions. Overall, most radiopharmacists were satisfied 

with their current position. Of the respondents 

practicing pharmacy, the most frequently cited reasons 

for leaving radiopharmacy practice, included 

family reasons, difficult hours, and management 

issues. 

Conclusions: The results of the survey provide 

information regarding radiopharmacists´ satisfaction 

with their T&E, and job satisfaction with their 

current radiopharmacy position. Results of this 

study can be used to improve existing radiopharmacy 

educational program curricula and to develop 

new continuing radiopharmacy education programs 

to address perceived T&E deficiencies. 

119—STABILITY OF FILTERED TC-99M 

SULFUR COLLOID. Ponto J, University of Iowa. 

E-mail: james-ponto@uiowa.edu 

Objective: Filtered Tc-99m sulfur colloid has 

recently gained popularity for use in lymphoscintigraphic 

mapping of lymphatic flow and identification 

of sentinel lymph nodes. This study was undertaken 

to evaluate the stability of filtered Tc-99m 

sulfur colloid stored in glass vials over a period of 8 

hours. 

Methods: About 100 mCi of routinely prepared 

Tc-99m sulfur colloid was passed through a 0.1- 

micron filter (Millex-VV, Millipore Corp, Bedford, 

Mass.). The filtrate was collected in a sterile glass 

vial (Hollister-Stier, Spokane, Wash.) and diluted to 

a concentration of about 4 mCi/mL. Samples were 

withdrawn from this stock vial at 2-hour intervals 

and subjected to the following testing: (1) thin-layer 

chromatography to assess radiochemical purity; (2) 

measurement of specific activity (mCi/gram) as 

assayed in a dose calibrator and weighed on an analytical 

balance, to indirectly assess 

sedimentation/adsorption to container walls; and (3) 

measurement of specific activity (mCi/gram) following 

re-filtration through another 0.1-micron filter 

to indirectly assess changes in particle size (e.g., 

aggregation or clumping). This procedure was 

repeated on a total of ten separate preparations of 

filtered Tc-99m sulfur colloid. 

Results: Results are expressed as mean (range) 

values. (1) Radiochemical purity of the filtered Tc- 

99m sulfur colloid in the stock vial decreased slightly 

from 99.3% (98.7–99.7%) at the time of preparation 

to 98.6% (98.3–99.5%) at 8 hours. (2) The specific 

activity of filtered Tc-99m sulfur colloid in the 

stock vial decreased slightly to 97% (94–101%) of 

its original value at 8 hours. (3) The specific activity 

of refiltered samples decreased slightly to 94% 





(89%–100%) of the corresponding specific activity 

of filtered Tc-99m sulfur colloid in the stock vial at 

8 hours. 

Conclusions: Filtered Tc-99m sulfur colloid 

stored in glass vials appears to maintain acceptable 

stability, in terms of radiochemical purity, sedimentation 

and adsorption to container walls, and particulate 

size, throughout a period of 8 hours. 

APhA–APPM Specialized 

Pharmaceutical Services 

120—ASSESSMENT OF A COMMUNITY 

PHARMACY-BASED DISEASE-STATE MAN- 

AGEMENT PROGRAM. Cuellar D, Dodd M, 

University of New Mexico. E-mail: 

mdodd@salud.unm.edu 

Objective: To describe a community pharmacybased 

disease-state management (DSM) program in 

the areas of diabetes and cardiovascular risk reduction 

in an ethnically diverse population and describe 

the effectiveness of this program in achieving 

national treatment guideline goals. 

Methods: This study reports outcomes from a 

recently developed community pharmacy-based 

DSM program in an ethnically diverse community. 

A retrospective review of patient data collected 

through January 2004 is presented. All patients seen 

in the community pharmacy-based DSM program 

for diabetes or cardiovascular risk reduction are 

included in this analysis. Physicians or pharmacists 

refer their patients to this community pharmacybased 

DSM clinic, or patients self-refer. All patients 

receive oral and written DSM education during 

every visit with the pharmacist. A complete medical 

history is collected at the initial visit. Additionally, 

blood pressure, glycosylated hemoglobin, fasting 

glucose, and a fasting lipid panel are obtained at 

baseline and every 6 weeks after enrollment. A plan 

is developed with the patient and assessed at each 

visit. Therapy recommendations are made to the 

patients’ primary provider after every visit. The 

analysis includes a description of patient demographics, 

including number of cardiovascular risks 

and number of patients at treatment goals by ethnicity, 

gender, age, type of physician, and type of insurance. 

Student’s t test is used to analyze differences 

in blood pressure, glycosylated hemoglobin, fasting 

glucose, and lipid panel values between visits. 

Acceptance of treatment recommendations by 

patients’ primary providers is also described. 

Results: NA. 


121—DEVELOPMENT AND IMPLEMEN- 

TATION OF A WEB-BASED TOOL TO 

ALERT, DOCUMENT, AND COMPENSATE 

CONSULTANT PHARMACISTS UNDER A 

POLYPHARMACY DRUG USE REVIEW 

PROGRAM. Trygstad T, University of North 

Carolina at Chapel Hill, Thorpe J, AccessCare Inc. 

E-mail: troy@unc.edu 

Objective: To describe and demonstrate a Webbased 

product that alerts consultant pharmacists to 

potential drug-related problems among nursing 

home patients and documents responses to problem 

alerts. 

Methods: A polypharmacy intervention project 

targeting North Carolina Medicaid recipients in 

nursing homes was launched in November 2002. 

The initiative developed rapidly and now serves 

more than 300 nursing facilities and 18,000 

Medicaid patients. The intervention was developed 

by pharmacists under the auspices of a nonprofit 

network of physicians serving Medicaid recipients 

(AccessCare). Consultant pharmacists are paid separately 

by the network for their response to potential 

drug therapy problem alerts generated from 

Medicaid claims data. Early experiences with a 

paper-based profile alert and documentation system 

stimulated the development of ConsultRx, a Webbased 

application. The software was developed in 6 

months and involved two programmers and two 

pharmacists. The program allows consultant pharmacists 

to access and download patient drug profile 

data from claims databases for purposes of identifying 

possible drug-related problems. The database is 

updated monthly with the most recent claims available 

that include drug name, amount paid, prescriber, 

and a host of other associated claims information. 

Additionally, the program allows for “flagging” 

of possible drug-related problems and suboptimal 

therapy. The flagging criteria can be updated 

whenever desired. The application also allows the 

pharmacist to document interventions and submit 

them for payment. 

Results: The success of ConsultRx is being evaluated 

after 6 months’ usage. Criteria for success 

include: (1) number of consultants who elect to use 

the system to identify and resolve potential drug 

therapy problems, (2) cost savings associated with 

editing and submitting claims for payment for drug 

therapy problem and resolution activities, (3) User 

satisfaction as measured by user response to a questionnaire 

administered after 6 months, and (4) efficiency 

of documentation, as measured by average 

intervention time from initiation to final submission, 

number of interventions per user per month, and 

response to flagging criteria as measured by rates of 

interventions regarding any of the given criteria. 


122—EDUCATING PHARMACY STU- 

DENTS ABOUT END-OF-LIFE CARE 

THROUGH A CLERKSHIP ROTATION. 

Amerson A, University of Kentucky, Kelley D, 

Hospice of the Bluegrass. E-mail: aamer1@uky.edu 

Objective: Describe the benefit to one hospice in 

providing rotation experiences for pharmacy students 

and discuss services that pharmacy students 

can provide as part of their learning experience. 

Methods: A 1-month rotation in end-of-life care 

was begun for pharmacy students at hospice in 

1995. Because there was no pharmacist at the hospice 

site, a college of pharmacy faculty member and 

the student coordinator for hospice (a nurse) jointly 

precepted the rotation. The student coordinator 

coordinated the activities for the student at hospice, 

and the pharmacy faculty member met with the student 

weekly for discussions on topics and review of 

patients and assignments. The hospice now employs 

a full-time pharmacist who helps precept students 

with the faculty member. An experience is provided 

for 8 –10 students per year. 

Results: Benefits for hospice are that the student 

provides in-service education for nursing staff, 

answers drug information questions as needed, 

works on medication use evaluation projects, counsels 

patients/caregivers on medication use, develops 

written information for patients/caregivers, newsletters, 

and the pharmacy and therapeutics committee, 

and extends existing pharmacy personnel for team 

meetings/rounds. Students benefit in that they learn 

the philosophy of hospice care, see roles of different 

team members (e.g., chaplain, social worker), 

address difficult symptom management issues 

(pain, dyspnea, nausea, vomiting), counsel patients 

and caregivers, prepare and present written drug 

information, and see patients in both home and inpatient 

settings. Specific student projects and activities 

are described. Comments from student evaluations 

have been very positive about the experience and 

indicate that students perceive a benefit from participating 

in end-of-life patient care. 

Conclusions: Students learn about opportunities 

to provide pharmacy services in end-of-life care. 

Original Citation: This poster was presented at 

the National Hospice and Palliative Care 

Organization’s 18th Management and Leadership 

Conference, September 7, 2003, Phoenix, Ariz. 

123—EFFECTS OF A ONE-YEAR PHAR- 

MACIST MANAGED CORONARY HEART 

DISEASE RISK REDUCTION PROGRAM AT 

AN AIR FORCE BASE CLINIC. Nicholson S, 

Benefis Healthcare, Great Falls, Montana. E-mail: 

stevecharm1@juno.com 

Objective: To reduce the risk for coronary heart 

disease (CHD) in identified patients. Therapeutic 

targets included attainment of National Cholesterol 

Education Program (NCEP) LDL cholesterol goals, 

modification of CHD risk factors, and reduction of 

10-year CHD risk estimates. 

Methods: Patients with diabetes or elevated 

cholesterol were identified from clinic records and 

invited to participate. Additional patients were 

enrolled through physician referrals. A total of 32 

patients participated for varying periods up to 14 

months. Charts, laboratory reports, and lifestyle 

questionnaires were used to collect risk data. 

Appointments were conducted individually with a 

clinical pharmacist, and these consisted of 

atherosclerosis education, CHD risk assessment, 

setting of therapeutic goals, and treatment planning. 

Intervention targets included nutrition, exercise, 

smoking, weight, blood pressure, stress level, and 

medication use. If appropriate, patients were 

referred to established diabetes, cholesterol, and 

tobacco cessation programs on base. Medication 

recommendations were made to the patient’s primary 

care provider (the pharmacist did not have prescriptive 

authority). Visits were documented in the 

patient’s medical record using a standardized charting 

form cosigned by a physician. Follow-up visits 




FEATURE 

and laboratory visits were generally scheduled at 3- 

month intervals. Computer software was used to 

calculate 10-year CHD risk estimates. 

Results: Enrollees who attended less than three 

appointments did not have significant changes in 

CHD parameters. A total of 23 enrollees attended 

three or more appointments. Among these patients, 

four attained NCEP LDL cholesterol goals, two 

eliminated major risk factors by increasing HDL 

cholesterol, nine attained triglyceride goals, two 

attained waist-reduction goals, and two attained 

body mass index goals. The mean estimated 10-year 

absolute risk of CHD decreased from 12.6% to 

10.8% in this group. 

Conclusions: This project demonstrates that a 

pharmacist managed CHD risk reduction program 

can reduce LDL cholesterol levels, modify CHD 

risk factors and reduce the estimated 10-year risk of 

CHD in patients who attend more than two appointments. 

124—ESTABLISHMENT OF A PHARMA- 

CIST CONSULTING TEAM FOR 

STATEWIDE BIOTERRORISM PREPARED- 

NESS. Feret B, Bratberg J, University of Rhode 

Island, Curzake J, CVS Pharmacy, Kogut S, Low G, 

University of Rhode Island, Cordy C, Orsini M, 

Rhode Island Department of Health. E-mail: 

bferet@uri.edu 

Objective: The objective of this program was to 

develop, test, and maintain a statewide bioterrorism 

preparedness plan in collaboration with a core group 

of pharmacy consultants. 

Methods: The Department of Health and Board 

of Pharmacy for the State of Rhode Island developed 

a plan for bioterrorism preparedness after the 

terrorist events of 2001. This included plans for the 

receipt, distribution, and dispensing of the Strategic 

National Stockpile (SNS) of medications and supplies 

from the Centers for Disease Control and 

Prevention (CDC). Since pharmaceuticals and dispensing 

of medications to the public constitute an 

important portion of a bioterrorism plan, the state 

recognized the importance of having pharmacists 

involved in the planning process. Five pharmacy 

consultants were recruited by the Board of 

Pharmacy through an application process. The five 

pharmacists hired were a community pharmacist, 

three faculty members from the University of Rhode 

Island with specialties in community pharmacy, 

infectious diseases, and pharmacoepidemiology, 

and a graduate student with expertise in pharmacoinformatics. 

The five consultants developed a 

plan for the local municipalities for the mass distribution 

of antibiotics to the public, drug selection 

algorithms, and the development of patient assessment 

tools. 

Results: To date the five pharmacy consultants, 

along with the Department of Health, have developed 

a plan for the mass-distribution municipal clinics 

for a bioterrorist event involving a bacterial 

agent, including drug selection algorithms based on 

current recommendations and a patient assessment 

form. This plan was recently exercised in August 

2003, including the receipt of a SNS training package 

from CDC. 

Conclusions: Collaboration between the pharmacy 

consultants and the Department of Health has 

been very successful in improving the preparedness 

for the state of Rhode Island and its local municipalities 

in the event of a bioterrorist event. 

125—SUCCESSFUL INCLUSION OF 

PHARMACY PRACTICE INTO THE HOME 

CARE SETTING. Macklin L, University of 

Montana. E-mail: macklinr@partnersinhomecare.org 

Objective: A multiservice, small home care 

agency wanted to elevate its standard of care by 

having a pharmacist help the home health and hospice 

nurses provide optimal drug therapy management 

for its patients. The local school of pharmacy 

needed more ambulatory care advanced practice 

experiences (APEs) and instructors for its expanding 

pharmacy program. In 1995, the two organizations 

collaborated to fund a full-time, split consultant 

pharmacist position to determine if such a position 

would meet their joint needs. 

Methods: The position was evaluated annually 

for integration of the pharmacist into the patient 

care teams and effectiveness of the pharmacist 

meeting predetermined educational, clinical, operational, 

and financial objectives. 

Results: The university secured not only a needed 

ambulatory care APE but also a clinical instructor 

to help teach didactic and experiential courses. 

The position is cost-effective because the agency 

has access to a full-time pharmacist and yet is only 

paying for a half-time position. The pharmacist 

helps with patient care by performing medication 

reviews and pain consults, participating in weekly 

team meetings, answering drug information questions, 

developing patient medication teaching materials, 

and going on home visits. To help with operational 

needs, the pharmacist coordinates pharmacy 

needs between hospice and the home infusion program, 

as well as with outside contract pharmacies. 

The pharmacist also serves as a mini-case manager 

for medication needs for rehabilitation patients. To 

help with quality improvement, the pharmacist performs 

drug-use reviews, helps develop agency policies 

and procedures when related to medications, 

and serves on the agency’s pain committee. Lastly, 

the pharmacist financially helps the hospice program 

by overseeing the medication formulary, contracting 

with local pharmacies, and reviewing pharmacy 

bills for accuracy. 

Conclusions: Since the inclusion of the consultant 

pharmacist/clinical professor position 8 years 

ago, the joint venture has been successful. 

Original Citation: “How to Succeed by Adding 

Pharmacy Services,” at the National Association of 

Home Care’s Meeting in Salt Lake City, UT. 

Session speaker, 10/28/2002. 

126—INFORMED CONSENT FORMS— 

GOBBLEDYGOOK? Colucci N, Massachusetts 

College of Pharmacy and Health 

Sciences–Worcester, Donahue M, Lahoz M, 

Massachusetts College of Pharmacy and Health 

Sciences–Worcester. E-mail: nancy.colucci@ 

students.mcp.edu 

Objective: An informed consent form (ICF) is 

intended to provide potential recruits to a clinical 

research trial (CRT) with details of the nature of the 

study, risks and benefits involved, and a recruit’s 

rights and responsibilities. We conducted a project 

to meet the requirements of an elective course, 

“Addressing the Health Literacy Challenge.” 

Studies have shown that language used in ICFs is 

not comprehensible to most people. The primary 

objective of our project was to measure the gap 

between the readability of ICFs and the literacy 

skills of CRT participants. Our secondary objectives 

were to raise awareness of this gap and to offer a 

solution for bridging this gap. 

Methods: We conducted our project at an outpatient 

CRT center over a 6-week period. We used the 

Fry formula and SMOG grading to assess the readability 

of 15 ICFs, and the Rapid Estimate of Adult 

Literacy in Medicine (REALM) test to measure the 

reading skills of a sample of 26 CRT participants. 

Results: The average readability score of the 

ICFs was 14th grade on the Fry chart and 12th grade 

on the SMOG. The REALM test showed that the 

average reading skill of the CRT participants was at 

the 11th grade level, which is higher than the reported 

average of 8th- to 9th-grade level for adult 

Americans. We presented our findings to the 

research coordinators. To help bridge the observed 

gap, we developed a seven-item test of comprehension 

that coordinators could use to help pinpoint 

specific ICF parts that may need further clarification 

with a potential CRT recruit. 

Conclusions: ICFs are written at readability levels 

that may be above the literacy skills of many 

CRT participants. Efforts should be made to simplify 

ICFs or supplement them with other forms of 

instruction so CRT recruits can really make an 

informed choice. 

APhA–APPM Miscellaneous 

127—ATTITUDES AND OPINIONS ON 

CONTINUING EDUCATION, TRAINING, 

AND READINESS TO ASSUME NEW PRO- 

FESSIONAL RESPONSIBILITIES BY CERTI- 

FIED PHARMACY TECHNICIANS. Jacobson 

S, Steere P, Foye L, Massachusetts College of 

Pharmacy and Health Sciences. E-mail: sjacobson@ 

mcp.edu 

Objective: To survey technicians certified by the 

Pharmacy Technician Certification Board in 

Massachusetts regarding such elements of practice 

as preferred channels for receipt of continuing education, 

perceptions of their present professional status, 

relationships between job training and actual 

duties performed in the course of practice, and their 

readiness to take on new or expanded roles. 

Methods: A grant application was submitted and 

accepted in 2002 supporting a 43-question survey 

that was approved by an institutional review board. 

The survey was mailed to 1,815 certified pharmacy 

technicians. The survey questions addressed phar- 





macy technicians’ training, aspects of their present 

responsibilities, and topics relevant to job satisfaction. 

It also examined their preferences regarding 

continuing education credit. 

Results: A total of 288 (16%) usable responses 

were returned. Data will be presented on broad 

opinions of respondents on issues such as salary 

commensurate with job duties, training, perceptions 

of their value to the profession, and desired channels 

and subject matter for continuing education. 

Information is being tabulated according to years of 

experience, practice setting and employment status, 

and the analysis will correlate impressions of continuing 

education with the technicians’ developmental 

needs toward assuming expanded roles within 

the profession of pharmacy. 


128—CREATION, IMPLEMENTATION, 

AND ASSESSMENT OF A WEIGHT MAN- 

AGEMENT ELECTIVE COURSE IN A PHAR- 

MACY CURRICULUM. Ahrens R, Ciardulli L, 

Shenandoah University. E-mail: rahrens@su.edu 

Objective: To develop, implement, and evaluate 

an interactive and interdisciplinary weight management 

course. 

Methods: Course objectives were designed to 

give students a background in weight management 

issues and to develop skills needed to assess and 

manage the overweight/obese patient. These skills 

were taught in a classroom and field exercise format. 

Students actively participated in applying skills 

taught through the use of diet/exercise histories and 

weekly health goals. As an interdisciplinary 

approach to learning, a dietitian and an athletic 

trainer were invited to share their ideas on lifestyle 

modifications. Field exercises included a grocery 

store and fitness center informational tour. Students 

were evaluated by presentations and the development 

of portfolios. Knowledge tests and physical 

assessments (cholesterol panel, weight, body fat 

percentage, waist circumference, blood pressure, 

and blood glucose) were administered before the 

course and upon course completion. The formal 

course evaluation included open-ended and closeended 

assessments. 

Results: The course was initially offered in fall 

2002 as a 1-hour elective with an enrollment of 16. 

Students were actively involved in the course format 

with open discussions of weight management 

issues on an individual and global level. Overall 

evaluations of the course were strongly positive. 

Open-ended comments were also positive and indicated 

a growth in knowledge of health issues and 

awareness of obesity as an epidemic. In addition, 

class participants indicated they would recommend 

the course to other students. 

Conclusions: Results indicate satisfaction with 

course design and content. Further expansion of 

course topics within the school’s curriculum will be 

explored. 

Original Citation: American Association of 

Colleges of Pharmacy Annual Meeting, 

Minneapolis, Minn., July 2003. 

129—HERBAL AND SUPPLEMENT USE 

IN A MILITARY HEALTH CARE SETTING 

AND THE ASSOCIATED DRUG- 

HERBAL/SUPPLEMENT AND DISEASE- 

HERBAL/SUPPLEMENT INTERACTIONS. 

Lagasse C, United States Air Force, Halperin T, 

University of the Pacific School of Pharmacy and 

Health Sciences, Johnson J, United States Air Force. 

E-mail: candice.lagasse@60mdg.travis.af.mil 

Objective: To describe the percentage of military 

outpatient pharmacy patrons who use herbal products 

and/or supplements and describe the associated 

potential drug-herbal/supplement or herbal/supplement-disease 

state interactions 

Methods: Design: Prospective and descriptive. A 

convenience sample of patients will be surveyed 

regarding their use of herbal and/or supplement 

products. Patient surveys will be conducted at three 

outpatient pharmacies while patients are waiting to 

pick up their medications. The patient’s medication 

profile and medical record (when possible) will be 

reviewed to assess for drug-herbal/supplement or 

disease-herbal/supplement interactions. Setting: 

Three outpatient pharmacies of a west coast Air 

Force base. Patients: This study will include 385 

English-speaking patients at least 18 years of age. 

Results: Age, gender, active duty/dependent status, 

and number of patrons using herbal products 

and supplements will be reported and analyzed. 

Herbal products and supplements used and associated 

drug-herbal/supplement and herbal/supplementdisease 

state interactions will also be categorized by 

number and type. In addition, the number of patients 

using these products who have informed their doctor, 

the patient’s self-assessed knowledge level of 

the products they are using, and the patient’s information 

sources will be recorded. 

Conclusions: The results of this study will provide 

an estimate of military pharmacy patrons who 

use herbals and supplements and the associated 

potential drug and disease interactions. This will 

give military health care providers a better idea of 

the scope of herb and supplement use, related drugherbal/supplement 

and disease-herbal/supplement 

interactions, and may suggest a need for increased 

education in this area. 

APhA–APPM Pharmacy 

Residents 

130—A COMPARISON OF THE VALIDITY 

AND RELIABILITY OF AUTOMATIC 

BLOOD PRESSURE MONITORS. Warburton S, 

Daniel K, Marsh W, Nova Southeastern University. 

E-mail: swarburton79@hotmail.com 

Objective: The objective of this study is to determine 

if there is a difference in the validity and reliability 

of four automatic blood pressure monitors 

when compared with the gold standard mercury 

sphygmomanometer in measuring blood pressure. 

The primary outcome of the study is the validity of 

blood pressure readings taken by each automatic 

blood pressure monitor when compared with blood 

pressure readings from the mercury sphygmomanometer. 

The secondary outcome of the study is 

reliability of each of the automatic blood pressure 

monitors. 

Methods: Thirty normotensive people are being 

recruited to participate in the study at Nova 

Southeastern University Clinic Pharmacy, Fort 

Lauderdale, Florida. Normotensive subjects are 

being chosen to reduce the variability within the 

measurements to better evaluate validity and reliability. 

Participants are at least 18 years of age and 

able to sign the written consent for participation. 

Each subject has his or her blood pressure measured 

by each of the four automatic blood pressure monitors 

and by the mercury sphygmomanometer two 

separate times with a two-minute interval between 

each measurement. All patients are asked to be seated 

with their arm at heart level and feet flat on the 

floor. The order of testing with each monitor is 

being randomized for each patient. For the primary 

outcome, the percent of times that each automatic 

monitor produces a result within 4 mm Hg of the 

measured blood pressure by the mercury sphygmomanometer 

will be used. Similarly, for the secondary 

outcome, the test–retest reliability of each 

automatic machine will be measured. If the two 

readings on any monitor differ by greater than 4 mm 

Hg, then a third measurement will be taken on that 

monitor. Before the study began, all researchers performed 

blood pressure measurements on a sample 

of subjects to check interrater reliability using the 

kappa coefficient, and then to resolve differences 

between researchers. Data will be analyzed using 

SPSS version 11.1. 

Results: Data are currently being collected. 

Preliminary results indicate a lack of validity with at 

least one of the store brand monitors. Final results 

will be presented at the meeting. 


131—A CROSS-SECTIONAL SURVEY OF 

COMMUNITY PHARMACISTS AND LEVEL 

OF COMFORT IN ANSWERING QUESTIONS 

ABOUT HERBS. Cormier L, Texas Southern 

University. E-mail: lfap420@hotmail.com 

Objective: To assess the comfort level of community 

pharmacists in answering questions about 

herbs and to compare comfort levels with corresponding 

demographics, education, and pharmacy 

practice experience. 

Methods: Design: Community pharmacists in a 

particular district of a retail chain in Houston, Texas 

will be surveyed between December 2003 and 

February 2004. The survey sheet will contain the 

following items: demographics, all previous and 

current practice settings, year graduated from pharmacy 

school, type of pharmacy degree obtained, 

average number of times the pharmacist is asked a 

question about herbs, which herbs have the most 

frequent questions, how comfortable they are to 

answer herbal questions, and the factors attributed 

to that comfort level. Setting: The survey will be 

conducted in the pharmacies of a particular district 

of a retail chain in Houston, Texas. 

Patients/Participants: Pharmacists in the pharmacies 




FEATURE 

of a particular district of a retail chain in Houston, 

Texas. Data Collection: Surveys with questions 

about demographics, pharmacy practice experience, 

graduation date from pharmacy school, pharmacy 

degree obtained, average number of herbal questions 

asked, herbs asked about most frequently, and 

comfort level in answering questions about herbs 

will be analyzed. Analysis Plan: The surveys will 

be analyzed to determine the average comfort level 

of community pharmacists in relation to answering 

questions about herbal products and if there is any 

correlation between comfort level and demographics, 

clinical education, and pharmacy practice experience. 

Other appropriate qualitative methods: NA. 

Results: It is hypothesized that most pharmacists 

will be slightly apprehensive in answering questions 

about herbs. 


132—AN EVALUATION OF A MICROAB- 

LUMINURIA SCREENING AND EDUCA- 

TION PROGRAM IN PATIENTS WITH DIA- 

BETES IN A COMMUNITY CHAIN PHAR- 

MACY. Olbricht T, Purdue University. E-mail: 

j2olbricht@hotmail.com 

Objective: To screen patients with diabetes for 

microalbuminuria and educate them about diabetic 

nephropathy. Additional goals are to: determine if 

pharmacists in a community pharmacy setting can 

identify patients at elevated risk of developing diabetic 

nephropathy (i.e., positive microalbumin test); 

and evaluate the program by conducting patient surveys 

to measure knowledge gained, suggestions for 

improvement, and satisfaction. 

Methods: Microalbuminuria screenings and education 

will be conducted in five community pharmacy 

locations and will involve 23 patients. The 

primary researcher will provide all educational and 

testing services, which will be free of charge to the 

patient. The educational component and the 

microalbumin protocol will be developed from the 

American Diabetes Association Guidelines and 

medical literature. Patient recruitment will be conducted 

by asking patients on diabetic medications to 

fill out a survey-test, which will evaluate their 

knowledge about diabetic nephropathy and find out 

if they are interested in joining the study. The education 

component will include such topics as a definition 

of diabetic nephropathy, what is microalbuminuria, 

and how to prevent progression into diabetic 

nephropathy. The microalbumin protocol will 

consist of three separate screenings using a 

Accubase ì Alb microalbumin test kit over a 12- 

week period, with educational components during 

the first and last screenings. Patients will be referred 

to their doctor if they test positive for microalbuminuria 

at any of the three screenings. All patients 

enrolled in the study will be asked to complete a 

pre- and postknowledge test as well as a satisfaction 

survey. 

Results: The effectiveness of this study will be 

evaluated in two parts. The first part will evaluate 

how many study patients are at high risk for developing 

diabetic nephropathy (i.e., positive for 

microalbuminuria). The second part will be an evaluation 

of the education component using a comparison 

of the pre- and postknowledge tests. 

Conclusions: It is expected that patients will gain 

knowledge about the pathogenesis, risk factors, and 

recommended goals associated with diabetic 

nephropathy and high-risk patients will be identified 

for referral to their physician. 

133—AN EVALUATION OF SENIOR CITI- 

ZEN PATIENT COMPLIANCE IN A COMMU- 

NITY GROCERY CHAIN PHARMACY 

AFTER INITIATING A REFILL REMINDER 

SYSTEM. Morales C, Hampton K, Safeway 

Pharmacy. E-mail: courtney.morales@safeway.com 

Objective: To assess the impact of a refill 

reminder system on senior citizen medication compliance 

by evaluating changes in medication compliance 

as well as patient and pharmacy staff satisfaction. 

Methods: The refill reminder system will be 

implemented in two pharmacy locations. Patients 

will be selected to participate based on certain 

inclusion and exclusion criteria. The inclusion criteria 

includes patients at least 60 years of age, patients 

having at least two refills for one “chronic” medication 

in the last year, and a Morisky score of 0 to 3. 

A baseline analysis will be conducted to determine 

each enrolled patient’s refill compliance over the 

past 6 months. Pharmacy personnel will call each 

patient 3 to 5 days prior to the refill date and inform 

them to call in that refill using our automated refill 

system. After a period of at least 3 months and up to 

6 months, refill compliance and poststudy Morisky 

scales will again be assessed and then compared 

with baseline. At the conclusion of the study, all 

participating patients and pharmacy staff will be 

given a survey to assess their satisfaction with the 

program. 

Results: The effectiveness of this program in 

improving patient compliance will be evaluated 

using a comparison of pre- and post-Morisky scales 

and an analysis of the time between prescription 

refills using appropriate statistical tests. In addition, 

patient and pharmacy staff satisfaction will be evaluated 

using descriptive statistics. 

Conclusions: It is expected that this refill 

reminder system will increase patient compliance 

and that both the patients and pharmacy staff will be 

satisfied with the program. 

134—ANALYSIS OF REIMBURSEMENT 

PATTERNS FOR PHARMACISTS WHO PRO- 

VIDE DIABETES CARE SERVICES. Wells A, 

Campbell University, Steiner G, Campbell 

University/Kerr Drug. E-mail: we2apothecary@ 

yahoo.com 

Objective: The primary objective of this study is 

to identify professional characteristics of pharmacists 

who are currently obtaining reimbursement for 

the provision of diabetes care services. The secondary 

objectives are to identify which third party 

payers are reimbursing pharmacists for these services 

and to determine the mechanism by which 

pharmacists working in physicians’ offices are 

being reimbursed. 

Methods: A questionnaire will be administered 

via the Internet. The population sample will include 

the 6,109 male and female pharmacists who maintain 

an active license on record with the state Board 

of Pharmacy (BOP) and have a current E-mail 

address. There are no anticipated risks for the population 

sample being studied. Data will be collected 

during the community pharmacy practice residency 

of the principal investigator. Each E-mail will consist 

of an informative letter requesting pharmacists 

who provide diabetes care to participate in the survey. 

A link to the survey web site will be provided 

at the bottom of each E-mail. Each participant will 

be provided a unique identifier located within the E- 

mail, which the individual must enter at the beginning 

of the Internet survey. This unique identifier 

will help the investigator identify information 

entered multiple times by the same user and keep 

data anonymous throughout the analysis. If duplicate 

information is collected, only the first submission 

will be used, all additional submissions will be 

discarded prior to data analysis. A limitation of the 

study is that there may be pharmacists who do not 

have a current E-mail address on file with the BOP. 

These subjects will be excluded from the study. 

Descriptive statistics will be used to examine the 

data collected in the survey. The Internet-based 

questionnaire will consist of 16 items and is 

designed to be completed in approximately 5 minutes. 

The survey will be located on a nonsearchable 

web site. The pharmacists will be categorized based 

upon various criteria, including gender, practice setting, 

and credentials. Pharmacists will be asked to 

identify diabetes care services offered, the setting in 

which these services are offered, collaborative 

efforts with other health care professionals, and 

reimbursement procedures. In addition, the questionnaire 

will examine respondents’ billing practices. 

Results: NA. 


135—ANALYSIS OF THE GROWTH 

TRENDS IN INDUSTRY-BASED POSTGRAD- 

UATE TRAINING PROGRAMS FOR PHAR- 

MACISTS. Lam A, Rutgers, The State University 

of New Jersey, Brady P, Eli Lilly & Company, 

Chow W, Crivera C, Goyal V, Rutgers, The State 

University of New Jersey, Patel A, Xavier 

University of Louisiana, Shprecher A, Toma S, 

Alexander J, Barone J, Rutgers, The State 

University of New Jersey, Hill B, Auxilium 

Pharmaceuticals, Suh D, Rutgers, The State 

University of New Jersey, Ramseyer K, Smith N, 

Eli Lilly & Company, Williams E, University of 

North Carolina at Chapel Hill, Romney M, 

GlaxoSmithKline. E-mail: andrew.lam@bms.com 

Objective: The objectives of this project are to: 

(1) conduct a retrospective analysis of the proliferation 

of industry-based postgraduate training programs 

over a 20-year period (1983–2003) to better 

understand the implications of growth, (2) evaluate 

trends within specific training disciplines, (3) 





improve awareness of the opportunities available to 

pharmacists within the pharmaceutical industry. 

Industry-based postgraduate training programs for 

pharmacists (e.g., residencies, visiting scientists, 

and fellowships) have experienced substantial 

growth over the past 20 years. Many companies 

have established these training programs for pharmacists 

within key disciplines, including Clinical 

Research, Drug Information, Medical Affairs, 

Marketing, Pharmacoeconomics, and Regulatory 

Affairs, to better prepare pharmacists for a career 

within the industrial practice setting. 

Methods: A 20-year retrospective analysis of 

industry-based postgraduate training programs will 

be conducted on data obtained from multiple 

sources. Data will be collected from electronic and 

printed sources published by professional pharmacy 

and industry-related associations (AACP, ACCP, 

APhA, ASHP, DIA, ISPOR), and data contributed 

from program sponsors. Due to the historical component 

of this project, programs that have been discontinued 

may also be accounted for through anecdotal 

evidence. In this analysis, industry-based postgraduate 

training programs include residencies, visiting 

scientist programs, and fellowships that recruit 

pharmacists for training within pharmaceutical 

research and manufacturing companies, biotechnology 

companies, and industry-affiliated consulting 

companies. Whenever possible, these programs will 

be quantified based on the number of participants 

that completed the program. 

Results: Based on preliminary data, we expect to 

see a growth in the number of postgraduate industry-based 

training programs for pharmacists over 

the last 20 years. The scope of this project also 

allows for the development of a comprehensive 

directory of industry-based postgraduate training 

programs available for pharmacists. 


136—ANALYZING SUN-DAMAGED SKIN 

AND EDUCATION ON PREVENTING 

FUTURE DAMAGE. Magnus L, Walgreens. E- 

mail: l_magnus@yahoo.com 

Objective: This year, the American Cancer 

Society estimates that 9,800 people will die from 

skin cancer, the most prevalent cancer in the United 

States. The primary goal of this study is to help 

decrease skin cancer deaths through screening and 

education. A pharmacist will use a Dermaview to 

show patients the present condition of their skin and 

provide education. The impact of the pharmacist on 

patients’ knowledge of sun protection/skin cancer 

and patient satisfaction with skin screening will be 

assessed. 

Methods: The screening will be primarily performed 

at two different locations within a large 

chain community pharmacy. About 200 patients 

will be targeted for enrollment. The patient begins 

by filling out a risk assessment survey to determine 

potential risk for skin cancer. Screening with the 

Dermaview machine can be performed on patients 

ranging from 13 to 80 years of age. The Dermaview 

uses a harmless black light to locate and identify 

dry, oily, and sun-damaged areas of the face. After 

the screening, the pharmacist provides recommendations 

and education. A pre- and postscreening 

quiz is administered to test the patients’ knowledge 

of the sun, tanning, and skin cancer. A survey is also 

completed by the patient to document the amount of 

satisfaction and willingness to pay for this type of 

screening. All patient materials will be approved by 

the Investigational Review Board. All data collected 

from the quiz and survey will be analyzed using 

appropriate statistical tests and then compiled into a 

written discussion of the project. 

Results: Preliminary results show that the screenings 

lead to an increase in skin care awareness and 

patient satisfaction. Such data are consistent with a 

single skin screening conducted in Massachusetts 

by dermatologists. Results from a site-specific 

needs assessment show patients are interested in 

skin screening. 

Conclusions: To be determined. 

137—ASSESSING PUBLIC KNOWLEDGE 

OF SAFE AND APPROPRIATE USE OF 

ACETAMINOPHEN. Dyer A, Whitaker A, Goode 

J, Virginia Commonwealth University. E-mail: 

amdyer@hsc.vcu.edu 

Objective: The purpose of this project is to compare 

the general public knowledge of safe and 

appropriate use of acetaminophen between prescription 

and nonprescription uses of acetaminophen 

product and to identify areas of education and counseling 

that need to be addressed through a standardized 

educational message designed to improve the 

safe and appropriate use of acetaminophen. 

Methods: This is a 3-month prospective study 

conducted in an independent pharmacy. A survey 

will be used to evaluate acetaminophen knowledge 

including dosing, interaction with alcohol, and liver 

toxicity. The survey will also identify individuals 

and/or places where consumers may have learned 

information about acetaminophen. All patients 

receiving an acetaminophen prescription product 

and nonprescription product will be asked to voluntarily 

complete the survey. After the respondents 

have completed their surveys, they will receive an 

educational pamphlet on acetaminophen. The data 

collected will be compared between the two groups 

to assess deficiencies in knowledge and education. 

After identifying potential problem areas with the 

knowledge of acetaminophen, an educational program 

will be developed for the pharmacy. The program 

will include staff development with a standardized 

approach to counseling and education of 

patients receiving acetaminophen. 

Results: The survey instrument and educational 

pamphlet have been developed for the project. 

Conclusions: By assessing the public knowledge 

of acetaminophen use, the pharmacy will be able to 

incorporate a standardized delivery of 

acetaminophen education. 

138—ASSESSING THE IMPACT OF A 

COMMUNITY PHARMACY–BASED RAPID 

HIV PREDIAGNOSTIC TESTING PRO- 

GRAM. Akhtar A, Childress J, Berry T, St. Louis 

College of Pharmacy. E-mail: aakhtar@stlcop.edu 

Objective: The objectives of this study are to (1) 

identify patients with multiple risk factors for contracting 

HIV, (2) educate individuals about appropriate 

strategies that may reduce their risk of contracting 

HIV, (3) provide preliminary results of HIV 

status, and (4) evaluate the impact of the availability 

of HIV screening in the setting of a community 

pharmacy. 

Methods: The study will be conducted at one primary 

community pharmacy with an opportunity to 

expand to other locations (within the same chain 

pharmacy) in the metropolitan area. The following 

subjects will be included: males and females ages 

18 years and older who possess risk factors for contracting 

HIV. Tests will be conducted using a rapid 

HIV-1 antibody test. Results of the test will be provided 

and subjects will receive pre- and posttest 

counseling. Subjects with negative test results will 

receive counseling on reducing high-risk behaviors. 

If these subjects engaged in high-risk behaviors in 

the 3 months prior to the test, a second test will be 

required in 3 months for confirmation. Subjects with 

a positive test result will receive counseling on preventing 

the transmission of HIV and be referred 

immediately to the local department of health for 

confirmatory testing and evaluation. All subjects 

will be contacted after 3 months to determine if further 

testing was needed and performed and to discuss 

implementation of risk reduction strategies. 

Results: Subject recruitment will begin in 

January 2004 and enrollment is anticipated to continue 

until 50 subjects are included. Evaluation of 

objectives will consist of documenting risk factors, 

giving subjects a posttest to assess understanding of 

risk reduction strategies, detection of HIV status, 

and completion of a survey to determine their attitude 

and receptivity toward HIV screening in this 

environment. Preliminary data will be evaluated and 

analysis of these data will be presented. 


139—ASSESSING THE IMPACT OF PER- 

FORMING BODY COMPOSITION ANALY- 

SIS ON OVERWEIGHT AND OBESE INDI- 

VIDUALS IN A COMMUNITY PHARMACY. 

Paulson K, Walgreens. E-mail: kellipaulson@ 

yahoo.com 


to provide overweight and obese patients with education 

and motivation for proper weight management. 

Body composition analysis will be provided 

as a pharmacy service along with the education and 

motivation for appropriate weight management. 

Methods: The project is designed to assess the 

knowledge and motivation of patients in a community 

pharmacy setting. Throughout the study, 

patients will have their body composition measured 

twice. At the initial screening, the patients will have 

their body composition measured and will be provided 

with education about their current body composition 

status. They will also be provided with 

techniques for appropriate weight management and 

their motivation will be assessed. Throughout a 3- 

month period, the patient will monitor their weight 

at home. When the patient returns to the site after 3- 

months they will have their body composition re- 




FEATURE 

measured and will have their knowledge and motivation 

reassessed. The patients will also be surveyed 

about their satisfaction with the service and their 

willingness to pay for future visits. The data collected 

will be assessed for any changes in body composition, 

weight, and motivation. All of the data will 

be analyzed for statistical significance, with a written 

report to be submitted for publication. 

Results: Preliminary results show positive 

patient satisfaction in body composition analysis 

performed in a community pharmacy setting as well 

as an increase in overall weight management knowledge 

among this population. 

Conclusions: Conclusions of this study will be 

determined upon completion. 

140—ASSESSMENT OF THE CON- 

SUMER’S SELF-CARE AND OVER-THE- 

COUNTER MEDICATION KNOWLEDGE 

WITH AND WITHOUT PHARMACIST 

INTERVENTION IN A COMMUNITY PHAR- 

MACY POPULATION. Downing J, Kerr 

Drug/UNC Chapel Hill School of Pharmacy, Brown 

L, Kerr Drug Clinical Services, Ferreri S, University 

of North Carolina. E-mail: jnorris2@Email.unc.edu 


to assess the knowledge of self-care and over-thecounter 

(OTC) medications in the community pharmacy 

population. The secondary objective of this 

study is to evaluate the effects of the pharmacist’s 

educational intervention on self-care and OTC medications. 

Methods: In this pilot study, volunteers complete 

a survey at the drop-off window in Kerr Drug pharmacy 

or before attending a scheduled educational 

program. The survey consists of five questions with 

multiple choice answers. Surveys 1 and 2 are general 

self-care and OTC medications questionnaires. 

Survey 3 is a self-care and OTC medication questionnaire 

designed specifically for consumers with 

diabetes. Customers who wish to attend an educational 

program on self-care indicate this desire my 

checking a box on the survey. Surveys will be collected 

at the drop-off window in a collection box. 

Only the investigators will read and analyze the data 

and will subsequently determine the self-care 

knowledge base of the community pharmacy population. 

Subjects will be recruited to attend a free 

educational program at Kerr Drug by the surveys, 

flyers, and word-of-mouth advertising. The educational 

program will consist of 10 subjects per program 

in a private classroom within Kerr Drug. At 

least 20 persons from surveys 1 and 2 and at least 10 

persons from survey 3 will be recruited for the educational 

program. Incentive to attend the program 

will consist of a coupon for $10 off any of the services 

offered in the Kerr Health Care Center. The 

community pharmacy resident will present a 20–30 

minute walking education tour of the OTC medication 

aisles followed by a 10–15 minute question and 

answer session. Subjects will then be asked to complete 

the same survey that was filled out before the 

educational program. Data will be collected and preand 

postprogram surveys will be compared by the 

community pharmacy resident. 

Results: NA. 


141—COMMUNITY PHARMACISTS’ USE 

OF INTERNET RESOURCES CONTAINING 

PATIENT EDUCATION MATERIALS. Cruse 

E, University of Tennessee and Chase Drugs, 

Johnson S, Hill L, Chase Drugs and Clinical 

Services, Timpe E, University of Tennessee, Hardin 

M, Chase Drugs and Clinical Services. E-mail: 

eperkins@mix.wvu.edu 

Objective: Community pharmacists are accessible 

to patients and are in a position to provide valuable 

education regarding a multitude of disease 

states and therapeutic modalities. The Internet has 

become a useful tool for health information, but 

using it to retrieve information can be daunting for 

patients and health care professionals alike. Several 

reliable sources for patient education materials are 

available on the Internet; these resources are often 

underused by pharmacists. The objectives of this 

study are to: (1) determine community pharmacists’ 

use of Internet resources containing patient education 

materials, (2) identify barriers to community 

pharmacists’ use of Internet resources containing 

patient education materials, and (3) educate community 

pharmacists about patient education materials 

on the Internet by distributing written materials 

that can assist them in the utilization of Internet 

resources to enhance patient care. 

Methods: Surveys asking questions about the use 

of and barriers to using patient education materials 

from the Internet will be mailed to the attention of 

the pharmacist-in-charge at 217 pharmacies in the 

state of Tennessee. The pharmacies will be randomly 

identified using an alphabetical list provided by 

the State Board of Pharmacy. The pharmacist-incharge 

at every seventh pharmacy on the list will 

receive a survey. A self-addressed, stamped envelope 

will be provided for return of surveys. 

Responses to each question will be recorded into 

tables and a statistician will assist in determining 

statistical significance. 

Results: The deadline for completion of surveys 

is January 15, 2004. Data analysis will be completed 

by February 15, 2004. The follow-up resource, 

currently being developed with the assistance of a 

faculty member at the University of Tennessee Drug 

Information Center, will be mailed March 1, 2004. 

Results from this study will be available at the time 

of the APhA annual meeting and exposition in 2004. 


142—EFFECTS OF A PHARMACY-BASED 

PHYSICAL ACTIVITY EDUCATION PRO- 

GRAM USING STEP-COUNTERS. Cole R, 

Leesburg Pharmacy, Ahrens R, Shenandoah 

University. E-mail: becaboo83@hotmail.com 

Objective: The purpose of this study is to: (1) 

create and implement a pharmacist-directed physical 

activity education program in a community 

pharmacy setting, (2) educate patients about the 

importance and benefits of physical activity, and (3) 

measure the effectiveness of a pharmacist-directed 

physical activity program in increasing patient 

activity levels and improving clinical measurements. 

Methods: This pharmacist-directed study will 

take place in a community pharmacy in Northern 

Virginia, enrolling 35 patients. The physical activity 

program, consisting of walking only, will be a 

structured 6-week program, of which weeks 0–2 are 

the control period and weeks 2–6 are the active period. 

Patients will return to the pharmacy weeks 2, 4 

and 6 for a total of four study visits. At their initial 

visit, a patient history and clinical measurements, 

including blood pressure, height, weight, and waist 

circumference, will be taken. Patients will be given 

a free step-counter, instructed on its use, and asked 

to record daily number of steps taken to determine 

their approximate daily activity level prior to the 

educational intervention. At week 2, activity logs 

will be collected and clinical measurements retaken. 

