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
Administrative &
Management Practice
1—A BUSINESS MODEL FOR A SELFSUSTAINING 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:
[email protected]
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
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•
•
•
•
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 ( ).
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: [email protected]
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 postNDA statutory term time.
3—CHARACTERISTICS OF NEW INDEPENDENTLY OWNED COMMUNITY PHARMACIES IN NC. Boyd J, Evans J, Robert C,
Campbell University School of Pharmacy. E-mail:
[email protected]
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
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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.
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6—EVALUATION OF MEDICATION NONCOMPLIANCE AT AN INDIAN HEALTH
SERVICE HOSPITAL. Dupree M, Foster S,
Dennewitz M, Cass Lake Indian Health Service
Hospital. E-mail: [email protected]
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 indi-
vidual 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 ANALYSIS 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:
[email protected]
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:
[email protected]
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 (18font 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
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2004 Abstracts of Contributed Papers
4—DRUG
BENEFIT
MANAGEMENT
STRATEGIES: CONSUMERS’ ATTITUDE AND
PERCEPTIONS REGARDING FORMULARIES. Sikri S, Kawatkar A, Sansgiry S, University of
Houston. E-mail: [email protected]
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 (В±
13.96) years. Overall, consumers had negative attitude
towards formularies 2.77 (В± 0.66). The respondents
were neutral with respect to satisfaction with drugs
included in their formulary 3.0 (В±0.9). However analysis indicated that consumers were motivated to seek
information regarding formularies 3.20 (В± 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 6months and 12-months postsentinel claim.
Results: Study findings will be presented.
Conclusions: A conclusion will be presented
based on study findings.
FEATURE
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: [email protected]
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.
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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 CHOLINESTERASE THERAPY CHANGE IN A MEDICAID DATASET. Bunz T, Dore D, Kogut S,
University
of
Rhode
Island.
E-mail:
[email protected]
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 OPPORTUNITY AWARENESS AMONGST HIGH SCHOOL
STUDENTS. Jain B, Stensland S, Jackson T,
Midwestern
University.
E-mail:
[email protected]
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
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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.
14—THE DEFENSE SUPPLY CENTER:
PHILADELPHIA’S COLD CHAIN MANAGEMENT PROGRAM FOR THE INFLUENZA
VIRUS VACCINE. Dallas D, Defense Supply
Center Philadelphia. E-mail: [email protected]
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
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15—THE EVOLVING ROLE OF PATIENT
ADVOCACY GROUPS IN IMPROVING
HEALTH AND HEALTH CARE. Lee S, Amgen,
Ascione F, McKercher P, University of Michigan. Email: [email protected]
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
ALZHEIMERВґS DISEASE: PERSISTENCE ON
CHOLINESTERASE INHIBITORS MEASURED 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.
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2004 Abstracts of Contributed Papers
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: [email protected]
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.
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
17—EVALUATION OF CARDIOPULMONARY RESUSCITATION CERTIFICATION AMONG PHARMACY STUDENTS. Patel
S, Eap N, Blodgett B, Onamade A, University of
Illinois at Chicago. E-mail: [email protected]
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’ ATTITUDES ABOUT MEDICALLY UNDERSERVED POPULATIONS. Langridge S, Jackson
T, Lurvey P, Midwestern University. E-mail:
[email protected]
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
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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 ANALYSIS FOR BONE MINERAL DENSITY (BMD)
SCREENING. Patel H, Shenandoah University,
Skelton J, US Wellness, Inc., Ahrens R, Stolte S,
Shenandoah University. E-mail: [email protected]
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: [email protected]
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 100mm 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 OXYMORPHONE IMMEDIATE RELEASE IN
POSTSURGICAL
ORTHOPEDIC
PAIN:
RESULTS OF A RANDOMIZED, DOUBLEBLIND, PLACEBO-CONTROLLED, DOSERANGING COMPARISON WITH OXYCODONE. Gimbel J, Lee W, Arizona Research
Center, Ma T, Zagorski A, Ahdieh H, Endo
Pharmaceuticals, Inc. E-mail: [email protected]
www.japha.org
March/April 2004
Vol. 44, No. 2
FEATURE
Annual Meeting Abstracts 2004
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 SATISFACTION OF COMMUNITY PHARMACISTS
INVOLVED WITH PHARMACEUTICAL
CARE. Swensgard L, Ohio State University. Email: [email protected]
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 establish-
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ments 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 COMMUNITY CLERKSHIP STUDENTS TO PROVIDE 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: [email protected]
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 CARDIOLOGY CLINIC. Glosner S, Pfizer Inc, Tynan S, Alsip
D, Cline K, Midwestern University, Konczal M,
Faaborg J, Marcinkowski L, Midwestern
University. E-mail: [email protected]
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/m2. 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 PHARMACY. Self T, University of Kentucky, Chou C,
Pfizer, Inc. E-mail: [email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
FEATURE
Annual Meeting Abstracts 2004
25–A REPRODUCIBLE MODEL FOR DISEASE STATE MANAGEMENT AND PHARMACEUTICAL ACCESS FROM A FEDERALLY 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: [email protected]
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: [email protected]
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%.
