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Annual Meeting Abstracts 2004 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. Methods: A subset of consecutively randomized 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. 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 283 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 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. Conclusions: NA. 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. 284 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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