Education will be given by the pharmacist on the 

benefits of physical activity, exercise techniques, 

and behavior modification. During weeks 2–6, 

patients will continue to record daily number of 

steps taken and return at weeks 4 and 6 for visits 

with the pharmacist. These visits will consist of 

clinical measurements and collection of daily activity 

logs. 

Results: The effectiveness of the education program 

will be evaluated by comparing activity levels, 

as measured by the step-counter, pre- and posteducational 

intervention. Clinical measurements will be 

evaluated to assess changes 

Conclusions: It is anticipated that patients’ physical 

activity will increase and clinical measurements 

will improve. 

143—ELDERLY HOME CARE MEDICA- 

TION MANAGEMENT SERVICE BY COM- 

MUNITY PHARMACISTS. Haughaboo A, 

Community Pharmacy Care. E-mail: haughaam@ 

E-mail.uc.edu 

Objective: In the United States, adverse drug 

events are a major problem for the elderly. The purpose 

of this study is to provide home medication 

management to the elderly and to provide patient 

education on medications, disease states, and wellness 

in an effort to decrease adverse drug events and 

deliver a pleasing patient interactive service. 

Methods: Candidates for the service will be 

recruited from senior residential facilities via presentation 

of the service. Brochures and word-ofmouth 

will be additional mechanisms of recruitment. 

Approximately 25 patients will be selected for 

this program. Initial and follow-up visits will be 

conducted to provide medication management and 

patient education on the treatment and prevention of 

high-risk disease states. Each patient will receive a 

portfolio including disease state information and 

their medication profile. The portfolio will be routinely 

updated. Recommendations to physicians for 

changes in medication therapy, such as inappropriate 

patient use of medication, inappropriate prescribing, 

duplicate therapy, therapy with no indica- 





tion, indication with no therapy, drug–drug interactions, 

and drug–disease interactions will be recorded. 

The number of interventions will be used to 

measure the ability of the community pharmacist to 

decrease adverse drug events. Results will be used 

to asses the impact of a community pharmacist on 

the pharmacotherapy of elderly patients. A patient 

satisfaction survey will be used to determine the 

value of the service and an individual’s willingness 

to pay out of pocket. 

Results: Data collection will begin in January 

2004. 

Conclusions: It is anticipated that the preliminary 

data will demonstrate the impact of community 

pharmacists’ ability to provide a pharmaceutical 

care home service and potentially a new method for 

reimbursement. This service is expected to improve 

elderly satisfaction with pharmacists and decrease 

the number of adverse drug events an elderly individual 

may incur. 

144—ENHANCING PATIENT SAFETY BY 

IMPROVING A CQI PROGRAM WITH EDU- 

CATION AND TECHNOLOGY IN A SUPER- 

MARKET CHAIN PHARMACY. Jones K, 

Goode J, Virginia Commonwealth University, 

Swiger K, Beckner J, Ukrop’s Super Markets, Inc., 

Hermann K, Virginia Commonwealth University. 

E-mail: kpjones@vcu.org 

Objective: To observe and assess workflow processes 

to determine trends, significance, frequency 

and outcomes on near-miss prescription incidents 

(incidents caught before reaching patient) and prescription 

incidents with the current CQI program. 

To evaluate if an education and reminder program 

and/or system change with improved dispensing 

technology will increase pharmacists’ comfort with 

the current CQI program and decrease near-miss 

prescription incidents. 

Methods: This is a prospective, matched control, 

year-long study conducted in eight super market 

pharmacies in Richmond, Virginia with an active 

CQI program. The CQI program includes documentation 

and analysis of prescription incidents. The 

pharmacies will be divided into two groups (an 

active and control group) consisting of four stores 

each. The initial phase of the study will include a 4- 

hour system analysis conducted by the investigators 

to assess workflow processes and adherence to the 

current CQI program. From the system analysis 

information, a continuous education program and E- 

mail reminder system will be developed for all staff. 

All sites will receive the education component, 

while only the active sites will receive new technology 

for the dispensing system. Data will be collected 

for 6 months and prescription incidents will be 

compared between stores and with the previous 

year’s data. Pharmacists’ comfort and confidence 

with the CQI program will be assessed with a preand 

postsurvey. 

Results: Observations have been made in four of 

the eight stores. The same problem areas were discovered 

in the workflow process and will be targeted 

for system change and education. 

Conclusions: It is anticipated that this project 

will result in improvement of pharmacists’ comfort 

with the CQI program and additional lowering of 

near-miss and prescription incidents. 

145—EVALUATING THE COST-EFFEC- 

TIVENESS OF THE FLORIDA MEDICAID 

QUALITY-RELATED EVENTS STUDY: A 

COMMUNITY PHARMACY PERSPECTIVE. 

Agboh B, Eckerd/Ohio Northern University 

Community Pharmacy Practice Residency, Sullivan 

D, Ohio Northern University. E-mail: bagboh@eckerd.com 

Objective: Recognizing the need for proper 

counseling among Medicaid patients, the Florida 

Agency for Health Care Administration has organized 

a pilot project to encourage pharmacists from 

all community pharmacies located in certain counties 

to identify, resolve, and document quality-related 

events (QREs) and also to provide patient education 

and follow-up for new prescriptions. Proper 

documentation will allow pharmacies to be reimbursed 

$7 for education and follow-up of each new 

prescription, $10 for each QRE involving patient 

compliance, and $15 for each QRE requiring physician 

consultation. The amount of reimbursement for 

cognitive services has not been adequately evaluated 

for cost-effectiveness. The primary objective of 

this study is to determine if it is cost-effective for a 

community pharmacy to participate in the Florida 

Medicaid Quality-Related Events program. A secondary 

objective is to determine if cost-effectiveness 

changes based on the class of medication. 

Methods: Ten Eckerd pharmacists actively participating 

in the Florida Medicaid Quality-Related 

Events Study will be selected to record the amount 

of time spent counseling, following up on new prescriptions, 

documenting and submitting QREs, correcting 

QRE claims that have been rejected, and 

time spent on miscellaneous events related to processing 

claims. A data collection sheet will be 

designed for documentation of time spent for each 

activity and the medication involved for each claim. 

A total of 10–15 QRE claims from each pharmacist 

will be evaluated for time spent and medication 

involved. Ancillary and administrative personnel 

responsible for inputting claims will also record the 

time spent in completing this task and medication 

involved. All costs associated with each QRE claim 

including salary, computer time, etc. will be evaluated. 

These costs will be compared with the reimbursement 

fees to determine if participation in 

Florida Medicaid’s QREs program is cost-effective 

and to determine if the medication class changes 

cost-effectiveness. 

Results: NA. 


146—EVALUATION OF AN INCENTIVE 

PROGRAM ON ADHERENCE RATES IN A 

COMMUNITY PRACTICE SETTING. Frasco 

A, Whitaker A, Goode J, Virginia Commonwealth 

University. E-mail: andyfrasco@hotmail.com 

Objective: The purpose of this study will be to 

evaluate the effect of an incentive program on 

adherence rates. The study will focus on medications 

specifically related to the treatment of blood 

pressure, diabetes, cholesterol, and depression. 

Methods: We will be conducting reviews of 

patient medication profiles in a mass-merchandise, 

community pharmacy setting. An experimental 

aspect will be introduced in the form of a financial 

incentive to determine changes in adherence. The 

study’s primary endpoints will be increased 

Medication Possession Ratio (MPR) and analysis of 

on-time refills. Patients will be asked to sign consent 

forms to participate in the study, after being 

selected from refill history profiles established by 

pharmacy reports. These reports are generated periodically 

by the pharmacy on all prescription department 

patients. Patients who have a 3-month refill 

history for medications from our indicated therapeutic 

categories will be targeted for our incentive 

program. We will exclude medications with a 

reminder system built into the packaging. When 

patients enroll in the study, they will receive a gift 

card in exchange for permission to review their 

medication profile. After the study begins, 3-month 

prospective refill history will be assessed and compared 

with a 3-month retrospective refill history in 

order to assess any adherence changes that may 

have been affected by the incentive program. 

Patients will be categorized based on class of medication, 

as defined by computer disease-state codes. 

This data will be used to subdivide the study population 

by disease state. With this information, we 

will calculate the Medication Possession Ratios 

(MPR). The goal is to assess MPR for the 3 months 

prior to the receipt of the gift card, and compare it 

with the MPR for the 3 months after implementation 

of the incentive. By comparing the MPRs for preand 

post-gift card receipt, we hope to determine the 

impact of an incentive on patient adherence. 

Results: When the study concludes, data will be 

analyzed by various methods of categorization and 

comparison statistics. All data will be de-identified, 

so that only medication name, dose and regimen, 

therapeutic class, and refill history will remain 

attached to the records. 

Conclusions: The adherence reports previously 

published reveal an alarming trend. It is our hope 

that an incentive will encourage patients to increase 

medication adherence. 

147—EVALUATION OF EXISTING 

PATIENT DATA FROM A COMMUNITY 

PHARMACY-BASED ASTHMA PROGRAM. 

Ward M, University of Florida/Walgreens, Weitzel 

K, University of Florida, Brad V, Walgreens, Leslie 

H, Asmus M, University of Florida. E-mail: 

mw696@aol.com 

Objective: The role of the community pharmacist 

in patient care has evolved beyond traditional medication 

dispensing to include clinical responsibilities such 

as disease state management in diabetes, hypertension, 

dyslipidemia, and asthma. This project will analyze 

data already being collected through an asthma patient 

care service in a community pharmacy. The analysis 

will focus on whether measuring pulmonary function 

identifies a greater proportion of patients with poor 

asthma control than symptom analysis alone. 




FEATURE 

Methods: Design: Retrospective chart analysis 

Setting: Four community chain pharmacies in 

Gainesville, Florida. Patients: Those offered an 

existing asthma education service. Data Collection: 

Currently, asthma patients are evaluated by National 

Heart, Lung, and Blood Institute (NHLBI) 

Symptom Assessment, spirometry, and NHLBI control 

classification by symptoms to determine 

whether their asthma is controlled or uncontrolled. 

Patients with a ratio < 0.8 for forced expiratory volume 

in 1 second (FEV1) over forced vital capacity 

(FVC) predicted demonstrate airway obstruction 

and are classified as having poor asthma control. 

Based on symptom assessment and spirometry measurement, 

patients are classified into four different 

categories (i.e., mild intermittent, mild persistent, 

moderate persistent, and severe persistent). A drug 

therapy assessment is performed on patients who 

are determined to be uncontrolled upon evaluation. 

Patients’ primary care providers are contacted by 

phone and by mail with recommendations for 

changes in therapy. After 6 months of providing the 

asthma service, patient charts will be reviewed. 

Analysis Plan: The primary outcome measures will 

be asthma control based on symptoms versus symptoms 

and FEV1 and whether pharmacist contacting 

physician resulted in change in therapy. Data collection 

will include: comparison of the number of 

patients controlled by symptoms versus those controlled 

by symptoms and FEV1; comparison of 

mean FEV1 in controlled and noncontrolled 

patients; and comparison of the number of recommendations 

for changes to therapy versus the number 

of those accepted. Other Appropriate Qualitative 

Measures: NA. 

Results: Pending. 

Conclusions: We hypothesize that the use of 

spirometry in the community setting may increase 

the number of patients detected with poor asthma 

control and result in changes to therapy that may 

improve patient outcomes. 

148—EVALUATION OF PHARMACIST 

INTERVENTIONS IN A COMMUNITY 

PHARMACY–BASED OSTEOPOROSIS 

SCREENING PROGRAM. Capka M, Happy 

Harry’s Discount Drugs. E-mail: dragonmount4@ 

hotmail.com 

Objective: To determine the outcomes of pharmacist 

intervention on screened patients at risk for 

osteoporosis and to determine the percentage of 

screened patients that are initiated on medications. 

Methods: Patients at increased risk for hip fracture 

(defined as any postmenopausal woman satisfying 

one of the following criteria: age older than 65 

years, personal history of fracture, first degree relative 

with history of fracture, currently smoking, oral 

corticosteroid treatment lasting longer than 3 

months, thyroid medication use, and anticonvulsant 

use) will be included in the study. Exclusion criteria 

include those patients already on bisphosphonates, 

selective estrogen receptor modulators, calcitonin or 

estrogen therapy as well as those with a history of 

fractures in both ankles. Patients will be recruited by 

on-site promotional materials, senior center visits 

and identification through prescription profiles with 

a goal of attaining 50 screened patients. These 

patients will be scanned in a community pharmacy 

setting using a Lunar Achilles Express bone densitometer. 

All screened patients will receive educational 

materials containing general information 

regarding osteoporosis and its management as well 

as strategies to help lower the risk of fracture. Those 

patients who receive a Stiffness Index T-score or 

Stiffness Index Z-score of < –1.0 will be referred to 

the primary care physician and for completeness, 

the physician will be made aware of both the T- and 

Z-scores via fax. Patients will be followed up via 

telephone interviews at 1-month and 3-month intervals 

post screening. Primary endpoints of the study 

include the percentage of screened patients who are 

referred to their physician, the percentage of 

referred patients who see their physician, the percentage 

of screened patients placed on medication 

to treat osteoporosis or osteopenia, the percentage of 

referred patients placed on medication to treat 

osteoporosis or osteopenia and the percentage of 

referred patients who have increased their calcium 

intake or amount of weight-bearing exercises. 

Results: NA. 


149—EVALUATION OF PHARMACY STU- 

DENTS’ ATTITUDES AND INTEREST ON 

ADMINISTERING ADULT IMMUNIZA- 

TIONS AS A HEALTH CARE SERVICE. Akala 

F, Powers M, University of Toledo. E-mail: 

folasade.akala@utoledo.edu 

Objective: To gain a better understanding and 

determine the attitudes and interest of pharmacy students 

toward the administration of adult immunizations. 

The study will also determine how receptive 

pharmacy students are toward providing this valuable 

health care service. 

Methods: A survey questionnaire evaluating the 

attitudes and interest of students will be conducted 

during December 2003 to PharmD students at a college 

of pharmacy. 209 students (n = 105 first professional 

year and n = 104 second professional year) 

are expected to participate in the survey. Surveys 

will be distributed in a classroom setting in which 

participation is voluntary. The survey consists of 

questions that either require responses in the form of 

a 5-point Likert scale (A = strongly agree, E= 

strongly disagree) or are dichotomous questions that 

require either a “Yes” or “No” response. The questions 

are divided into three subcategories (1) perceived 

barriers to immunization; (2) knowledge and 

interest; and (3) student demographics. The data 

collected will be analyzed using SPSS to determine 

correlations and compare differences and similarities 

in the interest and attitudes of students in the 

two classes. 

Results: Once data collection is complete and 

analyzed, the results will be used as a tool in designing 

an immunization-training course to be incorporated 

in the pharmacy curriculum. 

Conclusions: Pharmacists are the most accessible 

health care professionals in the community and 

because they are so accessible they can provide a 

range of health services, including immunizations. 

Since many pharmacy students will become the new 

practitioners in community pharmacies, it is essential 

to train and prepare pharmacy students to be 

competent in providing pharmaceutical care services. 

To prepare these students, their attitudes and 

interest in providing these services must be understood. 

150—EVALUATION OF THE EFFECTIVE- 

NESS OF COMPUTER-GENERATED MEAL 

PLANNING WITH BEHAVIORAL COUN- 

SELING SESSIONS TO PROMOTE WEIGHT 

LOSS. Devizia R, Kerr Drug and Campbell 

University, Greck B, Kerr Drug. E-mail: 

rjd08@yahoo.com 

Objective: The primary outcome is to evaluate 

the change in weight and body mass index among 

participants. Secondary outcomes will include 

changes in fasting blood glucose, waist circumference, 

blood pressure, and cholesterol. 

Methods: A single-center randomized, quasiexperimental, 

longitudinal pre–post cohort study 

conducted in Asheville, NC. DIME (Diabetes 

Information Management and Evaluation Program) 

is the computer-generated meal planning program 

that will be used. During the first visit all baseline 

measurements will be obtained. These measurements 

consist of a cholesterol panel using the 

Cholestech LDX, weight, height, waist circumference, 

blood pressure using an automated Omron 

blood pressure monitor, and a fasting blood glucose 

using the One Touch Ultra glucometer. Each patient 

will generate a 2-week patient specific meal plan 

with assistance from a pharmacist. During the initial 

session, the participants in the intervention group 

will develop goals to be met throughout the 12- 

week period. Participants in the intervention group 

will receive training in behavior modification, exercise 

routine establishment, and meal planning in 

order to meet these goals. After the initial session, 

the intervention group will return every 4 weeks for 

the opportunity to adjust meal plans. Measurements 

of weight, waist circumference, and blood pressure 

will be collected at each of these sessions. 

Cholesterol and fasting blood glucose will be done 

at the end of the 12-week period. The goals developed 

in the initial session will be assessed at each 4- 

week session and adjusted as necessary. Long-term 

weight management assessment will be assessed at 

24 weeks. This will be done only if time allows and 

the 24th week does not fall after July 1, 2004. 

Results: To be collected, assessed, and presented 

at the March 2004 APhA meeting and the 

Southeastern Residency Conference in May 2004. 

Conclusions: This study should demonstrate the 

effectiveness of community pharmacists in helping 

patients set attainable weight loss goals that are safe 

and effective. 

151—EVALUATION OF THE IMPACT OF 

A CLINICAL PHARMACIST ON FAMILY 

MEDICINE RESIDENTS’ DRUG KNOWL- 





EDGE BASED ON A NATIONAL STANDARD- 

IZED EXAM. Craft K, Mehra Harris I, University 

of Minnesota. E-mail: craft006@umn.edu 


the impact of regular interactions with a clinical 

pharmacist on family medicine residents’ drug 

knowledge based on a national standardized exam. 

Pharmacists are actively involved in 26.7% of family 

medicine residency programs. The effect of clinical 

pharmacists’ involvement on a resident’s 

understanding of drug therapy is unknown. Family 

medicine residents are required to take a yearly standardized 

exam, with a passing requirement, in 

preparation for the board exam. This In-Training 

Exam, from the American Board of Family Practice, 

is a general exam encompassing all areas of family 

medicine, including pharmacotherapy. 

Methods: The In-Training Exam does not have a 

separate category for drug-related questions. The 

exams for the past 3 years will be reviewed to determine 

which questions are drug related. The performance 

on the drug-related questions relative to the 

composite exam score will be compared between 

groups. Our family medicine residency program, 

which has pharmacist involvement, will be compared 

with a control group of residents in two other 

programs in areas that do not have pharmacist 

involvement. A separate analysis will compare performance 

in each of the 3 years of training the resident 

is in with fellow residents in the programs 

without a pharmacist. 

Results: NA. 


152—IMPACT ON MEN’S HEALTH: CO- 

ADMINISTRATION OF A STANDARDIZED 

SCREENING TOOL AND DIRECT PATIENT 

CARE SERVICES. Hammond J, American 

Pharmacy Services Corporation/ University of 

Kentucky, Mcintosh T, American Pharmacy 

Services Corporation, Freeman T, APSC 

Foundation for Education and Research, Inc., 

Blumenschein K, University of Kentucky. E-mail: 

jhammond@apscnet.com 

Objective: To determine if independent community 

pharmacists can identify men at risk for chronic 

disease and impact their access to health care, 

quality of life (QOL), and general satisfaction with 

pharmacy services using a standardized screening 

tool in combination with direct patient care services. 

Methods: Two pharmacy sites will be identified 

for subject recruitment; a control site and an intervention 

site. At each site, patients will be recruited 

and asked to complete an SF-12 to assess QOL and 

a questionnaire to obtain demographics and information 

on health care access and patient satisfaction. 

Recruited patients will be screened using a 

standardized screening tool—the Men’s Health Risk 

Assessment Tool (MHRAT) until 25 patients at 

each site are identified at risk for chronic disease. 

Intervention-site patients determined to be at risk 

will be asked to schedule an appointment with the 

pharmacist within 2 weeks of screening for education 

and direct patient care services using CLIAwaived 

testing devices. Intervention patients will be 

encouraged to schedule physician visits based on 

MHRAT results and objective test results. Controlsite 

patients identified at risk will be counseled to 

schedule a physician visit after completing the initial 

MHRAT screening; they will not receive any 

additional patient care services or education from 

the pharmacist. Six weeks postscreening, pharmacists 

at both sites will call patients to schedule 

appointments for completion of postintervention 

surveys and questionnaires. The pharmacists’ interventions 

will be considered a success if patients 

identified at risk accessed health care services or 

scheduled appointments to access care. 

Results: Pharmacist-intervention success rates 

between groups will be analyzed using the chisquare 

statistic; results from the SF-12 and patient 

questionnaire assessing access-to-care and satisfaction 

with pharmacy services will be analyzed using 

appropriate statistical tests. 

Conclusions: It is anticipated that independent 

community pharmacists can positively impact men’s 

access to health care, QOL and satisfaction with pharmacy 

services by administering MHRAT screenings. 

It is also anticipated that those pharmacists providing 

direct patient care services in addition to MHRAT 

screenings will have a greater impact than those providing 

screening services alone. 

153—IMPLEMENTATION AND EVALUA- 

TION OF A SMOKING CESSATION PRO- 

GRAM FACILITATED BY COMMUNITY 

PHARMACISTS. Wilhelm M, Balls Food Stores, 

Kerner S, Balls Foods. E-mail: schuster@kualumni.org 

Objective: The goals of the project are to: (1) 

assist patients to quit smoking, (2) measure patient 

success rate, and (3) evaluate patient satisfaction of 

the program. 

Methods: The American Lung Association’s 

Freedom from Smoking program offers a systematic 

approach to quitting by progressing patients from 

awareness of the smoking habit to behavioral 

changes. Two community pharmacists will facilitate 

the program on a corporate campus. Marketing techniques 

will include: (1) campus television ads, (2) 

tabletop cafeteria ads, (3) break area posters, and (4) 

a counter sign in the campus pharmacy. Patients will 

enroll in the seven-session program. A survey will 

be conducted during the last session, at 3 weeks, and 

6 weeks after completion of the program. Data from 

the survey will be evaluated for quitting success rate 

and patient satisfaction of the program. 

Results: The study is expected to assist patients 

in becoming smoke free. Patient acceptance of the 

program will be determined. 

Conclusions: The results will provide information 

to community pharmacists on the success of 

implementing and evaluating a smoking cessation 

program. 

154—IMPLEMENTATION OF EXPANDED 

PHARMACIST-PROVIDED CARE IN A FAM- 

ILY PRACTICE CLINIC. Bratten S, University 

of Iowa, Shepley A, Shepley Pharmacy, Currie J, 

University of Iowa, Brandt K, Mt. Vernon Family 

Practice, Ernst M, University of Iowa, Farris K, 

University of Iowa, Jackson A, Clark R, Shepley 

Pharmacy. E-mail: shelly-bratten@uiowa.edu 

Objective: This paper describes and evaluates the 

expansion of pharmacist-provided care services in a 

family practice clinic. 

Methods: Design: A process and impact evaluation 

will be conducted after program implementation. 

This study will take place in a family practice 

clinic currently utilizing a clinical pharmacist to 

manage anticoagulation services. Program 

Development: A community pharmacy initiated discussions 

with a local family practice clinic to 

expand the scope and extent of services being 

offered. After introductory discussions, pharmacy 

staff members outlined potential services to be 

delivered. Gaps in clinical services, patient education 

opportunities and patient groups who could 

benefit from working with pharmacists were identified. 

Pharmacists began working with the current 

clinical pharmacist in the practice to become familiar 

with clinic procedures. Clinic times and administrative 

procedures are in development. Program 

Implementation: Program implementation began 

September 2003. Evaluation: To describe the processes 

of the new service(s), data will be collected 

on number and type of patients seen, types of drug 

therapy problems identified, recommendations 

made and accepted, estimates of cost savings for 

patients by resolved drug therapy problems and time 

required for service provision. The impact of the 

service will be evaluated by quantifying revenues 

generated, the percent of patients with controlled 

disease states, and patient and physician satisfaction. 

Results: To be presented. 

Conclusions: Collected data will be used to 

describe the program and assess the impact of the 

enhanced physician–pharmacist relationship in the 

comprehensive care of patients in a family practice 

clinic. 

155—OUTCOMES OF A DIABETES CARE 

PROGRAM IN A CHAIN COMMUNITY 

PHARMACY SETTING. Patel U, University of 

Maryland, Baltimore, Rodriguez De Bittner M, 

University of Maryland at Baltimore, Layson-Wolf 

C, University of Maryland, Baltimore. E-mail: upatel@rx.umaryland.edu 

Objective: (1) Measure the clinical and humanistic 

outcomes of a pharmacist-managed diabetes care 

program in a chain community pharmacy. (2) 

Assess the economic impact of a diabetes care program 

for a chain community pharmacy. 

Methods: This is a retrospective study. Data 

from the Diabetes Care Program at Giant Pharmacy 

collected between November 1998 and September 

2003 will be evaluated. Participating patients are 

greater than 18 years of age and have type 1 or type 

2 diabetes. All patients included in the study have 

completed the eight-session diabetes care program. 

Patients who did not complete all eight sessions will 

be excluded. The outcomes measured include both 

clinical and humanistic. Clinical outcomes include 

hemoglobin A1c, blood pressure, weight, total 




FEATURE 

cholesterol, LDL, and HDL. Outcomes will be measured 

pre- and postprogram. Humanistic outcomes 

include patient’s pre- and postprogram quality of 

life, knowledge, and satisfaction. The quality-of-life 

survey from the Diabetes Control and 

Complications Trial was used for this study. 

Economic impact will be assessed from the income 

generated and expenses incurred for the program. 

The income generated from the program includes 

the fee for services, prescription sales, and sales of 

monitoring supplies. The pharmacy’s prescription 

database will be used to assess prescription sales. A 

survey will be sent to patients who completed the 

program to determine their use of monitoring supplies. 

Expenses incurred for the program includes 

pharmacist’s time, marketing supplies, and other 

expenses incurred during the sessions. 

Results: NA. 

Conclusions: It is anticipated that a pharmacistbased 

diabetes education program will improve 

patients’ clinical and humanistic outcomes. The 

results of this study will confirm or reject this conclusion. 

156—OUTCOMES OF A PHARMACIST- 

MANAGED TOBACCO-CESSATION PRO- 

GRAM IN A PRIVATE, RETAIL PHARMACY 

CLINIC. Haskins J, Pope N, University of Texas at 

Austin. E-mail: jessicahaskins@yahoo.com 

Objective: To measure the effectiveness of a 

tobacco-cessation program through pharmacist’s 

intervention in a private clinic. 

Methods: Setting: The Patient Care Center is a 

two-room clinic within a Walgreens store in Austin, 

Texas. Methods: Subjects will be recruited through 

referrals from health care professionals, advertisements, 

and patients in other programs conducted at 

the clinic. Included subjects will be men and 

women, age 18 years or older, who currently use 

tobacco products. Pregnant females and those currently 

enrolled in a tobacco cessation program will 

be excluded. Informed consent will be obtained 

from each participant prior to enrollment. Subjects 

will be enrolled in a 6-week tobacco cessation program 

with a fee paid on the initial visit. The program 

module will follow the U.S. Department of 

Health and Human Services Treating Tobacco Use 

and Dependence, Clinical Practice Guidelines. At 

enrollment, the initial 1-hour visit will consist of 

demographic collection, determining a quit date, 

education about techniques for quitting, recommendations 

for OTC cessation product use, and necessity 

for physician referral. One 30-minute visit will 

occur on the quit date, and a second 30-minute follow-up 

visit will occur 1 week after the quit date. 

Subjects will be contacted by phone weekly for the 

remainder of the program. Outcomes of intervention 

will be collected by phone after the end of the program 

every 2 weeks for 3 months. Data collection 

will consist of changes from baseline demographics, 

length of cessation, and assessment of successful 

intervention techniques in this setting. 

Results: To be determined. 

Conclusions: The role of community pharmacist 

intervention in tobacco cessation in this unique setting 

will provide a model for community pharmacists 

in the future. Outcomes of this study will provide 

information to determine successful intervention 

techniques, lower health care costs, and 

improve quality of life. 

157—PERFORMNG A PHARMACY CARE 

SERVICE NEEDS ASSESSMENT IN AN 

INDEPENDENT COMMUNITY PHARMACY. 

Cinelli E, Cerulli J, Albany College of Pharmacy. E- 

mail: cinellie@acp.edu 

Objective: To determine pharmacy care services 

desired and patients’ willingness to pay out-ofpocket 

for those services. A secondary objective is 

to receive feedback from the pharmacy staff on the 

effectiveness of current marketing strategies. 

Methods: A self-administered needs assessment 

was developed to determine pharmacy care services 

desired. It is being distributed to patients with prescriptions 

accompanied by a self-addressed, 

stamped reply envelope. The survey asked patients 

to identify pharmacy care services that interest them 

and indicate the fee they would be willing to pay for 

those services. A separate survey was developed to 

obtain staff input regarding the effectiveness of current 

marketing strategies such as usefulness of bag 

stuffers and the resident and staff roles in recruiting 

patients to the programs. 

Results: The needs assessment was piloted in late 

August. To date, about half of the responders were 

willing to pay out-of-pocket for some services. The 

most requested service was a weight loss program. 

Final numbers of services requested and willingness 

to pay will be reported. Staff survey responses were 

received by 9 out of 18 of the employees. Staff suggestions 

will be used to implement new marketing 

strategies, including providing pharmacy care service 

menus in physician’s offices and improving 

pharmacy signs to attract customers, remind staff 

and stimulate interest. 

Conclusions: Patient response to the survey will 

aid in determining the need for certain services and 

the patients’ willingness to pay. It is also projected 

that both surveys will help develop new or 

improved marketing strategies to expand patient and 

staff participation in the programs. 

158—PHARMACIST MANAGED DIA- 

BETES CLINIC: IMPROVING OUTCOMES 

FOR UNDERPRIVILEGED HISPANIC 

WOMEN. Gardner J, University of Houston, 

Adkison J, Memorial Hermann Southwest Hospital, 

Sansgiry S, University of Houston. E-mail: 

jennifer_gardner51@mhhs.org 

Objective: The incidence of diabetes mellitus 

(DM) is reaching epidemic proportions in the 

United States. The growing Hispanic American 

population is particularly affected, given their high 

number of risk factors and greater incidence of complications. 

Delivering health care to a patient with 

limited resources presents even more of a challenge 

in treating DM, because of his/her inability to afford 

medications, lack of transportation to the health care 

provider, psychosocial factors, etc. Diabetes mellitus 

is a complicated disease state that requires active 

participation from both the health care provider and 

the patient for optimal control and minimal complications. 

Clinical pharmacists are in the unique position 

to assist to this end, by suggesting alternative, 

more cost-effective medications, providing counseling 

to patients and families, and assisting with medical 

and financial issues as needed. The objective of 

this retrospective study is to examine clinical outcomes 

in Hispanic women who are patients in a 

pharmacist-managed indigent DM clinic. These 

results will be compared with a similar population 

receiving health care in a clinic not having clinical 

pharmacy involvement. 

Methods: Populations will include Hispanic 

females receiving care at the Memorial Family 

Practice Fort Bend pharmacist-managed clinic and 

those who are patients at the Memorial Family 

Practice Southwest clinic. Health outcomes examined 

will include glycosylated hemoglobin levels, 

lipids (LDL, HDL, triglycerides, and total cholesterol) 

levels and blood pressure readings. In addition, 

the study will obtain data to compare results at 

baseline and after pharmacist intervention. 

Pharmacist interventions include, but are not limited 

to, medication management, diabetic and dietary 

education, and medication counseling. In addition, 

satisfaction with care received at the clinic postintervention 

will be obtained. 

Results: Data collection is currently in progress 

and will be analyzed using SAS. It is anticipated 

that knowledge provided about the benefit of a pharmacist-managed 

diabetes clinic on controlling diabetes 

and improving heath outcomes, especially in 

Hispanic women, will enhance future interventions. 


159—PHARMACIST MANAGEMENT OF 

DIABETES IN AN ACUTE CARE SETTING 

USING A BASAL-BOLUS SUBCUTANEOUS 

INSULIN ORDER SET. Deloria G, Sampsel E, 

Lum G, Sharp Chula Vista Medical Center, Howard 

J, Sharp Grossmont Hospital. E-mail: gemma.deloria@sharp.com 

Objective: Optimizing glucose control in hospitalized 

diabetic patients has lead to decreased mortality, 

decreased postoperative infections, and 

decreased sternal wound infections. Whether the 

implementation of a standardized subcutaneous 

insulin order set (SIOS) will improve patient outcomes 

compared with conventional sliding scale 

insulin (SSI) and/or oral antidiabetic agents is 

unknown. 

Methods: Sharp Chula Vista Medical Center is a 

330-bed, tertiary care, nonteaching community hospital 

located in San Diego County. Up to 30% of 

patients admitted have a past medical history significant 

for diabetes. This standardized SIOS incorporates 

the use of long-acting insulin glargine 

(Lantus), as basal insulin, and rapid-acting insulin 

aspart (NovoLog), as prandial insulin to cover calories 

from meals via a sliding scale. The pharmacist 

will adjust insulin doses based upon patient-specific 

factors and individual needs in the acute care set- 





ting. We are performing a prospective, open-label 

pilot study of patients admitted to the telemetry unit 

and placed on the SIOS pursuant to a physician 

order. Our goal blood glucose range is 90–180 

mg/day. The control group will be randomized diabetic 

patients on the same unit who fit the same 

inclusion criteria, but did not receive the SIOS. 

Measured patient outcomes will include rates of 

infection, glucose control during hospitalization, 

and patient length of stay. Patient outcomes between 

the two groups will then be assessed and evaluated 

throughout hospital course until discharge. 

Results: We anticipate that optimizing glucose 

control through the implementation of a pharmacistmanaged 

SIOS will reduce the rates of infection 

during hospitalization, decrease patient length of 

stay, and improve glycemic control. 


160—PHARMACISTS’ PERCEPTIONS 

AND CONCERNS ABOUT BECOMING 

IMMUNIZATION PROVIDERS AND ISSUES 

AFFECTING PATIENTS’ ACCEPTANCE OF 

COMMUNITY PHARMACIST PROVIDERS. 

Johnson P, Barnett C, Mercer University. E-mail: 

akudo@bellsouth.net 

Objective: (1) To identify factors that pharmacists 

believe are barriers to provision of immunizations. 

(2) To measure the willingness of pharmacists 

to provide immunization services. (3) To measure 

pharmacists’ perceptions of factors for patients that 

present barriers to seeking immunization services. 

(4) To determine the factors that patients’ indicate 

affect their willingness to seek immunization services. 

Methods: Two groups of Kroger pharmacists 

will be selected. One group will consist of 200 pharmacists 

who have received training in immunization 

and another group of 200 will consist of pharmacists 

who have not received training. Kroger will provide 

a list of pharmacists in the Atlanta area who have 

and have not received training. A random sample of 

200 names will be selected from each list. The 

research design is a mail survey questionnaire. Both 

groups of pharmacists will be sent the same survey. 

The questionnaire will not be coded, so results will 

be anonymous. A replacement questionnaire will be 

sent to all the pharmacists after 2 weeks requesting 

that they complete the survey if they have not 

already done so. A list of Kroger pharmacies in the 

Atlanta area that do not participate in immunization 

services will be obtained. A random sample of 10 

pharmacies will be selected. The subjects are adult 

patrons of Kroger pharmacies where immunizations 

are not provided. The research design of this aspect 

of the study is an on-site questionnaire. A group of 

items on this questionnaire are the same as a group 

of items on the pharmacist questionnaire so that 

comparisons between the pharmacists and patients 

can be made. The principal investigator will provide 

each of these pharmacies with 50 questionnaires via 

a personal visit to the pharmacy. The pharmacists 

working at these pharmacies will be asked to give a 

survey with cover letter to adult patients waiting for 

prescriptions to be filled. The survey questionnaires 

will not be coded. A box will be provided for the 

patients to drop their completed surveys into. This 

will further ensure anonymity. Project Timeline: 

October 2003, selection of pharmacists (subjects) 

for pharmacist survey; selection of pharmacies for 

distribution of patient survey. November 1, 2003, 

mail pharmacist survey; deliver patient surveys to 

pharmacies. Nov 14, 2003, mail replacement pharmacist 

survey. December 2003–February 2004, data 

analysis. March 2004–May 2004, write-up results. 

Results: NA. 


161—PHARMACY EXPERIENCES AND 

PERCEPTIONS OF NEWLY ENROLLED 

PHARMACY STUDENTS. Huh J, Sorensen T, 

University of Minnesota. E-mail: 

huhx0007@umn.edu 

Objective: In newly enrolled pharmacy students: 

(1) identify the degree and type of pre-enrollment 

pharmacy experience; (2) analyze the impact of previous 

experience on perceptions of the role of pharmacists 

in health care. 

Methods: First-year pharmacy students at three 

Midwestern colleges of pharmacy were surveyed 

regarding previous pharmacy-related work experience. 

Surveys were distributed during school orientation 

or early in the first semester of enrollment. 

The survey instrument evaluated work experience 

and its relation to whether this was completed prior 

to choosing to pursue pharmacy as a career or after 

applying to schools. It also addressed the type of 

setting in which pharmacy-related experience was 

gained, observations of the type of work completed 

by pharmacists, and the perceptions of pharmacists’ 

responsibilities to medication dispensing and overall 

patient care. 

Results: Approximately 250 first-year pharmacy 

students received the survey in fall 2003. Data analysis 

will include assessment of whether previous 

experience and/or the setting of this experience 

affect perceptions of the role of pharmacists. 

Conclusions: When a profession is in the midst of 

changing its professional role, applicants to its 

schools may be basing their decision on observations 

of a role somewhat inconsistent with the profession’s 

desired future. It is prudent to determine the message 

the profession is sending potential pharmacy school 

applicants to ensure that those entering the profession 

are prepared to accept the expanding role of 

pharmacists in the health care system. 

162—PHYSICIANS’ PERCEPTIONS OF 

PHARMACISTS AS VACCINATORS. Welch A, 

Ferreri S, Caiola S, University of North Carolina at 

Chapel Hill. E-mail: acwelch@E-mail.unc.edu 

Objective: The objectives are to assess the awareness 

and support of physicians regarding pharmacists 

as vaccinators. This study also identifies the 

physicians’ common reasons for lack of support. 

Methods: A mail survey will be sent to the family 

practice physicians in North Carolina. Physician 

offices will be identified by the State Medical 

Board’s Web site using the physician locator function. 

Target areas will be the 255 towns and cities in 

the state with a local government. The survey will 

include a letter describing the intent of the study and 

return postage. The survey identifies how long the 

physician has been in practice, if vaccines are currently 

administered in their practice, and if the 

physician works closely with a pharmacist. A series 

of questions will be asked to assess physicians’ perceptions 

of pharmacists as vaccinators using a 

Likert scale. A follow-up letter will be sent in 3- 

weeks if no response. Results will be assessed using 

descriptive statistics. 

Results: Results are pending. 

Conclusions: The intent of the study is to provide 

pharmacists with a tool to use when approaching 

physicians on administering vaccines. With state 

regulations changing to favor pharmacists as vaccinators, 

the results may serve useful in marketing 

vaccination services. 

163—PROMOTING COLORECTAL CAN- 

CER AWARENESS AND SCREENING IN A 

RURAL COMMUNITY PHARMACY PRAC- 

TICE SETTING. Dolin D, Rite Aid Pharmacy, 

Meredith B, West Virginia University, Jacknowitz A, 

West Virginia University. E-mail: danipharmd@ aol.com 

Objective: This project will attempt to (1) 

increase colorectal cancer awareness and prevention 

through a community pharmacy-based education 

and screening program, (2) provide average and 

high-risk individuals with fecal occult blood tests 

(FOBT) for home use upon counseling and education 

by a pharmacist, (3) encourage colorectal 

screenings at appropriate intervals and foster communication 

between the patient and health care 

provider regarding colorectal cancer, and (4) determine 

if screening and education promote positive 

lifestyle modifications. 

Methods: Study participation will be offered to 

all pharmacy patrons and interested persons in the 

community. Colorectal cancer literature will be 

available in the pharmacy with pharmacists trained 

to answer patient inquiries. Participants will be individually 

educated in the pharmacy’s private counseling 

area regarding colorectal cancer, risk factors, 

and options for screening. FOBT will be distributed 

to average risk and high-risk individuals for home 

use upon providing instruction to the participant. 

Participants will contact the pharmacist with their 

results, and a brief questionnaire will be completed 

to determine whether colorectal cancer education 

and screening have influenced their health attitudes 

and practices. Providers will be notified of the test 

results and follow-up evaluated. 

Results: The objectives of this program will be 

evaluated for effectiveness by determining the number 

of participants who (1) receive literature on colorectal 

cancer, (2) rank as average and high risk 

according to American Cancer Society guidelines, 

receive FOBT through this initiative, (3) provide the 

results of their FOBT to the pharmacist, and followup 

with their health care provider for appropriate 

care/intervention, as well as (4) whether participants 

have improved their health practices and attitudes as 

a result of colorectal cancer education and screening. 

Conclusions: It is anticipated that knowledge of 




FEATURE 

colorectal cancer and its prevention will be 

increased with many patients receiving FOBT 

screening and education. Participants will establish 

appropriate screening habits, although continued 

education and reinforcement may be needed for 

enhancement of health attitudes and beliefs to occur. 

164—PROVISION OF WEIGHT MANAGE- 

MENT SERVICES BY A PHARMACIST IN A 

GROCERY STORE COMMUNITY PHARMA- 

CY. Hussein S, Briggs A, Dominick’s 

Pharmacy/Midwestern University, Zgarrick D, 

Midwestern University. E-mail: shusse@midwestern.edu 

Objective: The primary objective of the weight 

management program is for patients to safely lose 

weight, maintain lower body weight, and reduce 

risk of obesity-related disorders. The secondary 

objective is to assess patients’ satisfaction with the 

program, pharmacist, and pharmacy; likelihood of 

returning for other clinical services and prescription 

needs; and income generated from the program. 

Methods: Inclusion criteria: Men and women 

between the ages of 18 and 64 with a body mass 

index (BMI) of 25 to 34.9 kg/m 2 . Exclusion criteria: 

Pregnancy, lactation, psychiatric illness, bulimia, 

anorexia nervosa, substance abuse, cancer, severe 

gastrointestinal disease, renal or hepatic dysfunction, 

and recent start of a thyroid hormone. A medical 

release form authorizing the start of the program 

and physical activity regimen will be obtained from 

the physician. The program will involve an initial, 

individualized consultation with counseling on a 

low calorie diet, physical activity, and behavior 

therapy and the development of a practical treatment 

plan for each patient. At follow-up group 

meetings, the treatment strategy will be evaluated 

and modified. NIH guidelines will be followed 

when considering and recommending pharmacotherapy. 

Outcome measures: Weight, BMI, waist 

circumference, blood pressure, fasting and/or 2- 

hour postprandial blood glucose, and lipid profile. 

In addition, patients will be surveyed concerning 

secondary objective variables 3 months from the 

commencement of the program. 

Results: Intention to treat analysis and paired t 

test will be used to compare baseline with last visit 

values and determine if a statistically significant 

improvement in outcome measures occurred. 

Descriptive analysis will be performed for the 

results of the satisfaction survey. 


165—REDUCING SENIORS’ DRUG 

EXPENDITURES THROUGH MEDICATION 

REGIMEN REVIEW AND REVISION IN A 

COMMUNITY PHARMACY. Owen J, Fry’s 

Pharmacy/University of Arizona, Herrier R, 

University of Arizona, Spencer J, Fry’s Pharmacy. 

E-mail: owen@pharmacy.arizona.edu 

Objective: To provide seniors with an economically 

viable alternative to purchasing medications 

outside the United States by reducing out-of-pocket 

expenditures through eliminating unnecessary drug 

therapy, switching to generic or the cheapest brand 

medications when possible, and using manufacturer 

and store discount plans. 

Methods: The medication regimen review will be 

piloted at a pharmacy located within an hour of the 

Mexican border. Patients will be targeted via instore 

and newspaper advertising. Additionally, 

patients who might benefit from this service will be 

identified using the pharmacy computer system. 

Targeted patients will include those who are paying 

cash for their prescriptions, members of Medicare 

HMOs, or using discount cards. The clinical recommendations 

to alter the therapeutic regimen will be 

based on published drug literature and the relative 

cost of alternative medications. The suggestions for 

change will be presented to the patient’s primary 

care doctor for approval and/or modification. Data 

will be collected and analyzed for loss in prescription 

sales revenue, changes in patient purchases in 

other parts of the store, changes in patient expenditures 

for medications including those medications 

obtained from outside the United States, physician 

acceptance rates, types of changes made, pharmacy 

expenses to perform the service, changes in disease 

control, and patient satisfaction. A fee schedule for 

services provided will be determined based on the 

evaluation of collected data. 

Results: The effectiveness of the medication regimen 

review will be assessed by evaluating profitability, 

patient health status, and patient satisfaction. 

Conclusions: It is expected that the medication 

review will maintain or improve disease control, 

reduce patient out-of-pocket expenses, and provide 

a viable alternative to purchasing medications outside 

the United States. 

166—RETROSPECTIVE ASSESSMENT OF 

LONG-TERM OUTCOMES IN A COMMUNI- 

TY-BASED PHARMACEUTICAL CARE PRO- 

GRAM. Leighty J, Eckerd Corporation, Sullivan D, 

Ohio Northern University. E-mail: 

jrl5k@yahoo.com 

Objective: The role of a pharmacist is changing 

dramatically from dispenser of prescription drugs to 

a provider of patient care and medication management. 

Over the last few years, the value of pharmaceutical 

care has been evaluated in hospital, medical 

clinics, and community pharmacy settings. 

However, much of the research demonstrating the 

value of pharmaceutical care programs has been 

limited to short-term outcomes. One of the few projects 

that have evaluated long-term outcomes of 

pharmaceutical care was the Asheville Project. 

Unfortunately, there was a significant drop-out rate 

for its patients over the course of 3 years, which 

made the evaluation of long-term outcomes somewhat 

difficult. This leads us to the question of 

whether pharmaceutical care programs sustain positive 

patient outcomes over longer periods of time. 

The objective of this study is to assess the long-term 

outcomes of a community-based pharmaceutical 

care program for patients with diabetes, hypertension, 

and dyslipidemia. 

Methods: Patient charts will be randomly selected 

from all persons that have been enrolled in the 

Eckerd PatientCARE network for the last 3 years in 

the Tampa area. A total of 50 cases for each of the 

three disease states will be assessed for adherence to 

the nationally recognized clinical guidelines. Due to 

the overlap of some disease states within patients, 

the total number of patients evaluated will be 

between 80 and 120. For hypertension, the variables 

assessed will include the percentage of goal blood 

pressures, and proper choice of recommended medication. 

For diabetes, the variables assessed will 

include hemoglobin A1c, body mass index, and the 

ability to reach recommended goals. Preprandial 

and postprandial blood glucose values will also be 

included for those patients for whom the data is 

available. For dyslipidemia, the variables assessed 

will include triglycerides, total cholesterol, HDL, 

LDL, and the ability to reach recommended goals. 

Results: NA. 


167—RETROSPECTIVE COST–BENEFIT 

ANALYSIS OF A WELLNESS CENTER 

FROM AN INDEPENDENT COMMUNITY 

PHARMACY PERSPECTIVE. Kent K, 

McDonough R, Doucette W, University of Iowa, 

Ploehn L, Main at Locust Pharmacy Clinic. E-mail: 

kelly-bisgard@uiowa.edu 

Objective: Main at Locust Pharmacy Clinic 

developed and implemented a wellness center that 

provides health risk assessments and health screenings 

to interested patients. The purpose of the wellness 

center is to provide an advanced level of patient 

care as well as provide an additional revenue source 

for the practice. The objectives of this study are to 

(1) determine the revenues and costs associated with 

the delivery of the wellness center services, and (2) 

perform a cost–benefit analysis of the wellness center. 