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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 POPULATION. Conner C, Cherayil G, Pfizer, Inc. Email: [email protected]
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 PSYCHOSTIMULANTS USED IN THE TREATMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS. Sanchez R. E-mail: [email protected]
Objective: The purpose of this study was to
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 MANAGEMENT OF HYPERLIPIDEMIA IN COMMUNITY BASED OUTPATIENT CLINICS WITH A
CENTRALLY BASED CLINICAL PHARMACIST (“VIRTUAL CLINICAL PHARMACIST”). Evanko T, Jones W, Southern Arizona VA
Health Care System. E-mail: [email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
30—ANALYSIS OF A MEDICAID COX-2
PRIOR
AUTHORIZATION
PROGRAM.
Hermansen E, Gunning K, University of Utah. E-mail:
[email protected]
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
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such that quality care is provided while costs within
Medicaid are contained.
31—COLLABORATIVE
PRACTICE
AGREEMENTS: PERCEPTIONS OF PHARMACISTS AND PHYSICIANS. Causey L,
Causey’s Rx Solutions, Ramsey L, University of
Mississippi. E-mail: [email protected]
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 VERSUS DIETITIANS REGARDING HERBS AND
DIETARY SUPPLEMENTS. Mehta B, Ohio State
University, Giannamore M, Pfizer, Inc. E-mail:
[email protected]
Objective: The goals of this project were to determine: (1) differences in knowledge between pharma-
cists 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: [email protected]
Objective: To determine if community pharmacist performed spirometry would assist in identifying
Journal of the American Pharmacists Association
233
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 (FEV1), and the ratio
of these two measures. Patients with a FEV1/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.
Results: A total of 145 patients were identified as
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. FEV1/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 CENTERS. 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:
[email protected]
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
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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.
Conclusions: Conclusions will be presented
based on the analysis of data comparing baseline, 6month, 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:
[email protected]
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 OUTCOMES. 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:
[email protected]
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
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Vol. 44, No. 2
Annual Meeting Abstracts 2004
demonstrate clinical pharmacy services can improve
patient knowledge base and diabetes outcomes.
38—IMPACT OF PHARMACIST INTERVENTION THROUGH A TELEPHONE RUN
SMOKING CESSATION CLINIC. Foust S,
Porter J, Drake University College of Pharmacy. Email: [email protected]
Objective: To determine the impact of a pharmaVol. 44, No. 2
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39—MEDICATION UTILIZATION EVALUATION OF HMG-COA REDUCTASE
INHIBITORS IN LIPID CLINIC. Booth H,
Tomich D, Kassebaum P, Madigan Army Medical
Center. E-mail: [email protected]
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 HMGCoA reductase inhibitor between January 1, 2002
and September 30, 2003. A retrospective chart
review was conducted in patients who were identi-
fied as being treated with a HMG-CoA reductase
inhibitor other than simvastatin.
Results: A total of 565 patients were identified as
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.
Conclusions: NA.
40—MEDICATION
UTILIZATION
REVIEW OF ALENDRONATE. Seah J, Lim W,
Wee I, Changi General Hospital. E-mail:
[email protected]
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.
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2004 Abstracts of Contributed Papers
37—IMPACT OF PHARMACEUTICAL
CARE: A RANDOMIZED, CONTROLLED
TRIAL OF BLOOD PRESSURE CONTROL IN
HYPERTENSIVE PATIENTS. Amruso N,
Eckerd
PatientCARE
Network.
