Downloaded - Journal of American Pharmacists Association

More documents

Recommendations

Info

Annual Meeting Abstracts 2004 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 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 291 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 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. 292 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
Page 1 and 2:
FEATURE APhA2004 Abstracts of Contr
Page 3 and 4:
FEATURE Annual Meeting Abstracts 20
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16: FEATURE Annual Meeting Abstracts 20
Page 65: FEATURE Annual Meeting Abstracts 20
Page 77: FEATURE Annual Meeting Abstracts 20
show all

Downloaded - Journal of American Pharmacists Association

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?