Methods: Design: Retrospective review of the 

clinic’s wellness center records over a 2-year period. 

Setting: An independent community pharmacy 

wellness center. Data collection: Wellness center 

records for nine different services (blood pressure, 

blood glucose [BG], bone density, body fat, 

hemoglobin A1c, ALT, total cholesterol [TC]/HDL, 

TC/BG, full lipid panel) will be analyzed beginning 

October 1, 2001 thru September 30, 2003. Revenues 

will be determined by reviewing cash register 

receipts for that period. Direct and indirect costs 

associated with the delivery of the services will 

include the staff’s time involved with each service, 

equipment and supply costs, advertising, and the 

overhead costs associated with the practice. Data 

Analysis: Frequencies of each service will be tabulated. 

Revenues and costs will be determined for 

each service and discounted to October 2001 levels. 

A cost–benefit and sensitivity analysis will be performed. 

Sensitivity analyses will vary personnel 

costs and service volume. 

Results: Preliminary analysis of Main at Locust 

Pharmacy Clinic records demonstrates that more 

than 1,000 patient interactions have used the wellness 

center during the defined 2-year period. 





Conclusions: The wellness center has generated 

new revenue for the clinic. A cost–benefit analysis 

will determine the profitability and sustainability of 

the service. 

168—SUCCESS RATE OF A PHARMA- 

CIST-MANAGED SMOKING CESSATION 

PROGRAM IN A COMMUNITY PHARMACY 

SETTING. Free H, Rodriguez De Bittner M, 

Layson-Wolf C, University of Maryland at 

Baltimore, Fairfax, CVS Pharmacy. E-mail: 

hfree@rx.umaryland.edu 

Objective: To assess the effectiveness of a pharmacist-managed 

smoking cessation program, in a 

community pharmacy setting, on patients’ ability to 

remain smoke free after quitting, and assess 

patients’ knowledge about the consequences of 

smoking and its treatment. 

Methods: The study design is a single-center, 

prospective, pilot study. Phase I involves training 

pharmacists to serve as the smoking cessation facilitators. 

The pharmacists will be trained using the 

American Lung Association, “Freedom from 

Smoking” program. Procedures will be developed 

that define the roles and responsibilities of the facilitators 

using the tobacco dependence guidelines. 

Phase II will involve the implementation of the 

smoking cessation program. The program will begin 

with three individualized (patient and pharmacist) 

appointments followed by three group sessions and 

a 3-month group follow-up. Throughout the program, 

patients will be educated on smoking consequences, 

how to incorporate behavior modifications, 

and how to prevent relapse. Pharmacotherapy 

may also be used. At every session, monitoring 

parameters will be assessed, including blood pressure, 

pulse, weight, adverse drug reactions, and carbon 

monoxide levels. Written education materials 

will be supplied at every session. 

Results: Analysis of the pre- and postknowledge 

tests will be conducted. Quality of life at baseline 

and completion of the program will be measured. A 

Kaplan Meier survival curve will be used comparing 

the percent abstinence and relapse at weeks 1, 4, 

and 12 and will be compared with other published 

studies. In addition, patient satisfaction surveys will 

be reported. 

Conclusions: It is anticipated that a pharmacistmanaged 

smoking cessation program in a community 

pharmacy setting will be successful in helping 

patients quit and maintaining smoking abstinence. 

169—TARGET INTERVENTION PRO- 

GRAM TO PROMOTE CALCIUM SUPPLE- 

MENT USE IN COMMUNITY PHARMACY. 

Cinelli E, Cerulli J, Albany College of Pharmacy. E- 

mail: cinellie@acp.edu 

Objective: To determine if a Target Intervention 

Program (TIP) developed for community pharmacy 

can increase appropriate calcium supplement intake 

in patients receiving prescription osteoporosis therapy. 

A secondary objective is to determine baseline 

calcium supplement use in this population. 

Methods: Eligible patients will be identified by 

pharmacists and/or PharmD candidates based on a 

prescription (new or refill) for a medication to treat 

and/or prevent osteoporosis at six Community 

Pharmacy Advanced Practice Experience sites that 

include chain and independent settings. All eligible 

patients identified will be documented on an enrollment 

log. An assessment tool will be used by the 

students to determine baseline supplement use 

either in person or via telephone. Students will 

determine if patients presently on a calcium supplement 

are receiving the appropriate dose and/or are 

using the correct administration technique and will 

intervene as needed. A recommendation for an 

appropriate calcium supplement will be made to the 

patient and their physician if patients are not currently 

receiving a calcium supplement. Two months 

following any intervention, students will perform a 

follow-up phone call to patients to determine if the 

recommendations were accepted. 

Results: The percent of patients taking a calcium 

supplement with their prescription at baseline will 

be reported. The impact of the intervention will be 

determined by the number of recommendations 

made to add calcium supplementation or improve 

administration/dose. The number of patients who 

purchased a calcium supplement following the 

intervention and the number of patients reporting 

use on follow-up will be documented. 

Conclusions: Assuming baseline calcium supplementation 

is low, a recommendation by a pharmacist 

or pharmacy student is anticipated to 

increase calcium supplement intake in patients 

receiving osteoporosis medications. 

170—THE EVALUATION OF JNC VII 

ADHERENCE IN AN INTERDISCIPLINARY 

OUTPATIENT SETTING. Wylie K, Green C, 

Medow M, Ohio State University. E-mail: 

wylie.19@osu.edu 

Objective: (1) Evaluate percentage of patients at 

target blood pressure according to the seventh report 

of the Joint National Committee on Prevention, 

Detection, Evaluation, and Treatment of High 

Blood Pressure (JNC VII) guidelines, (2) determine 

areas in need of intervention, and (3) develop a 

patient assessment form to address deficits. 

Methods: Research will be conducted retrospectively 

at an interdisciplinary primary care clinic. 

Patients will be identified via ICD-9 codes signifying 

a hypertension diagnosis (401.X). Exclusion criteria 

include pregnancy, less than 18 years of age, 

and/or primarily managed by nephrologists. The primary 

end point is the percentage of patients achieving 

their blood pressure goal according to JNC VII 

guidelines. Secondary end points include assessment 

of drug selection, risk factors, comorbidities, 

and interventions. Individual charts will be pulled 

onsite and reviewed since the initiation of JNC VII 

(on May 14, 2003) using a self-created data collection 

sheet. The data collected will identify the 

patient’s goal, if the patient has met his/her goal, 

risk factors for major cardiovascular disease, relevant 

family history, comorbidities, and receipt of 

appropriate follow-up, laboratory tests, medications, 

and interventions. Upon completion of each 

chart review, a patient assessment sheet will be 

added to each chart as a reminder to health care 

providers of monitoring parameters. 

Results: Once data collection is complete, the 

percentage of clinically diagnosed hypertensive 

patients at goal and not at goal will be documented 

and reported. For those not at goal, the following 

will be taken into consideration and reported: treatment, 

follow-up, interventions, assessment of risk 

factors, and comorbidities. 

Conclusions: We anticipate that these results will 

accurately identify the percentage of patients at their 

target blood pressure and identify areas in need of 

intervention. The results will provide feedback to 

team members to determine whether we need to 

reengineer workflow to optimize hypertension management. 

171—THE EVALUATION OF PHARMA- 

CISTS’ ATTITUDES TOWARDS PROVIDING 

SMOKING CESSATION COUNSELING IN A 

CHAIN PHARMACY SETTING. Hendrickson J, 

Jackson T, University of Illinois at Chicago. E-mail: 

jaimeh@uic.edu 

Objective: The U.S. Public Health Service has 

published guidelines for treating tobacco use. A 

goal of these guidelines is to change practice patterns 

of health care professionals in identifying and 

offering treatment to tobacco users. While numerous 

smoking cessation programs exist, barriers prevent 

pharmacists from implementing them. The primary 

objective of this study is to objectively evaluate 

pharmacists’ knowledge and attitudes regarding 

smoking cessation counseling. Additionally, the frequency 

of identifications and interventions made 

will be evaluated. 

Methods: Pharmacists in the Chicago metropolitan 

area will be invited to attend a smoking cessation 

training program. The program will be developed 

using medical literature and U.S. Public 

Health Service guidelines. Pharmacists will be 

trained to identify smokers visiting the pharmacy 

and to apply the transtheoretical model to individually 

tailor counseling based upon information about 

a patient’s smoking behavior. Pharmacists will provide 

brief counseling on health consequences of 

smoking, behavioral strategies in quitting, and the 

use of nicotine replacement therapy. Investigators 

will assess pharmacists’ perceived knowledge and 

attitudes regarding the provision of smoking cessation 

counseling using an 11-item retrospective 

pretest/posttest administered 12 weeks after the 

training program. Additionally, program effectiveness 

and the number of smoking cessation interventions 

by pharmacists will be evaluated. 

Results: Responses to the assessment instrument 

will measure pharmacists’ knowledge and attitudes 

towards providing smoking cessation counseling. 

These data will be analyzed using the Rasch rating 

scale model. 

Conclusions: It is expected that pharmacists participating 

in this program will gain skills and confidence 

in counseling patients on smoking cessation. It 

is predicted that attitudes toward providing smoking 

cessation interventions will improve, and the frequency 

of the interventions will increase accordingly. 




FEATURE 

172—THE IMPACT OF COMMUNITY 

PHARMACISTS’ INTERVENTION ON 

PATIENTS’ LIPID PROFILES, KNOWLEDGE 

OF DISEASE STATE, AND QUALITY OF 

LIFE. Taylor C, Divine H, University of Kentucky. 

E-mail: joseph.taylor@insightbb.com 

Objective: To determine the impact on patients’ 

cholesterol levels after being educated by a community 

pharmacist about their lipid profiles and disease 

state compared with patients not receiving a 12- 

week education program from the pharmacist. The 

secondary objective is to improve patients’ quality 

of life and satisfaction with the services offered at 

the pharmacy. 

Methods: 100 patients taking medication for 

hyperlipidemia will be randomly assigned to one of 

two groups. The control group will not receive any 

special education sessions with the pharmacist. The 

intervention group will receive biweekly educational 

sessions with the pharmacist. At the beginning of 

the study, all 100 patients will have their fasting 

lipid profile measured by the pharmacist using a 

point-of-care device at the pharmacy. In addition, 

each patient will be asked to fill out three surveys; 

the SF 12 for quality of life, a quiz to measure 

knowledge of cholesterol, and a patient satisfaction 

with pharmacy services survey. For 12 weeks, the 

intervention group will receive biweekly educational 

sessions with a pharmacist. There will be a number 

of topics covered in each of the six sessions 

including evaluating each person’s risk of a coronary 

event in the next 10 years, dietary improvements, 

and lifestyle modifications. The patient’s 

information will be documented using Pfizer’s 

Lipid Goal Manager. With this program, the patient 

can see visually through graphs the impact small 

changes can have on their future. At the conclusion 

of the project, each of the 100 patients will be 

brought back in to the pharmacy to have their lipid 

profiles tested again. Each patient will also receive 

the three surveys to take again. 

Results: Data such as lipid profiles, quality-oflife 

survey, knowledge survey, and patient satisfaction 

survey will be analyzed for statistically significant 

differences between the control and intervention 

groups. 


173—THE IMPACT OF PHARMACIST 

CONSULTATION FOR LIFESTYLE MODIFI- 

CATION IN PREHYPERTENSIVE SUBJECTS 

IN A COMMUNITY PHARMACY. 

Patthanacharoenphon D, Dominick’s 

Pharmacy/University of Illinois at Chicago, 

Sommers Hanson J, Dominick’s Pharmacy, Jackson 

T, University of Illinois at Chicago. E-mail: 

dpatthan@uic.edu 

Objective: This pilot study will assess the impact 

of monthly educational visits of subjects identified 

by community pharmacists as prehypertensive 

according to the seventh report of the Joint National 

Committee on Prevention, Detection, Evaluation, 

and Treatment of High Blood Pressure (JNC VII) . 

Subjects will be encouraged by the pharmacist to 

make lifestyle modifications such as weight loss, 

weight maintenance and increased activity in order 

to decrease their blood pressure to normal as 

defined by JNC VII. 

Methods: Subjects will be selected from a convenience 

sample through both in-pharmacy and 

community blood pressure (BP) screenings. 

Subjects will be eligible if two BP readings on two 

separate occasions are in the range of 

120–139/80–89 mm Hg. Subjects will be excluded 

if they are less than 18 years old, are taking antihypertensive 

medications, or have been diagnosed as 

hypertensive according to JNC VII. Subjects will 

receive monthly pharmacist counseling on lifestyle 

modification and written educational information on 

hypertension and lifestyle modification to supplement 

the pharmacists education. Monitoring will 

occur over a 12-week period. Monthly consultations 

will include BP measurement, weight measurement 

and lifestyle assessment. Dependent variables 

included in analysis will be BP, weight and selfreported 

activity level. Independent variables 

included will be race, age, gender, and pre-existing 

conditions. The dependent Student t test will be 

used to compare group means for continuous variables. 

Rasch analysis will be used to measure attitudinal 

components of a retrospective pretest/posttest 

survey. 

Results: The designation of a new category of 

prehypertension is an opportunity to expand the role 

of the pharmacist in the prevention of hypertension. 

It is anticipated that patients receiving pharmacist 

consultation for lifestyle modifications will experience 

a reduction in blood pressure by the end of the 

12-week study. 


174—THE NORTH CAROLINA MEDI- 

CAID POLYPHARMACY INITIATIVE. Smith 

K, Mission St. Joseph’s Hospital–Asheville, NC, 

Bunting B, Mission St. Joseph’s/City of Asheville. 

E-mail: cphkds@msj.org 

Objective: Access II Care provides case management 

services for North Carolina Medicaid recipients 

with chronic illnesses through participating primary 

care offices. The Prescription Advantage List 

(PAL) is a statewide formulary for preferred medications 

that are considered the most cost-effective 

for Medicaid patients. The major goal of the study 

was to determine the initial cost-savings with the 

implementation of medication recommendations 

from the PAL list at a participating primary care setting. 

Methods: A retrospective chart review was performed 

for patients who were prescribed more than 

eight prescriptions a month, received North 

Carolina Medicaid, participated in the Access II 

Care program, and had a primary care physician 

(PCP) at the Buncombe County Health Center. 

Medication records were reviewed to determine the 

most appropriate and cost-effective medications 

from the PAL list. These written medication recommendations 

were communicated with the PCP and 

implemented with their approval. 

Results: Among the 37 charts reviewed, 57 recommendations 

were made to change drug therapy. 

Thirty-five of the 57 recommendations (61%) were 

accepted, 19 of the 57 recommendations (34%) 

were denied, and there was no response on 3 of the 

recommendations (5%) made. One physician 

refused to participate in the initiative and denied all 

of the recommendations made concerning his/her 

patients. These denials accounted for 75% of the 

total denied recommendations. The 35 accepted recommendations 

accounted for an estimated cost-savings 

of $800 per month and $10,000 per year. 

Assuming that 90% of the recommendations were 

accepted, cost-savings estimations increased to 

$1,200 per month and $14,000 per year. 

Conclusions: Implementation of a polypharmacy 

initiative that incorporated drug therapy review by a 

pharmacist improved appropriate prescribing of 

cost-effective medications for Medicaid patients in 

a primary care setting. 

Original Citation: Presented at the Southeastern 

Residency Conference, Athens, GA, May 2, 2003. 

175—THE USE OF PATIENT-CON- 

TROLLED ANALGESIA WITH OR WITH- 

OUT BASAL INFUSION FOR POSTORTHO- 

PEDIC SURGERY PAIN MANAGEMENT. 

Phan T, Luong K, Lum G, Sharp Chula Vista 

Medical Center, Elington M, Sharp Memorial 

Hospital–Security Trailer. E-mail: tuyvan.phan@sharp.com 

Objective: Patient-controlled analgesia (PCA) 

has become a widely used method of pain relief following 

major orthopedic surgery. PCA is effective 

because it allows the patient control of their pain 

management by self-administering doses depending 

on their level of pain. Adding a basal infusion to 

PCA is believed to sustain the level of drug in the 

body, thereby maintaining constant analgesia. 

However, patients who are on PCA with basal infusion 

are reported to experience more sedation and 

are less able to ambulate postoperatively than their 

counterparts, resulting in slower recovery and 

increased length of stay. 

Methods: This is a comparison study looking at 

recovery in patients who are on morphine PCA with 

or without basal infusion status postorthopedic 

surgery. It is a 3-month observational study of 

patients who are admitted to the medicine/orthopedic 

floor following orthopedic surgery such as joint 

replacement or fracture. Patients are excluded if 

they have nonorthopedic surgery or are on analgesia 

other than morphine PCA. Data are collected from 

documentation charted by anesthesiologists, nurses, 

physical therapists, and pharmacists. We are evaluating 

levels of sedation, ambulation, respiratory 

function, pain, nausea/vomiting, incidence of deep 

vein thrombosis, and length of stay. 

Results: Based on prior anecdotal observation, 

we expect to see patients who are on morphine PCA 

without basal infusion be less sedated, ambulate earlier, 

have less nausea/vomiting and have a shorter 

length of stay. Additionally, we may find less respiratory 

depression and fewer episodes of DVT. We 





anticipate no significant difference in pain control. 


176—THERAPEUTIC SUBSTITUTION 

WITH GENERIC LISINOPRIL: EVALUA- 

TION OF COST SAVINGS AND CLINICAL 

OUTCOMES FROM THE COMMUNITY 

PHARMACY SETTING. Vinti A, Caiola S, Coker 

H, Futrell D, Futrell W, University of North 

Carolina at Chapel Hill, Gouveia-Pisano J, Pfizer, 

Inc., Jones M, McDowell J, University of North 

Carolina at Chapel Hill. E-mail: vinti@unc.edu 

Objective: (1) Identify medical providers’ willingness 

to accept a therapeutic substitution recommendation 

as suggested by a community pharmacist. 

(2) Maintain blood pressure (for all patients) 

and kidney function (for diabetic patients) after 

therapeutic substitution of a brand name ACE 

inhibitor with generic lisinopril. (3) Maintain JNC 

VII blood pressure goals for those patients who are 

at goal prior to the intervention. (4) Achieve JNC 

VII blood pressure goals for those patients who are 

not at goal prior to the intervention. (5) Record outof-pocket 

costs incurred by the patient and health 

care system. (6) Discuss reimbursement for a community 

pharmacist’s pharmaceutical care services. 

Methods: This study enrolled adult male and 

female patients with a diagnosis of hypertension 

who had no change in antihypertensive medication 

regimen (agents or dosages) for the last 4 weeks, 

which included therapy with a brand name ACE 

inhibitor. Patients were identified through a drug 

utilization review of all patient medication profiles 

at two community pharmacies. Potential subjects 

were contacted via telephone to inform them briefly 

of the project and to request an initial screening. All 

subjects were assessed for demographics, current 

medications (prescription, over-the-counter, and 

herbal), past medical and surgical histories, and 

medication compliance with the Morisky Scale. 

Upon informed consent, dose conversion from the 

patient’s brand name ACE inhibitor to generic 

lisinopril was conducted by the pharmacist, and recommended 

to the patient’s medical provider by telephone 

or fax. Upon approval from the medical 

provider, the recommended dose of lisinopril was 

taken as a call-in prescription and dispensed. At dispensation, 

patients had their blood pressure 

checked, received counseling on their new medication 

and scheduled 12 follow-up appointments. 

Follow-up visits at the pharmacy occurred every 7 

days and included assessment of compliance, 

adverse events, and measurement of blood pressure. 

Those subjects who had a documented medical history 

significant for diabetes mellitus with microalbuminuria 

or proteinuria were asked to give urine 

samples for assessment of urine microalbumin/creatinine 

ratio. 

Results: NA. 


177—THROUGH A SELF-ASSESSMENT 

SURVEY, AT WHAT POINT OF SEVERITY 

OF SYMPTOMS, DOES AN ASTHMA 

PATIENT SEEK MEDICAL CARE? Heaton R, 

Moose J, Caiola S, Brock T, Spencer S, University 

of North Carolina at Chapel Hill. E-mail: 

rlheaton@E-mail.unc.edu 

Objective: The objective of this research survey is 

to qualify and quantify how patients perceive their 

symptoms and when they should seek medical attention. 

The objective at the conclusion of this survey is to 

educate asthma patients on how to manage their asthma, 

including when seeking health care is appropriate. 

Methods: A letter of intent, a retrospective survey 

and consent form will be mailed to 128 patients. 

The patients were selected through a drug recall 

report off of the database at Moose pharmacies’ 

computers. The drug recall selected patients that 

were prescribed and filled steroid inhalers and 

albuterol inhalers for the months of June, July, and 

August. The survey is to be filled out by participating 

patients and mailed back to Moose Pharmacies. 

A follow-up survey, letter of intent and consent 

form will be mailed to the same 128 patients if there 

is no response. A stamped envelope will be included 

in the package for the patient to return the survey 

and signed consent form. Children under the age of 

18, pregnant women, and patients with other respiratory 

diseases will not be included. 

Results: Pending. 

Conclusions: Pending. 

178—UNDERSTANDING OVER-THE- 

COUNTER DRUG USE AND MISUSE IN HIV- 

INFECTED PATIENTS. Ngo C, Sansgiry S, 

University of Houston College of Pharmacy. E- 

mail: cngo@mailcity.com 

Objective: This pilot study was designed to 

understand the involvement of HIV-infected 

patients in self-medication practices that may lead 

to drug misuse in order to optimize future drug therapy. 

Drug misuse is defined as self-reported experiences 

of excessive or inadequate use of over-thecounter 

(OTC) products as well as nonrecommended 

uses of the product with other medications. The 

advent of new drugs in treating HIV infection has 

decreased disease progression and imposed new 

challenges for health care providers. The significance 

of this study is to evaluate and understand 

OTC drug use and misuse in HIV-positive patients. 

Methods: A cross-sectional study will be conducted 

to understand self-medication practices that may 

lead to drug misuse in HIV-infected patients. A sample 

of approximately 120 patients will be selected 

randomly from a local HIV-care clinic in Houston, 

Texas. Patients between 18–55 years of age who are 

HIV positive will be considered as potential participants. 

Information on OTC drug use and misuse 

along with demographics will be obtained by using a 

combination of self-administered questionnaire and 

personal interview. A previously validated questionnaire 

will be administered by a trained and qualified 

data collection assistant with clinical knowledge on 

OTC drug use and misuse in HIV-infected patients. 

Data will be analyzed using descriptive and comparative 

analysis, including t test and Spearman correlation, 

to determine the extent of OTC drug use and 

misuse in HIV-infected patients. 

Results: NA. 

Conclusions: The study is currently in progress 

and will help researchers gain further understanding 

of the factors that should to be considered in optimizing 

self-medication practices for HIV-infected 

patients in order to optimize future drug therapy. 

Drug misuse may lead to adverse drug events and 

eventually affect health-related quality of life of 

patients. 

179—WEIGHT MANAGEMENT IN A 

PHARMACIST-RUN CLINIC: PATIENT SAT- 

ISFACTION AND OUTCOMES. Michalcik L, 

Randolph R, Marcrom R, University of Tennessee. 

E-mail: lmichalc@excite.com 


patient satisfaction with a pharmacist-run 

weight management program and the effects the 

program has on patient’s weight loss. Patients will 

complete a survey at the end of the study to determine 

their satisfaction with the program. 

Methods: Subjects will be recruited through 

posters, bag stuffers, and an informational radio 

program. Subjects who meet inclusion criteria will 

be chosen on a volunteer basis. The subject population 

will consist of approximately 20 volunteers 

with a body mass index greater than 25 kg/m 2 who 

are interested in improving their health through diet 

and exercise. Exclusion criteria will include patients 

who are currently taking weight loss medications, 

who are taking medications that commonly lead to 

weight gain, who do not have a health care provider, 

whose condition prevents them from performing 

moderate exercise, who are pregnant or lactating, 

who are less than the age of 21, who have uncontrolled 

psychiatric illness, who have active substance 

abuse, or who have a history of anorexia nervosa 

or bulimia nervosa. At the initial visit, a thorough 

medication review will be performed to determine 

these criteria. Motivation to lose weight will 

also be determined at this visit via a motivation 

questionnaire adapted from the NIH Practical 

Guidelines, A Brief Behavioral Assessment. Weight, 

body mass index, waist circumference, and blood 

pressure will be measured. The weight loss program 

being offered follows national guidelines provided 

by the National Heart, Lung, and Blood Institute 

and the American Dietetic Association. Emphasis 

on gradual weight loss through calorie reduction 

and increased exercise will be taught in seven educational 

follow-up sessions. Discussion topics will 

include: adding exercise, components of food, eating 

triggers, dining at restaurants, fiber, vitamins, 

minerals, getting the most from exercising, and 

maintaining weight loss. At the end of the program, 

the patient will be asked to complete a questionnaire 

to see if their weight loss goals and expectations of 

the program were met. Patients will be asked specifically 

what parts of the program with which they 

were pleased or displeased, and point values will be 

assigned to different levels of satisfaction. Data will 

be evaluated to determine the success of the program 

based on point values. 

Results: Weight loss of 5% to 7% is expected by 

the 14th week. 





FEATURE 

APhA–APRS Basic Sciences 

180—A QUICK AND SIMPLE HPLC 

METHOD FOR THE DETERMINATION OF 

CRYPTOLEPINE IN A COMMERCIAL SAM- 

PLE OF CRYPTOLEPIS SANGUINOLENTA 

HERB TEA. Ononiwu I, Howard University, 

Fakorede F, Walter Reed Army Institute of 

Research, Kumar K, Howard University, Iwu M, 

Bioresources Development and Conservation 

Programme. E-mail: imo_ugo@yahoo.com 

Objective: Cryptolepine is the antimalarial, 

antidiabetic, and cytotoxic substance in Cryptolepis 

sanguinolenta, a herb that is commercially available 

in alternative medical practice for the treatment of 

malaria and diabetes. As part of an ongoing program 

to develop methods for the standardization of herbal 

remedies with proven efficacy and safety, using 

chemical markers identified in the plant materials, a 

simple, quick, sensitive and robust high-performance 

liquid chromatographic method with simultaneous 

photodiode array and fluorescence detection 

for the identification and determination of cryptolepine 

has been developed. 

Methods: Isocratic elution was carried out using 

Waters 2690D separation module with a reversephase 

Zobrax SB C18 5 mm (4.6 × 250 mm) column. 

The mobile phase consisted of acetonitrile and 

10 mM potassium phosphate buffer in the ratio 

30:70 at pH 3 and 35°C. Detection was with a 

Waters photodiode array detector (PDA996) at a 

wavelength of 366 nm and 474 fluorescence detector 

at 366 excitation and 673 emission wavelengths, 

respectively. Data analyses was performed using 

Waters Empower software. 

Results: The average retention time for cryptolepine 

was found to be 2.8 minutes. Calibration 

curves for cryptolepine were linear with correlation 

coefficients (r 2 ) of > .999. Limits of detection and 

quantitation were, respectively, 4.5 and 10 ng/mL. 

The method was applied in the determination of 

cryptolepine in different batches of commercial 

herb tea samples of Cryptolepis sanguinolenta used 

in the treatment of malaria in Ghana. 

Conclusions: This selective and sensitive method 

can be used for high-throughput determination of 

cryptolepine in commercial and /or medicinal herbal 

preparations containing this indoloquinoline alkaloid. 

181—EVALUATION OF ACACIA AND 

SEMISYNTHETIC POLYMERS AS AN 

EMULSIFYING AGENT. Carp E, Wilkes 

University–Nesbitt School of Pharmacy, Lee C, 

Kibbe A, Wilkes University. E-mail: 

carpej@wilkes.edu 

Objective: To find a substitute for acacia in 

emulsions. Preliminary experiments were undertaken, 

and the decision to compare acacia, semisynthetic 

polymers, and semisynthetic polymers and a 

surfactant was made. 

Methods: The test samples were prepared on the 

same day using various methods to ensure quality 

emulsions. Physical appearance and viscosity was 

tested from day 0 (baseline) to day 29. There were 

three samples of each emulsion at different temperatures 

(32° C, 22° C, and 4° C). 

Results: In the pivotal experiment there were differences 

between the acacia emulsions and the 

semisynthetic emulsions. The semisynthetic polymers 

appeared to be more stable over time in their 

viscosity. 

Conclusions: Only the methylcellulose semisynthetic 

polymer made an acceptable, easy to use, and 

stable emulsion. 

APhA–APRS Clinical 

Sciences 

182—EXAMINATION OF MEDICATION 

ERRORS OCCURRING IN THE PATIENT’S 

HOME REPORTED TO USP’S MEDICATION 

ERROR REPORTING PROGRAMS. Camp S, 

United States Pharmacopeia. E-mail: scc@usp.org 

Objective: To examine reports submitted to 

USP’s medication error reporting programs, in 

which the error occurred in the patient’s home. 

Understanding the characteristics of these medication 

errors can contribute to the development of 

strategies to improve the safe use of medications. 

From these data, we hope to identify safe practices 

that health care professionals and consumers can 

use to prevent these errors from occurring in the 

patient’s home. 

Methods: Reports submitted to the USP MED- 

MARX and the USP/ISMP Medication Errors 

Reporting Programs, where the location of the error 

is in the patient’s home, are identified. Data are 

summarized using Microsoft Access and Excel to 

present information about the severity, type(s), 

cause(s), contributing factor(s), and product(s) associated 

with these errors. Information about where in 

the medication use process the errors initiated 

(node) and the level(s) of staff involved in the errors 

is also displayed. Finally, a review of action(s) 

taken in response to the errors is summarized. 

Results: The findings from this study will be 

used by USP’s Safe Medication Use Expert 

Committee to develop practice recommendations 

for health care professionals and/or safe medication 

use recommendations for consumers. 


183—A NEW ORAL OPIOID, OXYMOR- 

PHONE EXTENDED RELEASE, DOES NOT 

AFFECT HUMAN METABOLIC ENZYMES 

CYP 2C9 AND CYP 3A4. Adams M, SFBC New 

Drug Services, Inc., Ahdieh H, Gammaitoni A, 

Endo Pharmaceuticals, Inc., Pieniaszek H, HPP 

Consulting & Services, Inc. E-mail: livinginpa135@ 

yahoo.com 

Objective: To investigate the clinical significance 

of in vitro data linking suprapharmacologic 

concentrations of oxymorphone (> 3,000 times therapeutic 

levels) with induction of the human 

cytochrome P450 drug metabolizing enzymes CYP 

2C9 and CYP 3A4. 

Methods: Two single-center, randomized, openlabel, 

parallel-group studies compared the effects of 

high and low dosages of oxymorphone extended 

release (ER) on the metabolism of substrates of 

CYP 2CP and CYP 3A4. On days –1, 7, and 14, 

healthy adults received 1 dose of either a CYP 2C9 

probe (tolbutamide 500 mg, study 1) or CYP 3A4 

probes (midazolam and intravenous [ 14 CH 3 

N- 

methyl]-erythromycin for the erythromycin breath 

test [ERMBT], study 2). Five groups were randomized 

to 14 days of treatment with either (a) highdose 

oxymorphone ER (3 × 20 mg every 12 hours) 

plus naltrexone (50 mg every 24 hours to minimize 

opioid effects); (b) low-dose oxymorphone ER 

(10–20 mg every 12 hours); (c) rifampin (2 × 300 

mg every 24 hours) to induce CYP 2C9 and CYP 

3A4 activities; (d) naltrexone (50 mg every 24 

hours); or (e) CYP probes alone (controls). All treatments 

except erythromycin were oral. Tolbutamide 

AUC, midazolam AUC, and change from baseline 

in expired 14 CO 2 

were determined on days –1, 7, 

and 14. 

Results: In the oxymorphone ER and naltrexone 

groups, changes from baseline to days 7 and 14 in 

tolbutamide and midazolam AUCs and the percentage 

of expired 14 CO 2 

per hour in the ERMBT were 

not significantly different from the untreated control 

values. The positive control rifampin significantly 

decreased tolbutamide and midazolam AUCs and 

increased the percentage of 14 CO 2 

expired per hour 

on days 7 and 14. 

Conclusions: Oxymorphone ER did not affect 

the metabolism of CYP 2C9 or CYP 3A4 substrates, 

indicating that it has a low potential for altering the 

plasma levels of other drugs metabolized via these 

enzymes. This may result in fewer dosage adjustments 

in patients taking oxymorphone with other 

drugs metabolized by CYP 2C9 or CYP 3A4. 

184—SINGLE- AND MULTIPLE-DOSE 

PHARMACOKINETIC AND DOSE-PROPOR- 

TIONALITY STUDY OF OXYMORPHONE 

IMMEDIATE-RELEASE TABLETS. Adams M, 

SFBC New Drug Services, Inc., Ahdieh H, Endo 

Pharmaceuticals, Inc. E-mail: 

livinginpa135@yahoo.com 

Objective: To investigate the pharmacokinetics 

and dose proportionality of oxymorphone immediate 

release (IR) and its metabolites (6-OH-oxymorphone 

and oxymorphone-3-glucuronide) following 

single- and multiple-dose administration. 

Methods: A randomized, three-way crossover 

study of oxymorphone IR (5, 10, and 20 mg) was 

performed in 24 healthy adults (18–45 years). 

Subjects received all three dosage levels of oxymorphone 

IR. A single dose of 5, 10 or 20 mg was 

administered on day 1; beginning on day 3, subjects 

received the same dose every 6 hours through the 

morning of day 8 (22 total doses). Treatment periods 

were separated by a 7-day washout. Naltrexone 

hydrochloride was administered to prevent opioidrelated 

adverse events. Blood was collected up to 48 

hours after day 1 to determine single-dose pharmacokinetics 

and up to 6 hours after the day-8 dose for 

steady-state data. 

Results: Twenty-three subjects (12 men; 11 

women) completed the study. Following single 





doses of 5, 10, or 20 mg, the oxymorphone IR mean 

AUC (4.5, 9.1, and 20.1 ng•h/mL, respectively) and 

C max 

(1.1, 1.9, and 4.4 ng/mL, respectively) confirmed 

dose proportionality. Metabolites levels also 

increased in a linear fashion. Steady-state dosing 

data also showed proportional increases in the AUC 

and C max 

of oxymorphone and its metabolites. 

Adverse events generally were mild, and no clinically 

relevant changes in laboratory or other safety 

variables were noted. For all doses of oxymorphone 

IR, the single dose and steady state T max 

was 0.5 

hours. The terminal half-life of oxymorphone IR 

was measured at 7.25 to 9.43 hours. 

Conclusions: For oxymorphone IR tablets, the 

single-dose and steady-state pharmacokinetic profiles 

of oxymorphone and its metabolites were linear 

and dose proportional across the dosage range 

from 5 mg to 20 mg. The short T max 

predicts a rapid 

onset of analgesia. 

Original Citation: American Pain Society 

Annual Meeting; March 18–23, 2003; Chicago, Ill. 

Poster Presentation. 

185—BIOASSAY FOR DIRECT ANTIMI- 

CROBIAL ACTIVITY OF LANSOPRAZOLE 

AGAINST VAGINAL LACTOBACILLI. Rue K, 

UHS-COM, MSIV, Herndon B, Dempsey D, 

University of Missouri–Kansas City, Marinac J, The 

University of Health Sciences, Mathews T, 

Williams C, University of Health Sciences. E-mail: 

kchristopher@uhs.edu 

Objective: Determine the antimicrobial effect of 

lansoprazole on vaginal Lactobacillus. Background: 

Fourteen days of 30 mg lansoprazole reversibly 

increases vaginal pH and significantly reduces vaginal 

lactobacilli in healthy women. No data exists on 

antimicrobial effects of lansoprazole on vaginal lactobacilli. 

Methods: Lactobacillus was obtained from vaginal 

swabs of eight healthy female volunteers. 

Lactobacilli were inoculated onto an MRS agar 

plate surface and stored in sterile sleeves at 4°C. 

Lansoprazole 20 microliters was added to 6.3 mm 

sterile discs on the culture plate mimicking average 

human serum concentrations (765 ng/mL) following 

chronic oral administration. Three additional tests 

were also run on the specimens: lansoprazole dissolved 

in sterile water (control); lansoprazole dissolved 

in a series of low pH buffers (to determine 

influence of surrounding pH on antimicrobial activity); 

and lansoprazole at 10× and 100× average therapeutic 

serum concentrations. Cultures were anaerobically 

incubated for 30 hours at 37°C. Antimicrobial activity 

was evaluated by measuring the diameter of the clear 

area (lactobacillus kill) around the drug discs. 

Results: Minimal killing of lactobacilli was 

demonstrated at both the 10× (7.65 mcg/mL) and 

100× (765 mcg/mL) therapeutic lansoprazole concentrations. 

However, no vaginal lactobacilli were 

killed by the typical human serum concentrations of 

lansoprazole, the control solution, or the pH manipulation 

studies. 

Conclusions: Data suggest lansoprazole exhibits 

a small direct bactericidal effect on vaginal lactobacilli 

at high serum concentrations, but this is not 

likely to be of clinical importance because it only 

occurs well outside the typical therapeutic range. 

Based upon these in vitro findings, the reduction in 

vaginal lactobacilli following lansoprazole administration 

we previously reported is not a result of 

direct antimicrobial activity of the drug. Further 

studies are underway to determine the causal relationship. 

186—CLINICAL EXPERIENCE WITH A 

PHARMACIST-COMPOUNDED NALTREX- 

ONE IMPLANTABLE PELLET IN OPIOID 

ADDICTS. Baker J, Barr W, Virginia 

Commonwealth University, Coleman P, Coleman 

Institute. E-mail: jrbaker@mail2.vcu.edu 

Objective: The development of naltrexone 

(NTX) for the treatment of opioid addiction (OA) 

has been financially supported by the National 

Institute on Drug Abuse (NIDA) for over three 

decades. In 1984 FDA approved oral NTX for OA 

in only highly motivated patients because clinical 

trials proved compliance to be a significant drawback. 

Since realizing the limitation of oral NTX, 

NIDA has been supporting the development of sustained-release 

(SR) forms of NTX. Still waiting for 

FDA approval of SR forms of NTX, clinicians have 

turned to pharmacist-compounded preparations. 

This report describes 3-, 6- and 9-month follow-ups 

on patients who have received at least one compounded 

NXT implant, which has a duration of 

effect of about 6 weeks. There are no similar reports 

available in the literature. 

Methods: The Coleman Institute in Richmond, 

VA is an OA treatment center providing detoxification 

and long-term treatment. Follow-up consultations 

at 3-, 6-, and 9-month with patients who have 

received at least one NTX implant at the Coleman 

Institute between March 2003 and September 2003 

will be retrospectively reviewed. We will review 

opioid use, if patients are in behavioral therapy, and 

pellet complications. Also of interest is the incidence 

of pain problems that would normally require 

narcotic treatment and how these problems were 

treated. Last, we will review items that would relate 

to a patient’s quality of life, such as depression, 

arrests, and employment/student status. Baseline 

and follow-up characteristics will be compared. 

This study has been approved by Virginia 

Commonwealth University Health System’s institutional 

review board. 

Results: This retrospective review will describe the 

results obtained for all the study variables described 

above for up to 9 months after NTX implantation. 

Important to the possible increase in the future use of 

implants, this report will document complications that 

may arise in a nonresearch/clinical setting. A primary 

concern with implantable NTX therapy is how to deal 

with acute pain requiring narcotics. This descriptive 

review will detail the frequency of these circumstances 

and how they were resolved. 

Conclusions: The hypothesis to be tested is that 

the majority of patients using the NTX implant will 

remain abstinent from opioid use and will be 

employed or seeking education at each of their follow-ups. 

A description of pellet complications and 

treating emergent pain while a virtually nonremovable 

narcotic antagonist is in place will be detailed. 

Supported in part by T32-DA07027. 

187—COMPARISON OF ANTICOAGULA- 

TION PARAMETERS BETWEEN PATIENTS 

SEEN AT A PHARMACIST-MANAGED 

CLINIC AND ROUTINE MEDICAL CARE. 

Conner C, Pfizer, Inc., Pauly D, Dean Medical 

Center. E-mail: connerpharmd@yahoo.com 

Objective: The primary objective of this analysis 

was to compare INR goal attainment among patients 

seen in a pharmacist-managed (PM) and a physician-managed 

or routine medical care (RMC) setting. 

Methods: Patients included in the RMC or physician-managed 

clinic (East clinic) were identified 

using CPT codes for INR laboratory tests. To be 

identified for inclusion, patients had to have at least 

two INR values documented. After identification of 

a list of all eligible patients, based on more than two 

INR determinations, one of the investigators manually 

screened each patient chart to ensure that the 

INRs corresponded to a valid indication for longterm 

anticoagulation therapy. Patients in the PM 

clinic were identified by a screening of anticoagulation 

clinic records. INR lab data were extracted for 

all included patients. These lab data included all 

documented INR lab results from January 1, 2002 

through December 31, 2002. Valid indications for 

anticoagulation and target INR ranges were derived 

from the Chest guidelines. One of the studies’ primary 

investigators scanned a listing of unique 

patient ICD-9 codes and translated these into INR 

target ranges using the Chest guidelines. 

Results: An initial harvesting of the database 

yielded 969 patients for the analysis. Preliminary 

results will be presented. 

Conclusions: Though published evidence 

mounts on the topic of whether pharmacists operating 

an anticoagulation clinic perform as well as or 

better than primary care physicians, there remains 

some doubt in the minds of some health care decision 

makers as to the real-world effectiveness of 

these clinics. Published analyses comparing pharmacist-managed 

clinics to physician-managed clinics 

may exhibit characteristics that cause decision 

makers to feel that published results fail to generalize 

to their specific patient populations. 

Consequently, there is a need to conduct these outcomes 

analyses locally, so that conclusions can be 

drawn with regard to quality of care produced at 

these clinics within an individual health care system. 

This analysis represents such an endeavor. 

188—COMPARISON OF SEXUAL FUNC- 

TIONING IN PATIENTS RECEIVING 

DULOXETINE OR PAROXETINE: ACUTE- 

AND LONG-TERM DATA. Gonzales J, Eli Lilly 

and Company, Brannan S, Cyberonics, Detke M, 

Mallinckrodt C, Tran P, Eli Lilly and Company, 

Delgado P, Case Western Reserve University. E- 

mail: sbrannan@cyberonics.com 

Objective: Evaluate sexual functioning following 

acute- and long-term treatment with duloxetine, 




FEATURE 

paroxetine or placebo. 

Methods: Acute-phase data obtained from four 

8-week, double-blind studies, with patients randomized 

to duloxetine (20–60 mg BID; N = 736), paroxetine 

(20 mg QD; N = 359), or placebo (N = 371). 

Long-term data obtained from extension phases, in 

which acute treatment responders received duloxetine 

(40 or 60 mg BID; N = 297), paroxetine (20 mg 

QD; N = 140), or placebo (N = 129) for 26 additional 

weeks. Sexual function evaluated using the 

Arizona Sexual Experience Scale (ASEX). 

Results: In patients without initial sexual dysfunction, 

the probability of acute phase sexual dysfunction 

onset was significantly lower for duloxetine-treated 

patients compared with those receiving 

paroxetine (P = .015), although both rates were significantly 

higher than placebo (P = .007 and P < 

.001, respectively). Long-term data revealed that 

sexual function improved (ASEX total score 

reduced) in 70.9% of duloxetine-treated patients 

between baseline and end point, compared with 

57.6% for paroxetine (P = .060). For ASEX questions 

1 and 2, a significantly greater proportion of 

duloxetine-treated patients reported improvement 

compared with paroxetine (P = .050 and P = .037, 

respectively). No significant differences were found 

in Questions 3, 4, or 5. 

Conclusions: In these studies, the incidence of 

acute phase sexual dysfunction development among 

patients receiving duloxetine across its dose range 

(40–120 mg/day) was significantly lower than that 

of paroxetine at the low end of its dose range (20 

mg/day). On certain ASEX questions, a significantly 

higher percentage of duloxetine-treated patients 

reported improvement in sexual functioning compared 

with paroxetine. 

Original Citation: American Psychological 

Association, May 2003. 

189—DULOXETINE FOR THE TREAT- 

MENT OF MAJOR DEPRESSIVE DISORDER: 

SAFETY AND EFFICACY ASSOCIATED 

WITH RAPID DOSE ESCALATION (60–120 

MG QD). Gonzales J, Wohlreich M, Mallinckrodt 

C, Watkin J, Prakash A, Eli Lilly and Company. E- 

mail: mvmd@lilly.com 

Objective: Duloxetine, a dual reuptake inhibitor 

of serotonin/norepinephrine (5-HT/NE), has 

demonstrated efficacy for the treatment of emotional 

and painful physical symptoms of major depressive 

disorder (MDD) in double-blind, placebo-controlled 

trials at 60 mg QD. While the expected starting 

and therapeutic dose is 60 mg QD, we further 

investigated duloxetine’s pharmacologic profile by 

examining its safety and tolerability during dose 

escalation from 60 mg QD to 120 mg QD. 

Methods: Patients with MDD (N = 128), blinded 

to timing of dose escalations, received placebo for 1 

week followed by duloxetine (60 mg QD) titrated 

after 1 week to 90 mg QD and after a further week 

to 4 weeks of 120 mg QD. Efficacy measures 

included 17-item Hamilton Rating Scale for 

Depression (HAMD17) total score, Clinical Global 

Impression of Severity (CGI-S) scale, Patient 

Global Impression of Improvement (PGI-I) scale, 

and Visual Analog Scales (VAS) for pain. Safety 

was assessed using spontaneously reported treatment-emergent 

adverse events, changes in vital 

signs, and laboratory analytes. 

Results: Significant improvements were 

observed in all efficacy measures at end point (P < 

.001). The rate of discontinuation due to adverse 

events (16.3%) was comparable to rates observed in 

previous placebo-controlled trials. The most frequently 

reported treatment-emergent adverse events 

(TEAEs) were nausea, headache, dry mouth, dizziness, 

and decreased appetite. The majority of 

TEAEs were associated with initial duloxetine dosing—escalations 

in dose produced few additional 

TEAEs. Mean changes from baseline to end point in 

supine systolic and diastolic blood pressure were 1.2 

and 0.6 mmHg, respectively, with no reports of sustained 

hypertension. Mean change in heart rate was 

1.7 bpm, while mean changes in QTcB and QTcF 

were 1.8 and –5.4 msec, respectively. 

Conclusions: These results establish the safety 

and tolerability of duloxetine at once-daily doses 

above 60 mg, and demonstrate that rapid dose escalation 

can be achieved without incurring additional 

adverse events. 

Original Citation: European College of 

Neuropsychopharmacology, Prague, Czech 

Republic, September 2003. 

190—EFFECT OF LANSOPRAZOLE ON 

IL-6 IN HEALTHY WOMEN. Rue K, UHS- 

COM, MSIV, Marinac J, The University of Health 

Sciences, Mathews T, University of Health 

Sciences, Herndon B, University of 

Missouri–Kansas City, Williams C, Sun C, 

University of Health Sciences. E-mail: kchristopher@uhs.edu 

Objective: Determine the effect of 14 days of 

lansoprazole 30 mg (Prevacid) on serum interleukin-6 

(IL-6) concentrations in healthy women. 