E-mail:
[email protected]
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.
cist-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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
41—NATIONWIDE DISSEMINATION OF
THE RX FOR CHANGE TOBACCO CESSATION CURRICULUM: IMPACT OF A TRAINTHE-TRAINER PROGRAM FOR PHARMACY FACULTY. Corelli R, Fenlon C, Kroon L, Lem
K, Sullivan M, Hudmon K, University of California,
San Francisco. E-mail: [email protected]
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: [email protected]
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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 10day 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: [email protected]
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.
Conclusions: 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:
[email protected]
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 PHARMACOKINETICS. Bauer L, University of Washington.
www.japha.org
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Vol. 44, No. 2
Annual Meeting Abstracts 2004
46—USING THE OUTCOMES PHARMACEUTICAL HEALTH CARE CASE MANAGEMENT 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:
[email protected]
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.
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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 CERTIFICATION IN PHARMACY. Pradel F, Palumbo F,
Flowers L, Mullins C, Haines S, Roffman D,
University of Maryland at Baltimore. E-mail:
[email protected]
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: [email protected]
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.
Journal of the American Pharmacists Association
237
2004 Abstracts of Contributed Papers
E-mail: [email protected]
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 (<2.5
g/dL) and/or total bilirubin (>1.5 mg/dL). Steadystate phenytoin total and unbound concentrations
were measured using the TDx assay system (coefficient of variation <7%); ultrafiltration was performed at 25Вє C. NONMEM was used to fit concentration data to pharmacokinetic (steady-state
Michaelis–Menten equation) and statistical models.
Regression equations that related patient characteristics and other drug doses to population pharmacokinetic parameters were constructed using standard
NONMEM techniques. Statistical significance was
determined by computing changes in the objective
function (chi square >3.841, P <.05). Clinically relevant changes were determined for each factor by
when unbound fractions exceeded 15% or changes in
pharmacokinetic parameters exceeded 25%.
Results: These patient covariates were statistically significant and caused unbound fractions of more
than 15%: albumin <2.7 g/dL, total bilirubin >2.1
mg/dL, warfarin >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 (Vmax)
by more than 25%: albumin <2.5 g/dL plus total
bilirubin >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 Vmax values.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 CLINICS. Helou L, Sorensen T, University of Minnesota.
E-mail: [email protected]
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 4week 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 UTILIZING A CONTINUING EDUCATION PROGRAM. Morawiec K, Northeastern University,
Dougherty T, Presbyterian Medical Center, Penn
Family Care. E-mail: [email protected]
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, case-
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based 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. Email: [email protected]
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 phar-
macist 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: [email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
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.
54—BILINGUAL OVER-THE-COUNTER
PRODUCT LABELS TO ENHANCE PRODUCT USE. Sansgiry S, University of Houston.
Vol. 44, No. 2
March/April 2004
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55—BLOOD PRESSURE CONTROL OF
ELDERLY HYPERTENSIVE PATIENTS
WITH PHARMACEUTICAL CARE INTERVENTION AND HOME BLOOD PRESSURE
MONITORING. Christian M, Johnson & Johnson.
E-mail: [email protected]
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:
[email protected]
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
Journal of the American Pharmacists Association
239
2004 Abstracts of Contributed Papers
53—AN EVALUATION OF THE IMPACT
OF A PHARMACY BASED LATENT TUBERCULOSIS INFECTION COMPLIANCE CLINIC 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:
[email protected]
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 6month 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.
E-mail: [email protected]
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 (В± 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).
ScheffГ© 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 (В± SD) age is 48 В± 18 years. Patients average
2.7 В± 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 В± 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 OSTEOPOROSIS IN HISPANIC AND CAUCASIAN
WOMEN BASED UPON BONE DENSITY
MEASUREMENTS OBTAINED FROM COMMUNITY HEALTH SCREENINGS. Alvarez G,
Nova-Southeastern University, Marsh W, Hunter T,
Droege M, Nova Southeastern University. E-mail:
[email protected]
Objective: The objective of this study was to
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
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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 PHARMACIST AS A DRUG INFORMATION SOURCE.
Rollins B, Sullivan D, Ohio Northern University. Email: [email protected]
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 В± 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: [email protected]
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 2year 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: [email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
FEATURE
Annual Meeting Abstracts 2004
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: [email protected]
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.
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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: [email protected]
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 PRINTED MATERIALS ABOUT THE PURSUIT OF
HEALTH AT MINERAL SPRINGS. Lane A,
University
of
Wyoming.
