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Annual Meeting Abstracts 2004 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 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 279 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 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. Methods: A subset of consecutively randomized 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 280 Journal of the American Pharmacists Association www.japha.org March/April 2004 Vol. 44, No. 2 Downloaded From: http://japha.org/ on 01/25/2014
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