Background: Lansoprazole, a commonly prescribed 

proton pump inhibitor (PPI), has been shown to 

modulate the inflammatory response. Previous work 

has shown that PPIs possess antiinflammatory activity. 

PPIs may attenuate the oxidative burst of neutrophils 

(PMNs), downregulate the expression of 

adherence molecules on both PMNs and endothelial 

cells, as well as decrease circulating monocyte concentrations. 

Because lansoprazole modulates the 

inflammatory response, we hypothesized its usage 

may produce effects in IL-6, a cytokine that reflects 

inflammation. An increase in circulating IL-6 is 

indicative of an acute systemic inflammatory 

response. The effect of long-term lansoprazole 

administration on circulating plasma IL-6 concentrations 

is unknown. 

Methods: Twenty-one healthy, premenopausal 

women (mean age 30.6 years) were enrolled. 

Women taking hormones, those with acute infection, 

diabetes, or immunosuppressed conditions or 

who were taking confounding immune-modulating 

medications were excluded. Blood samples were 

obtained at baseline (V1) after 7 (V2) and 14 (V3) 

days of lansoprazole, and at washout (V4), 14 days 

after lansoprazole was discontinued. Human IL-6 

concentrations were determined using ELISA. Data 

are reported as mean (± SD) pg/mL. 

Results: A significant depression of IL-6 concentrations 

was found at V4 as compared with V1: 2.2 

(2.6) versus 1.6 (1.9); P = .02. IL-6 concentrations 

were similar at V1, V2, and V3: 2.2 (2.6), 2.3 (1.9) 

and 2.9 (3.6) pg/mL, respectively. 

Conclusions: Following discontinuation of drug 

given to healthy women for 14 days, IL-6 concentrations 

were significantly lower than before drug 

therapy. However, administration of lansoprazole 

results in no acute change in IL-6 concentrations. 

This finding suggests a delayed reduction in one 

marker of inflammation. Further work is needed to 

determine the causal relationship and clinical 

importance of this finding. 

191—EFFECT OF LANSOPRAZOLE ON 

PMN ACTIVITY AND CHEMOKINES IN 

HEALTHY WOMEN. Rue K, UHS-COM, MSIV, 

Marinac J, The University of Health Sciences, 

Mathews T, University of Health Sciences, Herndon 

B, University of Missouri–Kansas City, Williams C, 

Sun C, University of Health Sciences. E-mail: 

kchristopher@uhs.edu 

Objective: Determine the effect of 14 days lansoprazole 

30 mg on serum interleukin-8 (IL-8) concentrations, 

PMN chemotaxis, and PMN superoxide 

production in healthy women. Background: 

Lansoprazole is well known to modulate extracellular 

and intracellular acid in gastric mucosa. 

Neutrophils (PMNs) use similar ionic processes. 

Lansoprazole binds within PMN lysosomes, attenuating 

free radical production from activated PMNs. 

We hypothesized lansoprazole may also act indirectly 

by attenuating chemokines activating PMNs. 

IL-8 serum concentrations were measured in subjects’ 

whose PMNs were isolated and evaluated. 

Methods: Twenty-one healthy, premenopausal 

women (mean age 30.6 years) were enrolled. 

Women taking hormones, with acute infection, taking 

confounding medications, diabetics, and otherwise 

immune suppressed were excluded. Blood 

samples were obtained at baseline (V1), after 7 (V2) 

and 14 (V3) days of lansoprazole, and at washout 

(V4), 14 days after lansoprazole discontinuation. 

Human IL-8 ELISA was performed on the serum 

while PMN chemotaxis to fMLP and sod-cyto c 

assays were performed on PMNs isolated from the 

subjects’ blood. Data are reported as mean (± SD) 

pg/mL. 

Results: A significant increase in IL-8 concentrations 

was demonstrated at V4 as compared with 

both V1 and V3: V1 13.7 (11.0), V4 17.9 (24.4) P = 

.04; V3 15.0 (12.3), V4 17.9 (24.4) P =.04. 

However, no significant change in IL-8, chemotaxis 

to fMLP, nor superoxide production was demonstrated 

by subject PMNs while taking lansoprazole. 

V1, V2, and V3 IL-8 concentrations were similar: 

13.7 (11.0), 21.1 (22.2), 15.0 (12.3) pg/mL respectively. 

Conclusions: Upon discontinuation of lansopra- 





zole given to healthy women for 14 days, IL-8 concentrations 

were significantly higher than before or 

during drug therapy. However, subjects’ PMNs 

showed no attenuation of free radical production nor 

a decrease in chemotaxis to fMLP. This is the first 

study to relate chemokines to PMN activity in subjects 

treated with a proton-pump inhibitor. Further 

work is needed to determine the causal relationship 

and clinical importance of these findings. 

192—EXAMINATION OF A SERVICE- 

LEARNING–BASED PHARMACEUTICAL 

CARE PROGRAM DELIVERED BY THE 

PHARMACEUTICAL ACCESS PROJECT OF 

THE NESBITT SCHOOL OF PHARMACY. 

McManus M, Nesbitt School of Pharmacy and 

Nursing–Wilkes University, Graham B, Nesbitt 

School of Pharmacy and Nursing–Wilkes 

University. E-mail: mcmanus@wilkes.edu 

Objective: Examination of the impact of pharmacy 

student involvement on the delivery of pharmaceutical 

care to indigent and underserved patient 

populations and reflection on the impact of the service 

learning experience on the student’s perception 

of the professional role of the pharmacist. 

Methods: Data has been collected from three 

independent, free health care clinics. Each clinic has 

a distinct patient population and mission. Clinic data 

collection includes identification of the number of 

pharmaceutical care interventions by the students, 

patient diagnosis, tracking of the total number and 

type of medications prescribed. A student survey 

has been designed to assess student perception of 

the professional roles of pharmacists both before 

and after the service-learning experience. Final 

analysis of the data will be accomplished using 

SPSS. 

Results: Pharmaceutical care (as measured by 

number of direct patient contacts and medication 

dispensed) for indigent patients has steadily 

increased. The patient diagnoses that appear to have 

the most improved access are associated with asthma, 

hypertension and diabetes. Student perceptions 

of the professional role of the pharmacist demonstrated 

an increased appreciation for the skills and 

expertise the pharmacist brings to the health care 

team. 

Conclusions: The Pharmaceutical Access Project 

has evolved into a premier service-learning outreach 

program and research opportunity for the Nesbitt 

School of Pharmacy. It has rapidly grown over the 

past 3 years, from four free clinics to six. The program 

provides pharmaceutical services and medications 

(with the school of pharmacy acting as a 

restricted formulary warehouse) to the local indigent 

rural community. All of the services are provided 

by the students and faculty of the School of 

Pharmacy. Over the past 3 years, 40 students have 

had the unique experience of active involvement in 

ambulatory-based, collaborative efforts to improve 

health care delivery to the homeless and undeserved. 

The almost universal response of the students 

to the service-learning experience is one of 

compassion, increased confidence in professional 

skills, enhanced pride in the practice of pharmacy, 

and increased delivery of pharmaceutical care to the 

underserved individuals of the area. 

193—INCIDENCE AND MANAGEMENT 

OF ANTIDEPRESSANT-INDUCED NAUSEA: 

EXPERIENCE WITH DULOXETINE. Gonzales 

J, Eli Lilly and Company, Greist J, Healthcare 

Technology Systems, Mallinckrodt C, Rayamajhi J, 

Eli Lilly and Company, Raskin J, Eli Lilly Canada. 

E-mail: jgreist@healthtechsys.com 

Objective: Gastrointestinal disturbances, particularly 

nausea, are the most frequently reported 

adverse events for many antidepressants. 

Consequently, management of nausea is important 

for patient adherence. We investigated the incidence 

of nausea in patients with major depressive disorder 

(MDD) who were treated with the new antidepressant 

duloxetine, a potent dual reuptake inhibitor of 

serotonin and norepinephrine. 

Methods: Data were from eight double-blind, 

randomized, placebo- and active comparator-controlled 

trials of patients with MDD. The treatment 

arms were: placebo (N = 777), duloxetine 40 

mg/day (N = 177), duloxetine 60 mg/day (N = 251), 

duloxetine 80 mg/day (N = 363), duloxetine 120 

mg/day (N = 348), paroxetine 20 mg/day (N = 359), 

and fluoxetine 20 mg/day (N = 70). 

Results: In acute (8–9 week) placebo-controlled 

trials of duloxetine (40–120 mg/day), treatmentemergent 

nausea was reported by 19.9% of duloxetine-treated 

patients and 6.9% of patients receiving 

placebo (P < .001). Onset of duloxetine-induced 

nausea occurred primarily within the first 2 days of 

treatment with a median duration of 7 days. The 

incidence of nausea did not differ from placebo rates 

after 1 week. In paroxetine-controlled and fluoxetine-controlled 

studies, the incidence of treatmentemergent 

nausea in patients receiving duloxetine 

did not differ significantly from paroxetine (14.1% 

versus 12.0%) or fluoxetine (17.1% versus 15.7%). 

Most duloxetine-treated patients reported nausea to 

be mild (52.9%) or moderate (41.4%) in intensity. 

Treatment discontinuation secondary to nausea 

occurred in 1.4% of duloxetine-treated patients and 

0.1% of patients receiving placebo. The incidence 

of treatment-emergent nausea during 6-month continuation 

of duloxetine treatment (80 mg/day: 2.1%; 

120 mg/day: 1.3%) was similar to placebo (1.6%). 

Conclusions: These data indicate the new antidepressant 

duloxetine induces mild-to-moderate nausea 

in a subset of patients during treatment initiation. 

Nausea resolved rapidly with continued treatment. 

The incidence of duloxetine-induced nausea 

resembled that produced by the SSRIs paroxetine 

and fluoxetine. Duloxetine-induced nausea should 

have little impact on patient satisfaction and adherence. 

194—LEVEL OF DEPRESSIVE SYMP- 

TOMS AMONG PATIENTS WITH A PRIOR 

HISTORY OF DEPRESSION TREATED 

WITH VERAPAMIL SR-LED VERSUS 

ATENOLOL-LED TREATMENT STRATE- 

GIES. Ried L, University of Florida/Department of 

Veterans Affairs, Tueth M, Department of Veterans 

Affairs, Handberg E, Pepine C, University of 

Florida. E-mail: ried@cop.ufl.edu 

Objective: INVEST demonstrated equivalence 

for clinical outcomes between a verapamil SR (Ve)- 

led strategy and an atenolol (At)-led strategy in 

17,131 U.S. patients with hypertension and coronary 

artery disease. The study objective was to compare 

depressive symptoms between strategies 

among those with a previous diagnosis of depression. 

Methods: A subset of consecutively randomized 

INVEST patients living in the United States (N 

=2,317) were enrolled between April 1, and October 

31, 1999. Patients were mailed a survey within 24 

hours of randomization and 1 year later. The surveys 

contained a depression (CES-D) scale and 

questions about self-reported prior diagnosis of 

depression. Nearly 50.2% of patients returned both 

the randomization and follow-up surveys. 

Results: Among patients with a prior diagnosis 

of depression, the difference in CES-D scores 

between the At-led and Ve-led strategies after 1 year 

was 1.85 points (22.03 versus 20.18, t = 1.01, P = 

.31). Among patients without a prior diagnosis of 

depression, the difference was 1.43 points (12.12 

versus 10.69, t =2.29, P = .02). The baseline CES-D 

scores were similar when the two treatment groups 

were compared. Baseline (23.5 versus 12.0, P < 

.001) and follow-up (21.0 versus 11.4, P < .001) 

depressive symptoms were significantly higher 

among those with a prior diagnosis of depression (N 

= 201) when compared with those without a prior 

diagnosis of depression (N = 951). Patients with a 

prior diagnosis of depression improved by 2.5 

points after 1 year (t = 3.45, P = .001), whereas 

those without a prior history of depression improved 

by 0.6 points (t = 2.33, P = .02). 

Conclusions: Prior history of depression is consistently 

one of the most significant predictors of 

future depression. In INVEST, the treatment choice 

effected patients’ depressive symptoms similarly 

whether or not they had a prior diagnosis of depression, 

although the verapamil SR strategy had less 

mood-related impact than the atenolol strategy. 

195—LIPID MANAGEMENT AND FAC- 

TORS AFFECTING GOAL ATTAINMENT IN 

LATIN AMERICA. Alemao E, Merck and Co., 

Meaney E, Cardiovascular Unit Head, ISSSTE 

Regional Hospital 1º de octubre, Armaganijan D, 

Chief of Caronariopaty Medical Session, Dante 

Pazzanese Institute of Cardiology, Ramos A, 

Innoval, S.A. de C.V, Yin D, Merck and Co. E-mail: 

evo_alemao@merck.com 

Objective: Despite proven value of cholesterol 

reduction in coronary heart disease (CHD) prevention, 

many studies in Europe and the United States 

suggest that majority of patients receiving treatment 

do not achieve the efficacy needed for CHD prevention. 

The objective of this study was to evaluate 

treatment of hyperlipidemia patients in Mexico and 

Brazil and determine factors associated with attaining 

goals as defined in the Third Report of the Adult 

Treatment Panel of the National Cholesterol 

Education Program (ATP-III) in CHD/CHD-equiv- 




FEATURE 

alent patients (LDL-C goal ≤ 100 mg/dL) and 

non–CHD 2+ risk factor patients (LDL-C goal ≤130 

mg/dL). 

Methods: Retrospective observational study at 

randomly selected 25 specialist and 15 general practice 

(GP) centers in Mexico and Brazil. Physicians 

at the centers selected at random adult (age ≥ 18) 

patients that were prescribed lipid lowering drug 

(LLD) for minimum 12 weeks. Date of first LLD 

was the index prescription date; patients were followed 

for minimum 3 months (study period) from 

index date. Medical records were reviewed by 

physicians to collect patient-level data. A lipid profile 

was done in a centralized laboratory at end of 

the study. 

Results: Two hundred and forty patients were 

included for study, 38% from GP practice and 62% 

from specialist practice: 43% were 

CHD/CHD–equivalent patients, 35% 2+ risk factor 

patients and 22% < 2 risk factor patients. Mean (± 

SD) age was 57 (± 12) years, 53% were female. 

Median reduction in LDL-C required to attain ATP- 

III goals was 48% for CHD patients and 25% for 2+ 

risk factor patients. There was no significant difference 

in LDL-C reduction required at initiation of 

LLD in Mexico and Brazil. For CHD group, 27% 

were prescribed low-dose statins (simvastatin 10 mg 

or equipotent), 36% medium-dose statins (atorvastatin 

10 mg or equipotent) and 19% high-dose 

statins (atorvastatin 20 mg or equipotent) as initial 

LLD. Physicians in Brazil prescribed higher equipotent 

statin doses compared with Mexico (MH chisquare 

< .05). Overall 44% patients attained ATP- 

III recommended LDL-C goals. After controlling 

for age, gender, country, baseline LLD, titration and 

comorbidities, patients with baseline LDL-C ≥ 190 

mg/dL (OR = 0.41; 95% CI, 0.23–0.72), 3+ risk factors 

(OR = 0.51; 95% CI, 0.27–0.98) and CHD (OR 

= 0.38; 95% CI, 0.21–0.68) were less likely to 

achieve LDL-C goal. 

Conclusions: Majority (56%) of hyperlipidemia 

patients did not attain recommended ATP-III LDL- 

C goals. More aggressive lipid management is 

required in patients with high baseline LDL-C, 

CHD and multiple CHD risk factors in order to 

achieve recommended lipid goals in these patients. 

196—NOVEL, EPIDURAL, SUSTAINED- 

RELEASE MORPHINE PROVIDES 48-HOUR 

POSTOPERATIVE PAIN RELIEF. Viscusi E, 

Thomas Jefferson University, Martin G, Duke 

University Medical Center, Hartrick C, William 

Beaumont Hospital, Singla N, Huntington 

Memorial Hospital, Manvelian G, SkyePharma, Inc. 

E-mail: eugene.viscusi@jefferson.edu 

Objective: Rationale: Epidural morphine provides 

good postoperative analgesia, but requires use 

of an indwelling catheter for pain relief beyond 24 

hours. Obviating the need for an indwelling catheter 

with a single dose of sustained-release morphine 

could eliminate complications associated with 

indwelling epidural catheters, especially in patients 

receiving anticoagulants. Objective: To evaluate 

DepoMorphine, a novel, single-dose, sustainedrelease 

formulation of epidural morphine, in providing 

pain relief for 48 hours postoperatively. 

Methods: Adults (N = 194) undergoing total hip 

arthroplasty were randomized to receive an epidural 

injection of placebo (normal saline) or 

DepoMorphine 15, 20, or 25 mg for postoperative 

pain management. All patients had access to IV fentanyl 

via a PCA pump for breakthrough pain relief 

as needed. Postoperative fentanyl consumption 

through 48 hours was the primary efficacy end 

point. Pain intensity and pain relief were also 

assessed. 

Results: DepoMorphine reduced mean (± SD) 

fentanyl use versus placebo (510 ± 708 mcg versus 

2,091 ± 1,803 mcg; P < .0001) and delayed median 

time to first rescue with fentanyl (21.3 hours versus 

3.6 hours; P < .0001). DepoMorphine patients had 

lower mean (± SD) pain intensity scores with activity 

as measured by the VAS (0–100 mm) at 24 and 

48 hours (30 ± 28 versus 52 ± 29 and 29 ± 28 versus 

39 ± 27; P < .001 and P = .06). DepoMorphine 

patients were also more likely to rate pain relief as 

“good” or “very good” (90% versus 65%; P < .05). 

More DepoMorphine-treated patients did not 

require postoperative fentanyl at 12 (57% versus 

2%; P < .001) and 48 hours (25% versus 2%; P = 

.001). The incidence of adverse events was similar 

across treatment groups except for a higher incidence 

of vomiting and pruritus (P < .05) with 

DepoMorphine. Respiratory depression occurred in 

5 (4%) of DepoMorphine patients and no placebo 

patients (NS). 

Conclusions: Single-dose DepoMorphine provided 

postoperative pain relief for 48 hours, while 

avoiding complications associated with indwelling 

epidural catheters. 

197—ONSET OF IMPROVEMENT IN 

EMOTIONAL AND PAINFUL PHYSICAL 

SYMPTOMS OF DEPRESSION WITH 

DULOXETINE TREATMENT. Gonzales J, 

Wohlreich M, Eli Lilly and Company, Brannan S, 

Cyberonics, Mallinckrodt C, Detke M, Lu Y, 

Watkin J, Tollefson G, Eli Lilly and Company. E- 

mail: mvmd@lilly.com 

Objective: Duloxetine, a potent reuptake 

inhibitor of serotonin (5-HT) and norepinephrine 

(NE), is expected to show robust and rapid efficacy 

in treating emotional symptoms of depression. 5-HT 

and NE also play an important role in modulation of 

pain via a descending inhibitory pain pathway in the 

spinal cord. Therefore we hypothesized that duloxetine 

would also demonstrate efficacy in painful 

physical symptoms, which are commonly associated 

with depression. We examined the temporal pattern 

of efficacy of duloxetine 60 mg QD in both the 

emotional and painful physical symptoms associated 

with major depression. 

Methods: Data were pooled from two, 9-week 

randomized, double-blind, clinical trials of duloxetine 

60 mg QD (N = 244) and placebo (N = 251). 

Emotional symptom outcomes included the 17-item 

Hamilton Rating Scale for Depression (HAMD17) 

total score and its subfactors and items, as well as 

the Clinical Global Impression of Severity (CGI-S), 

and Patient Global Impression of Improvement 

(PGI-I) scales. Painful physical symptom outcomes 

included Visual Analog Scales (VAS) for pain. 

Results: For all emotional symptom outcomes, 

meaningful and significant advantages of duloxetine 

over placebo were observed at week 1 or 2, and continued 

to increase throughout the trial. In physical 

symptom outcomes, meaningful and significant 

advantages were again observed at week 1 or 2; 

however, maximal improvement was observed by 

week 3. For example, at weeks 1 and 9 the advantage 

of duloxetine over placebo in mean changes on 

HAMD17 item 1 were 0.19 and 0.57, respectively. 

For back pain, the advantage of duloxetine over 

placebo at weeks 1 and 9 in mean percent improvement 

was 23.1% and 25.1%, respectively. 

Conclusions: In these studies, duloxetine (60 mg 

QD) demonstrated rapid onset of robust and sustained 

antidepressant efficacy across a wide range 

of emotional and physical symptom outcomes. 

Original Citation: Society of Biological 

Psychiatry Annual Meeting, May 2003. 

198—OPEN-LABEL TREATMENT WITH 

DULOXETINE 60 MG ONCE-DAILY IN THE 

ACUTE TREATMENT OF MAJOR DEPRES- 

SIVE DISORDER. Gonzales J, Detke M, Wang F, 

Wiltse C, Prakash A, Wohlreich M, Eli Lilly and 

Company. E-mail: mdetke@lilly.com 

Objective: Open-label studies may better mimic 

normal clinical practice and may offer a better 

approximation of clinical practice results with 

duloxetine 60 mg QD than those seen in placebocontrolled 

studies. Together with data from placebocontrolled 

studies, the information from this study 

may help clinicians to determine the place for 

duloxetine among current pharmacotherapy choices 

for the treatment of major depressive disorder 

(MDD). 

Methods: Results were obtained from an openlabel, 

12-week, multinational clinical trial in MDD 

outpatients (age ≥ 18) receiving duloxetine at 60 mg 

(administered once daily.) 

Results: A total of 533 patients enrolled in this 

study. Mean changes in the HAMD17 total score, 

HAMD subfactors, CGI-Severity, and Visual 

Analog Scales for pain all showed highly significant 

(P < .001) improvements at all assessment times. 

Response and remission rates at end point were 

67.9% and 52.8%, respectively. Adverse events led 

to discontinuation in 11.3% of patients. The most 

frequently reported treatment-emergent adverse 

events were nausea (35.8%), headache (20.3%), dry 

mouth (18.0%), somnolence (13.5%), insomnia 

(10.5%), and dizziness (10.1%). Mean changes for 

pulse, systolic and diastolic blood pressure, and 

body weight were 1.72 bpm, 1.35 mm Hg, 0.71 mm 

Hg, and –.08 kg, respectively. 

Conclusions: Results from this study were generally 

consistent with previously reported doubleblind 

placebo-controlled studies that had established 

the safety and efficacy of duloxetine in the treatment 

of major depression. The results reported herein 





provide a useful estimation of the outcomes that will 

be seen in normal clinical practice. 

Original Citation: U. S. Psychiatric & Mental 

Health Congress, November 2003. 

199—PREVALENCE OF COMORBIDI- 

TIES IN DVT AND PE PATIENTS. Yin H, 

University of Illinois at Chicago, Vogenberg R, Aon 

Consulting. E-mail: hyin3@uic.edu 

Objective: Deep vein thrombosis (DVT) and pulmonary 

embolism (PE) patients tend to have multiple 

comorbidities that need to be considered when 

evaluating pharmacotherapy outcomes. DVT 

patients may have different comorbidities from PE 

patients, and until now this comparison had not been 

examined in the literature. This study aims to identify 

the prevalence of comorbidities in DVT and PE 

patients and to compare comorbidity prevalence of 

the DVT group to that of the PE group. 

Methods: The study is based on an administrative 

database from eight U.S. hospitals. There are 

2,506 DVT patients and 1,973 PE patients’ records 

in the pooled database. Patients with both DVT and 

PE were considered only as PE patient in the analysis. 

Comorbidities were categorized and summarized 

according to ICD-9-CM codes. A comorbidity 

was included in the analysis only when prevalence 

in DVT or PE group was greater than 1%. A chisquare 

test was performed to analyze whether the 

comorbidity burdens were similar or different 

between the two groups. 

Results: There are 29 comorbidities with prevalence 

greater than 1% in either DVT or PE group. 

DVT patients are found to be more likely to have 

peripheral vascular disease, anemia, cerebrovascular 

disease, and renal disease. PE patients are more 

likely to have cardiac arrhythmias, congestive heart 

failure, mild to moderate diabetes, chronic pulmonary 

disease, and cases of drug abuse. Further, a 

PE patient tends to have more comorbidities overall 

compared with a DVT patient. 

Conclusions: Prevalence of comorbidities differs 

between DVT and PE patients. Additional study is 

needed to address the reasons why PE patients are 

more likely to have certain comorbidities. DVT 

patients who have these comorbidities should be 

identified in effort to prevent PE development 

through pharmacotherapy prophylaxis. 

200—PROLONGED EPIDURAL ANALGE- 

SIA WITH SINGLE-DOSE, ENCAPSULATED 

MORPHINE VERSUS STANDARD EPIDU- 

RAL MORPHINE FOR POSTOPERATIVE 

PAIN AFTER HIP SURGERY. Viscusi E, 

Thomas Jefferson University, Kopacz D, Virginia 

Mason Medical Center, Hartrick C, William 

Beaumont Hospital, Martin G, Duke University 

Medical Center, Manvelian G, SkyePharma, Inc. E- 

mail: eugene.viscusi@jefferson.edu 

Objective: To evaluate the analgesic efficacy and 

safety of a single, preoperative, epidural injection of 

sustained-release morphine (DepoMorphine) compared 

with standard preservative-free morphine sulfate 

(MS) in patients undergoing total hip arthroplasty 

with intrathecal anesthesia. 

Methods: A prospective, open-label, serial 

cohort, dose-ranging trial at six U.S. sites enrolled 

39 patients scheduled for total hip arthroplasty with 

intrathecal anesthesia. Patients were assigned to 

receive DepoMorphine 10 (N = 4), 15 (N = 1), 20 

(N = 12), 25 (N = 1), or 30 mg (N = 8) or a control 

of MS 5 mg (N = 13) as a single injection via epidural 

catheter 30 minutes preoperatively. Regional 

anesthesia was then administered with an intrathecal 

injection of bupivacaine (12.5–17.5 mg). Patients 

had postoperative access to intravenous patient-controlled 

analgesia using fentanyl for treatment of 

breakthrough pain. Efficacy parameters were total 

fentanyl consumption, time to first fentanyl use, 

pain intensity rated by 100 mm visual analog 

(VAS), and 4-term categorical (CAT) scales. Safety 

was evaluated through clinical assessments and laboratory 

testing. 

Results: Mean total fentanyl use for 

DepoMorphine 10, 20, and 30 mg groups were 598 

± 230 mcg, 261 ± 95 mcg, and 143 ± 101 mcg, 

respectively, and 1,095 ± 280 mcg for MS (P = .01). 

Median times to first fentanyl dose were 18, 36, and 

35 hours for DepoMorphine 10, 20, and 30 mg, 

respectively, and 6 hours for MS (P < .001). VAS 

and CAT scores were comparable among all groups. 

Pain medication was rated “excellent” by 46% of 

DepoMorphine-treated patients and 15% of MStreated 

patients. The most common postoperative 

adverse effects for both groups were pruritus, fever, 

and nausea; respiratory effects were mild to moderate 

in severity and similar for both groups. 

Conclusions: DepoMorphine provided prolonged 

dose-dependent postoperative analgesia versus 

MS 5 mg in patients undergoing total hip arthroplasty 

with intrathecal anesthesia. This new treatment 

modality offers clinicians a new option that 

may simplify postoperative pain management. 

201—SUSTAINED-RELEASE EPIDURAL 

MORPHINE REDUCES POSTOPERATIVE 

PCA FENTANYL USE FOR 48 HOURS 

AFTER LOW ABDOMINAL SURGERY. 

Gambling D, Sharp Mary Birch Hospital for 

Women, Hughes T, Woodland Memorial Hospital, 

Martin G, Duke University Medical Center, 

Manvelian G, SkyePharma, Inc. E-mail: 

dgamb@san.rr.com 

Objective: Rationale: Complications can arise 

from epidural catheterization, especially when anticoagulants 

are administered. A new, sustainedrelease 

morphine (DepoMorphine [DM]) may obviate 

the need for an indwelling epidural catheter and 

provide prolonged analgesia. Objective: To compare 

analgesic efficacy and safety of four dosage 

strengths of DM with a single dose of DM 5 mg 

(dose-control) and with standard epidural morphine 

sulfate (MS) 5 mg after elective low abdominal 

surgery. 

Methods: 519 adults were randomly assigned to 

receive preoperative epidural injection of MS 5 mg 

or DM 5, 10, 15, 20, or 25 mg. Patients had patientcontrolled 

analgesia (PCA) using intravenous fentanyl 

for postoperative pain control. Fentanyl consumption 

through 48 hours was the primary efficacy 

endpoint. Pain intensity (VAS: 0–100 mm) and 

overall pain control (very good, good, fair, or poor) 

were also assessed. Adverse events were recorded. 

Results: Mean (± SD) total fentanyl use through 

48 hours decreased from 995.1 ± 987.0 mcg to 

682.5 ± 620.0 mcg, respectively, with DM 10 and 

25 mg compared with 1,213.3 ± 1079 mcg and 

1217.1 ± 894.0 mcg, respectively, with DM 5 mg 

and MS 5 mg (P< .05). In the DM 10, 15, 20, and 25 

mg groups, 15% of patients required no supplemental 

fentanyl through 48 hours compared with 6% 

and 2%, respectively, in DM 5 mg and MS 5 mg 

groups (P < .01). VAS scores were better with DM 

for 48 hours postdose. On Day 2, pain control was 

rated significantly better in the 15 and 25 mg DM 

groups versus the MS group (P < .05). Urinary 

retention and pruritus occurred more frequently in 

DM patients (9% versus 3% and 54% versus 39%, 

respectively; P < .05); other adverse events were 

similar across groups. 

Conclusions: A single epidural injection of DM 

provides prolonged postoperative analgesia, 

improved pain control, and decreased need for postoperative 

PCA fentanyl, thereby simplifying postoperative 

pain treatment. 

202—WEIGHT CHANGES DURING 

LONG-TERM TREATMENT WITH DULOX- 

ETINE AND PAROXETINE. Gonzales J, 

Mallinckrodt C, Detke M, Eli Lilly and Company, 

Raskin J, Eli Lilly Canada, Tran P, Watkin J, 

Wohlreich M, Eli Lilly and Company. E-mail: 

cmallinc@lilly.com 

Objective: Weight gain during long-term antidepressant 

treatment is a common concern and may 

interfere with compliance with pharmacotherapy. 

Methods: Data were pooled from two doubleblind 

studies. Patients received placebo (N = 192), 

duloxetine 80 mg/day (40 mg BID; N = 188), duloxetine 

120 mg/day (60 mg BID; N = 196), or paroxetine 

20 mg QD (N = 183) for 8 weeks. Acute treatment 

responders (≥ 30% reduction from baseline 

HAMD17 total score) continued double-blind therapy 

for an additional 26 weeks. Data from a 52- 

week open-label study of duloxetine 80–120 

mg/day (40–60 mg BID; N = 1,279) were analyzed 

separately. 

Results: Following acute treatment, mean 

changes in weight for patients receiving duloxetine 

80 mg/day (–0.2 kg), duloxetine 120 mg/day (–0.2 

kg), or paroxetine 20 mg QD (–0.1 kg) did not differ 

significantly from placebo (0.1 kg). After 34 

weeks, mean weight changes for duloxetine (80 

mg/day: 0.8 kg; 120 mg/day: 1.0 kg) did not differ 

significantly from placebo (0.1 kg), while patients 

receiving paroxetine 20 mg QD had a mean weight 

change significantly greater than the placebo group 

(1.2 kg; P = .020). Incidences of weight gain ≥ 7% 

during the 34-week study were: placebo (3.0%), 

duloxetine 80 mg/day (3.2%), duloxetine 120 

mg/day (8.8%), and paroxetine 20 mg QD (11.5%). 

In the open-label study, mean changes in weight at 

weeks 8, 32 and 52 were –.2 kg, 1.5 kg, and 2.1 kg, 

respectively. 

Conclusions: In these studies, changes in body 




FEATURE 

weight during long-term treatment with duloxetine 

(80–120 mg/day) were intermediate to the changes 

observed for placebo and paroxetine 20 mg QD. 

Original Citation: U. S. Psychiatric and Mental 

Health Congress, November 2003. 

203—INSPIRATORY FLOW THROUGH 

DRY-POWDER INHALERS (DPI) IN ASTH- 

MATIC CHILDREN 2 TO 12 YEARS OLD. 

Monske M, McNutt DH, Raissy H, University of 

New Mexico. E-mail: mmonske@salud.unm.edu 

Objective: To measure peak inspiratory flow 

(PIF) generated through Turbuhaler, Aerolizer, and 

Diskus dry-powder inhalers (DPIs) in children 2 to 

12 years old. 

Methods: An open-labeled, stratified, randomized, 

crossover comparison of the three DPIs in 

asthmatic children presenting to the Pediatric 

Pulmonary Clinic, University of New Mexico 

Hospital. All the patients had used MDIs previously, 

but were excluded if they had used a DPI previously 

or were experiencing an asthma exacerbation 

during their visit. Patients were instructed on how to 

use one device at a time and were asked to demonstrate 

the use without coaching from the study coordinator 

or parents. For patients aged 2 and 3 years 

who were unable to manually activate the device, 

parents were asked to help the patient and this was 

noted by study coordinator. 

Results: A total of 60 patients completed at least 

one part of the study. The PIF results are presented 

in the table. 

Conclusions: The majority (87%) of children 

less than 5 years old could not generate a PIF of 60 

L/minute, whereas the majority (85%) of children 

older than 2 years of age could generate a PIF of 30 

L/minute. When asked which device they preferred 

overall, a greater percentage (41%) chose Diskus. 

APhA–APRS Economic, 

Social & Administrative 

Sciences 

204—A CONFIRMATORY FACTOR 

ANALYSIS OF THE CENTER FOR EPIDEMI- 

OLOGIC STUDIES DEPRESSION SCALE OF 

VERAPAMIL SR-LED AND ATENOLOL-LED 

HYPERTENSION TREATMENT STRATE- 

GIES. Wilson D, Mueller M, Meng X, Ried L, 

University of Florida. E-mail: flowersinhergarden@hotmail.com 

Objective: To determine whether the fit of the 

Center for Epidemiologic Studies depression scale 

(CES-D) factor analytical model is similar for 

patients assigned to verapamil SR-led (Ve-led) and 

atenolol-led (At-led) hypertension treatment strategies. 


patients involved in an international high blood 

pressure treatment clinical trial (N = 2,317) was 

enrolled between April 1, 1999, and October 31, 

1999. These patients were mailed a survey that contained 

the CES-D scale within 24 hours of randomization 

and after 1 year. All 20 items were completed 

by 1,019 patients at 1 year. The four-factor CES- 

D model initially used to fit the data included somatic-retarded 

activity, depressed affect, positive affect, 

and interpersonal relationship factors. Multigroup 

confirmatory factor analysis procedures tested differences 

in the fit of the two treatment groups’ data 

after 1 year. Mean differences in CES-D scores 

from the four derived factors were compared 

between the At-led and Ve-led treatment groups 

using Student’s t-tests. 

Results: The data for the combined sample fit the 

postulated four-factor model. However, the item 

factor loadings were different between patients 

assigned to the Ve-led and At-led groups. The 

patients assigned to the At-led treatment group had 

scores indicative of higher depressive symptoms 

when compared with those assigned to the Ve-led 

treatment on all four factors. 

Conclusions: The four-factor CES-D model was 

confirmed. However, patients in the two high blood 

pressure treatment strategies endorsed the items in 

the four factors differently. This difference in 

endorsing the items may reflect the medications’ 

different pharmacological properties and side 

effects. Choice of treatment did not preferentially 

Mean (± SD) PIF (L/minute) 

Age Group (years of age) Diskus Aerolizer Turbuhaler 

2 29.2 ± 4.1 30.5 ± 6.1 20.2 ± 2.8 

3 43.8 ± 17.1 44.7 ± 10.3 37.9 ± 26 

4 41.6 ± 14 51.1 ± 20.9 35.0 ± 15.8 

5 51.1 ± 15.6 54.6 ± 18.3 44.6 ± 23.1 

6–9 58.5 ± 18.7 65.5 ± 27.6 39.7 ± 13.2 

10–12 58.6 ± 22.7 75.0 ± 28 47.9 ± 15.6 

influence the patients’ positive or negative affect or 

somatic symptoms, but patients assigned to the Veled 

treatment strategy endorsed fewer depressive 

symptoms for all four factors. 

205—A FIVE-YEAR COMPARISON 

STUDY OF ARIZONA PHARMACISTS IN 

RURAL AND URBAN COUNTIES. Eng H, 

University of Arizona. E-mail: aeng@ahsc. 

arizona.edu 

Objective: Similar to many states, Arizona is facing 

a shortage of pharmacists in both urban and rural 

settings. There is a growing concern about whether 

the state can keep up with the demands for pharmacists. 

The goal of this study is to answer the following 

question: Are the shortages greater in the rural 

counties than the urban counties in the state? 

Methods: Pharmacist data for 5 years 

(1997–2001) were obtained from the Arizona Board 

of Pharmacy. Only those with active pharmacist 

licenses residing in one of Arizona’s 15 counties 

were examined. An active licensed pharmacist 

could be a person who is not currently practicing 

pharmacy or a person who is a part-time practitioner. 

Pharmacists licensed in other states who were 

working in federal pharmacies were not examined. 

A comparison of the number of pharmacists and 

number of pharmacists per 100,000 residents for the 

two urban counties, two rural–urban counties, and 

the remaining 11 rural counties was performed during 

the 5-year study. 

Results: In 2001, a total of 3,743 individuals held 

active Arizona pharmacist licenses, an increase of 

843 pharmacists (29%) over 1997. During this 5- 

year period, the ratio of Arizona pharmacists per 

100,000 residents increased from 63 to 71. Most of 

the increases occurred in the two urban counties 

(30%). Maricopa County had higher pharmacist 

percentage increases than did Pima County (32% 

versus 27%). The 13 other counties had similar percentage 

increases, 20% in the two rural–urban counties 

and 21% in the remaining 11 rural counties. 

Conclusions: Examination of the Arizona pharmacist 

data shows that over the study period, greater 

increases in the number of pharmacists occurred in 

the urban counties. The ratio of pharmacists per 

100,000 residents increased from 71 in 1997 to 80 in 

2001. By contrast, the ratio of pharmacists to 

100,000 residents increased from 44 to 45 in the 

rural-urban counties and 36 to 37 in the rural counties. 

These data indicate that the shortage of pharmacists 

is greater in the rural counties than in the 

urban counties. 

206—A STUDY OF FACTORS RELATED 

TO PATIENTS’ SHARING OF SIDE EFFECT 

AND SYMPTOM SELF-MONITORING 

INFORMATION WITH THEIR ONCOLO- 

GISTS. Hermansen-Kobulnicky C, University of 

Wyoming. E-mail: cjhkobul@uwyo.edu 

Objective: To explore the potential reasons as to 

why some cancer patients used intervention-based 

self-monitoring side effect and symptom information 

when talking with their oncologists, while others did 

not. Variables of Self-Efficacy for Participating with, 





and perceived Interpersonal Relationship Quality of, 

the oncologist in addition to patient age and education 

were compared across whether or not patients 

reported using self-monitoring information in this 

way after being instructed to do so. 

Methods: A longitudinal, descriptive design was 

employed using experimental subject data from a 

larger study. Subjects were adult cancer outpatients 

beginning chemotherapy at three cancer clinics, randomly 

assigned to an intervention designed to teach 

them to self-monitor side effects and symptoms and 

to use such information with their oncologists. Data 

collection was via pretest, posttest, and clinic chart. 

Variables for hypothesis testing are patients’ Self- 

Efficacy for Participating with, and perceived 

Interpersonal Relationship Quality of, the oncologist, 

measured as multi-item summated scales, and 

patient age and education. Other variables are used 

for sample description. Analysis for hypothesis testing 

includes Student’s t-, matched-pair, and chisquare 

tests. 

Results: Data were analyzed from 39 of 61 

experimental group subjects (63.9%) who completed 

the larger study and self-monitored using the 

intervention materials. Most subjects were women 

(79.5%), white (94.9%), and educated (48.5% had a 

college degree). Significant findings include higher 

Interpersonal Relationship Quality ratings of oncologists 

among those who reported using their selfmonitoring 

information with their oncologists 

(112.5 > 97.4, t = –2.120, P < .05). 

Conclusions: Study results suggest better 

provider–patient relationships may improve patient 

sharing of side effect and symptom information. 

Provider training, including that of pharmacists, 

should include how to better elicit patients’ side 

effect and symptom concerns. Future research is 

needed to determine how patient self-monitored 

information can be incorporated into the routine of 

ambulatory care. 

207—ACTIONS OF COMMUNITY PHAR- 

MACISTS IN RESPONSE TO CONCURRENT 

USE OF PRESCRIBED MEDICINES WITH 

COMPLEMENTARY AND ALTERNATIVE 

MEDICINE. Shah S, Brown C, Barner J, 

University of Texas at Austin. E-mail: 

sonaleecs@mail.utexas.edu 

Objective: (1) To determine how often pharmacists 

inquire about complementary and alternative 

medicine (CAM) use among their patients; (2) to 

identify actions pharmacists take in response to 

patients’ use of CAM along with prescribed medications; 

and (3) to examine if demographic, professional, 

or setting characteristics predict differences 

in pharmacists’ rate of inquiry about CAM use and 

in the actions taken. 

Methods: A survey was mailed to 400 Texas 

community pharmacists. The questionnaire collected 

information on pharmacists’ inquiries about 

CAM, their actions in response to patients’ concurrent 

use of CAM and prescription medications, and 

their demographic, professional, and setting characteristics. 

Pharmacists’ responses were analyzed both 

descriptively and inferentially. Chi-square analyses, 

Student’s t-tests, and analysis of variance 

(ANOVA) were used to examine the differences in 

pharmacists’ responses. 

Results: A total of 107 completed surveys were 

analyzed. Pharmacists rarely to sometimes (mean ± 

SD, 2.5 ± 0.9) inquired about a patients’ use of 

CAM. Most pharmacists (72.9%) either encouraged 

the use of CAM if appropriate or neither encouraged 

nor discouraged the use of CAM. Pharmacists who 

had additional training in CAM (P = .002) and those 

who had a place on patients’ profiles to document 

CAM use (P = .04) were more likely to inquire 

about CAM use than others. Pharmacists who 

stocked herbals or homeopathic products would 

more often encourage (P = .02) or recommend (P = .03) 

use of CAM therapies than others. Pharmacists who 

worked in independent pharmacies were less likely 

to encourage or discourage use of CAM than pharmacists 

in other settings (P = .004). 

Conclusions: The rate of inquiry about patients’ 

CAM use was rare among pharmacists. They most 

often encouraged CAM use if deemed medically 

appropriate. Pharmacists’ actions and rate of inquiry 

varied based on professional and practice setting 

characteristics. 

208—AN ASSESSMENT OF FRESHMAN 

PHARMACY STUDENTS’ CONSUMPTION 

OF AND PERCEPTIONS ABOUT DRUG AND 

ALCOHOL USE. Patwardhan P, Mukherjee K, 

Siganga W, Lundy J, University of Toledo. E-mail: 

pallavi_patwardhan@yahoo.com 

Objective: Pharmacy students will become 

providers of pharmaceutical care services and will 

have easy access to potentially abusive drugs and 

alcohol. The goals of this study were to determine 

from first-year pharmacy students the following 

about themselves and their peers: (1) reasons for 

alcohol consumption, (2) the frequency of binge 

drinking, (3) perceptions about illegal drug use, (4) 

types of illegal drugs commonly used, and (5) perceptions 

about the effect of current and future drug 

or alcohol consumption on their future professional 

integrity. 

Methods: A 25-item questionnaire was administered 

to 353 first-year pharmacy students over a 1- 

week period during the fall semester 2002. 

Questionnaires were distributed to students in 17 

sections of a freshman pharmacy class. The data 

were analyzed using SPSS version 11.5. 

Results: A total of 329 students responded 

(93%). Almost all were under 21 years of age. 

Enhancement of social activity was reported as the 

main reason for alcohol consumption by 62% of students. 

Forty-four percent of the students thought 

that 51%–75% of their peers consumed alcohol at 

least once every 2 weeks. Forty-four percent reported 

binge drinking more than two times in the month 

before the survey. Sixty-two percent of the students 

thought that 1%–25% of first-year pharmacy students 

used drugs illegally. Marijuana was the most 

commonly used illegal drug. Fifty-nine percent of 

the students thought that use of drugs or alcohol 

would affect their future professional integrity as 

health care providers. 

Conclusions: Having a majority of underage 

freshman pharmacy students involved in drug and 

alcohol use should be a concern for the College of 

Pharmacy. Students must be educated about the hazards 

of drug and alcohol use. Alcohol abuse prevention 

and treatment programs could help change the 

drinking behavior of the students over a period of 

time. 

Original Citation: Date: July 2003 Location: 

Ohio Pharmacist Journal, Volume 52, No. 7, pages 

16 and 17. 

209—AN EVALUATION OF MANAGING 

THE RISK OF GLUCOCORTICOID- 

INDUCED OSTEOPOROSIS. McDonough R, 

Doucette W, Kumbera P, Klepser D, University of 

Iowa. E-mail: randal-mcdonough@uiowa.edu 

Objective: To assess the impact of risk-management 

activities on patient risk of glucocorticoidinduced 

osteoporosis. 

Methods: This was a randomized control study, 

set in 15 Iowa community pharmacies, of patients 

18 years of age or older who had been on the equivalent 

of at least 7.5 mg of prednisone for at least 6 

months. Patients in the control group received usual 

and customary care. Patients in the treatment pharmacies 

received education and a take-home educational 

pamphlet about the risks of glucocorticoidinduced 

osteoporosis. In addition, the treatment 

group pharmacists monitored the patients’ drug 

therapy and identified and addressed any drug-related 

problems. Data on the glucocorticoid taken by 

the patient, other medications, and osteoporosis risk 

factors were collected at baseline and after 9 months 

of monitoring, via a Web-based survey completed in 

the pharmacy. Patients also reported use of osteoporosis 

preventive therapies, whether anyone had 

discussed osteoporosis risk from glucocorticoids or 

the need for a bone mineral density test, and 

whether they had had a bone mineral density test. 

Results: When the pre–post frequencies changes 

were compared between the groups, the contrasts 

were significant in favor of the treatment pharmacies 

for the frequency of patients taking a calcium 

supplement (control, –4 [–6.9%]; treatment, 7 

[17.1%], P < .05). Education by the treatment pharmacies 

also raised patient awareness of bone mineral 

density testing. 

Conclusions: Community pharmacists are capable 

of identifying patients at risk for glucocorticoidinduced 

osteoporosis. Pharmacists who educate atrisk 

patients can positively affect the self-care of these 

patients, including the use of calcium supplements. 

210—ASSESSING THE STATE OF DISEASE 

STATE MANAGEMENT PROGRAMS IN 

COMMUNITY PHARMACY SETTINGS IN 

CALIFORNIA. Law A, Western University, 

Okamoto M, Western University of Health 

Sciences. E-mail: alaw@westernu.edu 

Objective: The purpose of the study was to 

assess the prevalence, types, and characteristics of 

disease state management (DSM) programs in the 

community pharmacy setting in the state of 

California. 