E-mail:
[email protected]
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:
[email protected]
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:
[email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
FEATURE
Annual Meeting Abstracts 2004
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 EDUCATION ON PATIENT KNOWLEDGE OF NOSEBLEED MANAGEMENT: AN ANTICOAGULATION CLINIC INTERVENTION. Hassenplug
K, Burkiewicz J, Jackson T, Peppers L, Midwestern
University.
E-mail:
[email protected]
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
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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 (В± SD) age of the
patients was 71 В± 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 COLLABORATION 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: [email protected]
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 DIABETES. Dinh Q, Zgarrick D, Cornell S, Midwestern
University. E-mail: [email protected]
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: [email protected]
Objective: We plan to: (1) identify processes
required to expand the Pharmaceutical Case
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March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
69—EVALUATION OF BENZODIAZEPINE
UTILIZATION IN A FAMILY MEDICINE
OFFICE. Santee J, Howell J, University of
Missouri-Kansas City. E-mail: [email protected]
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.
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mined 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 CARDIOVASCULAR RISK AMONG PARTICIPANTS OF A
VIETNAMESE HEALTH AWARENESS PROGRAM. Wong N, Merrigan D, Pfizer. E-mail:
[email protected]
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 HealthSystem 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.
Journal of the American Pharmacists Association
243
2004 Abstracts of Contributed Papers
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 5point 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
72—EVALUATION OF REIMBURSEMENT
METHODS UTILIZED BY PHARMACISTS
PERFORMING DISEASE STATE MANAGEMENT SERVICES. Beatty S, Mehta B, Rodis J,
Ohio State University. E-mail: [email protected]
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.
[email protected]
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 communi-
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ty. 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/k2 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:
[email protected]
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 6month 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 EDUCATION SERVICE IN A COMMUNITY PHARMACY. 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
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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.
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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 PHARMACIST-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. Email: [email protected]
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).
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76—IMPLEMENTATION OF A LIPID
MANAGEMENT PROGRAM IN A COMMUNITY PHARMACY. Nesbitt K, Ferris State
University/Pfizer/Meijer, Durst S, Ferris State
University, Detloff R, Pfizer, Ruhlman B, Vanlente
H, Meijer, Inc.. E-mail: [email protected]
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 (HDLC), 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 6month 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.
Conclusions: NA.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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:
[email protected]
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 presenta-
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tion on their observations of the impact on animalassisted therapy in patients followed during the 4week 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 PHARMACY. Mcfee J, University of Illinois at Chicago.
E-mail: [email protected]
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 EVALUATION OF NON-ENGLISH SPEAKING
PATIENTS. Westberg S, Sorensen T, University of
Minnesota. E-mail: [email protected]
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
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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 nonEnglish 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 nonEnglish 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.
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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: [email protected]
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 vari-
ety of problems with therapy.
86—PREDICTING AND UNDERSTANDING THE INTENTION TO USE HERBAL
MEDICINES AMONG HISPANIC AND NONHISPANIC 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: [email protected]
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 R2 = .59, ОІ = .78, P < .001;
non-Hispanics, adjusted R2 = .57, ОІ = .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. Email: [email protected]
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
Journal of the American Pharmacists Association
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84—PHARMACIST AND PHARMACY
STUDENT KNOWLEDGE AND ATTITUDES
REGARDING EMERGENCY CONTRACEPTION. 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 chi-
square 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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: [email protected]
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 partic-
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ipated 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 POPULATION WITH A HIGH RATE OF DIABETES
ACCORDING TO THE NEW JNC-7 GUIDELINES. Feldman L, Zuni Comprehensive
Community Health Center, Binning R, Christensen
K, University of Wisconsin–Madison. E-mail: [email protected]
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-INFLAMMATORY DRUG INDUCED COMPLICATIONS IN
COMMUNITY PHARMACY SETTINGS.
Anzisi L, Lee A, Algozzine T, Brady G, Pfizer Inc.
E-mail: [email protected]
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:
[email protected]
Objective: To improve the efficiency of serving
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92—STUDYING THE PROFESSIONAL
INTERRELATIONSHIP BETWEEN COMMUNITY 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
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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: [email protected]
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 DEPARTMENT IN A UNIVERSITY MEDICAL CLINIC. Jacobson S, Massachusetts College of
Pharmacy and Health Sciences, Debay G,
Massachusetts Institute of Technology. E-mail:
[email protected]
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 PUBLIC HEALTH: A SURVEY OF HEALTH
DEPARTMENT OFFICIALS. Cottrell J, Albany
College of Pharmacy, Blumenschein K, University
of Kentucky, Paavola F, None. E-mail:
[email protected]
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 serJournal of the American Pharmacists Association
249
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 SATISFACTION OF COMMUNITY PHARMACISTS
INVOLVED WITH PHARMACEUTICAL
CARE. Swensgard L, Ohio State University. Email: [email protected]
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 establish-
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ments 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 COMMUNITY CLERKSHIP STUDENTS TO PROVIDE 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: [email protected]
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 CARDIOLOGY CLINIC. Glosner S, Pfizer Inc, Tynan S, Alsip
D, Cline K, Midwestern University, Konczal M,
Faaborg J, Marcinkowski L, Midwestern
University. E-mail: [email protected]
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/m2. 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 PHARMACY. Self T, University of Kentucky, Chou C,
Pfizer, Inc. E-mail: [email protected]
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
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Microsoft Access.
Conclusions: NA
101—DEVELOPMENT OF A HELICOBACTER PYLORI RAPID SCREENING PROGRAM
IN THE COMMUNITY PHARMACY SETTING. Kurpius M, University of Iowa, Sommers
Hanson J, Dominick’s Pharmacy. E-mail: [email protected]
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
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102—NATIONAL PATTERNS OF ASPIRIN
PROPHYLAXIS IN PATIENTS WITH DIABETES. Holness P, Lee E, Hogue V, Lombardo F,
Howard University. E-mail: [email protected]
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 (В± SD) age of the population was
54.3 (В± 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 В± 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’ EXPECTATIONS OF COLLABORATIVE WORKING
RELATIONSHIPS (CWRS) AMONG PHARMACISTS, PHYSICIANS, AND PATIENTS.
Stehling D, Gaebelein C, St. Louis College of
Pharmacy. E-mail: [email protected]
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.
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2004 Abstracts of Contributed Papers
100—BRANDING PHARMACEUTICAL
CARE SERVICES USING THE BRAND
CLARITY PYRAMID. Abraham J, Bircea E,
Stubbings J, University of Illinois at Chicago. Email: [email protected]
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.
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
104—PROVIDING MEDICATIONS TO
UNDERSERVED POPULATIONS UTILIZING
340B. Reid C, Jackson T, Langridge S, Midwestern
University. E-mail: [email protected]
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 PRESCRIBED MEDICATIONS IN THE COMMUNITY PHARMACY SETTING. Rodriguez I,
NOVA Southeastern University, Lai L, Nova
Southeastern University. E-mail: [email protected]
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
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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.
Conclusions: NA.
APhA–APPM Hospital &
Institutional Practice
106—APPROPRIATE TREATMENT OF
SYSTOLIC HEART FAILURE IN THE PRIMARY 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: [email protected]
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 (В± SD)
age of the patients was 65 В± 11.3 years, the mean
ejection fraction was 29 В± 9.5%, and the mean number of drugs prescribed per patient (other than study
drugs) was 9.5 В± 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 fail-
ure 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 OXIDASE 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 THERAPY IN THE TREATMENT OF ANEMIA IN
CHRONIC RENAL FAILURE PATIENTS.
Canney
T,
Kindred
Hospital.
E-mail:
[email protected]
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
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March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
109—EXPERIENCE WITH A SYMPTOMTRIGGERED 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: [email protected]
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
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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 ANALYSIS OF ADVERSE EVENTS FROM THREE
POSTHERPETIC NEURALGIA CLINICAL
TRIALS. Parsons B, Pfizer, Tive L, Huang S,
Pfizer, Inc. E-mail: [email protected]
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 DISINTEGRATING 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: [email protected]
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 Г— 5 mg, 2 Г— 5 mg, 4 Г— 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 (Cmax)
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 Cmax. 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 minJournal of the American Pharmacists Association
253
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
utes). Small early concentration differences at
become indistinguishable before reaching Cmax.
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: [email protected]
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.
Conclusions: NA.
APhA–APPM Nuclear
Pharmacy Practice
113—ENHANCED LIVER UPTAKE OF TC99M–LABELED RED BLOOD CELLS DURING
GASTROINTESTINAL
BLEED
SCINTIGRAPHY USING TRANSFUSED RBC
COMPARED TO AUTOLOGOUS RBC.