FEATURE 

Methods: The study used an exploratory telephone 

survey and targeted all 5,270 community 

pharmacies in California. Pharmacies willing to participate 

were surveyed about current or past DSM 

programs in the pharmacy. The reasons for closure 

of past DSM programs were also obtained. For 

pharmacies with no DSM programs, interest as well 

as perceived barriers in developing DSM programs 

were examined. The pharmacies with existing DSM 

programs were sent a follow-up survey about the 

characteristics of the DSM program, including challenges 

faced in establishing DSM programs, DSM 

protocols used, measurement of outcomes, reimbursement 

patterns, and documentation of success 

of the program. Demographic information was 

obtained from all participating pharmacies. 

Results: Data from a total of 1,299 pharmacies 

had been analyzed when this abstract was prepared. 

Only about 4% (51) of the sample had a DSM program 

currently in place; a substantial proportion 

(37) were in independent pharmacies. Diabetes care 

was the most prevalent program, followed by asthma 

and hyperlipidemia. Seven pharmacies had a 

program that closed down because of either limited 

patient acceptance or exit of directing pharmacist. 

About 20% of the pharmacies who did not have a 

program were interested in implementing a DSM 

program. Interest was highest for diabetes care. 

Commonly perceived barriers to new programs 

were limited time and staff. 

Conclusions: Independent pharmacies tended to 

have more DSM programs and more autonomous 

decision making about developing such programs. 

The most prevalent and the most desired type of 

DSM program appeared to be diabetes. Data from 

the remaining pharmacies and DSM programs are 

being analyzed and tabulated. 

211—COLLEGE STUDENTS AND STRESS: 

WHAT IS THE CONNECTION? A HUMANIS- 

TIC OUTCOMES ASSESSMENT. White A, 

University of Florida, Xiao H, Florida A&M 

University. E-mail: whiteann@ufl.edu 

Objective: The objectives of this study are to 

determine the top three stressors for college students 

and to explore how different demographics affect 

those stressors. 

Methods: Primary Data Collection, Cross- 

Sectional Study Items for the questionnaire were 

obtained from the Brief College Student Hassles 

Scale (BCSHS), Erindale College University of 

Toronto. Students responded to a Likert-type scale 

that ranged from 1 (never) to 5 (extremely often) 

and ranked stressors in terms of frequency and the 

extent to which they were bothered by the stressor. 

The sample consisted of 122 students in pharmacy 

school at Florida A & M University. Frequencies, 

Student’s t-test, correlation, regression, and oneway 

ANOVA were conducted using SPSS. 

Results: t-Tests: For men (P < .01), the five highest 

ranked items were (1) parking problems (µ = 

4.13), (2) preparing for examinations (µ = 4.11), (3) 

lack of money (µ = 3.48), (4) schoolwork (working 

on term papers, reading tedious hard material; µ = 

3.42), and (5) unavailable resources (µ = 3.18). For 

women (P < .01), the five highest ranked items were 

(1) parking problems (µ = 4.36), (2) examination (µ 

= 4.20), (3) schoolwork (µ = 3.83), (4) lack of 

money (µ = 3.39), and (5) waiting in lines, appointments 

(µ = 3.22). Pearson’s Correlation: A negative 

relationship between age and the stressor appearance 

of self (P = .021). A positive relationship 

between female and the stressor health physical 

symptoms of self (e.g., headache, premenstrual syndrome, 

allergies) (P = .001). A positive relationship 

between female and the stressor roommates/house 

mates relationship (P = .020). A positive relationship 

between female and the stressor weight/dietary 

management (P = .007). One-Way ANOVA: 

Significant differences were identified between age 

groups with regard to finding or moving into housing 

and parking problems; between races with 

regard to bills/overspending; and between men and 

women with regard to health–physical symptoms. 

Regression Analysis: Males, age 26 and up (P = 

.029) and age 17–22 years (P = .016) were less 

stressed by money than those ages 23–25 years. 

Whites were less stressed out by money than other 

races (P = .043). For women, no significant differences 

were identified among demographics and 

stressors. 

Conclusions: Demographics and stress are related, 

according to the results of this study. Areas in 

which efforts should be focused for improvement in 

the future are identified. 

Original Citation: International Society for 

Pharmacoeconomics and Outcomes Research, 8th 

International Meeting, May 2003, Arlington, Va. 

212—COMMUNITY PHARMACISTS’ 

PERCEPTIONS OF COMPUTERIZED 

DRUG–DRUG INTERACTION ALERTS. 

Malone D, Abarca J, Skrepnek G, Rehfeld R, 

Armstrong E, Murphy J, Grizzle A, Woosley R, 

University of Arizona. E-mail: malone@ 

pharmacy.arizona.edu 

Objective: To evaluate community pharmacists’ 

attitudes toward computerized drug–drug interaction 

(DDI) alerts, self-perceived ability to interact 

with physicians, and perceived physician receptiveness 

to DDIs. 

Methods: A survey was mailed to pharmacy 

managers of 3,000 randomly selected community 

pharmacies in 17 distinct Metropolitan Statistical 

Areas. A 31-item survey instrument was developed 

for this study. Of these, seven attitudinal questions 

using a 6-item Likert scale (1: strongly disagree to 

6: strongly agree) were included to obtain pharmacists’ 

attitudes towards DDI alerts and their self-perceived 

ability to handle DDIs. Another item collected 

information on the ability to obtain detailed DDI 

information from the pharmacy computer system. 

Each pharmacy was sent an announcement postcard, 

a cover letter and survey instrument, a reminder 

postcard, and a follow-up survey for nonresponders. 

Results: A total of 718 usable surveys were 

returned (24% response rate). Pharmacy managers 

reported that they had confidence in the ability of 

their computer system to identify DDIs (mean ± SD, 

4.49 ± 1.23). Most did not think that DDI alerts 

were a waste of time (mean ± SD, 2.14 ± 1.13). 

Pharmacy managers agreed with the statement that 

they had confidence in their own ability to identify 

DDIs (mean ± SD, 4.91 ± 0.91) and that DDIs are 

easily differentiated from other DUR alerts (mean ± 

SD, 4.14 ± 1.42). When responses were analyzed 

with respect to whether the pharmacy computer system 

provided detailed information about DDIs or 

not, those pharmacists with pharmacy systems that 

provided detailed information were more likely to 

agree that they were confident that their computer 

system provided meaningful alerts, less likely to 

agree that DDI alerts were meaningless, more confident 

in their ability to identify DDIs, and less likely 

to agree that the volume of alerts makes it difficult 

to differentiate clinically meaningful interactions 

from unimportant interactions (P < .01). 

Conclusions: The results of this study suggest 

that pharmacy managers in a community setting are 

confident in the ability of their computer system to 

identify DDIs and their ability to contact physicians 

about DDIs. Most pharmacists did not feel the DDI 

alerts were useless or a waste of time. Pharmacists 

working in stores with computer systems that provide 

detailed information about DDIs were more 

likely to agree with statements that DDI alerts were 

meaningful. 

213—COMPARING OKLAHOMA MEDI- 

CAID RX REIMBURSEMENT RATE VERSUS 

THE OFFICE OF INSPECTOR GENERAL’S 

REPORT OF ACQUISITION COST. Phung Q, 

Oklahoma State University, Jacobs E, University of 

Oklahoma Health Sciences Center. E-mail: 

hoa-phung@ouhsc.edu 

Objective: The objective of this study is to estimate 

the reimbursement rate to Oklahoma pharmacies 

based on the discount off of average wholesales 

price (AWP) and compare it to the four tier system 

suggest by the Office of Inspector General (OIG) to 

determine how well Oklahoma’s reimbursement 

rates match the OIG’s report of acquisition cost. We 

also incorporate the State Maximum Allowable 

Cost (SMAC) and narrow therapeutic index (NTI) 

drugs into the analysis to reflect the state’s current 

Medicaid policies. 

Methods: The study population was derived from 

the Oklahoma Healthcare Authority (OHCA) 

Medicaid prescription database for the year 2002. 

This database was combined with Medi-Span 

Master Drug Database (MDDB) and a SMAC 

dataset to obtain pricing information such as AWP, 

the federal upper limit (FUL), and SMAC. The data 

were classified into a tier system reflective of the 

OIG report and the mean discount off of AWP was 

calculated for each tier. The results were compared 

with the OIG report for significance. The data were 

further reclassified into a different tier system to 

incorporate SMAC and NTI into the analysis. 

Results: The results indicated that OHCA reimbursement 

rate was comparable to the estimated 

acquisition cost of pharmacy. For Brand, OHCA 





reimbursement rates were only 3.27% lower off of 

AWP than the OIG estimated acquisition cost. For 

generic, the difference ranged from 8.5% to 12.45% 

(P < .001). The results from the second analysis 

were also consistent with OIG’s rates. 

Conclusions: NTI drugs had a higher discount 

rate as it incorporated both brands and generics into 

the analysis. Accounting for SMAC resulted in an 

increased in discount rate. The State’s SMAC reimbursement 

system appears to be successful in further 

minimizing cost by reimbursing pharmacy closer 

to their acquisition cost. 

214—CONTENT ANALYSIS OF PRINT 

DIRECT-TO-CONSUMER DRUG ADVER- 

TISEMENTS TO DETERMINE NUMBER 

AND SPECIFICITY OF RISK STATEMENTS. 

Valluri S, Pedersen C, Ohio State University. E- 

mail: valluri.1@osu.edu 

Objective: Our objective for the current study is 

to determine the number and the specificity of the 

risk factors (side effects, specific side effects, contra 

indications, total number of sentences) disclosed in 

typical direct-to-consumer print advertisements 

published in 2002. 

Methods: Content analysis of all product-specific 

prescription drug advertisements appearing in 

seven consumer magazines from January 2002 to 

December 2002 was done. The variables measured 

were “side effects, specific side effects, contraindications, 

and the number of sentences containing risk 

statements.” Sets of operational guidelines were 

developed to define these variables. Other than the 

author, two judges independently coded the advertisements. 

The judges were trained for this purpose. 

Since the data obtained was of interval type it was 

recoded into a nominal scale. This was done to 

determine interrater agreement using Cohen’s 

Kappa. Each brand name drug advertisement served 

as the unit of analysis. Descriptive statistics were 

the primary tool for analytical procedures. 

Results: A total of 349 advertisements were identified 

representing 40 distinct brand drugs. Multiple 

advertisements for the same brand drug were not 

analyzed as they had the same risk information. Of 

the total advertisements analyzed, 28 (70%) of the 

40 drugs were for long-term use. An average of 4.6 

side effects per advertisement were listed. Of these, 

0.7 specific side effects were mentioned per advertisement. 

Each advertisement contained 1.7 contraindications 

and a total of 2.55 sentences. The 

interrater agreement between “judge 1” and “judge 

2” for side effects, specific side effects, contraindications, 

and number of risk statements was 0.89, 

0.50, 0.849, and 0.498 respectively. 

Conclusions: The risk statements in direct-toconsumer 

print advertisements tend to be limited. 

Overall, advertisements contained only 2.55 risk 

statements. The average number of side effects disclosed 

in a typical advertisement is less than 5. Also, 

drugs for long-term use were more likely to be 

advertised than those for acute conditions. Future 

studies on risk disclosure in direct-to-consumer 

print advertisements should take into account the 

current risk disclosure in such advertisements. 

215—COST-EFFECTIVENESS ANALYSIS 

OF A CONTRACEPTIVE PATCH: AN 

EMPLOYER’S PERSPECTIVE. Patkar A, 

Holdford D, Virginia Commonwealth University. 

E-mail: patkarad@vcu.edu 

Objective: To compare the costs and effectiveness 

of a new combined hormonal contraceptive 

transdermal patch with a combined hormonal oral 

contraceptive pill from an employer’s perspective. 

Methods: Design: A cost-effectiveness model 

was developed using decision tree software. Setting: 

Randomized controlled trials. Participants: Women 

of childbearing age. Data collection: Data were collected 

from a variety of public sources including 

clinical trial data, the Alan Guttmacher Institute, the 

Kaiser Family Foundation, and databases that provide 

cost and effectiveness associated with pregnancy 

outcomes. Analysis plan: The outcome of treatment 

was failure characterized by pregnancy and 

subsequent pregnancy-associated childbirths, 

induced abortions, or spontaneous abortions. The 

model examined direct and indirect costs to 

employers associated with unintended pregnancies 

and pregnancy-related outcomes. Key variables 

considered in the model were the failure rate (effectiveness) 

associated with each contraceptive, cost of 

each contraceptive, and lost workforce productivity. 

All the costs were estimated for a 1-year period for 

1,000 contraceptive users. Data analyses: Data analyses 

included incremental cost-effectiveness ratio 

estimation and sensitivity analyses across a range of 

the key variables. 

Results: For an employer, the cost of covering the 

contraceptive patch to prevent an additional pregnancy 

would be $3.44 more per employee per year than 

for oral contraceptives. Sensitivity analyses demonstrated 

that effectiveness of oral contraceptives and 

costs of the patch were the most important variables 

that had an impact on the choice of treatment. 

Conclusions: Contraceptive patch can be costeffective 

in preventing unintended pregnancies 

when compared with oral contraceptives. 

Employers should consider covering the contraceptive 

patch to avoid further costs of pregnancy-related 

outcomes. 

216—DECISION-MAKING PREFERENCE 

AMONG COMPLEMENTARY AND ALTER- 

NATIVE MEDICINE USERS AND 

NONUSERS. Shah B, Chewning B, University of 

Wisconsin–Madison, Sleath B, University of North 

Carolina at Chapel Hill, Rubin R, Department of 

Internal Medicine, University of New Mexico. E- 

mail: bkshah@wisc.edu 

Objective: To examine decision-making preference 

patterns of complementary and alternative 

medicine (CAM) users and nonusers. 

Methods: Data involving use or nonuse of CAM, 

decision-making preferences of participants, and 

general demographics were extracted from a data 

set collected during 1995 at the family practice and 

general medicine clinics at the University of New 

Mexico Health Sciences Center in Albuquerque. 

Descriptive statistics and cross-tabs were carried out 

using SPSS version 11.0. 

Results: A little more than one fourth of the 

patients reported using CAM in the past month. 

More than two thirds of the CAM users and 

nonusers preferred shared decision making. While 

about one sixth of CAM users preferred patients 

only to make decisions, a lesser number of nonusers 

(about 10%) preferred patients to make the decisions. 

There was no evidence that CAM use was 

greater among patients who were more dissatisfied 

with care, less confident in care, or felt their feelings 

were not considered by the physician in prescribing 

medicines compared with satisfied, confident 

patients and patients who felt their feelings had been 

considered by the physician. Lastly, while 14.3% of 

those who rated their health as poor used CAM, a 

larger number of those who rated their health as 

excellent (35.7%) had used CAM in the last month. 

Conclusions: This study has major implications 

for pharmacist training and continuing education. 

Given that more than 25% of respondents had used 

CAM in the past month, pharmacists need to be 

prepared to assist those patients who prefer shared 

decision making. Background and information 

resources are needed to train pharmacists for counseling 

regarding CAM. Second, communication 

skills training is needed to help pharmacists assess 

and adapt to a patient’s preferred degree of shared 

decision making. While some patients may not want 

assistance in the actual decision, the pharmacist can 

still help a patient be a well-informed and safer decision 

maker. 

217—DEPRESSIVE SYMPTOMS AMONG 

PATIENTS WITH A HISTORY OF DEPRES- 

SION SIX MONTHS AFTER INITIATING 

BETA-BLOCKER TREATMENT. Taylor M, 

Sauer B, Munyer T, Ried L, University of Florida. 

E-mail: mdtaylor@ufl.edu 

Objective: To determine whether prior depression 

diagnosis is associated with higher depressive symptoms 

in coronary artery disease patients 6 months 

after initiating beta-blocker (atenolol) therapy. 


patients (N = 2,317) involved in an international high 

blood pressure treatment trial was enrolled between 

April 1, 1999, and October 31, 1999. Patients were 

mailed a survey within 24 hours of randomization 

and again 6 months later. The surveys contained a 

measure of current depressive symptoms. Patients 

also reported whether a physician or psychiatrist had 

previously diagnosed them with depression. Logistic 

regression was performed to examine the association 

between depression history and high risk of current 

depression 6 months after initiating beta-blocker 

therapy, controlling for age, gender, race, and baseline 

depressive symptoms. 

Results: Surveys were sent to 1,134 patients 

assigned to receive a beta-blocker. Baseline and 6- 

month surveys were returned by 824 (73%) and 657 

(58%) patients, respectively. At baseline, 19% of 

the patients reported an earlier depression diagnosis, 

and 24.6% had currently high depressive symptoms. 

Six months later, 22.4% had high depressive symptoms 

(McNemar’s chi-square = 3.32, P = .082). 

After controlling for covariates, patients with a prior 




FEATURE 

depression diagnosis were more likely to have high 

depressive symptoms 6 months after initiating betablocker 

therapy (OR = 2.04, 95% CI = 1.02, 4.08). 

Conclusions: Beta-blocker therapy for hypertension 

may be indicated for patients with coronary 

artery disease (e.g., myocardial infarction). There 

was a statistically nonsignificant decrease in the 

proportion of patients with high depressive symptoms 

among those prescribed atenolol. Patients with 

a depression diagnosis before initiating hypertension 

therapy were at greater risk of depressive 

symptoms after 6 months when compared with 

those without prior history of depression. Clinicians 

should screen for onset or worsening of depressive 

symptoms after initiating atenolol therapy, especially 

among those with a history of depression. 

However, it probably is not a reason to avoid prescribing 

atenolol when indicated. 

218—DEPRESSIVE SYMPTOMS AND THE 

IMPACT ON PHYSICAL FUNCTIONING: 

ARE MALES AND FEMALES DIFFERENT? 

Gerhard T, Ballentine A, Nyanteh H, Tueth M, Ried 

L, University of Florida. E-mail: tgerhard@ufl.edu 

Objective: Major depression occurs in 1%–3% of 

the elderly population and an additional 8%–16% 

have clinically important depressive symptoms. 

These symptoms often result in lower physical functioning. 

However, whether this relationship is similar 

for men and women has not been established. 

This study examined whether men and women are 

equally sensitive to the physical impact of depressive 

symptoms. 


patients (N = 2,317), living in the United States and 

enrolled in an international hypertension clinical trial 

between April 1 and October 31, 1999, was mailed 

surveys within 24 hours of randomization and more 

than 72% were returned. The survey included a measure 

of depressive symptoms and the physical functioning 

and role physical domains of the MOS SF- 

36. Of the returned surveys, approximately 81% (N 

= 1,359) contained complete data regarding depressive 

symptoms and were included in the analysis. 

Results: Older women with high depressive 

symptoms (Center for Epidemiologic 

Studies–Depression [CES-D] >20) were more likely 

to report limitations in daily activities such as work, 

household chores, and self-care (physical functioning). 

However, the negative impact of depression on 

physical functioning was 1.7 times greater for men. 

While depressed women (N = 181) scored 15.5 

points lower on the physical functioning scale than 

nondepressed women (N = 392), depressed men (N 

= 159) scored 26.5 points lower than nondepressed 

men (N = 627). Patient age, baseline CES-D score 

and the interaction between gender and depression 

were significant predictors of patients’ role limitations 

due to physical health (role physical). The negative 

impact of depression on patients’ work and 

other daily activities as a result of their health is 

about 40% greater for men than for women (a 

decline of 37.3 versus 28.2 points, respectively). 

Conclusions: Although depression occurs more 

frequently among older community-dwelling 

women, it has a larger negative impact on men’s 

performance of everyday physical activities. Health 

care practitioners should increase their efforts to 

detect later-life depression among their older 

patients and assess its effect on their independence. 

219—DETERMINANTS OF PERCEIVED 

NEED AND INTENTION TO ADOPT 

HEALTHIER LIFESTYLE CHOICES IN INDI- 

VIDUALS WITH DIABETES. Maddigan S, 

Institute of Health Economics/University of 

Alberta, Johnson J, University of Alberta. E-mail: 

maddigan@ualberta.ca 

Objective: The purpose was to assess factors 

associated with perceived need and subsequent 

intention to adopt healthier lifestyle choices in diabetes 

(i.e., increase exercise, weight loss, change 

eating habits, or smoking cessation). 

Methods: The study sample included 4,125 

respondents from the 2000–2001 Canadian 

Community Health Survey who reported having 

diabetes diagnosed by a health care provider. 

Respondents were dichotomized according to perceived 

need for lifestyle change (yes/no) and intention 

to make such a change in the next 12 months 

(yes/no). Logistic regression analysis was used to 

determine demographic, health status, and current 

lifestyle factors associated with the perceived need 

and behavioral intention. 

Results: Approximately 57% of respondents felt 

they should do something to improve their health in 

the next 12 months. Most frequently cited improvements 

were to increase exercise (38.5%), lose weight 

(18.0%), and quit smoking (7.2%). Younger individuals 

(P < .001), those with higher levels of education 

(P < .001), with higher incomes (P = .005), with 

higher body mass indexes (P < .001), who were inactive 

(P = .002), or who drank regularly (P < .001) 

were more likely to perceive they needed to make 

lifestyle changes. Health-related quality of life 

(HRQL) (P < .001) and greater impact of health 

problems (P = .010) were also significant. 

Approximately 68% of individuals intended to make 

a lifestyle change in the next 12 months. Intention 

was associated with higher levels of HRQL (P = 

.048), lack of perceived barriers to change (P = 

.028), lower age (P < .001), being physically inactive 

(P < .001), being a regular drinker (P < .001) or holding 

a college or university degree (P < .001). 

Conclusions: The majority of people with diabetes 

perceived they needed to make lifestyle 

changes and intended to do so in the next 12 months. 

Lack of intention to make lifestyle changes was 

associated with relatively poor health status, greater 

perceived barriers to change, and lack of education. 

Original Citation: The Canadian Diabetes 

Association Meeting, Ottawa Ontario, October 

15–18, 2002. Podium Presentation. 

220—DEVELOPING OLDER DIABETICS’ 

MEDICATION-RELATED KNOWLEDGE, 

BELIEFS, AND PERCEIVED ABILITIES: IS 

THE PHARMACIST–PATIENT RELATION- 

SHIP IMPORTANT? Worley-Louis M, University 

of Minnesota. E-mail: worl0016@d.umn.edu 

Objective: Diabetes and diabetes-related complications 

affect older adults (65 years and older) more 

than other age groups in the population. Diabetic 

patients engage in sustained interactions with health 

care professionals, as well as self-management. The 

study purpose was to investigate the association of 

pharmacist–patient relationship characteristics with 

aspects of the medication use process from older diabetic 

patients’ perspectives. The theoretical framework 

used in this study consisted of antecedents to 

building pharmacist–patient relationship quality and 

outcomes of pharmacist–patient relationships. 

Antecedents to building pharmacist–patient relationship 

quality are: (1) pharmacist participative behavior/patient-centeredness 

of the relationship, (2) 

patient participative behavior, and (3) 

pharmacist–patient interpersonal communication. 

Using self-efficacy theory as a framework, the following 

medication use outcomes are investigated: 

(1) medication-related knowledge, (2) medicationrelated 

outcome expectations (beliefs), and (3) medication-related 

self-efficacy (perceived abilities). 

Methods: Design: Cross-sectional and descriptive. 

Setting: United States. Participants: Systematic 

random sample of 600 noninstitutionalized adults, 

65 years and older with type 1 or 2 diabetes, and 

using at least one prescription medication to treat 

diabetes. Data Collection: Mailed questionnaire. 

Data Analysis Plan: All study constructs will be 

assessed for reliability using Cronbach coefficient 

alpha. Discriminant validity will be assessed via 

exploratory factor analysis. Associations between 

pairs of study constructs will be assessed using 

Pearson Product Moment correlations and will be 

tested for significance at an alpha level of .05. 

Results: Data collection is complete. The overall 

response rate is 52.9% (311 responses out of 588 

questionnaires mailed). Currently, the data analysis 

plan is being conducted for this phase of the 

research project. 

Conclusions: Study results will be discussed as 

implications for pharmacy practitioners as they 

develop counseling and relationship building strategies 

for older patients with diabetes. Implications 

for researchers who investigate the medication use 

process in older patients with diabetes will be discussed. 

The American Foundation for Pharmaceutical 

Education, through the American Association of 

Colleges of Pharmacy New Investigators Program 

for Pharmacy Faculty, provided funding for this 

research. 

221—DIRECT-TO-CONSUMER ADVER- 

TISING OF PRESCRIPTION DRUGS: MEA- 

SURING EFFECTIVENESS AND EDUCA- 

TIONAL VALUE ACROSS DIFFERENT 

MEDIA. Sullivan D, Ohio Northern University. 

E-mail: d-sullivan@onu.edu 

Objective: To assess the educational value, information, 

understandability, and consumer attitudes 

toward direct-to-consumer (DTC) advertising in 

television, print, and Internet ads. 





Methods: A total of 480 Ohio consumers were 

randomly selected for inclusion in the study. The survey 

instrument was a self-administered, mailed questionnaire 

using a Likert-type scale, with 1 = strongly 

disagree to 6 = strongly agree. Consumers were asked 

to compare the three types of media on risk–benefit 

information, educational value, drug information 

quality, understandability, and usefulness. 

Results: Of the 187 (39% response rate) respondents, 

25% indicated they had talked to their doctor 

about an advertised drug within the past year; 15% 

had asked their doctor for a prescription for an 

advertised product; and 13% had saved an ad from 

a magazine/newspaper. Respondents slightly to 

moderately agreed that both print and television ads 

were written at a level they could understand (mean 

± SD = 4.44 ± 1.29 and 4.51 ± 1.24, respectively). 

However, respondents slightly agreed that print and 

television ads lacked information on side effects and 

risks. Consumers felt that prescription drug ads in 

magazines and newspapers had more educational 

value that those on television (t = –2.86, df = 179, P 

= .005) and Internet ads had more educational value 

than television ads (t = 3.51, df = 159, P = .001). 

Consumers felt that information in Internet ads was 

more useful (mean = 3.82 ± 1.42) than television 

ads (mean ± SD = 3.65 ± 1.45) (t = –2.136, df = 146, 

P = .034). Consumers indicated that ads on television 

(mean ± SD 4.36 ± 1.40) and in 

magazines/newspapers (mean = 4.19 ± 1.59) lacked 

important information more so than ads on the 

Internet (t = 4.45, df = 148, P < .001) and (t = 2.752, 

df = 148, P = .007), respectively. Finally, consumers 

found magazine/television ads more truthful (mean 

± SD = 3.64 ± 1.37) than television ads (mean ± SD 

= 3.42 ± 1.38) (t = 2.54, df = 172, P = .012). 


222—DISABILITY IN STROKE OUT- 

COMES RESEARCH. Kwon S, Hartzema A, 

Duncan P, University of Florida, Lai S, University 

of Kansas Medical Center. E-mail: 

kwon@cop3.health.ufl.edu 

Objective: Residual disability after stroke presents 

a major economic and humanistic burden. To 

quantify disability in patients, three disability instruments 

are globally used: Barthel Index (BI), Motor 

component of Functional Independence Measure 

(M-FIM), and Modified Rankin Scale (MRS). The 

purpose of this study is to understand the relationship 

among these disability measures by examining 

the differentiating ability of the BI and the M-FIM 

to the global disability scale MRS. 

Methods: Kansas City Stroke Study data were 

used for the current study. Polytomous logistic 

regression analysis was applied to produce probabilistic 

distributions of BI and M-FIM corresponding 

to MRS. Model-fit statistics were examined to 

verify logistic regression appropriateness. A categorization 

scheme, which minimized the false positive 

rate, was selected as the optimal categorizing system. 

Results: Three measures were highly correlated. 

BI and M-FIM do not differentiate disability well in 

higher level of functioning. BI differentiated four 

levels with the following categorization scheme: 0 ≤ 

MRS5 < 15, 15 ≤ MRS4 < 70, 70 ≤ MRS3 < 95, and 

95 ≤ MRS(0,1,2) ≤ 100, and M-FIM differentiated 

three levels with the scheme: 13 ≤ MRS5 < 26, 26 ≤ 

MRS4 < 62, and 62 ≤ MRS(0,1,2,3) ≤ 91. These 

cutoff points were consistent for baseline, 1, 3, and 

6 months. 

Conclusions: The proposed categorization 

scheme can serve as a translation between measures. 

However, due to the ceiling effect of BI and M-FIM, 

the translation could not be completed for all six distinct 

levels of MRS. No apparent variation over time 

in the categorization scheme was observed. 

223—DO DIABETIC PATIENTS’ MEDICA- 

TION USE BELIEFS AND PERCEIVED ABIL- 

ITIES VARY BY ACTUAL, PREFERRED, 

AND POTENTIAL SOURCES OF MEDICA- 

TION HELP? Worley-Louis M, University of 

Minnesota, Hermansen-Kobulnicky C, University 

of Wyoming. E-mail: worl0016@d.umn.edu 

Objective: Diabetic patients’ medication use 

involves both self-management and sustained interaction 

with health care providers. This pilot study’s 

purpose is to explore how diabetic patients’ beliefs 

(outcome expectations) and perceived abilities (selfefficacy) 

for medication management and monitoring 

vary by patients’ preferred, actual, and potential 

sources of diabetes medication-related help. 

Methods: Design: Cross-sectional and descriptive. 

Setting: United States. Participants: Random 

sample of 300 noninstitutionalized adults (18 years 

and older) with type 1 or 2 diabetes, and using at 

least one diabetes prescription medication. Data 

Collection: Mailed questionnaire. Patients’ beliefs 

and perceived abilities for medication management 

and monitoring are measured using multi-item 

scales. These will be assessed for reliability using 

Cronbach coefficient alpha, refined using interitem 

and item-to-total correlations, and assessed for discriminant 

validity using principal component analysis. 

Patients’ actual and preferred sources for diabetes 

medication help are measured as two categorical 

variables. Patients’ potential for using a pharmacist 

as a source for help is measured by evaluating 

the likely presence of a pharmacist–patient relationship. 

Data Analysis Plan: Means comparisons 

will evaluate beliefs and perceived abilities across 

actual, preferred and potential sources for obtaining 

help about diabetes medication use and monitoring. 

Cross tabulations will be used to compare actual, 

preferred and potential sources. 

Results: Data collection is ongoing. Overall 

response rate to date is 42.5% (124 of 292). 

Conclusions: Study results may include finding 

differences among patients’ self-report of actual, 

preferred, and potential sources of help, as well as 

differing beliefs and perceived abilities across 

patients’ whose report of actual, preferred, and 

potential sources of help match, versus those 

patients that do not match. Evidence of a pharmacist–patient 

relationship may support opportunities 

for pharmacists to assist diabetic patients in the 

areas of medication management and monitoring, 

and helping to build patients’ beliefs and perceived 

abilities in these areas. Research implications also 

will be discussed. 

224—DOES OWNERSHIP TYPE RELATE 

TO MANAGERIAL TIME CULTURE IN 

COMMUNITY PHARMACIES? Gurney M, 

Mount J, University of Wisconsin–Madison. E- 

mail: mkgurney@pharmacy.wisc.edu 

Objective: (1) Describe how ownership relates to 

strategic and operational management in community 

pharmacies. (2) Examine relationships between 

ownership and strategic and operational management, 

controlling for organizational factors that may 

covary. 

Methods: Cross-sectional, multimethod study of 

stratified random sample of community and ambulatory 

pharmacies involved in a school of pharmacy’s 

experiential learning program. Data were collected 

via telephone interviews with pharmacy managers 

and mail-back surveys from manager and staff 

pharmacists. Of 173 surveys sent, 82 (47.4%) surveys 

(39 pharmacy managers; 43 pharmacists) were 

analyzed. Data on management activities were collected 

using a series of 25 questions. A strategic 

management index (SMI) and an operational management 

index (OMI) were constructed to measure 

temporal aspects of planning functions (in SMI) and 

organizing, implementing, and controlling functions 

(in OMI). Data on other pharmacy factors were 

gathered during telephone interviews. Ordinary 

least squares regression was used to analyze relationships 

between ownership and strategic management 

and operational management. 

Results: While ownership is not a significant predictor 

of SMI for the total sample, it is a significant 

predictor of SMI for both the manager and staff 

pharmacist subgroups. This is in opposite directions, 

with independent managers reporting significantly 

lower involvement in strategic activities than 

their staff pharmacist colleagues of their chair pharmacy 

counterparts. Results remain similar when 

covariates are entered into the analysis. In contrast, 

ownership is largely unrelated to OMI for the total 

sample, mangers, and staff pharmacists. Although 

having no direct effects, ownership appears to have 

an indirect effect on OMI through its effects on 

SMI, particularly for staff pharmacists. 

Conclusions: Independent, health-system, and 

corporate chain pharmacies have markedly different 

management approaches, with involvement being 

the most manager-centered in corporate chain pharmacies 

and most devolved to staff pharmacists in 

independent pharmacies. In study pharmacies, managerial 

time orientation was not uniformly held, 

suggesting that the time aspect of organizational 

culture is fragmented. Further research is needed 

into how cultural content and structure relate to 

efforts to change pharmacy’s model of patient care. 

225—DRUG THERAPY COST SAVINGS 

AND QUALITY INITIATIVES DIRECTED TO 

MEDICAID RECIPIENTS IN NORTH CAR- 

OLINA. Trygstad T, Christensen D, University of 

North Carolina at Chapel Hill, Thorpe J, 

AccessCare Inc. E-mail: troy@unc.edu 




FEATURE 

Objective: The aim of this study is to develop, 

demonstrate, and evaluate a structured retrospective 

DUR and intervention project aimed at North 

Carolina Medicaid nursing home residents. 

Consultant pharmacists in nursing homes were provided 

patient drug profiles that targeted/flagged 

potential drug therapy problems. Specific objectives 

are to assess the impact of this intervention in terms 

of (1) the type and frequency with which potential 

drug therapy problems were reported, (2) the impact 

of changes in terms of the quality and cost of drug 

therapy received by residents, and (3) the downstream 

impact of changes in use of services and 

associated medical costs. With Phase 1 only recently 

completed (March 2003), we present results related 

to objective 1 and partially for objective 2. As 6- 

month follow-up data become available, we will use 

pharmacy claims to validate pharmacist reports of 

drug cost savings (objective 2), and use hospital and 

physician services claims to report downstream 

impact on quality. Phases 2 and 3 will incorporate 

another 15,000 or more residents and will be analyzed 

when their respective claims become available. 

Methods: This is a cohort study with comparison 

group. The study group consists of 9,310 nursing 

home residents in 253 nursing homes. The comparison 

group consists of 13 geographically separated 

nursing homes. The impact of pharmacist activities, 

in terms of numbers and types of interventions as 

well as projected cost savings, are reported and discussed. 

Additionally, 6 months of claims data 

before and after the date of intervention will be used 

to validate the drug and medical care cost impact. 

Results: An average of 1.22 recommendations 

were made per resident. An average drug cost savings 

of approximately $40 per patient per month 

was achieved for each intervention. There was evidence 

that drug-related quality was improved as a 

result of interventions. For example, 936 drugs were 

found to have a potential for serious adverse drug 

reactions, 631 recommendations were made to 

change therapy for Beers’ list drugs, and 448 recommendations 

were made to discontinue duplicative 

drug therapy. 

Conclusions: A program of medication profile 

review of Medicaid nursing home residents by pharmacist 

consultants collaborating with physicians is 

projected to be cost-beneficial based solely on drug 

cost savings. We estimate the cumulative savings 

potential of the program to be in excess of $14 million 

through December 2004. 

226—EFFECT OF AN AUTOMATED PRE- 

SCRIPTION FILLING SYSTEM AND 

INSPECTION ENHANCEMENT TOOL ON 

DISPENSING ACCURACY. Flynn E, Barker K, 

Auburn University. E-mail: flynnel@auburn.edu 

Objective: To compare the rate of dispensing 

errors before and after the implementation of an 

automated dispensing system providing two levels 

of control. 

Methods: Design: Explanatory study. 

Participants: One independent and one chain pharmacy. 

Data collection: A pharmacist–researcher 

evaluated the accuracy of prescriptions filled during 

2-week periods before and after the installation of 

an automated dispensing system in each pharmacy. 

A robotic device filled the top 200 oral solid dosage 

forms, and all drugs were subject to bar code verification. 

A dispensing error was defined for new prescriptions 

as any deviation from a prescriber’s written 

order, and for refills as any deviation between 

the prescription content and the label. Data analysis: 

A paired two-sample t test for means was employed 

to compare daily error rates before and after system 

implementation. 

Results: At the independent pharmacy the dispensing 

error rate was 2.8% before (99 errors on 

3,427 prescriptions) and 2.1% after (68 errors on 

3,241 prescriptions) the automated system was 

installed, a statistically significant decrease (P = 

.099). At the chain pharmacy, the dispensing error 

rate was 1.9% before (64 errors on 3,424 prescriptions) 

and 2.4% after the new system (74 errors on 

3,028 prescriptions), which was not a statistically 

significant difference (P = .225). 

Conclusions: The implementation of the automated 

dispensing system was associated with a statistically 

significant decrease in the overall dispensing 

error rate in the independent pharmacy but not 

the chain pharmacy. A close inspection of the processes 

and specific errors revealed much about the 

challenges of reducing prescription dispensing 

errors via automated dispensing systems. 

227—EVALUATING THE INSTRUCTION- 

AL DESIGN OF A WEB-ENHANCED PRO- 

GRAM FOR TEACHING THE PRACTICE OF 

PHARMACEUTICAL CARE. Droege M, Nova 

Southeastern University. E-mail: droege@nova.edu 

Objective: The objectives of this study were to 

design a new, Web-enhanced educational tool to 

teach students and practitioners the fundamental 

principles of pharmaceutical care practice and to 

evaluate the extent to which it might be effective. 

Methods: A Web-enhanced educational tool for 

teaching the practice of pharmaceutical care was 

designed applying principles of problem-based 

learning (PBL) and a formative evaluation of the 

learning materials was performed aimed at the 

usability of the software and its content. The method 

used in the evaluation of the instructional design 

was an inspection method similar in style to the 

heuristic method for usability testing described for 

the evaluation of computer interfaces. This expertise-oriented 

evaluative approach involved having 

11 evaluators examine the interface and judge its 

compliance with the stated objectives. Evaluators 

were recruited who possessed expertise in software 

development; instructional design as well as pharmaceutical 

care practice. 

Results: Evaluation data suggest that a valid and 

reliable instrument for evaluating the educational 

tool was developed. In addition, evaluator comments 

led to the identification of a small number of 

problems that need to be addressed before the 

release of the educational tool. These deficiencies 

pertained to three general areas: interface design, 

instructional design, and content of the design. No 

major problems were identified that would question 

the release of the educational multimedia program. 

Conclusions: The problem-based, Webenhanced 

approach appears to be a practical tool to 

support an effective learning experience for teaching 

the fundamental principles of pharmaceutical 

care practice. 

228—EVALUATION OF VITALITY AND 

DEPRESSIVE SYMPTOMS ON PHYSICAL 

FUNCTIONING IN A COHORT OF ELDERLY 

PATIENTS WITH CORONARY ARTERY DIS- 

EASE. Mayhew D, Schiller K, Telfair T, Ried L, 

University of Florida. E-mail: mayhew@ cop3. 

health.ufl.edu 

Objective: The objective is to investigate if vitality 

effects physical functioning after considering 

depressive symptoms in coronary artery disease 

patients. 


patients enrolled in an international high blood pressure 

clinical trial and who were living in the United 

States (N = 2,317) were enrolled into a concomitant 

substudy between April 1, 1999. and October 31, 

1999. These patients were mailed surveys within 24 

hours of randomization; 1,359 patients returned the 

baseline survey, and 1,116 patients returned 1-year 

surveys. The survey included the Center for 

Epidemiologic Studies—Depression scale, a measure 

of depressive symptoms, and the vitality and 

physical functioning domains of the Medical 

Outcome Study Short Form 36. The temporal ordering 

of the depressive symptoms and vitality variables 

and their direct and indirect influence on 1- 

year physical functioning were examined using path 

analysis. 

Results: Persons with lower energy and vitality 

were more limited in their daily activities (standardized 

regression coefficient [beta] = 0.332, P < .001). 

Patients reporting more depressive symptoms were 

more limited in their daily activities (beta = –0.352, 

P < .001). Higher baseline depression scores were 

associated with more fatigue and tiredness (beta = 

0.418, P < .001), whereas baseline vitality had little 

impact on depressive symptoms 1 year later (beta = 

–0.002, P = .233). The effect of 1-year depression 

scores on 1-year vitality was significant (beta = 

–0.882, P < .001), even after controlling for baseline 

levels of vitality and depressive symptoms. 

Conclusions: Higher levels of depressive symptoms 

directly limit patients’ work, exercise and 

other daily activities. Depressive symptoms also 

indirectly limit these activities because of its impact 

on patients’ vitality and energy levels. While 

depressive symptoms and vitality are associated, 

depressive symptoms seem to be more associated 

with lower energy levels and fatigue rather than 

patients interpreting their lower energy levels and 

fatigue as depressive symptoms. 





229—EXAMINING THE RELATIONSHIPS 

WITHIN AND PRESENCE OF THE SERVICE 

PROFIT CHAIN IN INDEPENDENT COMMU- 

NITY PHARMACY. Bonnarens J, University of 

Wisconsin–Madison, Wilkin N, University of 

Mississippi Medical Center, McCaffrey D, Garner 

D, University of Mississippi. E-mail: 

jbonnarens@pharmacy.wisc.edu 

Objective: The intent of this study is to explore 

whether satisfied and loyal employees provide quality 

service, to explore whether this service is related 

to satisfied and loyal customers, and to explore if 

satisfied and loyal customers are correlated with 

revenue growth and profitability. 

Methods: This exploratory study was designed to 

use primary data collection techniques to examine 

the each of the seven “links” proposed in the service 

profit chain model. The study was to test the applicability 

of the model in community pharmacy, 

specifically independent community pharmacies. 

Recruitment efforts focused on a national pharmacy 

franchise corporation. A sample of pharmacies (N = 

40) was recruited. To collect the necessary data dictated 

by the service profit chain model, three groups 

of participants were identified: owners/managers, 

employees, and customers. A multistage data collection 

method was implemented using a total of 

three different instruments, one for each participant 

group, to collect the varied amount of data identified 

in the model. Scale measures were adapted from the 

literature. Reliabilities were measured using 

Cronbach and factor, when appropriate, and results 

showed similar reliabilities found in the literature. 

Then, correlation coefficients were calculated for 

each link in the chain model. 

Results: Based on specific criteria, 47.5% of 

pharmacies were eligible for analysis, including a 

usable response rate of 61.5% for employees and 

29.8% for customers. Based on correlation analyses, 

five of the possible seven relationships predicted by 

the service profit chain were found to be significant. 

In addition, the significant relationships that were 

identified support previous empirical testing of the 

model in other industries. 

Conclusions: Although further research is needed, 

the service profit chain holds potential as a management 

tool useful in explaining the link between 

customer satisfaction, employee satisfaction and 

financial performance of an independent community 

pharmacy. 

230—EXPERIENCE WITH A WORKSITE 

EDUCATIONAL PROGRAM ON ARTHRITIS 

AND MUSCULOSKELETAL DISORDERS. 

Gianarkis D, Pfizer. E-mail: dean.gianarkis@ 

pfizer.com 

Objective: The objectives of the program were to 

measure the impact of arthritis on work productivity, 

assess the effectiveness of treatments, and educate 

participants about arthritis. 

Methods: Workshops were conducted at 13 different 

sites at 6 different companies nationwide. 

Participants were provided with educational materials, 

attended a lecture, and were then asked to complete 

a survey. A total of 798 surveys were evaluated, 

648 contained 11 questions, and 150 had 39 

questions. 

Results: Overall, 71% (106/150) of participants 

experienced symptoms of arthritis. 32% (48/150) 

had the disease for at least 5 years, 20% (26/133) 

had symptoms greater than 6 months, and 33% 

(46/140) experienced 10 or more episodes per year. 

Further, 61% (85/139) rated their symptoms as 

moderate to severe. 28% (31/111) of the population 

reported missing 5 or more work days in the last 12 

months and more than 70% (87/124) reported working 

6 months or more with arthritis symptoms in the 

past year. When the total impact of presenteeism 

was considered, arthritis reduced workforce productivity 

by 16.2%. The survey also included questions 

on medication use. 33.6% (45/140) of the sample 

did not take any medication for their arthritis symptoms, 

33.6% (47/140) take nonprescription products, 

and only 18.6% (26/140) reported taking prescription 

NSAIDs. Lastly, control of arthritis symptoms 

was measured. 38% of participants rated their 

symptom control as fairly poor, poor, or very poor 

and 29% (23/80) were dissatisfied or very dissatisfied 

with their current medication. After attending 

the workshop, 60% (303/506) of attendees plan to 

speak to their doctor about arthritis treatments and 

94% (615/657) indicated the ability to have a productive 

discussion with their doctor about arthritis. 

Conclusions: This workshop was successful in 

increasing awareness of the signs and symptoms of 

arthritis and knowledge of treatment options. 

231—FACTORS AFFECTING BARGAIN- 

ING POWER OF DRUG-PURCHASING 

GROUPS IN THAILAND. Ngorsuraches S, 

Saichol S, Faculty of Pharmaceutical Sciences, 

Prince of Songkla University. E-mail: 

surachat@ratree.psu.ac.th 

Objective: To examine the effects of purchasing 

volume, purchasing group size, purchasing time, history 

of contract, and geographic location on bargaining 

power of the drug-purchasing groups in Thailand. 

Methods: Design: The bargaining model developed 

by Brooks, Doucette, and Sorofman (1999) is 

applied to the situation between drug-purchasing 

groups and manufacturers. Data Sources/Setting: 

This study uses retrospective analysis of two national 

databases, which are drug price information and 

hospital information for 2002, established by 

Ministry of Public Health. Data Collection: The 

drug price information database comprises two 

types of drug price lists, which are reference price 

and bid purchasing price for drug products. The reference 

price list is set as maximum allowable cost of 

each product that public hospitals can possibly buy, 

while the bid purchasing price list is bid prices 

agreed between a purchasing group and a manufacturer. 

The reference price list is composed of generic 

name, package size, and unit price, while the bid 

purchasing price list contains generic name, trade 

name, package size, manufacturer, volume of purchased 

products, purchasing time, and bid purchasing 

price from each purchasing group. Enalapril 20 

mg tablets, gemfibrozil 300 mg tablets, hyoscine n- 

butylbromide 10 mg tablets, and ceftriaxone 1 gram 

vials are chosen in the study because they have high 

purchase volumes and represent either short- or 

long-term treatment. The hospital database contains 

numbers of beds of the hospitals in each purchasing 

group and health care zones, which are geographically 

assigned by Thai government. Main Outcome 

Measure: Bargaining power of drug-purchasing 

groups. Analysis Plan: Multiple regression analysis 

is planned for estimating coefficients in the bargaining 

model, which will reflect the effects of studied 

factors on the bargaining power. 

Results: Descriptive statistics show evidence of 

different bargaining power across the drug-purchasing 

groups. 


232—FACTORS AFFECTING UTILIZA- 

TION OF NEW PRESCRIPTION DRUGS. 

Agarwal S, Ye X, Cline R, University of Minnesota. 

E-mail: agar0040@umn.edu 

Objective: The objective of the present research 

is to analyze factors affecting utilization of new prescription 

drugs. 