Melchior W, Wong K, Beauvais M, Snyder S,
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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 Tc99m–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 Tc99m–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-HODGKINВґS LYMPHOMA.
Chumney E, Kit S, Cheng K, Chris B, Hall P,
Medical University of South Carolina. E-mail:
[email protected]
Objective: The recent introduction of radiolabeled antibodies (radioimmunotherapy) has offered
a promising new therapy for indolent nonHodgkin’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 pub-
lished 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
LYMPHOSCINTIGRAPHY 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.
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
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.
117—QUALITY CONTROL OF [F18]FACBC: A NON-NATURAL AMINO ACID
TUMOR IMAGING AGENT. Crowe R, Yu W,
Goodman M, Emory University. E-mail:
[email protected]
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
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118—RADIOPHARMACISTS’ SATISFACTION WITH THEIR EDUCATION/TRAINING, JOB SATISFACTION, AND PROFESSIONAL PRACTICE PATTERNS: RESULTS
OF A NATIONAL SURVEY. Wittstrom K,
Norenberg J, Borrego M, University of New
Mexico. E-mail: [email protected]
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 radiopharmacistsВґ 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: [email protected]
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 0.1micron 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 Tc99m 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%
Journal of the American Pharmacists Association
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2004 Abstracts of Contributed Papers
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:
[email protected]
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 ОІ-CFT
[(-)-2-ОІ-carbomethoxy-3-ОІ-(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)ОІ-CFT in 200 ВµL of
dimethylformamide cooled in an ice bath. The reaction mixture is heated at 70Вє 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 ВµM 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 Вµ
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]ОІCFT in a 10% ethanolic solution.
Results: Batch yields of [C-11]ОІ-CFT prepared
in this manner are 28.3 В± 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]ОІ-CFT
for PET studies of human subjects.
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-Вµm 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
(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 MANAGEMENT PROGRAM. Cuellar D, Dodd M,
University
of
New
Mexico.
E-mail:
[email protected]
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.
Conclusions: NA.
121—DEVELOPMENT AND IMPLEMENTATION 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: [email protected]
Objective: To describe and demonstrate a Webbased product that alerts consultant pharmacists to
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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.
Conclusions: NA
122—EDUCATING PHARMACY STUDENTS ABOUT END-OF-LIFE CARE
THROUGH A CLERKSHIP ROTATION.
Amerson A, University of Kentucky, Kelley D,
Hospice of the Bluegrass. E-mail: [email protected]
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 stu-
dent 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 PHARMACIST MANAGED CORONARY HEART
DISEASE RISK REDUCTION PROGRAM AT
AN AIR FORCE BASE CLINIC. Nicholson S,
Benefis Healthcare, Great Falls, Montana. E-mail:
[email protected]
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
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Annual Meeting Abstracts 2004
and laboratory visits were generally scheduled at 3month 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.
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125—SUCCESSFUL INCLUSION OF
PHARMACY PRACTICE INTO THE HOME
CARE SETTING. Macklin L, University of
Montana. E-mail: [email protected]
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 PROFESSIONAL RESPONSIBILITIES BY CERTIFIED 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 pharJournal of the American Pharmacists Association
257
2004 Abstracts of Contributed Papers
124—ESTABLISHMENT OF A PHARMACIST
CONSULTING
TEAM
FOR
STATEWIDE BIOTERRORISM PREPAREDNESS. 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:
[email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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.
Conclusions: NA.
128—CREATION, IMPLEMENTATION,
AND ASSESSMENT OF A WEIGHT MANAGEMENT ELECTIVE COURSE IN A PHARMACY CURRICULUM. Ahrens R, Ciardulli L,
Shenandoah University. E-mail: [email protected]
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.
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129—HERBAL AND SUPPLEMENT USE
IN A MILITARY HEALTH CARE SETTING
AND
THE
ASSOCIATED
DRUGHERBAL/SUPPLEMENT AND DISEASEHERBAL/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: [email protected]
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: [email protected]
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 sphygmo-
manometer. 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.
Conclusions: NA.
131—A CROSS-SECTIONAL SURVEY OF
COMMUNITY PHARMACISTS AND LEVEL
OF COMFORT IN ANSWERING QUESTIONS
ABOUT HERBS. Cormier L, Texas Southern
University. E-mail: [email protected]
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
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Annual Meeting Abstracts 2004
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.
Conclusions: NA.