Methods: The household component and prescribed 

medicines event files from the Medical 

Expenditure Panel Survey (MEPS) 2000 were used 

for this study. The analysis was limited to the 

antiarthritic therapeutic category. Elderly people 

over the age of 65 with arthritis were selected and 

COX-2 or NSAID prescriptions for these individuals 

were identified using National Drug Codes 

(NDC). The outcome variable was classified into 

two separate categories: (1) ever-use of a COX-2 

inhibitor and (2) never-use of a COX-2 but with a 

prescription for NSAID. Those who had at least one 

prescription of COX-2 were coded as having used 

newer drugs (Y = 1), while others with prescriptions 

of only NSAIDS were coded as not having tried 

newer drugs (Y = 2). The independent variables 

selected were guided by Andersen’s Health Services 

Utilization Model, which include predisposing variables 

(age, gender, and ethnicity), need variables 

(comorbidity, health status) and enabling variables 

(income, insurance status, copayment for a prescription 

drug). The difference in utilization rates was 

modeled using all the independent variables in a 

multivariate logistic regression equation model and 

the effects of each independent variable on the prescription 

of COX-2 were tested at the significance 

level of .05. 

Results: Preliminary results suggest a relationship 

between utilization of newer drugs and co-payments. 

Higher out-of-pocket prescription drug 

expenditures are associated with lower newer prescription 

drug use regardless of health status and comorbidities. 

Conclusions: People with higher copayments are 

deterred from using higher-priced newer prescription 

drugs. In addition, lower copayments could introduce 

moral hazard and lead to unnecessary use of expensive 

drugs. Insurers should introduce strategies that 

reduce needless consumption of new drugs while 

ensuring adequate access to appropriate therapy. 




FEATURE 

233—FORECASTING THE IMPACT ON 

COX-2 NSAID UTILIZATION IN A MEDI- 

CAID PROGRAM USING PRIOR AUTHO- 

RIZATION CRITERIA. Vuchetich P, Juracek J, 

Jorgensen A, Creighton University. E-mail: 

philv@creighton.edu 

Objective: Prior Authorization in the Nebraska 

Medicaid program is designed primarily to promote 

appropriate use of medication, and secondarily as a 

cost-containment tool. The goal of this project was 

to forecast the impact on COX-2–specific NSAID 

utilization based on a draft set of prior authorization 

criteria. These estimates would be used by the 

Nebraska Medicaid DUR Board as part of the discussion 

about specific prior authorization criteria 

and would aid in the development of final prior 

authorization criteria recommendations to the state. 

Methods: A draft version of the prior authorization 

criteria, including seven specific criteria sequenced in 

a stepwise order, was created by the drug-use review 

board. The researchers used these draft criteria to estimate 

the impact on utilization and cost using actual 

pharmacy and medical claims paid over the previous 

12-month period (April 2001 through March 2002). 

The reporting and statistical analysis was based on the 

most recent actual claims data for the population 

impacted by the prior authorization. 

Results: The results of this study identified that a 

majority of patients who had received COX-2–specific 

NSAIDs in the 12-month period immediately 

preceding the study would receive prior authorization 

according to the draft criteria. Approximately 

70% of the 13,898 patients who received a COX- 

2–specific NSAID would be approved using the 

draft criteria based on the data available. Of the 

patients who would be denied, more than one-half 

(52%) did not have a medical claim with a diagnosis 

for which an NSAID is indicated. 

Conclusions: The forecasting of the impact of 

the prior authorization criteria, both as individual 

criteria and as an algorithm was possible using 

available claims and administrative data that were 

already captured as part of the normal business processes. 

This forecasting was used as part of the decision-making 

process by a drug-use review board, 

and was available for program administrators to 

help predict the impact on utilization and cost of 

implementing a prior authorization program. This 

initial study will serve as a foundation for evaluating 

the actual impact on pharmacy and medical utilization, 

program costs, and clinical impact of the 

prior authorization program. 

234—FUNCTIONAL HEALTH LITERACY 

AMONG CHINESE POPULATION IN CHICA- 

GO. Ko Y, University of Arizona, Lin S, Salmon J, 

Crawford S, University of Illinois at Chicago. E- 

mail: yko@E-mail.arizona.edu 

Objective: (1) Measure functional health literacy 

(FHL) among a Chinese population in Chicago 

using the shortened version of the Test of 

Functional Health Literacy in Adults (S-TOFHLA). 

(2) Determine relationships between FHL and 

sociodemographic variables. 

Methods: A convenience sample of Chinese 

adults was recruited in the city of Chicago in May 

2003. A sociodemographic questionnaire and the S- 

TOFHLA were administered by face-to-face interview. 

The S-TOFHLA tests the participant’s ability 

to perform basic reading and numerical tasks 

required to function in health care environments, 

such as the ability to interpret instructions on prescription 

bottles and an appointment card. Summary 

statistics, bivariate analyses, and multiple regression 

were conducted to meet the study objectives. 

Results: A total of 50 Chinese adults participated 

in this study. Overall, 34% of the participants had 

inadequate or marginal FHL. About 25% of the participants 

could not correctly interpret information 

provided on prescription bottles and the test result 

card. Bivariate analyses indicated that lower FHL 

was significantly associated with older age, less 

education, owning a residence, and using English as 

second language (P < .05). However, education was 

the only significant predictor of FHL in multiple 

regression model after controlling for other covariates, 

with subjects having more years of education 

also having a higher FHL score. 

Conclusions: This is the first study to examine 

the FHL level of a Chinese population. About one 

third of the participants in this study had inadequate 

or marginal FHL, and a significant portion had 

problem interpreting frequently encountered medical 

information and instructions. As non–Englishspeaking 

population in the United States is increasing, 

there is an urgent need to identify patients without 

adequate FHL and to develop appropriate intervention. 

Pharmacists should be aware of the difficulty 

their patients may encounter in understanding 

health information and instructions. 

235—GENERIC DRUG UTILIZATION 

PATTERNS AMONG ELDERY AND NON- 

ELDERLY INDIVIDUALS. Agarwal S, Zhang D, 

Schondelmeyer S, University of Minnesota. E-mail: 

agar0040@umn.edu 

Objective: The objective of the present study was 

to determine and compare the generic drug-utilization 

rates amongst elderly and nonelderly 

Americans. 

Methods: The household component and prescription 

drug event files of Medical Expenditure 

Panel Survey (MEPS) 1998 were used for this 

descriptive research. The generic availability status 

of a drug was obtained from multisource codes 

available in Medi-Span’s Master Drug Database 

(MDDB). Analyses on generic drug-utilization rates 

categorized according to age, sources of payment, 

out-of-pocket spending, therapeutic category and 

income were conducted. Generic drug utilization 

was defined in three ways: (1) generic prescribing 

rate, (2) generic dispensing rate, and (3) generic 

consumption rates. Generic prescribing rate was the 

ratio of the number of multiple-source brand and 

generic drugs used to the total number of drugs 

used. Generic dispensing rate was the ratio of the 

number of generics used to the total number of 

drugs that had the opportunity to be generically used 

(multiple-source brand + generics). Generic consumption 

rate was the ratio of the total number of 

generics used to the total number of drugs used. 

Results: Seniors had poorer rates of insurance 

coverage of prescription drugs than the younger 

individuals. The older cohort with no prescription 

drug coverage had lower generic dispensing rates, 

generic prescribing rates and generic consumption 

rates than the nonelderly group. In situations where 

medications could be generically substituted, the 

elderly had lower generic dispensing rates than did 

the nonelderly (i.e., a cheaper generic drug was dispensed 

less often for the elderly). 

Conclusions: The preliminary results of this 

study indicate that seniors in certain circumstances 

tend to use generics at a lower rate than do nonseniors. 

Higher utilization rates of generic drugs 

would result in lower drug expenditures for the 

elderly. 

236—GETTING PHARMACISTS TO 

RESPOND: A COMPARISON BETWEEN 

MAIL AND TELEPHONE SURVEYS. 

Chamnanmoh S, Mount J, University of Wisconsin– 

Madison. E-mail: schamnanmoh@wisc.edu 

Objective: The main goal of this study was to 

evaluate the effectiveness of mail and telephone surveys. 

Three specific objectives were to (1) evaluate 

the level of study participation and quality of 

response between mail and telephone surveys; (2) 

compare the costs for data collection in mail and telephone 

surveys; and (3) assess the pattern of response 

between mail and telephone survey participants. 

Methods: A short postcard-length and a brief 

telephone survey were used to collect data concerning 

pharmacy-based immunization activities in 

Washington State. First, a mail census of community 

pharmacies was conducted. Next, a 5-minute follow-up 

telephone survey, using the same questions 

contained in the mail survey, was conducted with 

110 randomly selected pharmacies that did not 

respond to the mail survey. 

Results: Of the 1,143 mail surveys, 328 were 

returned and 2 were undeliverable, yielding the 

cooperation rate of 28.7%. For the telephone survey, 

of 110 pharmacies contacted, 92 agreed to participate 

and 3 were ineligible, yielding the cooperation 

rate of 86%. Using completeness of answer to survey 

questions as a measure of quality of response, 

the response quality was greater for the telephone 

survey. Additionally, costs for each usable survey 

was compared. The mail survey was the most 

expensive, the telephone survey using an advanced 

notification letter was the second most expensive, 

and the telephone method not using an advanced letter 

was the least expensive method. The results also 

revealed that the type of pharmacy and the existence 

of an immunization protocol did not affect participation 

for either the mail or telephone survey. 

However, participating pharmacies in the mail and 

telephone surveys were different in their involvement 

in some immunization activities. These differences 

were due to nonresponse bias. 

Conclusions: The telephone survey achieved a 





higher level of participation as well as high response 

quality, with a reduced cost per response. Future 

researchers should consider using a telephone survey 

as a: (1) screening tool to document prevalence 

of pharmacy/pharmacists’ activities, (2) survey 

method to replace a mail survey, or (3) follow-up 

method with mail survey nonrespondents to examine 

nonresponse bias. A telephone survey is a viable 

data collection method that holds many promises in 

pharmacy research. 

237—HEALTH CARE DECISIONS UNDER 

BUDGET CONSTRAINT IN THAILAND. 

Kasemsup V, Schommer J, Hadsall R, Cline R, 

Dowd B, University of Minnesota. E-mail: 

kase0025@umn.edu 

Objective: To improve access to health care, in 

2001, the Thai government launched a new policy 

named the “30-baht-per-visit” program in an 

attempt to provide health insurance coverage to 

Thai people who had not been covered by other public 

insurance plans. Because the cost of providing 

coverage for high-cost treatments such as renal 

replacement therapy (RRT) for end-stage renal disease 

(ESRD) and antiretroviral drugs for people living 

with HIV/AIDS would undermine financial viability 

of the 30-baht-per-visit program, these therapies 

have not been included in the program’s benefit 

package. As a result, almost all ESRD patients 

have not received RRT and people living with 

HIV/AIDS have not been optimally treated with 

antiretroviral drugs. Under limited resources, we 

assert that it is better to provide some treatments for 

selected patients than not providing any care at all. 

From this perspective, we propose that rationing criteria 

will be used for decision making under budget 

constraint and that these criteria should be established 

with input from the general public. Therefore, 

the specific aims of this study are as follows: (1) 

Determine rationing criteria that would be accepted 

by Thai citizens for selecting patients for high-cost 

therapies; and (2) investigate the extent to which 

“five principles” of rationing [(a) lottery principles 

or “not playing god”; (b) distribution according to 

immediate need or “rule of rescue”; (c) health maximization; 

(d) equalizing lifetime health or “fair 

inning”; and (e) equalizing opportunity for health or 

“choicism”] are related to rationing decisions. 

Methods: Data will be collected from three focus 

groups and from a household survey of 500 respondents 

in Thailand. Methods of analysis are descriptive 

analysis, one-sample t test, ANOVA, factor 

analysis, and multinomial logistic regression. 

Results: Results of the study will be used for policy 

decisions related to high-cost treatments in 

Thailand. 


238—HEALTH-RELATED QUALITY OF 

LIFE AMONG URBAN INDIGENT PERSONS 

WITH HIV INFECTION. Viswanathan H, Purdue 

University, School of Pharmacy and Pharmacal 

Sciences, Anderson R, New Century Medical 

Imaging (at the time of the study, Dr. Anderson was 

Director of Health and Education Services at the 

Damien Center), Thomas J, Purdue University, 

School of Pharmacy and Pharmacal Sciences. E- 

mail: hema1@pharmacy.purdue.edu 

Objective: To assess health-related quality of life 

(HRQOL) among urban indigent persons with 

HIV/AIDS, to compare participants’ HRQOL 

scores to general population norms and those for 

chronic conditions, and to examine relationships 

between patient characteristics, nonadherence, and 

HRQOL. 

Methods: A cross-sectional written survey of 

HIV/AIDS infected individuals currently taking 

antiretroviral medication was conducted at an 

HIV/AIDS service center. The Medical Outcomes 

Study Short Form 12 Version 1 (SF-12) was used to 

assess HRQOL. Nonadherence was assessed using 

the 9-item Morisky Adherence Scale. Data also 

were collected on social support, number of 

antiretroviral medications, CD4 counts, and time 

since diagnosis. Statistical analyses were conducted 

using t-tests and linear regression. 

Results: Of the 112 surveys received, 86 surveys 

were analyzed because 2 survey codes were not discernible, 

11 did not meet inclusion criteria, and 13 

had missing data on the SF-12. Approximately 84% 

of participants were men, and 50% were white. The 

mean ± SD physical component summary (PCS) 

score of 41.0 ± 12.5 and mental component summary 

(MCS) score of 41.9 ± 11.0 were lower than population 

norms (P < .001). Participants’ PCS scores 

were lower than those of individuals with hypertension 

(44.3 ± 10.8) and depression (45.0 ± 12.0). 

Participants also had lower MCS scores than individuals 

with hypertension (52.2 ± 9.3) and diabetes 

(51.9 ± 9.5). In multivariate analyses, employment 

and higher social support were positively associated 

with PCS scores (P


FEATURE 

provided with a home BP monitoring device and 

instructed to measure their BP at least once daily for 

the next month. Home BP readings were used by the 

pharmacists to develop treatment recommendations 

for the patient’s physician. Recommendations were 

discussed with the physician and, if approved, 

implemented by the pharmacist. Control pharmacies 

did not provide patient education, home BP monitoring, 

or physician recommendations. These 

patients were referred to their physician for evaluation. 

The primary outcome measure was the difference 

in systolic BP (SBP) between the intervention 

and control patients at program conclusion. BP measurements 

were performed in the pharmacies using 

a uniformly dedicated, automatic electronic device. 

A trained pharmacist recorded the average of two 

BP readings separated by 5 minutes of rest. 

Secondary study end points include hospitalizations, 

emergency department visits, physician office 

visits, medication adherence, and quality of life. 

Data were submitted via a secured Web-based 

claims processing system, the Outcomes Case 

Management Program. Analyses of differences in 

SBP will be performed using t tests. Chi-square tests 

will be used for analyses of secondary end points. 

Results: 120 patients have been enrolled, with 64 

completing the study. The study population is an 

average of 64.1 (SD = 12.2) years old and 59% 

women. For patients completing the study, baseline 

SBP was not significantly different between the control 

group (N = 37) and the intervention group (N = 

27) (154 versus 153.6 mm Hg, respectively; P = 

.892). At study completion, SBP was significantly 

reduced in the intervention group compared with the 

control group (133.9 versus 141.6 mm Hg, P = .05). 

Conclusions: Preliminary results suggest this 

model can improve BP control. Final results will be 

presented. 

241—IMPACT OF MEDICATION MAN- 

AGEMENT ON INFORMAL CAREGIVERS 

OF PATIENTS WITH DEMENTIA AND 

ALZHEIMER’S DISEASE. Byrd J, Sleath B, 

University of North Carolina at Chapel Hill, Clipp 

E, Doyle M, Richard L, Duke University Medical 

Center. E-mail: jbyrd@unc.edu 

Objective: To compare the amount of time spent 

helping with medicines versus other caregiving 

tasks for informal caregivers who provide care for 

elderly relatives with progressive dementia. To 

determine the caregiver and patient characteristics 

that are related to the amount of time that caregivers 

help with their medications. To examine whether 

increased time spent managing medication is associated 

with lower emotional health status of the 

informal caregiver. 

Methods: The data are from the National 

Longitudinal Caregiver Sample, a survey of 2,279 

informal caregivers of elderly male veterans diagnosed 

with probable Alzheimer’s disease or vascular 

dementia. All variables were measured using 

caregiver self-report on a mailed survey. Time spent 

managing medicines is reported in average minutes 

per day, as are the other caregiving tasks. Emotional 

health of the caregivers was measured and categorized 

using a modified version of the Center for 

Epidemiological Studies – Depression (CES-D) 

scale and a combined version of the Short 

Psychiatric Evaluation Schedule (Pfeiffer) and the 

Langer Twenty-Two Item Screening scale to measure 

stress and psychological distress. 

Results: Medication management requires more 

time (mean, 19.5 minutes per day) than the majority 

of the seven personal management tasks and all 

eight physical care tasks. Results of the regressions 

of time spent helping with medicines on caregiver 

and patient characteristics and of caregiver emotional 

health on medication management time are 

currently being conducted. 

Conclusions: This study has found, thus far, that 

more time is spent by caregivers helping with 

medicines than on the majority of other personal 

management tasks and all of the physical care tasks 

provided to patients with dementia. This suggests 

that the caregiver’s role in medication management 

for demented adults is important in the overall caregiving 

process and that pharmacists can develop 

interventions to decrease the time spent by caregivers 

and enhance their overall emotional health. 

242—IMPACT OF SUSTAINED-RELEASE 

LINE EXTENSIONS ON GENERIC DRUG 

UTILIZATION. Agarwal S, Schondelmeyer S, 

University of Minnesota. E-mail: agar0040@ 

umn.edu 

Objective: The objectives of the study were to: 

(1) determine the generic utilization rate of drugs 

with sustained-release line extensions, and (2) 

describe the effect of sustained-release line extensions 

on price competition in the post–generic drug 

market. 

Methods: This descriptive study used a longitudinal 

secondary database from IMS Health on sales 

of prescription drugs that had first generic entry 

between 1993 and 2001. Oral solid drug products 

that had a sustained-release line extension introduced 

within a year of generic entry were included 

in the study. Line extensions without any generic 

substitutes constituted the nonsubstitutable portion 

of the market. Dosage forms with generic alternatives 

formed the substitutable component. Defined 

daily doses sold for each drug product were calculated 

to obtain a measure of units used. Generic utilization 

rates were calculated using two different 

denominators: (1) total chemical entity market (substitutable 

and nonsubstitutable), and (2) substitutable 

section of the chemical entity market. Price 

competition in the substitutable and nonsubstitutable 

markets was assessed. 

Results: Separate analyses were performed with 

the inclusion and exclusion of fluoxetine in the sample. 

In the market with substitutable drugs, the 

generic utilization rate was almost 30% (50% with 

fluoxetine) 6 months after generic entry. The total 

chemical entity market had approximately 25% 

(42% with fluoxetine) generic penetration 6 months 

after generic entry. The price of the nonsubstitutable 

section of the market was about 50% more than the 

price of generics at 24 months after generic entry. 

Conclusions: The generic penetration rates for 

the total chemical entity market were lower than the 

utilization rates for the substitutable component. 

Sustained-release extensions introduced at the time 

of generic entry acquired a significant portion of the 

post–generic drug market. 

243—JUDGING A BOOK BY ITS COVER: 

THE PREDICAMENT WITH CANADIAN 

PHARMACY ADVERTISEMENTS AND 

AMERICAN CONSUMERS. Ballentine A, 

Lipowski E, University of Florida. E-mail: 

ajballen@ufl.edu 

Objective: To gauge the adequacy of Canadian 

pharmacy advertisement content by comparing the 

information contained within the advertisement to 

the information consumers are recommended to 

obtain prior to forming a judgment about a pharmacy’s 

quality and authenticity. 

Methods: The U.S. Food and Drug 

Administration (in conjunction with 14 other organizations 

including the American Pharmacists 

Association), the National Association of Boards of 

Pharmacy, and the American Association of Retired 

Persons have each published consumer guidelines 

on how to safely and securely purchase prescription 

medication from Internet and foreign pharmacies. 

The guideline sets were compared and main themes 

extracted. These themes were then compared with a 

pretest sample of pharmacy advertisements from 

two Florida newspapers during June 1–30, 2003. 

Content analysis will be performed on Canadian 

pharmacy advertisements appearing in 10 Florida 

newspapers over a 1-month period, from September 

1–30, 2003. 

Results: The consumer guidelines contained 10 

unique themes, such as provision of pharmacist 

access, pharmacy address, phone and license number, 

patient privacy policy, an explanation of 

Canadian and American drug and labeling differences, 

along with the requirement of the patient’s 

medical history and prescriptions from the consumer’s 

personal doctor. In the pretest sample, not a 

single pharmacy advertisement mentioned consumer 

access to a pharmacist and only one mentioned 

licensure and provided a nonresident pharmacy 

license number. The greatest number of 

guideline themes addressed in any one advertisement 

was four. 

Conclusions: According to the pretest sample 

content analysis, Canadian pharmacy advertisements 

do not contain an adequate amount of information 

for consumers to accurately judge the authenticity 

and quality of a Canadian pharmacy. The public policy 

implications may be that new educational campaigns 

or regulatory changes need to be implemented 

if Americans are to follow specified guidelines 

intended to safeguard their well-being. 

244—MEDICATION SAFETY IN THE 

PHYSICIAN’S OFFICE—OPPORTUNITIES 

FOR COMMUNITY PHARMACISTS. Galt K, 

Clark B, Rule A, Bramble J, Moores K, Creighton 

University. E-mail: kgalt@creighton.edu 





Objective: To study the safety aspects of the 

medication use process in primary care office practice, 

and to recommend practical improvements to 

enhance patient safety. 

Methods: A 154-item written survey was developed 

to assess medication safety practices in primary 

care office practice. Safety domains were identified 

and items developed. The survey was piloted on 

two offices to assure content and face validity, and 

reduce item ambiguity. The survey was administered 

using the interviewer-assisted technique to 31 

primary care office managers in the Nebraska and 

Iowa region. Direct observation and on-site interviews 

were conducted to assess the environment, 

facilities, technologies, and office behaviors related 

to the medication use process. 

Results: 44% of the practices report no specific 

procedure to respond to a serious medication error, 

56% report no established procedure for providing 

prescription drug samples to patients, 36% report 

that pharmacists repeat back the prescription when 

they telephone prescriptions in to minimize errors 

associated with verbal transmission, 33% report 

updating the patient’s chart when they renew medications 

by phone, 24% report dismissing individuals 

from employment because of errors. The prescribing 

process itself was studied to determine areas for 

practice improvement for safer prescribing. 

Information is presented on practices related to 

maintaining current patient charts, collecting timely 

medication histories from patients, the generation of 

new prescriptions, the processes associated with 

prescription renewal, methods of prescription transmission, 

and prescription clarification once received 

by the pharmacists. 

Conclusions: Improving the medication use process 

initiated in primary care offices is an important 

step to improving medication safety for the public. 

This research contributes new knowledge to our 

understanding of outpatient medication safety, supports 

evidence-based decisions about improvement 

practices, and helps to define where inter-professional 

efforts between primary care physicians and 

pharmacists are necessary, add value, and how successful 

they may be in a wide scale effort to improve 

patient medication safety in the local community. 

245—OSTEOPOROSIS BELIEFS AND 

ANTIRESORPTIVE MEDICATION CHOIC- 

ES: RESULTS OF A SURVEY IN MINNESO- 

TA. Cline R, Farley J, University of Minnesota, 

Hansen R, University of North Carolina at Chapel 

Hill, Schommer J, University of Minnesota. E-mail: 

cline011@umn.edu 

Objective: Osteoporosis is a disease that causes 

deterioration in bone strength and often results in 

fractures of the hip, wrist, and vertebra. Although a 

number of prescription medications are effective in 

the treatment and prevention of osteoporosis, little is 

known about the factors influencing women’s decisions 

to use medications such as the antiresorptives. 

The objectives of this study were (1) to better understand 

how beliefs regarding osteoporosis and antiresorptive 

drugs are associated with decisions to use 

these drugs and (2) to assess the utility of the health 

belief model (HBM) in predicting choices among 

hormone replacement therapy (HRT), newer antiresorptives, 

and no prescription drug therapy for 

osteoporosis. 

Methods: A cross-sectional survey design was 

used. Survey forms were mailed to 1,700 community-dwelling 

women aged 45 and older residing in 

Minnesota. Respondents completed measures of 

HBM constructs, as well as medication profiles and 

demographics. Data were analyzed using multivariable 

logistic regression models. 

Results: A total of 990 usable survey forms were 

returned, yielding an adjusted response rate of 

61.1%. Higher perceptions of susceptibility to 

osteoporosis were associated with the choice of 

newer antiresorptives over no therapy as were some 

cues to action (having been diagnosed with osteoporosis 

or ever having a test for the disease). 

Women attributing strong benefits to these drugs 

were more likely to use them, as were women who 

perceived few barriers to their use. Respondents 

were likely to choose HRT relative to no therapy if 

they had ever been tested for osteoporosis and if 

they perceived few barriers to the use of prescription 

medicines for its treatment. 

Conclusions: Several HBM constructs were associated 

with the decision to use newer antiresorptive 

drugs relative to no prescription therapy. However, 

few HBM components were operative in the choice 

of HRT relative to no therapy. Although the HBM 

appears to provide a plausible model of the decision 

to undertake newer antiresorptive drug therapy, it 

explains little about women’s use of HRT. 

246—PATIENT EXPECTATIONS, PER- 

CEPTIONS ON PERFORMANCE AND SATIS- 

FACTION WITH PHARMACIST DIRECTIVE 

GUIDANCE. Stroud L, Bharmal M, Thomas J, 

Purdue University. E-mail: mfb@pharmacy.purdue.edu 

Objective: The study objectives were to: (1) 

assess patients’ expectations, perceptions on performance, 

and satisfaction with directive guidance provided 

by pharmacists, (2) assess associations 

between patient expectations and perceived satisfaction 

with pharmacists’ services, (3) examine correlations 

between disconfirmation of expectations and 

patient satisfaction. 

Methods: Based on review of literature, a survey 

was developed to assess patients’ expectations, perceptions 

on pharmacists’ performance and satisfaction 

with pharmacist directive guidance. Some items 

assessed perceptions regarding pharmacists providing 

medication-related instructions (i.e., more basic 

care), while the remainder assessed perceptions 

regarding pharmacists providing feedback and goal 

setting (i.e., more advanced care). Disconfirmation 

was calculated by subtracting individuals’ expectation 

ratings from their rating of pharmacists’ performance 

on individual items. The initial survey was 

mailed to 1,000 randomly selected Indiana residents. 

To increase the survey response rate, two follow-up 

mailings were made at approximately 4- 

week intervals. Data were analyzed using SAS for 

Windows version 8.2. Kruskal–Wallis tests were 

used to assess associations between demographic 

variables and expectations, performance, disconfirmation, 

and satisfaction. Spearman rank correlation 

coefficients were used to assess associations 

between expectations, performance, disconfirmation, 

and satisfaction. An a priori alpha level of .05 

was used for all statistical tests. 

Results: A total of 306 completed surveys were 

returned, a response rate of 30.6 percent. 

Cronbach’s alpha reliabilities of the all the scales 

were good, and ranged from 0.74 to 0.92. There was 

a low nonsignificant negative correlation (–0.12, P 

= .069) between expectation and satisfaction. The 

correlation between satisfaction and performance 

was moderate (0.41, P < .05). However, the correlation 

between disconfirmation and satisfaction was 

highest (0.51, P < .05). 

Conclusions: The results of the study support 

application of expectation-disconfirmation theory to 

examining patients’ attitudes toward pharmacy services. 

Although expectations were low for higher 

level services (i.e., feedback and goal setting), disconfirmation 

of those expectations had significant 

associations with satisfaction. The findings should 

reinforce pharmacies’ efforts to advance higher 

level services. 

247—PATIENT SELF-MANAGEMENT 

BEHAVIOR ADOPTION IN CHRONIC CON- 

DITIONS BASED ON TRANSTHEORETICAL 

MODEL READINESS STAGE OF CHANGE 

PROFILES FOR SELF-MANAGEMENT. 

Sankaranarayanan J, Mason H, Purdue University. 

E-mail: jysan@purdue.edu 

Objective: To determine the: (1) distribution of 

readiness stages for Transtheoretical Model 

Readiness Stage of Change Profiles for Self- 

Management (TTMSM) and its significance in identifying 

patient type (risk status), and (2) associations 

among sociodemographic, psychosocial (coping, 

stress, self-efficacy, goal setting), self-management 

behavior, and perceived health status outcome 

(using the Medical Outcomes Study Short Form 12 

Version 2 [SF-12]) variables with TTMSM-stage. 

Methods: Prospective, cross-sectional random 

mail survey of Indiana-based managed care 

enrollees, 18 years and older with asthma, diabetes, 

hyperlipidemia, or hypertension included 4,040 

low-risk and 700 high-risk patients. The study protocol 

was approved by Purdue University’s 

Institutional Review Board. 

Results: The usable survey response rate was 

13%. Patients with a mean of two chronic conditions, 

maximum disease duration of 12 years, and a 

majority wanting self-management advice distributed 

into TTMSM-stages (precontemplation, contemplation, 

preparation, action, or maintenance). The 

evaluable patients (N = 607) were distributed across 

all five TTMSM-stages for three self-management 

domains of participation with doctor, general, and 

lifestyle management, but not for the medical care 

domain. More patients (36.9%) were in precontemplation–contemplation 

for general self-management. 

In ANOVA models, association between the 

TTMSM summated score and chronic conditions 




FEATURE 

were not significant (P = .5590). The TTMSM-stage 

of lifestyle management was significant (ordinal 

logistic-regression, P = .007) in classifying a patient 

as low- or high-risk user. Only goal setting had significant 

association with TTMSM summated score 

(ANOVA, 10.2%, P < .05). The TTMSM summated 

score was explained by self-management behavior, 

age, goal setting and number of information 

support sources (ANOVA, 36.8%, P < .05). Patient 

type, the four TTMSM domains, diabetes, coexistence 

of asthma, high cholesterol and hypertension 

and all four medical conditions, were significant in 

explaining SMBI (ANOVA, 41.7%, P < .05). 

Conclusions: More patients reported advanced 

TTMSM-stage for medical care than for general 

self-management. Independent of chronic conditions, 

the TTMSM-stage appears to indirectly 

impact health status through patient self-management 

behavior. In the delivery of effective self-management 

education programs, health providers need 

to consider patients’ TTMSM-stage in addition to 

their chronic conditions. 

248—PATIENTS’ EVALUATION OF CARE 

FOLLOWING A DENIAL OF AN ADVER- 

TISEMENT-RELATED PRESCRIPTION 

DRUG REQUEST: THE ROLE OF EXPECTA- 

TIONS, SYMPTOM SEVERITY AND PHYSI- 

CIAN DECISION-MAKING STYLE. Shah M, 

Bentley J, McCaffrey D, University of Mississippi. 

E-mail: mshah@olemiss.edu 

Objective: To assess the influence of physician 

decision-making style, patients’ expectations of 

receiving a prescription, and perceived symptom 

severity on patients’ evaluation of care following a 

physician denial of a prescription drug request stimulated 

by direct-to-consumer advertising. 

Methods: This study uses a 2 × 2 × 2, betweensubjects, 

experimental design. Physician decisionmaking 

style, patients’ expectations of receiving a 

prescription medication, and patients’ perceived 

symptom severity were manipulated using 

vignettes. Manipulations were reviewed by experts 

and pretested. Patients’ postvisit evaluation of care 

was assessed by measuring trust in the physician, 

visit-based satisfaction with the physician, and commitment 

towards the physician. University staff 

members were randomly assigned to read one of the 

eight vignettes and then responded to a Web-based, 

self-administered survey. Factorial analysis of variance 

procedures for a three-way design were used to 

test the hypotheses and propositions. 

Results: Postvisit patient evaluation of care was 

significantly associated with physician decisionmaking 

style (partnership response led to better 

evaluation of care). Prior expectations and perceived 

symptom severity were not significant predictors 

of evaluation of care; however, nonsignificant 

trends in mean scores were in the predicted 

direction. No significant interactions were detected. 

Conclusions: Physicians attempting to minimize 

the effect of request denials on patient evaluations 

should attempt to make the patient feel involved in 

the decision-making process. The manner in which 

a physician communicates with the patient is an 

important determinant of patient evaluation of care 

following a denial of a patient’s request. Prior 

expectations of patients and symptom severity need 

to be further explored as determinants of patient 

evaluation of care. The results have implications for 

other health care professionals, including pharmacists, 

who commonly respond to patient requests. 

249—PDA PRESCRIBING IN OUTPA- 

TIENT SETTINGS: BARRIERS AND SOLU- 

TIONS. Galt K, Bramble J, Rule A, Clark B, 

Siracuse M, Taylor W, Lust E, Creighton 

University, Schwartz A, University of Nevada, 

Moores K, Creighton University. E-mail: 

kgalt@creighton.edu 

Objective: Successful adoption of the personal 

digital assistant (PDA) use by primary care physicians 

in office practice may result in improved safety 

when prescribing takes place. However, introducing 

of new technologies may meet with user adoption 

barriers. This research identifies adaptation and 

adoption barriers perceived by physicians using 

PDAs as a prescribing tool in outpatient practice 

and the strategies physicians employed to overcome 

these barriers. 

Methods: Forty primary care physicians were 

provided PDAs with both a drug information and 

prescription writing software package. After successful 

completion of training, subjects used the 

PDA as a drug information source and prescriptiongeneration 

tool. We conducted qualitative interviews 

2 weeks after initiation of the PDAs to elicit 

the barriers experienced and how they overcame 

these barriers. Five experts identified themes and 

patterns that emerged using a content analysis process 

employing human factors, organizational theory 

and technology diffusion theory as a framework. 

Results: Four major themes emerged related to 

inhibition of full adoption of PDA use and applications: 

Technology, Time/Workload, Environment, 

and Personal. Physicians reported the software did 

not always meet their needs and that the time to 

learn, the speed of the PDA, and the work environment 

were not conducive to full adoption. Four 

themes related to responses to these barriers 

emerged: self-help, seeking assistance, avoidance, 

and partial adoption. Physicians either “gave up” and 

returned to their “old” ways or partially adopted the 

piece of technology that was easiest to learn and efficient. 

When PDA use interfered with “seeing” 

patients the technology was deemed “not worth it.” 

Conclusions: Barriers and solutions to PDA use 

exist on both an individual and system level. 

Technology adoption for individual users requires 

adaptation at both levels. Users need to have the 

time to learn how to implement the technology so it 

is an asset and not an inhibitor to daily practice. 

250—PHARMACEUTICAL CASE MAN- 

AGEMENT: A CASE OF IDENTIFYING AND 

RESOLVING DRUG-RELATED PROBLEMS 

IN THE COMMUNITY. Klepser D, Doucette W, 

McDonough R, McCarthy R, University of Iowa. E- 

mail: donald-klepser@uiowa.edu 

Objective: The Iowa Medicaid program has initiated 

a pharmaceutical case management (PCM) program 

in which community pharmacists and physicians 

work together to manage the drug therapy for 

ambulatory patients taking at least four chronic 

medications. The objective of this project was to 

describe the drug-related problems identified at one 

pharmacy during the first 2 years of the PCM program. 

Methods: In the PCM program pharmacists make 

written recommendations to the patient’s physician 

after assessing a patient’s drug therapy. For 153 

patients who had at least one documented visit during 

the first year of the PCM program, data were 

abstracted from the pharmacy records. Collected 

data included patient demographics, number of 

chronic conditions and medications at first visit, 

type and number of drug-related issues, pharmacist 

recommendations, and physician acceptance of the 

recommendations. 

Results: The patients had an average age of 54.2 

(SD, 19.3) years and nearly 74% were women. They 

were taking a mean of 9.3 (SD = 4.5) medications 

and had 6.2 (SD = 2.9) medical conditions at the 

start of PCM. A total of 901 drug-related issues 

were classified into nine categories: inappropriate 

compliance, 232 (25.8%); needs additional therapy, 

200 (22.2%); wrong drug, 122 (13.5%); unnecessary 

drug therapy, 113 (12.6%); adverse drug reaction, 

98 (10.9%); dosage too low, 85 (9.4%); dosage 

too high, 47 (5.2%); and two types less than 1% 

each (drug duplication, drug interaction). The pharmacists 

made 672 recommendations regarding the 

drug-related issues, which resulted in 323 changes 

in drug therapy for the patients. Specifically, pursuant 

to a pharmacist’s recommendation physicians 

changed dosage 87 times, changed to a different 

medication 84 times, stopped a medication 78 times, 

and added a medication 74 times. 

Conclusions: The PCM program showed that the 

safety of drug therapy for ambulatory patients can 

be improved through collaboration between physicians 

and pharmacists. 

251—PHARMACIST COLLABORATIVE 

PRACTICE IN HOSPITALS. Bharmal M, Purdue 

University, Lin S, University of Michigan Hospital, 

Thomas J, Purdue University. E-mail: mfb@pharmacy.purdue.edu 

Objective: The objectives of this study were to: 

(1) identify the extent and scope of collaborative 

practice (CP) occurring in U.S. hospitals, (2) identify 

perceived facilitators and barriers for CP, (3) 

assess perceptions of pharmacy directors regarding 

support for CP, and (4) assess the perceived strategic 

impact and financial impact of CP. 

Methods: A mail survey was developed and 

pretested in January 2002 with 30 hospital pharmacy 

directors in Illinois, Indiana, and Michigan. A 

national random sample of 1,000 hospital pharmacy 

directors stratified by state were mailed surveys. 

Pharmacy directors’ perceptions regarding support 

for CP and impact of CP were obtained through ratings 

of statements on a 5-point Likert scale (1 = 





strongly disagree, 2 = disagree, 3 = neutral, 4 = 

agree, and 5 = strongly agree). SAS for Windows 

version 8.2 was used for descriptive statistics and t 

tests comparing responses from CP and non-CP 

institutions. 

Results: Usable responses were received from 

318 hospitals, a 31.8% usable response rate. A total 

of 155 respondents, 49.2%, indicated some pharmacist(s) 

in their hospital were engaged in CP. 

Infectious disease (79.3%), anticoagulation 

(60.6%), and parental nutrition (55.6%) were most 

frequently mentioned CP disease state/therapeutic 

areas. Payment or reimbursement for some CP was 

received in 12.7% of hospitals with CP. Upper hospital 

administration support for CP was rated higher 

in CP hospitals (mean ± SD = 3.85 ± 0.78) than in 

non-CP hospitals (2.98 ± 0.91) (P < .0001). CP hospitals’ 

pharmacy directors also perceived a favorable 

strategic impact of collaborative services 

through enhancing upper administration’s perceptions 

of the value of the pharmacists (4.25 ± 0.67) 

and physicians asking staff to provide more 

advanced services because of CP (3.91 ± 0.88). 

Conclusions: Pharmacy directors of CP hospitals 

perceived upper hospital administration, physicians, 

management staff, and nurses as more supportive of 

CP compared with non-CP hospitals. CP has provided 

positive strategic benefit to pharmacists practicing 

in hospitals. 

252—PHARMACISTS’ ORGANIZATION- 

AL COMMITMENT: AFFECTIVE, CONTIN- 

UANCE, AND NORMATIVE. Kahaleh A, Ohio 

Northern University, Gaither C, University of 

Michigan. E-mail: a-kahaleh@onu.edu 

Objective: To distinguish between three dimensions 

of pharmacists’ organizational commitment. 

Methods: The study has a cross-sectional design. 

Self-administered questionnaires were mailed to a 

national random sample of 1,200 pharmacists. Data 

were coded, entered, and analyzed using SPSS 10.0 

for Windows statistical software. Descriptive statistics 

were used to examine demographics. Validity 

and reliability of multiple-item measures were 

assessed using factor analysis and Cronbach’s coefficient 

alpha. Given the hyperdemand for pharmacy 

services, employers are working hard to recruit 

pharmacists. Organizational commitment is becoming 

more important to consider in recruiting and 

retaining qualified pharmacists. Organizational 

commitment was measured as (1) affective (attachment 

to the organization); (2) continuance (perceived 

costs associated with leaving the organization); 

and (3) normative (obligation to remain in the 

organization). 

Results: Factor analysis revealed that the three 

dimensions were distinguishable from one another. 

Reliability tests for affective (AC), continuance 

(CC), and normative (NC) commitment showed that 

Cronbach’s alphas were 0.87, 0.50, and 0.86 respectively. 

Using a 7-point Likert scale, NC had the highest 

mean (± SD) 4.25 ± 1.5, followed by AC, 3.75 ± 

1.7, and CC, 3.50 ± 1.8. Also, 67% of the pharmacists 

indicated that they are willing to spend the rest 

of their careers with their organizations, 51% said 

that they are staying in the organization because of 

sense of obligation to the people in it, and 48% stated 

that staying with the organization is a necessity. 

Conclusions: Consistent with theoretical considerations, 

the results provided evidence that organizational 

commitment has three distinct dimensions: 

affective, continuance, and normative. Employers 

can help their organizations by increasing pharmacists’ 

affective commitment. Pharmacists who have 

a high level of affective commitment tend to have a 

high interest in achieving the organization’s goals. 

253—PHARMACISTS’ VIEWS OF DEVEL- 

OPING COLLABORATIVE WORKING 

RELATIONSHIPS WITH PHYSICIANS. 

Nevins J, McDonough R, Doucette W, University of 

Iowa. E-mail: justin-nevins@uiowa.edu 

Objective: A conceptual model of collaborative 

working relationships between physicians and pharmacists 

states that collaboration is affected by three 

sets of characteristics: individual, context, and 

exchange. The objective of this study was to test the 

conceptual model to empirically determine which 

sets of characteristics influence collaboration. 

Methods: Data were collected through a survey 

mailed to a national sample of 321 pharmacists 

identified by state pharmacy associations as being 

innovative practitioners. Individual variables 

included demographics and personality measures. 

Context variables included practice environment 

and professional interactions between pharmacists 

and physicians. Exchange characteristics were measured 

using the three domains of the 

Physician/Pharmacist Collaboration Instrument 

(PPCI): trustworthiness, role specification, and relationship 

initiation. Four items asked about the pharmacist’s 

collaborative care with a physician and 

were rated using a 7-point Likert scale. A linear 

regression analysis was performed with collaborative 

care as the dependent variable and the individual, 

context, and exchange characteristics as the 

independent variables. 

Results: A total of 166 usable surveys (53.4%) 

were returned. About 64% of the respondents were 

men with a mean age of 43.7 (SD, 11.2) years. 

Independent pharmacy owners were the most common 

respondents, while family practice was the 

most common specialty of collaborating physicians. 

Linear regression analysis of the model produced an 

R 2 = 0.790 (P < .001). Significant predictors in the 

model included professional interaction, trustworthiness, 

and role specification. 

Conclusions: Overall, the collaborative working 

relationship model explained the development of 

collaborative care between pharmacist and physicians. 

The exchange characteristics trustworthiness 

and role specification were positively correlated 

with collaborative practice. In addition, the scope of 

professional interactions, a context variable, had a 

positive influence on the level of pharmacist–physician 

collaboration. Further work is needed to extend 

our understanding of collaboration between pharmacists 

and physicians. 

254—PHARMACY-BASED IMMUNIZA- 

TION PROGRAMS IN WASHINGTON 

STATE. Chamnanmoh S, Mount J, University of 

Wisconsin–Madison, Rochon J, Washington State 

Pharmacy Association. E-mail: schamnanmoh@ 

wisc.edu 

Objective: Describe the level of pharmacy 

involvement in and trends related to pharmacybased 

immunization programs in the State of 

Washington. 

Methods: Using a postcard-length survey, a census 

of community pharmacies in Washington was 

conducted during August and September 2003 to 

identify the prevalence of and changes in immunization 

programs. Specific programs to be considered 

were immunization consultation, immunization 

promotion, out-sourced immunization service, pharmacist-administered 

immunization service under a 

collaborative drug therapy agreement protocol and 

pharmacist-administered immunization service pursuant 

to prescribers’ order. A follow-up telephone 

survey with nonrespondents was conducted during 

late September and October 2003 to examine nonresponse 

bias. 

Results: Results were based on the returned postcard-length 

survey. Of the 1,143 survey packages 

sent, 2 were undeliverable; 328 (28.7%) were 

returned. Of the returned surveys, 315 were usable. 

Results show that more than 50% of pharmacies 

reported that their pharmacies were involved in 

immunization consultation and promotion activities. 

Approximately one third of the respondents reported 

that their pharmacies provided pharmacistadministered 

immunization service under a protocol. 

Almost 30% of pharmacies were involved in an 

out-sourced immunization service and vaccine 

administration for patients with prescription orders. 

Additionally, there is an increasing trend for all 

immunization programs, except for out-sourced 

immunization service. 

Conclusions: Pharmacy-based immunization 

programs, including consultation/promotion activities 

and delivery services are important to the community 

as they help increase immunization rates. 

Washington State pharmacists are actively involved 

in these immunization activities. Further research is 

needed to examine reasons why pharmacies offer 

(or do not offer) immunization delivery service, to 

facilitate greater pharmacy/pharmacist involvement 

in this practice. 

Original Citation: Chamnanmoh S, Mount JK, 

Rochon J. Pharmacy-based immunization programs 

in Washington State. Poster presentation at the 

Washington State Public Health Association 10th 

Annual Joint Conference on Health, Yakima, 

Wash., October 13–15, 2003. 

255—PHYSICIAN ADAPTABILITY TO 

HANDHELD COMPUTER USE: A PATH 

ANALYSIS OF CORRELATES WITH 

EXPECTED BEHAVIORS. Siracuse M, Galt K, 

Clark B, Rule A, Taylor W, Creighton University. 

E-mail: msiracuse@creighton.edu 

Objective: The objective was to determine 

human factors (attitudes, beliefs, and abilities) asso- 




FEATURE 

ciated with the use of computers in general and 

handheld devices in particular (specifically, personal 

digital assistants [PDAs]). 

Methods: The population of study was primary 

care office-based practice physicians who were new 

or relatively inexperienced learners of handheld 

technologies. Our study involved 78 primary care 

physicians in 32 office-based practices located in 

the Eastern Nebraska–Western Iowa region. The 

initial instrument assembled a total of 60 items, with 

an equal distribution of items requiring a positive or 

negative response. All of the items were scored on a 

5-point Likert scale. The instrument was completed 

by physicians in their routine office practice setting 

using self-administered, interviewer-assisted technique. 

The instrument was administered to the study 

population after it was piloted on six physicians to 

confirm face validity and to reduce ambiguity. 

Results: Of the 78 physicians surveyed, 73% did 

not use a PDA at work, and only 3% specifically 

received formal training in the use of PDAs. 

Exploratory factor analysis resulted in the following 

eight subscales being identified: (1) emotional reaction 

toward computers (0.93); (2) learning related 

attitudes toward computers (0.88); (3) dexterity limitations 

to computer use (0.77); (4) physical sensory 

barriers and computers (0.90); (5) beliefs about utility 

of PDA use in prescribing (0.90); (6) expectations 

of being slowed down by PDAs (0.84); (7) fear 

of loss (0.86); and (8) belief that PDAs increase efficiency 

(0.84). 

Conclusions: Path analysis will be done to analyze 

the association between the aforementioned 

subscales and physician attitude regarding current 

and future use of handheld devices. Ultimately, the 

association between successful adaptation to handheld 

technology by individual physicians and 

human factors will be determined. 

256—PHYSICIAN ATTITUDES TOWARD 

DIRECT-TO-CONSUMER ADVERTISING OF 

PRESCRIPTION DRUGS: A CONTENT 

ANALYSIS OF OPINION-BASED PUBLICA- 

TIONS. Zhang D, Carlson A, University of 

Minnesota. E-mail: zhan0446@umn.edu 

Objective: Increases in spending on direct-toconsumer 

advertising (DTCA) have coincided with 

a sharp rise in the number of prescriptions being 

written and in spending on prescription drugs. 

Although the physicians’ role in prescribing is central, 

only a few studies have attempted to identify 

physician attitudes toward the value and effect of 

DTCA on the patient care process. The objective of 

this study was to: (1) identify physician attitudes 

toward DTCA of prescription drugs using opinionbased 

articles published in professional journals and 

other mass media sources and (2) compare these 

published opinions with the results of two very 

recent surveys of physicians regarding DTCA. 

Methods: Opinion-based publications such as 

letters to the editor, editorials, comments, controversies, 

or manuscripts that present information 

about DTCA without original data collection were 

identified using MEDLINE, CINAHL, and 

International Pharmaceutical Abstracts supplemented 

by hand search of secondary references. 

Articles must be published after 1985 and have at 

least one physician (with MD or DO degree) as an 

author. Content analysis was used to group statements 

about the influence of DTCA on patient and 

physician behaviors into relevant themes. 

Results: A total of 40 eligible publications have 

been identified, and 29 have been reviewed. Eight 

(27.6%) expressed positive views of DTCA, and 21 

(72.4%) expressed negative views. Some 94 statements 

have been catalogued and grouped into five 

positive and eight negative themes. Positive themes 

include the educational value to patients and 

DTCA’s role in improving patient compliance. 

Negative comments are related to the quality of discussions 

between physicians and patients and the 

negative influence of DTCA on the patient–physician 

trust relationship. None offer evidence that 

DTCA has contributed to poor patient outcomes. 

Conclusions: Review of opinion-based literature 

identifies concerns about DTCA that are supported 

by results of national surveys of physicians. 

Evidence connecting concerns with negative patient 

outcomes is lacking. 

257—PREDICTING DISCONTINUATION 

OF TREATMENT AMONG PATIENTS WITH 

MULTIPLE SCLEROSIS: AN APPLICATION 

OF THE TRANSTHEORETICAL MODEL OF 

CHANGE. Berger B, Auburn University, Hudmon 

K, University of California, San Francisco, Liang H, 

Florida Atlantic University. E-mail: 

bergeba@auburn.edu 

Objective: To delineate factors associated with 

discontinued use of Avonex, a medication for treatment 

of multiple sclerosis (MS), a chronic disease 

affecting the central nervous system. These factors 

would serve as a basis for the development of an 

intervention to promote treatment persistency. 

Methods: In-depth telephone interviews with 56 

patients followed by a 12-page written questionnaire 

mailed to 946 patients with MS. The 

Transtheoretical Model of Change provided the theoretical 

framework for the study. Setting: United 

States. Participants: 531 completed questionnaires 

(56%) were returned; 79% were currently using 

Avonex for treatment of MS. Main outcome measure: 

discontinuation of Avonex treatment. 

Results: A series of four key variables accurately 

identifies 82% of patients who discontinue drug 

use while also correctly identifying 81% of patients 

who stay on the drug. These variables are pros of 

Avonex use, cons of Avonex use, highest level of 

education completed, and level of disability. 

Conclusions: Constructs from the 

Transtheoretical Model of Change were effective in 

differentiating patients who had discontinued their 

Avonex treatment versus patients who continued 

treatment. This behavioral model likely would be an 

effective framework for a medication persistency 

software intervention program that would be stage 

and patient specific. 

258—PREDICTING THE TREATMENT OF 

MENTAL HEALTH PROBLEMS–COMPAR- 

ISONS BETWEEN LOGISTIC REGRESSION 

AND CHAID MODELS. Lin S, Tan H, University 

of Illinois at Chicago. E-mail: slin5@uic.edu 

Objective: The objectives are to (1) estimate the 

prevalence of mental health (MH)–related symptoms, 

diagnoses and treatments in ambulatory visits 

made to office-based physicians in the United 

States, (2) evaluate the discrepancy between symptom 

reporting and the diagnosis and treatment of 

MH-related problems, and (3) compare models from 

traditional logistic regressions and CHAID (classification-tree 

analysis with the chi-square automatic 

interaction detection) on their performance to predict 

and explain the treatment of mental health problems. 

Methods: Data from the 1997 to 2000 National 

Ambulatory Medical Care Survey were used for the 

study. Visits made by adults to primary care physicians 

or psychiatrists were selected for analysis. 

Dependent variables were the probabilities to report 

symptoms and receive diagnoses and treatments of 

MH-related problems. Independent variables 

include patient demographics, payment and health 

plan types, physician specialty, and proportion of 

MH-related symptoms encountered by each physician. 

Logistic regressions and Exhaustive CHAID 

are statistical methods used. 

Results: A total of 26,043 visits met the inclusion 

criteria, among them 17% reported at least one MHrelated 

symptom, 24% were given MH-related diagnoses, 

and 27% received MH-related treatments. 

Ten percent of the visits did not report a MH-related 

symptom but were given a MH diagnosis, and 

6% had neither a MH-related symptom nor a diagnosis 

but were prescribed a MH-related treatment. 

Results from the logistic regressions indicated that 

females and whites (as compared with African 

Americans) were more likely to report symptoms, 

and to be diagnosed and treated with their MH problems. 

Compared with visits made by private insured 

patients, Medicaid visits were not associated with a 

higher probability to report symptom but were more 

likely to be diagnosed and received MH-related 

treatments. 

Conclusions: MH-related symptoms, diagnoses 

and treatments were prevalent. Considerable inconsistency 

was found in diagnosing MH problems and 

prescribing MH treatments. 

259—PREDICTORS OF STUDENT SATIS- 

FACTION AND COMMITMENT TO THEIR 

PHARMACY SCHOOL. Holdford D, Patkar A, 

Virginia Commonwealth University. E-mail: 

daholdfo@vcu.edu 

Objective: To test a service quality framework 

that presents seven educational quality inputs that 

influence four outcomes and examine the predictive 

validity of an educational service quality instrument. 

Methods: Design: Self-administered survey. 

Instrumentation: A 68-item instrument using a 5- 

point Likert scale was selected to assess seven 





inputs (i.e., service quality, courses, student friendships, 

faculty friendships, workload, perceived 

accomplishment, and student organizations) and 

four outcomes (i.e., overall satisfaction, school 

commitment, perceived value, and willingness to 

serve). Participants: Pharmacy students in their final 

year of school before graduation (P-4). Data collection: 

Four graduating classes of students (2000 to 

2003) at an Southeastern University were surveyed 

during P-4 clerkships. Data Analysis: Descriptive 

and regression analyses were conducted. 

Results: Four separate stepwise models showed 

substantial explanatory power of overall satisfaction 

(73%), school commitment (42.4%), perceived 

value (50.5%), and willingness to serve (33.6%). 

Five of the seven educational quality inputs in the 

proposed framework had a significant impact on at 

least three of the four outcomes. Service quality had 

the greatest impact on overall satisfaction (R 2 = 

.619) and school commitment (R 2 = .307). Courses 

had the greatest impact on perceived value (R 2 = 

.384) and willingness to serve (R 2 = .200) and significant 

influence on overall satisfaction (R 2 = .101) 

and school commitment (R 2 = .064). Other important 

predictors were student organizations, faculty 

friendships, and academic accomplishments. 

Student friendships had no impact on any outcome, 

and workload had marginal impact on perceived 

value. 

Conclusions: This research demonstrates that 

student perceptions of the school are based upon a 

broad range of educational inputs including but not 

limited to service quality. Most important are the 

courses and the way they are delivered. 

Extracurricular activities such as participation in 

student organizations and interactions with faculty 

also influence perceptions. 

260—RANDOMIZED TRIAL OF A PHAR- 

MACIST CONSULTATION PROGRAM FOR 

FAMILY PHYSICIANS AND THEIR ELDER- 

LY PATIENTS: 17-MONTH FOLLOW-UP. 

Sellors C, Kaczorowski J, Sellors J, Goeree R, 

Dolovich L, Willan A, Woodward C, Howard M, 

Blackhouse G, McMaster University. E-mail: csellors1@comcast.net 

Objective: To report the longer term (17 months) 

health and economic impacts of the Seniors 

Medication Assessment Research Trial (SMART). 

Methods: The study was a pairedcluster, randomized, 

controlled trial. A total of 48 randomly 

selected pair-matched physicians and 889 of their 

randomly selected senior patients taking five or 

more medications participated and were randomized 

to the intervention (pharmacist consultation) group 

(N = 24) or the control group (N = 24). For each 

senior in the intervention group, a pharmacist completed 

a medication assessment, then discussed the 

written recommendations with the physician. 

Outcomes included health care and medication utilization 

and costs determined by administrative 

databases, control of blood pressure (BP), blood 

glucose, glycosylated hemoglobin, and cholesterol 

(by chart audit), medication appropriateness measured 

by a published tool, and quality of life. 

Analyses are based on the 12 months (phase 2) after 

the 5-month intervention period and took account of 

the cluster design. 

Results: A total of 779 seniors (374 intervention 

group, 405 control group) participated in phase 2. 

Seniors in both groups were 74 years of age on average, 

and approximately two thirds were female. 

Pharmacists identified 1,093 drug-related problems 

in the intervention group. During the 12 months of 

phase 2, seniors in the intervention and control 

groups filled a similar average number of prescriptions 

(34.6 versus 33.9, respectively, P = .81), and 

had a similar number of hospitalizations (0.27 versus 

0.33, respectively, P = .38). The total average 

cost (including the pharmacist consultation in that 

group) in the intervention and control groups over 

the 12 months was $5,042.72 versus $4,781.49, P = 

.67. The proportions of seniors with hypertension, 

hypercholesterolemia, and diabetes, who had 

uncontrolled (including an absence of any readings 

in the chart) BP, cholesterol, and blood glucose 

were high in both groups (58%–95%), and were not 

statistically significantly different between groups 

after taking account of baseline group imbalances. 

Conclusions: The one-time pharmacist consultation 

intervention did not result in changes in health 

care utilization or clinical management of hypertension, 

diabetes, or hyperlipidemia, but demonstrated 

a need to address drug-related problems and a successful 

collaboration process between pharmacists 

and physicians. 

Original Citation: Canadian Association for 

Population Therapeutics, Quebec City, Quebec, 

Canada, March 31, 2003. 

261—RATES AND IMPLICATIONS OF 

DRUG COST IMPUTATIONS IN THE MEDI- 

CARE CURRENT BENEFICIARY SURVEY. 

Mott D, Kreling D, Chou C, University of 

Wisconsin–Madison. E-mail: damott@pharmacy. 

wisc.edu 

Objective: The objectives of this study were to 

examine trends in the rates of statistical imputation 

for drug cost data in the MCBS data, determine how 

those rates vary by drug coverage source, and 

explore potential implications of those imputations 

on resulting drug cost and out-of-pocket cost estimates. 

Methods: Data on prescription drug use and 

spending for persons age 65 and older from the 

Medicare Current Beneficiary Survey (MCBS) Cost 

and Use Files from 1994 to 1999 were used. A variable 

identifying whether drug cost information for 

prescribed medicine events was statistically imputed 

was used to track rates of imputation. The effects 

of statistical imputation were examined with data 

from 1994 by comparing summary cost variables 

calculated using all prescribed medicine events, 

using only prescribed events that did not have 

imputed costs and using prescribed medicine events 

only for persons with no imputed medicine events. 

Results: The general trend for out-of-pocket was 

an increase in the rate of statistical imputation each 

year. The least amount of imputations occurred 

among the no coverage group. In terms of total 

spending, the rates of statistical imputation were 

more consistent across the years, and lower than 

those for out-of-pocket costs except for the 

Medicaid-covered group. Imputation effects on estimates 

of drug use and cost occurred when prescriptions 

with imputation were removed or persons with 

imputation were removed. 

Conclusions: Variation in rates of statistical 

imputation for drug cost information in the MCBS 

data among seniors with different drug coverages, a 

trend toward more statistical imputations over time, 

and higher amounts of out-of-pocket cost and drug 

costs in cases of imputation suggests caution is warranted 

by users of these data and the results of studies 

based on these data. 

262—RESORPTIVE DRUG USE PAT- 

TERNS AMONG MINNESOTA FEMALES: 

RESULTS OF A STATEWIDE SURVEY. Farley 

J, Cline R, University of Minnesota, Hansen R, 

University of North Carolina at Chapel Hill. E-mail: 

farl0032@umn.edu 

Objective: A number of drugs (referred to as 

resorptive medications) including antiepileptics, 

loop diuretics, and corticosteroids can reduce bone 

mineral density in users and ultimately increase 

their risk of osteoporosis. Although the use of 

resorptive medications can positively affect the 

health of users, few studies have examined their 

prevalence or predictors of use. Primary objectives 

were to (1) establish the prevalence of use of resorptive 

medications in Minnesota women aged 45 or 

older and (2) describe factors associated with 

resorptive medication use. Secondary objectives 

were to explore the occurrence of osteoporosis and 

osteopenia as well as the use of newer antiresorptive 

medications, calcium, and hormone-replacement 

therapy (HRT) among women using resorptive 

drugs. 

Methods: Design: Secondary data analysis of a 

cross-sectional mailed survey. Instrumentation: 75- 

item questionnaire with 5 sections including health 

belief model constructs, medication profiles, and 

demographics. Participants: Survey forms were 

mailed to 1,700 community-dwelling women aged 

45 and older residing in Minnesota. Analyses: Chisquare 

analysis and logistic regression were used to 

test bivariate and multivariate relationships between 

demographic variables, health characteristics, 

resorptive medications, and use of newer antiresorptives, 

calcium, and HRT. 

Results: A total of 990 usable survey forms were 

returned (adjusted response rate of 61.1%). Eightyfour 

respondents (8.5%) reported use of a resorptive 

medication. Age, health status, and health care utilization 

(monthly physician visits and prescription 

use) were all associated with resorptive medication 

use, controlling for other variables in the model. 

Women using resorptive drugs were more likely to 

report osteopenia or osteoporosis, were more likely 

to report using an antiresorptive medication but were 

not more likely to report using HRT or calcium. 

Conclusions: Resorptive medication use was 

common among respondents and was correlated 

with diagnoses of osteoporosis or osteopenia. 




FEATURE 

Identification of risk factors such as health status, 

health care utilization, and age may be helpful to 

clinicians targeting interventions of women using 

resorptive medications. 

263—RESPONSE QUALITY OF INFOR- 

MATION FROM “ASK THE PHARMACIST” 

SERVICES ON INTERNET PHARMACY 

SITES. Nath D, Duquesne University, Holmes E, 

University of Mississippi, Markuss J, Desselle S, 

Duquesne University. E-mail: nath405@duq.edu 

Objective: There is concern over the veracity and 

comprehensiveness of information provided by 

Internet pharmacy sites. Some sites offer an “Ask 

the Pharmacist” service whereby consumers E-mail 

questions to a pharmacist who subsequently returns 

a response. The objectives of this study are to (1) 

compare the quality of responses from questions 

submitted to “Ask the Pharmacist” services among 

Verified Internet Pharmacy Practice Sites (VIPPS) 

and non-VIPPS pharmacy practice sites and among 

standalone, brick-and-mortar chain community, and 

brick-and-mortar independent community practice 

sites; and (2) determine if the quality of responses 

services differ among the sources providing the 

drug information (i.e., drug information specialist 

versus community pharmacist). 

Methods: Design: Content Analysis. VIPPS sites 

were acquired through the NABP’s current listing of 

sites provided on www.nabp.org. Other sites are 

obtained though in a WebFerret 5.0 metasearch 

engine query. Professional pharmacy students are 

submitting five drug information questions to each 

of the pharmacy practice sites sampled using fictitious 

Internet E-mail accounts. The drug information 

questions and scoring schemata for each question 

were developed by a focus group panel comprising 

pharmacists and academicians who were 

guided by information from resources typically 

available to practicing pharmacists. Trained professional 

pharmacy student judges will score the 

responses obtained from the sites. Each response 

will be scored by three judges working independently. 

Interrater reliability among the judged will 

be determined from the calculation of intraclass correlation 

coefficients. Student t tests and analyses of 

variance with Tukey’s HSD posthoc tests will be 

used to determine differences in response quality. 

Results: A panel of five pharmacists and academicians 

have developed questions and constructed 

scoring templates for standard items to assure 

these met predetermined criteria. Submission of 

questions has been initiated. 

Conclusions: All responses will have been evaluated 

and the analysis completed by the time of presentation. 

264—SURVEY OF PHARMACY STUDENT 

WORK EXPERIENCE. Siracuse M, Creighton 

University, Schondelmeyer S, Hadsall R, 

Schommer J, University of Minnesota. E-mail: 

msiracuse@creighton.edu 

Objective: The objective of this study was to survey 

pharmacy students to determine the type of 

pharmacy work environments they have experienced 

and their attitudes towards these experiences. 

Methods: A total of 533 third-year (in a four-year 

program) PharmD students from eight colleges and 

schools of pharmacy in the Midwest volunteered to 

participate in this study using a written survey. The 

students were surveyed as a group at their respective 

institutions. Data collection included demographics, 

workplace descriptive information, and Likert 

scales to determine student attitudes toward their 

work environment. Data cleansing resulted in 509 

usable surveys. Statistical analysis included determination 

of frequencies and means for descriptive 

data and Likert scale mean item scores for the attitudinal 

data. 

Results: Overall, 496 (97.4%) students reported 

at least one pharmacy work experience. Of these 

students, the most frequently reported work sites for 

their most recent or current positions were: 331 

(65.0%) in chain pharmacies; 74 (14.5%) in hospital 

pharmacies; 58 (11.4%) in independent community 

pharmacies; and 12 (2.4%) in long-term care 

pharmacies. Overall, students spent most of their 

time (69.0%) in dispensing, distribution, and compounding 

activities. Students spent considerably 

less time in direct patient care/pharmaceutical care 

(10.5%) activities and providing drug information to 

patients (11.6%), but not in the same depth that 

would be expected from a pharmaceutical care consultation. 

Students spent the least amount of time 

(4.2%) providing consultative services to other 

health care professionals. Other activities such as 

cashiering and clerical duties took up 4.7% of student 

time. A 5-point Likert scale used to analyze 

student attitude toward resulted in: 390 (78.6%) students 

either agreed or strongly agreed their current 

work experience was favorable; 290 (58.6%) students 

either agreed or strongly agreed they would 

have a fulfilling career working in a pharmacy that 

is similar to their current work experience. 


265—TALKING TO PHARMACISTS 

ABOUT DIABETES: HOW TO ASK ABOUT 

MONITORING CLINICAL TARGETS. 

Guirguis L, Chewning B, University of 

Wisconsin–Madison. E-mail: lmguirguis@ 

pharmacy.wisc.edu 

Objective: To (1) discuss the development of an 

interview instrument to assess community pharmacists’ 

use and beliefs about clinical targets such as 

blood glucose, cholesterol levels, and blood pressure, 

for their patients with diabetes and (2) present 

pharmacist perceptions of outcome monitoring in 

response to pilot questions. 

Methods: Twelve pharmacists were asked to participate 

in one of four stages of the development of 

a paper instrument for face-to-face interviews: (1) 

developmental interview, (2) behavioral item 

pretesting, (3) subjective item pretesting, and (4) 

cognitive testing. 

Results: In the developmental interview, pharmacists 

used medications rather than patients to 

recall routine interactions with patients, talked about 

clinical targets primarily when changes occurred, 

and had differing reasons for asking about blood 

sugars. In the development of behavioral items, 

pharmacists found it easier to describe a recent 

interaction with a patient when they named the 

product involved. They asked routine questions 

about whether patients had any concerns instead of 

asking about clinical targets and used estimation to 

report how often they asked about clinical targets. 

Because so few pharmacists monitored clinical outcomes, 

it became important to structure the interview 

to minimize respondent embarrassment by 

allowing them to comment on the busyness of their 

practice and their usual questions to patients prior to 

questions regarding rates and importance of asking 

about clinical targets. 

Conclusions: The combination of a developmental 

interview, pretesting, and cognitive testing 

helped create a detailed interview to understand 

how and why pharmacists do or do not talk to 

patients with diabetes about clinical targets. 

266—THE SPREAD AS A SOURCE OF 

PBM REVENUE. Clark B, Creighton University, 

Garis R, Creighton University School of Pharmacy 

& Health Professions. E-mail: bclark@creighton.edu 

Objective: To conduct a pilot study that develops 

valid methodology for documenting the spread in 

drug ingredient cost between what PBMs charge 

employers and what PBMs pay dispensing pharmacies 

for the drug ingredient portion of prescription 

transactions. Spread is defined as the difference 

between the drug ingredient cost billed to an 

employer by a PBM and the drug ingredient cost 

that is paid to the dispensing pharmacy by the PBM 

on behalf of the employer. 

Methods: Researchers conducted a retrospective 

review of two sets of financial records issued by 

each of two PBMs. These financial records were: 

(1) line-item prescription transactions billed to 

employers and (2) line-item transaction data accompanying 

PBM payment to dispensing pharmacies. 

Drug ingredient cost amounts billed to employers 

were compared with the amounts paid to pharmacies 

for 129 prescription transactions. 

Nonparametric analyses were used for comparisons 

of these non–normally distributed outcome variables. 

Results: Taking both PBMs together, the average 

spread of $12.29 per prescription ranged from 

–$1.67 to $201.65. Considering all 129 transactions 

together, there was a significant difference between 

brand-name drugs and generics with mean spreads 

of $4.65 and $23.45 per prescription, respectively. 

The spread difference between PBMs on generic 

drugs was suggestive (P < .09). A significant difference 

between PBMs was found only in the spread 

percentage charged on brandname drugs (P < .02). 

Conclusions: For the PBMs and prescriptions 

analyzed, results indicate dramatic differences in 

spread and spread percent when comparing generic 

and brand-name drugs, but essentially no difference 

between PBMs. Wider ranges in spread opportunities 

available with generic drugs are, in part, 

explained by the disparity between generic drug 





acquisition cost and the published generic AWP. 

Results presented, and their statistical significance 

in this small sample, have severe limitations clearly 

associated with the extremely limited number of 

prescription transactions and PBMs studied. 

267—THE ECONOMIC BURDEN OF 

HYPERPHOSPHATEMIA-RELATED END- 

STAGE RENAL DISEASE IN FLORIDA MED- 

ICAID PATIENTS. White A, University of 

Florida, Odedina F, Florida A&M University. E- 

mail: whiteann@ufl.edu 


determine whether end-stage renal disease (ESRD) 

associated with hyperphosphatemia had a significant 

impact on health care costs from a third party 

payers’ perspective. Study objectives were to: (1) 

describe the characteristics of these patients in terms 

of demographics, comorbidities, and utilization, (2) 

evaluate the primary cost drivers in the treatment of 

these patients, and (3) assess the economic burden 

associated with treating hyperphosphatemia-related 

ESRD patients. 

Methods: Retrospective study using secondary 

data from the Florida Medicaid database provided 

by the Agency for Health Care Administration. 

Patient inclusion criteria consisted of recipients taking 

either Renagel or Phoslo, verification of continuous 

eligibility, time period of July 1, 1999 to 

December 31, 2002 (July 1 through December 31, 

1999, was a washout period). Patient exclusion criteria 

consisted of diagonosis of with HIV or 

hemophilia. Data frequencies were examined using 

regression and quarterly trend analyses. 

Results: Results of the cost analysis showed that 

patients with hyperphosphatemia-related ESRD 

impose an economic burden of $228 million. 

Facility claims expenditures represented the largest 

proportion of increase in total direct costs, increasing 

from $56 million in 2000 to $78 million in 2002. 

Results showed that the major cost driver for 

2000–2002 in the treatment of hyperphosphatemiarelated 

ESRD among Medicaid patients was dialysis 

center visits with a total cost of $95 million, followed 

by general hospital visits with a total cost of 

$92 million, and prescription medication with a total 

cost of $11 million. Health care for the study population 

was most often used through facility visits 

(78.1%), followed by pharmacy-related services 

(17.2%), and then medical services (4.7%). Based 

on medical claims utilization patterns, ambulance 

service contributed the most to health care utilization 

by patients with hyperphosphatemia-related 

ESRD (8.7%), followed by recipient home visits 

(3.3%) and inpatient visits (2.1%). Facility claim 

utilization was dominated by dialysis center visits 

(48.5%), followed by general hospital visits (43.3%) 

and lastly nursing home visits (7.4%). 

Conclusions: This study has shown that health 

care costs for this population of patients had a substantial 

impact on the Florida Medicaid budget. 

Additional efforts should be undertaken to further 

enhance the diagnosis, treatment, and recovery of 

these patients. 

268—THE EFFECT OF DIRECT-TO-CON- 

SUMER ADVERTISING ON PRESCRIPTION 

DRUG USE AMONG THE INSURED. Hansen 

R, University of North Carolina at Chapel Hill, 

Schommer J, Cline R, University of Minnesota. E- 

mail: rahansen@unc.edu 

Objective: Direct-to-consumer advertising 

(DTCA) has become a common promotional technique 

among the pharmaceutical industry. The relative 

effect of DTCA on prescription drug utilization 

and spending is unknown, in part because of the 

effect of insurance on consumers’ marginal cost. 

The objective of this study was to determine if the 

effect of DTCA is moderated by cost-sharing incentives 

among insured individuals. 

Methods: Design: retrospective cohort study. 

Study population: 396,500 employees and dependents 

with employer-sponsored health insurance 

continuously enrolled in a contributing plan during 

July 1997 through December 1998. Data: Personlevel 

enrollment and claims data were provided by 

MEDSTAT MarketScan. DTCA data were provided 

by Competitive Media Reporting (CMR) and linked 

to the MEDSTAT enrollment files by metropolitan 

statistical area. Analysis plan: Localized DTCA levels 

for one class of medication were evaluated and 

matched with prescription claims for MEDSTAT 

contributors residing in one of 47 defined advertising 

markets. Product use within the advertised medication 

class was evaluated by the intensity of the 

advertising campaign for various types and levels of 

cost-sharing incentives, controlling for health status 

and other covariates. 

Results: The effectiveness of DTCA was modified 

by the type and amount of beneficiary out-ofpocket 

payments for provider visits and prescription 

drugs. Significant relationships were observed for 

use of the advertised product as well as its competitor. 

When high levels of DTCA were present, 

increased product use of the advertised product was 

observed for those with high provider out-of-pocket 

costs, and decreased use was observed among those 

with high prescription costs. 

Conclusions: Insured individuals may respond 

differently to DTCA, depending on the type and 

level of cost-sharing incentives employed by their 

insurance plan. More research is needed in this area 

to verify the findings of this study and explore the 

interactive effects of insurance coverage and pharmaceutical 

promotion. 

269—THE EFFECT OF DIRECT-TO-CON- 

SUMER AD CONTENT ON BELIEF TENACI- 

TY: A STUDY OF APPEALS, ARGUMENT 

TYPES, AND JUDGMENTS. Jalnawala N, 

University of Mississippi, Wilkin N, University of 

Mississippi Medical Center. E-mail: nekshanj@ 

olemiss.edu 

Objective: This study was conducted to evaluate 

the usefulness of inoculation theory (sidedness of 

appeals) and theory of belief formation (argument 

types and judgments) in understanding belief tenacity. 

Direct-to-consumer advertisements (DTCAs) 

and negative experiences were used to study these 

theories. 

Methods: A 2 (one-sided versus two-sided) × 2 

(causal versus authoritative) factorial study design 

was employed. A total of 263 undergraduate students 

were nonsystematically assigned to view one of the 

four mock influenza medication advertisements and 

complete a questionnaire. Subjects were then presented 

with a negative scenario and were asked to fill 

out a questionnaire based on the information in the ad 

and in the negative scenario. The dependent measures 

included belief change, change in purchase intent and 

standardized price change. Data were analyzed using 

two-way analysis of variance. 

Results: Subjects exposed to two-sided appeals 

showed lower belief change, standardized price 

change, and change in purchase intent following a 

negative experience than subjects exposed to onesided 

appeals (P < .05). No significant difference 

was found between subjects who received causal 

and authoritative arguments. A significant interaction 

effect was observed between sidedness of 

appeal and argument type on initial belief and initial 

purchase intent. Belief change was correlated with 

the change in information reliability (r = .525, P = 

.01) and the change in information relevance (r = 

.583, P = .01). Changes in relevance and reliability 

also were significantly greater in those subject 

exposed to one-sided appeals (P < .05). 

Conclusions: Some support for aspects of inoculation 

theory and theory of belief formation was 

found. The findings suggest that complying with the 

“fair-balance” requirement may be beneficial to 

pharmaceutical marketers as two-sided appeals 

increase the tenacity of consumers’ beliefs. Higher 

initial belief and purchase intent when causal arguments 

are used in two-sided promotional messages 

suggest that evidence-based advertising may result 

in enhanced beliefs about the merits of advertised 

products (P < .05). 

270—THE EFFECTS OF PHARMACISTS’ 

POSITIONS ON EMPOWERMENT AND 

ORGANIZATIONAL BEHAVIORS. Kahaleh A, 

Ohio Northern University, Gaither C, University of 

Michigan. E-mail: a-kahaleh@onu.edu 

Objective: To assess the impact of pharmacists’ 

position on antecedents and consequences of psychological 

and structural empowerment. 



national random sample of 1,200 licensed pharmacists. 

Descriptive statistics, reliability and validity 

tests, analyses of variance, and path analyses using 

structural equation techniques (SEM) were used to 

analyze the data. The theoretical model examines 

the effects of need for achievement and power factors 

on psychological and structural empowerment 

that in turn affect loyalty, organizational commitment, 

identification, and job turnover intention. 

Power factors are structural elements that enhance 

empowerment. Psychological empowerment is 

defined as the affective state that individuals must 

experience for managerial interventions to be successful. 

It has four dimensions: meaning, competence, 

self-determination, and impact. Structural 

empowerment is defined as having access to knowl- 




FEATURE 

edge, resources, opportunity, and support in an 

organization. 

Results: Findings of ANOVA showed that managers 

had significantly higher levels of psychological 

and structural empowerment. They had significantly 

higher levels of competence, self-determination, 

and impact. Similarly, they had significantly 

higher levels of opportunity, knowledge, support, 

and resources. Although SEM revealed similar patterns, 

there were differences between managers and 

staff pharmacists. Power factors had stronger effects 

on psychological and structural empowerment 

among staff pharmacists compared with managers. 

Also, working in management positions resulted in 

significant impacts of psychological empowerment 

on commitment. Similarly, loyalty and commitment 

had stronger impact on job turnover among staff 

pharmacists in comparison with managers. 

Conclusions: Consistent with other studies in the 

business and nursing literature, managers had higher 

levels of psychological and structural empowerment. 

Managers are more likely to have autonomy, 

confidence in their skills, and control over what 

happens in their departments than staff pharmacists. 

Administrators may strengthen their relationships 

with staff pharmacists by increasing their level of 

empowerment. 

271—THE EFFECTS OF WORK SETTING 

ON PHARMACISTS’ EMPOWERMENT. 

Kahaleh A, Ohio Northern University, Gaither C, 

University of Michigan. E-mail: a-kahaleh@ 

onu.edu 

Objective: To assess the impact of work setting 

on pharmacists’ psychological and structural 

empowerment. 



national random sample of 1,200 licensed pharmacists 

in United States. Descriptive statistics, reliability 

and validity tests, and analyses of variance were 

used to analyze the data. Psychological empowerment 

is defined as the affective state that individuals 

must experience for managerial interventions to 

be successful. It has four dimensions: meaning, 

competence, self-determination, and impact. 

Structural empowerment is defined as having access 

to knowledge, resources, opportunity, and support 

in an organization. 

Results: Results of the analyses of variance 

revealed that significant differences in the levels of 

empowerment among independent, chain, and hospital 

pharmacists. Results of the analyses showed 

that pharmacists who worked in independent settings 

had significantly higher levels of psychological 

and structural empowerment than those who 

worked in chains or hospitals. Specifically, pharmacists 

who worked in independent settings had significantly 

higher levels of self-determination and 

impact than those who worked in chains or hospitals. 

In the same vein, those who worked in independent 

settings had significantly higher levels of 

knowledge and support than did their counterparts 

in chain or hospital settings. 

Conclusions: Managers in independent settings 

appears to foster a more empowering work environment 

than did those in chain or hospital settings. 

Pharmacists in independents described their work 

environment as a low-stress setting due to having 

adequate personnel. Administrators may enhance 

the quality of work life for pharmacists in chains 

and hospitals by empowering them through increasing 

their participation in the decision-making processes 

and their access to knowledge, support, and 

opportunity in their organizations. 

272—THE EXPERIENCE OF COMMUNI- 

TY PHARMACISTS WITH MEDICATION 

INTENDED FOR USE IN PRIMARY AND 

SECONDAY SCHOOLS. Reutzel T, Holtorff M, 

Midwestern University Chicago College of 

Pharmacy. E-mail: treutz@midwestern.edu 

Objective: The purpose of this research was to 

observe the degree to which community pharmacists 

are aware of and involved in issues related to 

the use of medications in primary and secondary 

schools and to identify the interventions they use to 

deal with these issues. 

Methods: A short questionnaire was mailed to a 

random sample of 3,333 Illinois pharmacists selected 

from the Illinois Department of Professional 

Regulation roster of registered pharmacists. 

Subjects with current or recent (within the last year) 

community pharmacy experience were asked to 

return a completed questionnaire. A total of 569 

returned questionnaires met inclusion criteria and 

were used in the research (a 17% overall response 

rate and a 34% estimated community pharmacist 

response rate). 

Results: Almost all subjects (97%) reported that 

they have dispensed medications for use in school, 

and two-thirds thought taking medications at school 

creates the potential for special problems (e.g., 

missed dose, social stigma). Of nine interventions 

that could help minimize these problems, respondents 

used an average of 3.33. The most common 

intervention (used by 94% of subjects) was providing 

separate, labeled containers for school. 

Respondents who believed medication use in school 

causes special problems used significantly more 

interventions than those that did not think so. 

Conclusions: This is the first study of pharmacists’ 

views on this important area of drug therapy. 

The results show that many pharmacists are aware 

of and involved in this phenomenon and make use 

of interventions available to all community pharmacists. 

Still, pharmacists overall could do much better, 

and further efforts to raise their awareness levels 

are warranted. For example, colleges of pharmacy 

might wish to develop student interest in this 

important area of drug therapy by providing more 

coverage of it within and outside the curriculum. 

273—THE IMPACT OF ANTIDEPRESSANT 

EDUCATION AND MONITORING BY COM- 

MUNITY PHARMACISTS ON MULTIPLE CON- 

SUMER OUTCOMES. Rickles N, Long Island 

University, Svarstad B, University of 

Wisconsin–Madison. E-mail: nathaniel.rickles@ liu.edu 

Objective: The study explores the impact of consistent 

antidepressant education and monitoring by 

community pharmacists on multiple consumer outcomes. 

Methods: A total of 63 consumers presenting 

new antidepressant prescriptions at eight Wisconsin 

community pharmacies were randomized to receive 

either three monthly telephone calls from pharmacists 

providing pharmacist-guided education and 

monitoring (PGEM) or usual pharmacist’s care. At 

the end of the 3-month study, consumers reported 

their antidepressant knowledge, beliefs, frequency 

of patient feedback with pharmacist (FPFP), orientation 

toward treatment progress (OTTP), and 

antidepressant adherence at 3 months. To evaluate 

improvement in depression, consumers completed a 

Beck Depression Inventory-II (BDI-II) at baseline 

and at the end of the study. Pharmacy and health 

system records were used to objectively measure 

antidepressant adherence during and 3 months after 

the study. Data were analyzed using descriptive 

statistics, analysis of variance, chi-square, linear and 

logistic regressions. 

Results: Overall, 60 consumers completed the 

study: 28 received PGEM and 31 received usual 

pharmacist’s care. PGEM had a significant and positive 

impact on the consumer’s antidepressant 

knowledge (P ≤. 05), beliefs (P ≤ .01), FPFP (P ≤ 

.001), OTTP (P ≤ .001), and adherence at 6 months 

(P ≤ .05). PGEM did not have a significant impact 

on either adherence at 3 months or improvement in 

depression. Multivariate analyses indicated that (1) 

antidepressant knowledge (P ≤ .05) and beliefs (P ≤ 

.001) are significant predictors of adherence at 3 

months, (2) consumer’s education (P ≤ .01) and 

adherence at 3 months (P ≤ .01) were significant 

predictors of improvement in depression, (3) antidepressant 

beliefs (P ≤ .05) and adherence at 3 months 

(P ≤ .001) were significant predictors of adherence 

at 6 months, and (4) FPFP mediated the relationship 

between PGEM and the patient’s OTTP. 

Conclusions: This is the first experimental study 

to demonstrate that antidepressant education and 

monitoring by community pharmacists can have a 

significant impact on the consumer’s antidepressant 

knowledge, adherence, FPFP and OTTP, pharmacists 

can also have a significant and sustainable 

impact on antidepressant adherence by facilitating 

more positive antidepressant beliefs. More research 

is needed using larger and more diverse samples to 

explore how collaboration between prescribers and 

community pharmacists impact consumer outcomes. 

274—THE PROVISION OF CARE AND 

RETIRED OHIO PHARMACISTS. Birdwell S, 

NA. E-mail: skbirdwell@msn.com 

Objective: This study assessed attitudes and perceptions 

of retired pharmacists regarding an 

increased level of care and identified aspects of 

pharmaceutical care that were provided. 

Methods: A questionnaire was sent to a random 

sample of 171 retired pharmacists registered in 

Ohio. The questionnaire measured attitudes and perceptions 

toward provision of an increased level of 





care and provision of various services associated 

with pharmaceutical care. 

Results: The majority of respondents indicated 

that they did not know if automation assisted in the 

provision of an increased level of care but agreed 

that technology did assist in the provision of an 

increased level of care. Respondents disagreed that 

incentives were used to provide an increased level 

of care and that inadequate personnel and high 

workload pressures prevented the provision of an 

increased level of care. While the majority agreed 

that they had the appropriate amount of information, 

the majority indicated that they lacked the confidence 

to obtain needed additional information. The 

majority agreed that pharmacist should provide clinical 

services, advice on medications, and immunizations 

and disagreed that an increased level of care 

would have been provided if properly reimbursed 

and that physicians in their area disapproved of 

spending more time with patients. The majority 

worked in an organization that kept patient profiles 

and screened for problems with medications and 

allergies and sometimes or always developed 

patient-specific education programs; however, 

many respondents indicated that the profile did not 

include the pregnancy or breast-feeding status. 

Conclusions: The respondents in this study 

agreed that pharmaceutical care is necessary and 

many of the services associated with pharmaceutical 

care were provided. Many respondents lacked the 

confidence needed to obtain needed additional 

information; therefore, educational programs should 

consider the age of the target group and provide the 

necessary tools for providing the appropriate services. 

275—THE RELATIONSHIP BETWEEN 

ADHERENCE TO ANTIDEPRESSANT CLIN- 

ICAL GUIDELINES AND DIABETES MEDI- 

CATION ADHERENCE AMONG MANAGED 

CARE ENROLLEES. Chao J, University of 

Michigan, Nau D, University of Michigan, Aikens 

J, University of Michigan. E-mail: 

jchaoz@umich.edu 

Objective: The objectives of this study were to: 

(1) determine the proportion of patients with diabetes 

within a managed care organization who 

received an antidepressant medication; (2) examine 

the adequacy of antidepressant use among patients 

with diabetes; and (3) examine the relationship 

between adequacy of antidepressant use and oral 

antihyperglycemic medication adherence. 

Methods: Administrative claims data were 

extracted from a managed care database for January 

to December 2001 to identify patients who used oral 

antihyperglycemic medications, indicating a diagnosis 

of diabetes. Based on Agency for Healthcare 

Research and Quality guidelines for treatment of 

major depression, the adequate use of antidepressants 

in the acute phase was defined as filling at 

least 90 days of therapy during the 118 days from 

the first antidepressant fill, while adequacy in the 

long-term phase was filling at least 120 days of therapy 

within 155 days of the initial fill. The medication 

possession ratio (MPR) for antihyperglycemic 

medications was compared among patients with 

adequate use of antidepressants, those with inadequate 

use of antidepressants, and those who did not 

receive an antidepressant. 

Results: Among 2,027 patients who used oral 

diabetes medications, 497 (24.5%) had at least one 

claim for an antidepressant medication. Of the 497 

patients who used an antidepressant, 295 (59.4%) 

received an adequate trial of medication for the 

acute phase, while 269 (54.1%) met the adequacy 

criteria for the long-term phase of treatment. 

Patients with inadequate use of antidepressants had 

a mean antihyperglycemic MPR that was significantly 

lower than patients with adequate antidepressant 

use, as well as significantly lower than those 

diabetes patients without antidepressant use. 

Conclusions: Many patients with diabetes and 

depression may not receive adequate medication therapy 

for depression. Inadequate treatment for depression 

among patients with diabetes was associated with 

lower antihyperglycemic medication adherence. 

276—THE RELATIONSHIP BETWEEN 

WANTING AND DOING: THE EFFECTS OF 

GOAL COMPATIBILITY ON CONSUMERS’ 

RESPONSES TO PRESCRIPTION DRUG 

ADVERTISING. Sumpradit N, Ascione F, 

University of Michigan, Bagozzi R, Rice 

University. E-mail: nithima@umich.edu 

Objective: The aim was to determine how directto-consumer 

advertising (DTCA) of prescription 

drugs motivates consumers to take particular 

actions, based on the combined framework of selfregulatory 

focus and self-construal orientation. Selfregulatory 

focus posits that behavior is regulated by 

two systems: promotion (emphasizing achievements) 

and prevention (emphasizing safety/obligations). 

Self-construal orientation suggests that 

behavior is guided by two self-views: independentself 

(emphasizing self-fulfillment/uniqueness) and 

interdependent-self (emphasizing family/social relationships). 

The independent-self emphasizes selffulfillment 

and therefore is compatible with promotion 

focus. The interdependent-self emphasizes 

maintaining relationships and avoiding mistakes 

and therefore is consistent with prevention focus. 

First, we hypothesized that goal-compatible advertisements 

would lead to more favorable advertisement/brand 

attitudes, greater intention-to-act, 

greater likelihood-of-action, higher perceived drug 

benefits, and lower perceived drug risks. Second, 

we hypothesized that prevention-focused advertisements 

would elicit better risk information recall and 

more negative emotional responses to the advertisement. 

Conversely, promotion-focused advertisements 

would elicit more positive emotional responses 

to the advertisement. 

Methods: A two (independence versus interdependence) 

× two (promotion versus prevention) factorial 

design was used. A random sample of 220 

women aged 40 years or older was randomly 

assigned to view a mock antihyperlipidemia drug 

advertisement and completed a questionnaire. Main 

outcome measures included advertisement/brand 

attitudes, intention-to-act, likelihood-of-action, perceived 

drug benefits and risks, emotional responses, 

and risk information recall. Data were examined 

using analyses of variance/covariance. 

Results: Results partially supported the hypotheses 

regarding goal-compatibility and emotional 

responses to the advertisement. Surprisingly, results 

for risk information recall were in the opposite 

directions to those hypothesized. Subgroup analysis 

showed that positive/neutral DTCA-attitude individuals 

reacted to goal-compatible advertisements 

consistent with our predictions, whereas negative 

DTCA-attitude individuals reacted to the same message 

in the opposite directions to what we predicted. 

Conclusions: The motivational themes in DTCA 

affect consumer behavior. The impact is a function 

of the interaction between the themes and the preexisting 

beliefs and attitudes of the consumer. 

277—THE ROLE OF INFORMATION REL- 

EVANCE AND RELIABILITY IN DIRECT- 

TO-CONSUMER ADVERTISING. West D, 

University of Arkansas for Medical Sciences, 

Bentley J, Wilkin N, University of Mississippi 

Medical Center. E-mail: westdonnas@ 

exchange.uams.edu 

Objective: To describe patients’ judgments of 

information relevance and reliability with respect to 

direct-to-consumer advertising (DTCA) and to 

examine the role of information relevance and reliability 

judgments in persuasion. 

Methods: Patients at community pharmacies in a 

southern state were randomly selected; a total of 

118 people participated in the study. Upon agreement 

to participate, each patient was asked to complete 

a self-administered questionnaire. The questionnaire 

included four DTCAs, specifically ones 

for Avandia, Zyrtec, Lipitor, and Prevacid. The 

questions following each advertisement measured 

persuasion, information relevance, information reliability, 

likelihood of asking a physician about a 

medication, and demographics. Summated scale 

scores were used as measures of information relevance, 

information reliability, persuasion, and likelihood 

of asking for the medication. Descriptive 

statistics were calculated. Multiple regression was 

then used to determine the relationship between relevance 

and reliability and persuasion. 

Results: The investigators used multiple regression 

to test the relationship among persuasion, information 

reliability, and information relevance, controlling 

for demographics (race, age, gender) and 

medication use variables (heard of medication, 

use/used medication, use medication in the therapeutic 

class). Persuasion was the dependent variable. 

For each DTCA, multiple regression yielded a 

significant model with information reliability and/or 

information relevance as predictors in the model. 

The findings indicated that consumers are more 

likely to be persuaded as they deem the information 

to be relevant and reliable. The model is supported 

in the DTCAs of Lipitor, Prevacid, and Zyrtec. 

Conclusions: The results of this study provide 

insight into the role of judgments of relevance and 

reliability in persuasion. Regardless of a person’s 

demographics or past experience, judgments of rel- 




FEATURE 

evance, and reliability significantly predict persuasion. 

Understanding these relationships will provide 

a better understanding of how to design promotional 

pieces and how to manipulate information relevance 

and reliability to influence persuasion. 

278—THEORY OF PLANNED BEHAVIOR 

AND WOMEN’S DECISIONS ABOUT HOR- 

MONE-REPLACEMENT THERAPY. Huston S, 

Kirking D, Shimp L, University of Michigan, 

Bagozzi R, Rice University. E-mail: 

hustons@umich.edu 

Objective: (1) Determine the proportion of 

women with and without diabetes intending to initiate 

or continue HRT. (2) Evaluate the relative 

importance of the modified Theory of Planned 

Behavior (TPB) variables on HRT intention. (3) 

Determine if an identity variable “menopause is natural” 

(MN) increases variance in HRT intention 

explained. (4) Determine differences in variable 

influences between current, previous and never 

HRT users, and women in early or late stages of 

menopause. 

Methods: Data were collected via a survey 

mailed to 821 women with and 1,065 women without 

diabetes between the ages of 46 and 60 who met 

specific inclusion/exclusion criteria and were 

enrolled in a southeastern Michigan health maintenance 

organization (HMO). Data were analyzed 

using ANOVA, chi-square, t tests, and multiple 

regression. Confirmatory factor analysis through 

structural equation modeling (SEM) verified variable 

structure. 

Results: Overall usable response rate was 42.2%. 

Mean intention to initiate or continue using HRT 

was 3.27, (1 = extremely unlikely, 7 = extremely 

likely). There was no significant difference in mean 

intention between women with and without diabetes 

overall, but never HRT users with diabetes were significantly 

more likely to be undecided (chi square 

7.2, P = .027) than those without diabetes. Previous 

users with diabetes were more likely to intend to not 

use HRT compared with those without diabetes. 

Model variables explained 67.4% of variance. 