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133—AN EVALUATION OF SENIOR CITIZEN PATIENT COMPLIANCE IN A COMMUNITY GROCERY CHAIN PHARMACY
AFTER INITIATING A REFILL REMINDER
SYSTEM. Morales C, Hampton K, Safeway
Pharmacy. E-mail: [email protected]
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 PROVIDE 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 Email, 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.
Conclusions: NA.
135—ANALYSIS OF THE GROWTH
TRENDS IN INDUSTRY-BASED POSTGRADUATE TRAINING PROGRAMS FOR PHARMACISTS. 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: [email protected]
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)
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2004 Abstracts of Contributed Papers
132—AN EVALUATION OF A MICROABLUMINURIA SCREENING AND EDUCATION PROGRAM IN PATIENTS WITH DIABETES IN A COMMUNITY CHAIN PHARMACY. Olbricht T, Purdue University. E-mail:
[email protected]
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 Г¬ Alb microalbumin test kit over a 12week 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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.
Conclusions: NA.
136—ANALYZING SUN-DAMAGED SKIN
AND EDUCATION ON PREVENTING
FUTURE DAMAGE. Magnus L, Walgreens. Email: [email protected]
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
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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:
[email protected]
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 PROGRAM. Akhtar A, Childress J, Berry T, St. Louis
College of Pharmacy. E-mail: [email protected]
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.
Conclusions: NA.
139—ASSESSING THE IMPACT OF PERFORMING BODY COMPOSITION ANALYSIS ON OVERWEIGHT AND OBESE INDIVIDUALS IN A COMMUNITY PHARMACY.
Paulson K, Walgreens. E-mail: kellipaulson@
yahoo.com
Objective: The primary objective of this study is
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 3month period, the patient will monitor their weight
at home. When the patient returns to the site after 3months they will have their body composition rewww.japha.org
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Annual Meeting Abstracts 2004
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.
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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:
[email protected]
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.
Conclusions: NA.
142—EFFECTS OF A PHARMACY-BASED
PHYSICAL ACTIVITY EDUCATION PROGRAM USING STEP-COUNTERS. Cole R,
Leesburg Pharmacy, Ahrens R, Shenandoah
University. E-mail: [email protected]
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 MEDICATION MANAGEMENT SERVICE BY COMMUNITY 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 indicaJournal of the American Pharmacists Association
261
2004 Abstracts of Contributed Papers
140—ASSESSMENT OF THE CONSUMER’S SELF-CARE AND OVER-THECOUNTER MEDICATION KNOWLEDGE
WITH AND WITHOUT PHARMACIST
INTERVENTION IN A COMMUNITY PHARMACY 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: [email protected]
Objective: The primary objective of this study is
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 pre-
and postprogram surveys will be compared by the
community pharmacy resident.
Results: NA.
Conclusions: NA.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 EDUCATION AND TECHNOLOGY IN A SUPERMARKET 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: [email protected]
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 4hour 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 Email 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
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will result in improvement of pharmacists’ comfort
with the CQI program and additional lowering of
near-miss and prescription incidents.
145—EVALUATING THE COST-EFFECTIVENESS 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: [email protected]
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.
Conclusions: 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: [email protected]
Objective: The purpose of this study will be to
evaluate the effect of an incentive program on
adherence rates. The study will focus on medica-
tions 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:
[email protected]
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.
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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
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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.
Conclusions: NA.
149—EVALUATION OF PHARMACY STUDENTS’ ATTITUDES AND INTEREST ON
ADMINISTERING ADULT IMMUNIZATIONS AS A HEALTH CARE SERVICE. Akala
F, Powers M, University of Toledo. E-mail:
[email protected]
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 accessi-
ble 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 EFFECTIVENESS OF COMPUTER-GENERATED MEAL
PLANNING WITH BEHAVIORAL COUNSELING SESSIONS TO PROMOTE WEIGHT
LOSS. Devizia R, Kerr Drug and Campbell
University, Greck B, Kerr Drug. E-mail:
[email protected]
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 12week 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 4week 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 KNOWLJournal of the American Pharmacists Association
263
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
EDGE BASED ON A NATIONAL STANDARDIZED EXAM. Craft K, Mehra Harris I, University
of Minnesota. E-mail: [email protected]
Objective: The objective of this study is to evaluate 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.
Conclusions: NA.