Attitude (ATT), subjective norm (SN), perceived 

control over behavior (PCB), and self-efficacy (SE) 

were all significant. Physicians (independent from 

SN) were one of the most significant predictors of 

intention. In all groups SE was positively associated 

with intention to use HRT and MN was significant, 

adding 0.5% to explained variance. Interactions 

were found between HRT status and PCB, ATT, 

SN, and diabetes status. 

Conclusions: Study variables do significantly influence 

HRT decisions. This information can be used to 

help provide women with targeted information. 

279—TREATMENT PATTERNS AND 

COSTS FOR AFRICAN AMERICAN 

PATIENTS WITH TYPE 2 DIABETES WHO 

ARE POORLY CONTROLLED ON ORAL 

HYPOGLYCEMIC AGENTS AT BASELINE. 

Ernst F, Eli Lilly and Company, Coons S, 

University of Arizona, Hayes C, Eli Lilly and 

Company, Draugalis J, University of Arizona, 

Ziemer D, Caudle J, Emory University. E-mail: 

fre@lilly.com 

Objective: To evaluate 1-year treatment patterns, 

resource utilization, and costs for African American 

adults with type 2 diabetes poorly controlled on oral 

antihyperglycemic agents. 

Methods: Patients were poorly controlled (glycosylated 

hemoglobin [A1c] ≥7 %, random plasma 

glucose [RPG] > 150 mg/dL, or fasting plasma glucose 

[FPG] > 120 mg/dL) at an index visit to a 

Grady Health System clinic from July 1999 through 

June 2000 and were taking oral antihyperglycemic 

medications. Patients were grouped on 1-year antihyperglycemic 

treatment patterns. Retrospective 

demographic, clinical, laboratory, hospital, pharmacy, 

and provider data were analyzed. Statistical 

comparisons included ANOVA, t tests, and logistic 

and multiple linear regression. 

Results: Of 606 patients, 36% took a sulfonylurea–metformin 

combination at index and end 

(SM–SM), followed by 18% taking only sulfonylureas 

(S–S). The most frequently used treatments 

also had the longest durations. The S–S and metformin-only 

(M–M) groups had disproportionately 

more controlled patients, but improvement was usually 

small and incremental. Short-term costs and 

resource utilization varied significantly by treatment 

group. Treatment patterns, duration of diabetes, 

body mass index, Charlson Comorbidity Index 

score, A1c tests, and number of treatment changes 

were associated with total costs, but overall total 

costs did not differ by treatment group. Medication 

costs were greatest for patients receiving combinations, 

such as SM–SM, and lowest among patients 

taking S–S. No differences in total hospital, 

office/clinic visit, or laboratory testing costs were 

found. Microvascular complication-associated total 

costs were highest for the SM–SM group and lowest 

for the M–M group. The treatment pattern 

groups contributing most to total costs, relative to 

the least-contributing S–S group, were SM–SM, 

sulfonylurea–metformin at index and sulfonylurea–metformin–insulin 

at end (SM–SMI), and 

then M–M. 

Conclusions: No optimal treatment pattern 

emerged, as each had different effects on outcomes 

and costs. Thus, treatment choice cannot be based 

on a single comparator, such as glycemic control 

achievement or cost. Rather, there are multiple clinical 

and economic effects produced by the choice of 

one treatment choice over another. 

Original Citation: Drug Information 

Association/Agency for Healthcare Research and 

Quality 5th Annual Workshop on Pharmaceutical 

Outcomes Research; Tucson, Ariz., January 21–23, 

2004. 

280—TRENDS IN PRESCRIPTION COST 

SHIELDING FOR MEDICARE BENEFICIA- 

RIES BY DRUG COVERAGE: 1994 TO 1999. 

Kreling D, Mott D, Chou C, University of 

Wisconsin–Madison. E-mail: dhkreling@ 

pharmacy.wisc.edu 


examine trends in out-of-pocket costs for seniors 

and the proportion of total spending that the out-ofpocket 

costs represented across different sources of 

drug coverage. 

Methods: Data on prescription drug use and 

spending for persons age 65 and older from the 

Medicare Current Beneficiary Survey (MCBS) Cost 

and Use Files from 1994 to 1999 were used. Drug 

coverage source was derived from a summary variable 

(Medicaid) or a systematic iterative process 

identifying drug coverage as a part of health insurance 

coverage for respondents and was classified as 

Medicaid, Private HMO, Medicare HMO, employer-sponsored, 

individually purchased, other coverage, 

and no coverage. To examine the extent of cost 

shielding we calculated the ratio of out-of-pocket 

drug costs to total spending per prescription. 

Results: The percentage of respondents with 

drug coverage increased between 1994 and 1999 as 

did the number of prescriptions per person. Seniors 

with employer-sponsored drug coverage had the 

largest increase in total spending per prescription 

across time and seniors with no drug coverage had 

the largest increase in out-of-pocket costs per prescription 

across time. Over time, other than seniors 

with Medicaid drug coverage, seniors with employer-sponsored 

drug coverage were shielded the most 

for the cost of their drug use. 

Conclusions: Overall, between 1994 and 1999 

seniors paid a decreasing proportion of total spending 

for prescription drugs out-of-pocket; however, 

this trend was mainly due to seniors with employersponsored 

drug coverage. Closer examination of the 

differences in benefit structures and cost-sharing 

provisions and how those differences influence the 

extent of cost shielding for seniors is an important 

consideration for potential drug benefit programs 

under Medicare. 

281—UTILIZATION OF SUPPLEMENTAL 

MEDICINE IN U.S. ADULTS: WHO ARE THE 

USERS AND WHAT ARE THEY USING? 

Mazyck-Brown J, Mazyck P, Medical University of 

South Carolina. E-mail: mazyckjf@musc.edu 

Objective: In recent years, supplemental products 

have been increasingly used by consumers in 

the United States, either as alternative or adjunctive 

therapy. Health care professionals need to engage 

their patients in open communication about the use 

of these therapies and remain informed about the 

potential risks and benefits of these treatments. The 

objective of this study was to describe the utilization 

patterns for dietary supplements and nonprescription 

products in adults in the United States with 

regard to age, race, gender, and disease state. 

Methods: The National Health and Nutrition 

Examination Survey (NHANES) is a populationbased 

survey designed to collect information on the 

health and nutrition of the U.S. household population. 

Data from the NHANES III national survey (N 

= 20,050) were analyzed and estimates of dietary 

supplements were determined among patients. 

Statistical analysis was conducted using SAS. 

Analysis was conducted on the newly released 





1999–2000 NHANES data to determine if utilization 

rates among U.S. adults have increased since 

1988. Logistic regression was performed controlling 

for age, gender, race and socioeconomic status. 

Results: Of the 20,050 participants surveyed, 

7,381 (37%) stated that they have used vitamin/mineral 

products within the last month. The mean supplement 

usage intake was 1.7 products/month. In 

regard to race, 73% of the participants were 

Caucasian, 24% African American, and 3% other. 

Women consumed more vitamin/mineral products 

than did men (60% versus 40%). When analyzed, by 

region, the percentage of supplement users was 

greater in the Southeast. Diseases among the supplemental 

respondents were unspecified hypertension, 

unspecified heart disease, fluid overload, and 

diabetes without complications, unspecified 

arthropathy, and postmenopausal hormone-replacement 

therapy. Vitamin C, multivitamins, vitamin E, 

calcium, and iron were among the vitamins/mineral 

supplement with the highest usage. Other than those 

previously stated, garlic, fish oil, chromium, alfalfa, 

and lecithin were frequently used among the supplement 

users. 

Conclusions: Based on the available evidence, 

adults in the United States commonly report use of 

dietary supplements products. 

282—DIRECT-TO-CONSUMER ADVER- 

TISING OF PRESCRIPTION VERSUS NON- 

PRESCRIPTION DRUGS. Pastakia S, 

Wertheimer A, Temple University. E-mail: 

spastaki@temple.edu 

Objective: The purpose of this article is to analyze 

the differences in economic implications and 

impact on patient care between prescription and 

nonprescription drug advertising to consumers. 

Methods: The current medical literature was 

researched using both the Medline and International 

Pharmaceutical Abstracts databases. Due to a paucity 

of information regarding nonprescription drugs, 

consumer groups such as the National Consumer’s 

League, Consumer Healthcare Products 

Association, and Kaiser Family Foundation were 

used to provide data and statistics on the public’s 

perception of DTCA. 

Results: The economic statistics describing prescription 

drug advertising illustrate the vast market 

share that advertised drugs have (advertised drugs 

are responsible for approximately 48% of the 

increase in spending on pharmaceuticals). Studies 

analyzing patient care have shown that patients have 

an increased interest in acquiring information on 

prescription drugs, while inquiries regarding nonprescription 

drugs have increased at a much lower 

rate. Patient surveys have also shown patients rely 

heavily upon the convenience and relief nonprescription 

drugs provide. 

Conclusions: All these factors have left patients 

in a precarious position as they attempt to treat 

themselves with nonprescription drugs based on the 

limited information they receive from health care 

providers and nonprescription drug advertisements. 

283—PREVALENCE OF ANTIDEPRES- 

SANT USE IN CHILDREN AND ADOLES- 

CENTS: WHO PRESCRIBES AND WHAT 

ARE THE DIAGNOSES? Legorreta A, University 

of California, Los Angeles, School of Public 

Health/Health Benchmarks, Inc, Hassan M, West 

Virginia University, Pharmaceutical Systems and 

Policy/Health Benchmarks, Inc. E-mail: 

Alegorreta@healthbenchmarks.com 

Objective: To determine prevalence trend of 

antidepressant utilization among children and adolescents 

and to characterize antidepressant utilization 

in terms of the patient’s age, gender and medical 

diagnosis, subclass of antidepressant, and physician 

prescribing patterns. 

Methods: Retrospective analysis of all antidepressant 

prescription claims between 1998 and 2001 

of members less than 20 years of age using an 

employer-based managed care claims data. 

Prevalence trend was studied by categorizing all 

claims into four 1-year cross-sectional datasets. 

Results: Antidepressant prevalence was about 7.2 

to 7.6 per 1,000 children and adolescents between 

1998 and 2000 but decreased to 5.2 per 1,000 in 2001. 

Greater proportion of antidepressant users were found 

in higher age categories. Though depression was the 

most common diagnosis throughout 1998 to 2001, a 

considerable proportion of antidepressants were being 

used for attention-deficit/hyperactivity disorder 

(ADHD). However, antidepressant users with ADHD 

had decreased from 19% in 1998 to 12% in 2001. 

About 63% of children and adolescents receiving 

antidepressants did not have any record of a psychiatric 

diagnosis in the claims data. Highest proportion 

of antidepressant prescriptions were for selective serotonin 

reuptake inhibitors (SSRIs) followed by miscellaneous 

antidepressants. Greater number of SSRI and 

miscellaneous antidepressants were prescribed by 

psychiatrists, whereas greater number of tricyclic 

antidepressants were prescribed by pediatricians. 

Zoloft, Prozac, and Paxil were among the most frequently 

prescribed antidepressants throughout the 4 

years. About 66% of children and adolescents had 

received antidepressants without any consultation 

with a psychiatrist. Most of the patients receiving 

antidepressants without a psychiatric diagnosis (74%) 

had received the prescription from a nonpsychiatrist. 

Conclusions: Though the clinical evidence 

regarding efficacy and safety of antidepressant use 

among children and adolescents is lacking, antidepressant 

use is prevalent among this population. 

Nonpsychiatrists are responsible for a large proportion 

of antidepressant prescriptions in this population. 

Such widespread “off label” prescribing of 

antidepressants by physicians should be monitored. 

American Society for 

Pharmacy Law (ASPL) 

284—DETERMINANTS OF PATENTING 

IN THE U.S. PHARMACEUTICAL INDUS- 

TRY BASED ON RECENT CAFC CASE LAW. 

Rumore M, Scully, Scott, Murphy & Presser. E- 

mail: rumorem@aol.com 

Objective: Life-cycle management of pharmaceuticals 

involves a wide range of patents that may 

be obtained before as well as after approval of a new 

drug. The intersection between Hatch–Waxman and 

patent laws has spawned a great deal of litigation 

involving “Orange Book” patents. This paper analyzes 

recent Court of Appeals for the Federal Circuit 

(CAFC) decisions involving patents on metabolites, 

polymorphs, purity, off-label uses, dosing regimens, 

and “submarine patents” and explores ramifications 

on patenting of pharmaceuticals in the United 

States. 

Methods: Various strategies for extending exclusivity 

for blockbuster drugs have evolved since passage 

of the Hatch–Waxman law and are discussed 

herein. One such strategy involves patenting 

metabolites and listing them in the Orange Book, 

sometimes on the eve of patent expiration. This 

strategy worked merely because the ensuing litigation 

itself was effective in preventing generic competition. 

Another strategy involves the patenting of 

polymorphs. Such patents may be listed in the 

Orange Book without actually being used in the 

commercial drug product. Recent decisions are of 

import in future use of these strategies. 

Results: The decision in Andrx Pharmaceuticals, 

Inc. v. Biovail Corp. suggests that suits against FDA 

under the Administrative Procedures Act when 

FDA has improperly listed a patent is an appropriate 

mechanism to pursue. Additionally, the decision in 

Bristol-Myers Squibb Co. v. Mylan Pharmaceuticals Inc. 

reflects that improper patent listing in the Orange 

Book may subject the holder of a New Drug 

Application to enormous liability under antitrust 

laws. In Schering v. Geneva Pharmaceuticals, the 

CAFC held that a patent on a drug that does not 

explicitly describe a metabolite inherently discloses 

the metabolite if it teaches administration of the 

drug to the patient and it necessarily follows that the 

metabolite is formed. In some cases companies are 

seeking delisting of Orange Book patents to avoid 

being the target of antitrust lawsuits from states, the 

Federal Trade Commission, and patients. 

Conclusions: A unique hybrid of food, drug, and 

cosmetic law and patent law continues to be carved 

from recent CAFC decisions. Additionally, FDA’s 

newly issued regulations on criteria for listing certain 

types of patents in the Orange Book will have 

far reaching effects on patenting of pharmaceuticals 

in the United States. 

285—EXTERNAL TAGGING PRACTICES 

ON OTC MEDICATION PRODUCTS: 

POTENTIAL RISK AND LIABILITIES FOR 

PHARMACISTS. Pawaskar M, Sansgiry S, 

University of Houston, Bix L, Clark R, Michigan 

State University. E-mail: p_manj@rediffmail.com 


make pharmacists aware of potential risk and liabilities 

associated with external tagging practices with 

respect to over-the-counter (OTC) products. The 

study examined information concealed by antitheft 

tags and price tags affixed on OTC medication 

labels. 

Methods: The study was conducted in two cities 




FEATURE 

Houston, Tex. (24 stores) and East Lansing, Mich. 

(33 stores) by examining labels of OTC products 

containing acetaminophen. Four products from each 

store were selected, and five packages for each of 

these products were evaluated for presence of external 

tags. Data with respect to type of tags and the 

information concealed on these labels were coded 

and analyzed to report information obscured. 

Results: From the 57 stores, 124 products and 

718 packages were evaluated. There were more 

price tags (N = 515, 63.1%) as compared with 

antitheft tags (N = 178, 21.8%). Information concealed 

by antitheft tags was predominantly from the 

Drug Facts Panel (44.4%), namely warnings 

(15.3%), active ingredients (3.7%), inactive ingredients 

(3.3%), and product use (1.1%), which is 

required by the FDA to be clearly visible on each 

package. Price tags were predominately on the face 

of packages and concealed mainly information such 

as brand name (38.5%), product description (24%), 

and various sections of the Drug Facts Panel 

(27.5%). 

Conclusions: Results indicate that inappropriate 

tagging by retailers and manufacturers evidently 

obscure important information mandated by the 

FDA on OTC medication labels. These external tags 

could make it difficult for consumers to make 

informed decisions regarding product selection and 

use. Pharmacists should realize the importance of 

consumer rights to access vital information from 

OTC medication labels and be aware of lawsuits 

and liabilities associated with such issues. 

Recommendations for improvement and/or change 

in practice are suggested. 

286—LEGAL, ECONOMIC AND ETHICAL 

ISSUES INVOLVING REIMPORTATION OF 

DRUGS. Djuric M, University of Illinois at 

Chicago. E-mail: KDmar79@hotmail.com 

The elderly population of the United States is 

limited in its options to pay for its prescriptions and 

need other options. Some qualify for programs like 

Circuit Breaker and Senior Care, which allow for a 

small copayment for many prescription medications. 

For the rest of the elderly population that do 

not qualify for these programs, the choice for some 

individuals each month is between buying food and 

buying medicine. As a result of this economic pressure, 

many people have started to get their prescriptions 

filled in Canada, where prescription drug 

prices are lower. Canadian “pharmacies” buy prescription 

drugs from U.S. pharmaceutical companies 

and sell them in Canada at lower, governmentfixed 

prices. U.S. citizens travel to Canada or go 

through a “pharmacy” in the United States to buy 

their prescriptions at this lower price. From a legal, 

economic, and health care standpoint, the reimportation 

of drugs from Canada to the United States is 

unacceptable because it is illegal. FDA has not regulated 

Canadian pharmacies, and therefore safety of 

products dispensed by them cannot be guaranteed. 

Most importantly, if this continues, pharmacists in 

the United States will not be providing pharmaceutical 

care nor practicing the art and science of pharmacy: 

they will simply be running an importing 

business. The solutions provided by lawmakers 

have included circumventing U.S. authority over 

importation of foreign drugs by allowing pharmacists 

and wholesalers to import drugs from Canada, 

negotiating with health provider plans to reimburse 

patients for drugs bought in Canada, and fining 

manufacturers who refuse to sell their drugs to 

Canadian pharmacies that dispense to U.S. patients. 

Continuing to allow and even assist the elderly of 

the United States in getting their prescriptions from 

Canada is not a solution. Possible solutions to the 

problem of prescription coverage for the elderly will 

be presented. 

287—MEDICAL ERROR AND THE LAW: 

LEGAL ISSUES FOR PHARMACISTS IN 

PERFORMING SAFETY WORK. Liang B, 

University of Houston. E-mail: baliang@ 

alum.mit.edu 

Objective: To determine legal risks for pharmacists 

performing patient safety and medical error 

reporting and research. 

Methods: A review of error reporting statutes, 

the sentinel event policy of the Joint Commission on 

the Accreditation of Healthcare Organizations 

(JCAHO), peer review/quality assurance privilege 

law, attorney–client privilege law, Medicare Quality 

Improvement Organization (QIO) statutes, federal 

medical privacy law, and mediation confidentiality 

rules to identify potential holes that may allow 

patient safety information to be used to support lawsuits 

rather than be limited to safety efforts. 

Results: Significant legal risks are associated 

with participating in medical error reporting and 

patient safety research. Error reports may be used to 

sanction providers, JCAHO sentinel event policy 

information may be discoverable, Medicare QIO 

laws may allow for broad litigation support, privilege 

law appears inapplicable to safety information, 

the federal privacy law may inhibit patient safety 

research and subject participants to significant 

penalties, and mediation communications to engage 

patients in safety efforts are likely not confidential. 

Conclusions: Significant legal risks are involved 

in reporting medical error and engaging in patient 

safety work. Attention to these risks is essential to 

avoid unintended liability and to encourage patient 

safety efforts. 

288—PHARMACIST PROVISION OF 

IMMUNIZATIONS: ANALYSIS OF STATE 

LAWS AND REGULATIONS IN 7 UPPER 

MIDWESTERN STATES. Chamnanmoh S, 

Mount J, University of Wisconsin–Madison. E- 

mail: schamnanmoh@wisc.edu 

Objective: (1) To compare laws related to pharmacist 

provision of immunizations of 7 upper 

Midwestern States (Indiana, Illinois, Iowa, 

Michigan, Minnesota, Ohio, and Wisconsin) in 

terms of their forms (i.e., statutory versus regulatory) 

and sources, pharmacists’ ability to immunize, 

scope of laws (i.e., vaccine types and age of recipients), 

and additional requirements (i.e., training and 

liability insurance); (2) To explore implications of 

these laws for immunization delivery service implementation 

and public health outcomes. 

Methods: State statutes and regulations from all 

study states were systematically reviewed. Key 

informants of the seven state boards of pharmacy 

were invited for a brief telephone interview using a 

structured interview format. Five key informants 

completed the telephone interview, and two others 

completed it in writing (100% response). 

Results: Among the selected states, Illinois is the 

only state that does not allow pharmacists to administer 

vaccines. Most states had established state 

statutes allowing pharmacists to administer vaccines 

before establishing regulations. Two mechanisms 

for pharmacists to administer vaccines are practicing 

under a collaborative agreement protocol (Iowa, 

Michigan, Minnesota, Ohio, and Wisconsin) and 

administering vaccines pursuant to written prescriptions 

(Indiana, Iowa, Minnesota, and Wisconsin). 

Additionally, some states restrict the types of vaccines 

that may be administered (Iowa, Minnesota, 

and Ohio) and/or the age of vaccine recipients 

(Iowa, Minnesota, Ohio, and Wisconsin). Lastly, 

states also vary greatly in terms of training and liability 

insurance requirements. 

Conclusions: States vary widely with respect to 

the forms of immunization laws and their sources, 

pharmacists’ ability to immunize, scope of laws and 

additional requirements. These variations may 

influence pharmacists’ receptivity to and participation 

in pharmacy-based immunization services. 

Further research is needed to examine the effects of 

state laws on pharmacists’ behaviors and on public 

health outcomes. This understanding can help policy-makers 

plan effective strategies for involving 

pharmacists in addressing immunization-related 

goals of Healthy People 2010. 

Original Citation: Chamnanmoh S, Mount JK. 

Pharmacist provision of immunizations: analysis of 

state laws and regulations in 7 upper midwestern 

states. Poster presentation at the Wisconsin Public 

Health and Health Policy Institute Bi-Annual 

Conference, Madison, Wis., October 3, 2003. 

289—THE DEVELOPMENT OF DIRECT- 

TO-CONSUMER PRESCRIPTION DRUG 

ADVERTISING REGULATION. Palumbo F, 

Mullins C, University of Maryland at Baltimore. E- 

mail: fpalumbo@rx.umaryland.edu 

Historically, prescription drug advertising in the 

United States was directed primarily to prescribers. 

The 1906 Pure Food and Drug Act was directed 

toward product labels and contained no provisions 

regarding advertising Primarily because, at the time 

of its enactment, the labels under which drugs were 

sold were the primary medium for drug promotions. 

Moreover, the Federal Trade Commission (FTC) 

Act of 1914 gave the FTC jurisdiction over advertising 

practices. In addition, at that time the FTC did 

not have the authority to regulated deceptive advertisements 

unless it could prove that they injured 

another company. By the time the 1938 Federal 

Food Drug and Cosmetic Act (FFDCA) was passed, 

advertising media such as radio had emerged, and 





the need to regulate was different from that in 1906. 

In 1962, the Kefauver–Harris amendments to the 

FFDCA transferred regulatory authority over prescription 

drug advertising from the FTC to the FDA. 

The FTC retained regulatory authority over advertising 

of nonprescription products. The first U.S. 

direct-to-consumer (DTC) advertisements for prescription 

medications were issued by Boots 

Pharmaceuticals for Rufen in 1981. This was followed 

by advertisements for Merck’s Pneumovax 

vaccine. The FDA Commissioner issued a formal 

request to the industry for a moratorium on DTC 

advertisements while FDA considered its position. 

Subsequently, FDA issued a Federal Register notice 

asserting its jurisdictional authority and stating that 

DTC ads must meet the same legal requirements as 

other prescription drug advertising. In 1997, FDA 

issued a draft guidance on consumer-directed broadcast 

advertisements and subsequently issued a final 

guidance on this in 1999. This opened the door to 

the plethora of DTC advertisements presently seen 

in the United States. This paper presents the history 

and current regulation of DTC advertising in the 

United States, DTC activities in other countries, and 

legislative activities designed to control DTC advertising. 

290—WASHINGTON’S UNIFORM HEALTH 

CARE INFORMATION ACT: A STRONG 

EXAMPLE OF STATE LAWS THAT ARE 

NOT PRE-EMPTED BY HIPAA. Fassett W, 

Washington State University, Hazlet T, University 

of Washington. E-mail: fassett@wsu.edu 

Objective: To compare the requirements of 

Washington state’s Uniform Health Care Information 

Act of 1991 with the provisions of the Federal Health 

Information Portability and Accountability Act 

(HIPAA) of 1996, and with the requirements of the 

U.S. Department of Health and Human Services’ 

Privacy Procedural Enforcement Rule adopted in 

2003; and to assess potential compliance issues for 

practicing pharmacists and pharmacies. 

Methods: Design: Comparative legal analysis. 

Setting: Single state law and regulation compared 

with federal law and regulation. Analysis: Provisions 

of the laws and regulations were compared to identify 

any standards in Washington that were more stringent 

and not pre-empted by federal law. Samples of 

pharmacy notices of privacy practices were collected 

at independent and chain pharmacy sites or via 

the Internet to examine whether the statements conformed 

with Washington law as well as federal law. 

Results: The basic provisions of Washington law 

and HIPAA are similar. Certain provisions of 

Washington law are more stringent than HIPAA, 

particularly in the handling of requests by patients 

to view their records, consent by minors, and handling 

of military record requests. Washington Board 

of Pharmacy rules preclude certain disclosures 

without written consent that would be allowed 

under HIPAA rules. Considerable variation exists 

among Notices of Privacy Practices regarding the 

particulars of Washington laws, and pharmacies that 

do mention Washington specifics have not consistently 

interpreted the Washington statute. 

Conclusions: Procedural compliance with 

Washington law will likely result in compliance 

with HIPAA. However, compliance with HIPAA 

procedures, particularly in dealing with requests for 

records, will not assure compliance with 

Washington state rules. These results suggest that 

notices of privacy practices in other states may also 

inconsistently accord with more stringent rules in 

those jurisdictions. 

American Institute of the 

History of Pharmacy (AIHP) 

291—“ALWAYS AND EVERYWHERE”— 

QUININE IN THE AMERICAN CIVIL WAR. 

Flannery M, University of Alabama at Birmingham. 

E-mail: flannery@uab.edu 

Hardtack and Coffee (1887), John D. Billings‘ 

amazingly detailed account of the soldier’s life in 

the Civil War, states, “Quinine was always and 

everywhere prescribed with a confidence and freedom 

which left all other medicines far in the rear” 

(p. 176). This 15-minute slide presentation will discuss 

the curious history of quinine during the Civil 

War from therapeutic and economic standpoints. 

The paper argues that quinine and its cinchona variants 

not only played a significant role in therapeutics 

but its prevalent use in the war provided a proving 

ground for the remedy of unprecedented proportions. 

Quinine, it will be argued, was also a catalyst 

to the wartime boom of pharmaceutical mass production, 

making Rosengarten & Sons and Powers & 

Weightman major players in the pharmaceutical 

market. The talk is supplemented with illustrations 

of the firms and men who played a major role in its 

manufacture and distribution along with graphs 

tracking various economic aspects of quinine during 

the war years, 1861–1865. 

292—18TH AND 19TH CENTURY PRINT- 

ED MATERIALS ABOUT THE PURSUIT OF 

HEALTH AT MINERAL SPRINGS. Lane A, 

University of Wyoming. E-mail: 

amlane@uwyo.edu 

The tradition of people going to special places to 

restore or maintain their health is a long one, dating 

from ancient times up to the present. Some natural 

locations offer bathing and drinks of “healing” 

spring water; some health resorts offer other attractions. 

Through the eighteenth and nineteenth centuries, 

aspects such as increased middle and upper 

middle class wealth, greater leisure time, and more 

efficient transportation allowed more people to travel 

further to seek relief. Promoters emphasized both 

scientific facts and subjective testimonials in stressing 

the legitimacy of their establishments. This 

study will focus on eighteenth and nineteenth century 

materials in the Toppan Rare Books Library that 

explain just how, and why, certain diseases and 

physical problems were said to be helped at particular 

places. Books and pamphlets to be discussed 

include: A treatise on the three medicinal mineral 

waters at Llandrindod, in Radnorshire, South Wales, 

by Diederick Wessell Linden, MD, 1761; A Sketch 

of Lebanon Springs (New York), by Daniel Gale, 

1872; America’s Baden-Baden, where it is, what it 

is, and how to get there (Hot Springs, Arkansas), 

1879; Invalids & Tourists Hotel, Buffalo, N.Y., by 

Ray Vaughn Pierce, MD, 1879; Asheville, Western 

North Carolina, nature’s trundle-bed of recuperation 

for tourist & health seeker, by Hinton, A. 

Helper, 1886; Souvenir of Poland Springs (Maine) 

by Hiram Ricker and Sons, 1890; and Health resorts 

of the South and summer resorts of New England, 

1896. The association, if any, of physicians and 

pharmacists with these places will be considered. 

293—AMERICA’S SECOND OLDEST 

PHARMACY? Weart C, Karig A, Medical 

University of South Carolina. E-mail: 

weartcw@musc.edu 

Virtually forgotten in the pages of pharmacy history 

is one of America’s oldest pharmacies, perhaps 

the second oldest, which operated in Charleston, 

South Carolina. Founded in 1781, the pharmacy was 

operated by a continuous succession of owners until 

closing in 2002. The pharmacy became known as 

“Apothecaries Hall” in 1816 and later would be 

known as “Schwettmann’s,” a name associated with 

the business until its end. In 1781, Dr. Andrew 

Turnbull set up an apothecary shop in Charleston. 

He imported, prescribed, prepared, and dispensed 

his own medicines acting as both pharmacist and 

physician. In 1792, Dr. Joseph Chouler took over 

the practice as physician and apothecary. Dr. 

Chouler was succeeded by Mr. William Burgoyne 

who practiced as an apothecary until 1816. Dr. 

Jacob De la Motta, a prominent Charleston physician, 

purchased the establishment, enlarged the shop 

and named it “Apothecaries Hall.” A large golden 

mortar and pestle sign became its hallmark. In 1845, 

Dr. William Trott took over Apothecaries Hall from 

Dr. De la Motta. In 1849 he hired Christian 

Frederick Schwettmann as a pharmacist’s clerk. 

From 1863 to 1865 the business was temporarily 

relocated because of shelling from Fort Sumter. The 

business narrowed its focus to retail pharmacy and 

compounded a number of specific remedies under 

Dr. Trott’s name. In 1870, Dr. Trott sold the pharmacy 

to his one-time pharmacist’s assistant, Dr. 

Christian Frederick Schwettmann. Associating with 

his son, Dr. F. W. Schwettmann, the business 

became C. F. Schwettmann and Son, Pharmacists 

and operated until 1915 when it was purchased by 

Dr. John Hutching. In 1920, the pharmacy moved to 

a new location. It was renamed the Poulnot Drug 

Company and managed by Dr. Frederick Poulnot, 

grandson of the late Dr. C. F. Schwettmann. The 

pharmacy underwent several ownership and location 

changes before closing in 2002. 

294—AN ILLUSTRATED HISTORY OF 

THE STERLING DRUG COMPANY. Wendt D, 

National Museum of American History. E-mail: 

wendtdl@nmah.si.edu 

In 2001, the National Museum of American 

History acquired an outstanding collection of artifacts 

and archival material from Sterling Drug Inc. 

This material had been housed and processed by 




FEATURE 

The History Factory (a private archival management 

company) for Sterling Drug since 1991, but became 

“orphaned” after the divestiture of Sterling in 1995. 

The collection (225 linear feet of archival material 

and 850 artifacts) includes product samples and 

packaging, advertising, sales and marketing material, 

and corporate history files. Sterling Drug originated 

in 1901, when boyhood friends William E. 

Weiss and Albert H. Diebold established the 

Neuralgyline Company in Wheeling, W.V., for the 

purpose of manufacturing the pain-reliever product 

Neuralgine. Over the next 85 years the company 

expanded through the acquisition, both directly and 

indirectly, of about 130 companies. Some of the earliest 

acquired products included Dandarine, No-To- 

Bac, Cascarets, and California Syrup of Figs. 

During World War I, Sterling set up the Winthrop 

Company to manufacture German drugs made 

unavailable by Allied blockade, and after the 

armistice, Sterling bought the American Bayer 

Company at an auction of alien property. Through 

licensing agreements, Sterling–Winthrop continued 

to produce drugs developed by Bayer and Hoechst, 

including Demerol, Prontosil, Atabrine, Salversan, 

and Luminal. Weiss and Diebold headed up the 

company until forced to resign in 1941. Using the 

artifacts and archives of the Smithsonian collection, 

this presentation will take a look at the first 40 years 

of Sterling Drug—its roots in the “patent medicine” 

business, expansion through aggressive acquisition, 

and entry into pharmaceutical manufacturing during 

World War I and its aftermath. 

295—COD AND THE CONSUMPTIVE: A 

HISTORY OF COD-LIVER OIL IN THE 

TREATMENT OF PULMONARY TUBERCU- 

LOSIS. Grad R, University of Alabama at 

Birmingham. E-mail: rgrad@peds.uab.edu 

In 1841, Dr. John Hughes Bennett, of Edinburgh, 

published a treatise extolling the great benefit of 

cod-liver oil in the treatment of consumption. 

Within 10 years, cod-liver oil had entered the 

United States Pharmacopoeia and had become “one 

of the most esteemed remedies in the whole catalogue 

of the Materia Medica.” (United States 

Dispensatory [USD], 1851, p. 509). The agent 

quickly became regarded as the most effective remedy 

ever in the treatment of consumption, and its 

use was widespread during the second half of the 

nineteenth century. More than a simple food, it was 

thought to stimulate nutrient uptake, resulting in 

weight gain, and production of healthy lung tissue. 

The major drawback was its foul taste and smell. 

Although enthusiasm for the use of the agent for 

consumption waned at the dawn of the twentieth 

century, individuals still advocated its use in consumption, 

and the USD included a tuberculosis indication 

as late as 1960. This 15-minute slide presentation 

will discuss the history of cod-liver oil as a 

remedy for consumption in the United States, using 

successive editions of the USD, textbooks of 

medicine, pediatrics and materia medica, and journal 

articles of the period. 

296—CORA DOW 1868–1915, PHARMA- 

CIST, ENTREPRENEUR, PHILAN- 

THROPIST. Henderson M, Independent Scholar, 

Worthen D, Lloyd Library and Museum. E-mail: 

mlhender@ix.netcom.com 

Cora Dow took over her father’s patent medicine 

store in Cincinnati when he became ill. She hired a 

clerk while she attended the Cincinnati College of 

Pharmacy, graduating in 1888. By 1890 she opened 

a second store and began her career as a pioneer 

owner of a chain of discount drug stores. This business 

philosophy made her unpopular with other 

Cincinnati pharmacists and some manufacturers. 

However, she was well regarded by her employees 

and the community. She set high standards for quality 

of goods in her stores. When the dairy did not 

meet her expectations she opened her own ice cream 

factory. She received 150 trademarks for her line of 

cosmetics and toiletries. She built a drugstore with 

fixtures and services specifically for the woman 

shopper. Cora Dow sold her 11 stores shortly before 

her early death from tuberculosis in 1915. She never 

wanted to be a pharmacist; she wanted to be a musician. 

The major benefactor in her will was the 

Cincinnati Symphony Orchestra. She was a very 

successful entrepreneur. 

297—JAMES O. MAY, CONNECTICUT 

DRUGGIST AND ENTREPRENEUR. Brodeur 

D, Sacred Heart University. E-mail: 

BrodeurD@sacredheart.edu 

James O. May (1853–1904) a life-long resident 

of Naugatuck, Conn., was a druggist, pharmaceutical 

manufacturer, real estate developer, and politician. 

For many years, he was the proprietor of The 

Naugatuck Drug Company, one of several drugstores 

in town. He later established The Diamond 

Laboratory Company, which was known for the 

manufacture of Diamond Ginger Ale as well as several 

successfully marketed proprietary products. 

The best known and most widely advertised of these 

products was May’s Marshmallow Cream, which, 

according to its label, was “unexcelled as a curative 

agent in diseases of the lungs and throat.” May also 

was one of the largest real estate owners in the 

Borough of Naugatuck and was a Burgess from the 

First Ward. That he left a positive mark on the town 

is borne out by the headline of his obituary which 

read, “Sad Demise of Burgess May: Naugatuck 

Loses One of Her Best Citizens.” 

298—MARMOLA, THE FTC, AND THE 

BATTLE OVER AUTHORITY AND OBESITY 

IN THE 1920s AND 1930s. Swann J, US Food and 

Drug Administration. E-mail: jswann@ora.fda.gov 

This paper examines the history of Marmola, a 

preparation of desiccated thyroid and other ingredients 

sold to consumers for weight reduction. 

Introduced in the first decade of the twentieth century, 

Marmola became a widely—and some argued, 

wildly—advertised medicine for the masses in an 

era that increasingly prized the sleek, trim, and even 

emaciated figure. Seen as an unsafe and unscientific 

remedy thriving beyond the reach of the Food and 

Drugs Act, the Federal Trade Commission took 

issue with Marmola’s claims and ordered its manufacturers, 

the Raladam Company, to cease advertising 

that it was a harmless medicine for self-medication. 

Raladam appealed this ruling, and eventually 

the Supreme Court ruled in favor of Raladam. The 

FTC moved against Marmola again in the mid- 

1930s, with similar results. However, Marmola’s 

existence was short-lived once the 1938 Federal 

Food, Drug, and Cosmetic Act was passed. In the 

two cases between Raladam and the FTC, both sides 

marshaled scientific evidence on the use of thyroid 

in the treatment of disease. Their arguments, framed 

in the context of what was known and recommended 

concerning obesity management at the time, will 

be analyzed, as will the subsequent history of 

Marmola under the 1938 Act. 

299—MEDICINE IN THE TIME OF AULUS 

CORNELIUS CELSUS, 1st CENTURY ROME 

VERSUS MEDICINE TODAY. Ali M, Emory 

University, Warren F, University of Georgia. E- 

mail: mali@emory.edu 

Aulus Cornelius Celsus, who lived in the first 

century A.D., was a great Roman medical writer and 

the author of De Medicinia, a classic source of 

information about medicinal practices before and 

during that time period. Celsus was a nobleman who 

headed his household, and as such, was responsible 

for the medical care of both the members of the 

household and the slaves who served them. De 

Medicinia consists of eight books, which consider 

prescriptives for healthy living, and descriptions of 

various disease states, along with their treatments. 

The treatments might include food, drink, adjustments 

to the body, plant pharmaceuticals, or 

surgery. For example, he gave specific directions 

for amputation of a limb, necessarily cutting off 

some of the good tissue as well as the bad, to ensure 

that no diseased tissue remained in the body. This 

paper will present some examples of Celsus’s writings 

and compare them with modern day conditions 

and their treatments. 

300—THE EARLY HISTORY OF PHAR- 

MACY IN OUACHITA PARISH, LOUISIANA. 

Sirmans S, University of Louisiana at Monroe. E- 

mail: sirmans@ulm.edu 

Objective: The early history of pharmacy in 

Ouachita Parish, La., was greatly influenced by 

social, economic, and political issues that differ 

from those found in the southern part of Louisiana. 

Through most of the nineteenth century residents 

were relatively isolated and economic development 

was hampered; roads were poor, railroads were 

nonexistent, and steamboats were not able to travel 

to the area until 1819. The first advertisements for a 

drugstore did not appear until 1852. Most of the 

early pharmacists of the area were involved in multiple 

pursuits including publishing, agriculture, fraternal 

organizations, civic organizations, real estate, 

and elected office. The first college of pharmacy 

graduate in Monroe was George Washington 

McFee, an 1855 graduate of the Philadelphia 

College of Pharmacy. He and Jethro Moore of 

Trenton operated the only two drugstores in the area 





until after the Civil War. These businesses continued 

operations into the 1880s and were joined by no 

more than two other interests during the 

Reconstruction Period. During and for 20 years following 

Federal occupation, East-West and North- 

South railroad routes were established or extended 

through the area and fueled economic growth. By 

the turn of the century at least five pharmacies were 

in operation, most solely or partly owned by physicians. 

Physician ownership of pharmacies decreased 

during the early 1900s and the number of pharmacist 

owned pharmacies exploded with the large 

increase in population related to discovery of gas 

and oil in the area in 1916. The number of pharmacies 

kept pace with population growth despite the 

economic depression of the 1930s and a national 

pharmacist shortage during World War II. During 

this period the first female pharmacist of Monroe, 

Arnetta Pierce, joined her father’s practice, and first 

and second generation Italian American pharmacists 

established pharmacies in Monroe. 

301—THE NATURAL HISTORY OF PLINY 

VERSUS CURRENT ALTERNATIVE THERA- 

PY. Warren F, University of Georgia, Ali M, Emory 

University. E-mail: fwarren@mail.rx.uga.edu 

Pliny the Elder was author of The Natural 

History, an encyclopedic work that served as an 

authority on medical and scientific matters up to the 

Middle Ages. The Natural History, containing 37 

books, was completed in A.D. 77. Pliny explained 

his purpose as the study of “the nature of things.” 

Previously, no author had collected the older, scattered 

material that belonged to encyclical culture. 

The Natural History covers most subjects, including 

humans (Book VII), botany (Books XII to XIX) and 

medicine and drugs (Books XX to XXXII). Reading 

The Natural History became a substitute for a general 

education, and many monastic libraries possessed 

copies. Pliny’s authority was unchallenged, 

partly because of a lack of reliable information and 

partly because his assertions often could not be tested. 

The first attack on Pliny’s work came in 1492, 

and Pliny’s influence diminished as more writers 

questioned his statements. By 1700, The Natural 

History had been rejected by leading scientists. This 

paper will present some of Pliny’s descriptions of 

diseases and their Roman treatments and compare 

them with those recommended by present-day alternative 

therapy practitioners. 

302—THE NISEI PHARMACY STUDENTS. 

Worthen D, Lloyd Library and Museum. E-mail: 

dbworthen@fuse.net 

In post-Pearl harbor 1942 a number of students 

were forced from four West Coast colleges of pharmacy, 

not for poor grades, but because of their ethnicity. 

Frequently the students were forced to leave 

despite the wishes of the school to keep them. Some 

of the students were forced into assembly centers 

and relocation camps before finding another pharmacy 

school that would allow them to return to their 

professional studies. Other students were able to 

gain admittance quickly and avoided the camps 

altogether. Some schools, notably Idaho State 

University, the University of Nebraska, and the St. 

Louis College of Pharmacy, admitted a number of 

these transfer students. Other schools were precluded 

from accepting Nisei students, frequently 

because of military contracts with the University. 

This paper draws on school records and materials in 

the National Archives to document the story of both 

individuals and institutions during the internment of 

the Nisei students. 

303—THE PROVENANCE OF THE 

MEDICINA PENSYLVANIA, CA. 1770. Wilson 

R, Johns Hopkins University. E-mail: 

rwilson@jhsph.edu 

This presentation examines the provenance of a 

large and complex German–English dispensatory at 

the College of Physicians in Philadelphia compiled 

by George de Benneville, a physician trained in 

Germany and practicing in the North American 

colonies. Of particular interest is the selective use of 

seventeenth and eighteenth century German and 

English sources, suggesting that more than one 

author was involved. Current findings confirm a 

mixed provenance. The section on spagyrical diseases 

and uroscopy draw on a Paracelsian tract by a 

sixteenth century German court physician, Johannes 

Hayne. By contrast, the section on medicinal simples, 

including some of the oils, wines, and salts, is 

a fairly verbatim condensed extract of the 1753 New 

Dispensatory of William Lewis. The more complex 

tinctures and balsams and the numerous prescriptions 

for specific conditions appear to introduce yet 

another set of sources, probably the recipe collections 

of German chemiatrists such as Johann 

Schroeder. The presentation also inquires into the 

commercial expectations underlying the compilation 

and publication plans for this manuscript. 

Absent American dispensatory imprints before the 

1770s, its author or authors may have wished to 

address colonial medical markets and their 

providers. Here, a major question is whether the 

inclusion of disparate sources was intended to serve 

concrete therapeutic objectives or marketing strategies, 

or represents a synthetic approach in a new 

multicultural environment. 

304—THE ROACH DRUGSTORE, WASH- 

INGTON, D.C. Jentsch E, National Museum of 

American History. E-mail: Jentsche@si.edu 

Many remember the elaborate 1890s Drugstore 

Exhibit in the National Museum of American 

History’s old Medical Sciences Hall. The fixtures 

for this display were taken from the Roach 

Drugstore, a pharmacy that sat on 8th and G streets 

in southeast Washington, D.C., for almost 50 years. 

This paper presents information on the Roach drugstore, 

its owners, and the community it served. The 

store was one owned by the O’Donnell family. 

Under patriarch James O’Donnell, this family ran at 

least eight other pharmacies in the Washington area. 

The paper discusses the leadership of the O’Donnell 

family among Washington’s pharmacists and shows 

how their pharmacies became valuable community 

spaces, from serving as ballot places for 

Washington’s most popular Irishman contests to 

selling advertising space for the Washington Post. 

The presentation uses advertisements, city directories, 

newspaper articles, and objects from museum 

collections to examine the history of the Roach 

store. Since the store opened at a time when southeastern 

Washington was a thriving area, and closed 

as the neighborhood fell into disarray, the paper will 

reveal how city history is reflected through the history 

of the store. 

305—THE TRADING WITH THE ENEMY 

ACT OF 1917 AND ITS AFFECT ON DRUG 

REGULATION. Cooper D, Independent Scholar. 

E-mail: dalecooper@compuserve.com 

This paper discusses how the Trading with the 

Enemy Act of 1917 affected drug regulation 

through its authorization of the seizure of German 

patents. An Executive Order created the Office of 

the Alien Property Custodian and authorized the 

Federal Trade Commission (FTC) to issue licenses 

for the patents. The FTC was given the authority to 

set the terms of the licenses along with the power of 

revocation. Because of shortages, high prices, and 

health significance, the most critical patents were 

for synthesized drugs, especially the antisyphilitic 

agent Salvarsan. The FTC recognized the potential 

quality problem new non-German suppliers posed. 

The FTC, with the advice and support of the 

National Research Council, the U.S. Public Health 

Service, and the American Medical Association, 

developed an evaluation and control procedure. 

Generic names and price control provisions were 

established. The Alien Property Custodian’s sale in 

1919 of all German patents to the Chemical 

Foundation, a private organization, weakened 

FTC’s control. The U.S. Public Health Service grew 

uneasy about the loss of government control over 

arsphenamine (the generic name for Salvarsan). 

However, the agency gained control over the medication 

when the Solicitor of the Treasury issued an 

opinion that arsphenamine was subject to the 1902 

Biologics Control Act as an analogous product. 

306—TINS AND PHARMACY. Silberman H, 

Independent Scholar. E-mail: aihp@ facstaff.wisc.edu 

Tin collecting is a widespread hobby. The beauty 

and richly decorated metal boxes attract collectors. 

This talk focuses on small boxes in which 

drugs, especially throat medications, were and are 

sold. Slides show boxes of American and European 

origin. Emphasis is on early manufacturing practices 

in producing and decorating tin-clad iron containers. 

A variety of narcotics (alkaloids) were 

incorporated into cough medications. Extended 

claims were made in the early part of the twentieth 

century as to the benefits of such over-the-counter 

preparations, promising for instance the cure from 

lung diseases such as tuberculosis and whooping 

cough. A handout lists a bibliography of European 

and American books and articles on the subject. 

Modern equipment of a production line in a leading 

metal box manufacturing company is presented.

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