152—IMPACT ON MEN’S HEALTH: COADMINISTRATION 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:
[email protected]
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
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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 EVALUATION OF A SMOKING CESSATION PROGRAM FACILITATED BY COMMUNITY
PHARMACISTS. Wilhelm M, Balls Food Stores,
Kerner S, Balls Foods. E-mail: [email protected]
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 FAMILY 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: [email protected]
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: [email protected]
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
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Annual Meeting Abstracts 2004
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.
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157—PERFORMNG A PHARMACY CARE
SERVICE NEEDS ASSESSMENT IN AN
INDEPENDENT COMMUNITY PHARMACY.
Cinelli E, Cerulli J, Albany College of Pharmacy. Email: [email protected]
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 DIABETES 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:
[email protected]
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 melli-
tus 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.
Conclusions: NA.
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: [email protected]
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 setJournal of the American Pharmacists Association
265
2004 Abstracts of Contributed Papers
156—OUTCOMES OF A PHARMACISTMANAGED TOBACCO-CESSATION PROGRAM IN A PRIVATE, RETAIL PHARMACY
CLINIC. Haskins J, Pope N, University of Texas at
Austin. E-mail: [email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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.
Conclusions: NA.
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:
[email protected]
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
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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.
Conclusions: NA.
161—PHARMACY EXPERIENCES AND
PERCEPTIONS OF NEWLY ENROLLED
PHARMACY STUDENTS. Huh J, Sorensen T,
University
of
Minnesota.
E-mail:
[email protected]
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: [email protected]
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 3weeks 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 CANCER AWARENESS AND SCREENING IN A
RURAL COMMUNITY PHARMACY PRACTICE 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
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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.
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: [email protected]
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
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166—RETROSPECTIVE ASSESSMENT OF
LONG-TERM OUTCOMES IN A COMMUNITY-BASED PHARMACEUTICAL CARE PROGRAM. Leighty J, Eckerd Corporation, Sullivan D,
Ohio
Northern
University.
E-mail:
[email protected]
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 select-
ed 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.
Conclusions: 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:
[email protected]
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.
Journal of the American Pharmacists Association
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2004 Abstracts of Contributed Papers
164—PROVISION OF WEIGHT MANAGEMENT SERVICES BY A PHARMACIST IN A
GROCERY STORE COMMUNITY PHARMACY. Hussein S, Briggs A, Dominick’s
Pharmacy/Midwestern University, Zgarrick D,
Midwestern University. E-mail: [email protected]
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/m2. 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 2hour 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.
Conclusions: NA.
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 PHARMACIST-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:
[email protected]
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 PROGRAM TO PROMOTE CALCIUM SUPPLEMENT USE IN COMMUNITY PHARMACY.
Cinelli E, Cerulli J, Albany College of Pharmacy. Email: [email protected]
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
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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:
[email protected]
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 PHARMACISTS’ ATTITUDES TOWARDS PROVIDING
SMOKING CESSATION COUNSELING IN A
CHAIN PHARMACY SETTING. Hendrickson J,
Jackson T, University of Illinois at Chicago. E-mail:
[email protected]
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.
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
173—THE IMPACT OF PHARMACIST
CONSULTATION FOR LIFESTYLE MODIFICATION 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:
[email protected]
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
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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.
Conclusions: NA.
174—THE NORTH CAROLINA MEDICAID POLYPHARMACY INITIATIVE. Smith
K, Mission St. Joseph’s Hospital–Asheville, NC,
Bunting B, Mission St. Joseph’s/City of Asheville.
E-mail: [email protected]
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-CONTROLLED ANALGESIA WITH OR WITHOUT BASAL INFUSION FOR POSTORTHOPEDIC SURGERY PAIN MANAGEMENT.
Phan T, Luong K, Lum G, Sharp Chula Vista
Medical Center, Elington M, Sharp Memorial
Hospital–Security
Trailer.
E-mail:
[email protected]
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
Journal of the American Pharmacists Association
269
2004 Abstracts of Contributed Papers
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: [email protected]
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 12week 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.
Conclusions: NA.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
anticipate no significant difference in pain control.
Conclusions: NA.
176—THERAPEUTIC
SUBSTITUTION
WITH GENERIC LISINOPRIL: EVALUATION 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: [email protected]
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.
Conclusions: NA.
177—THROUGH A SELF-ASSESSMENT
SURVEY, AT WHAT POINT OF SEVERITY
OF SYMPTOMS, DOES AN ASTHMA
PATIENT SEEK MEDICAL CARE? Heaton R,
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Moose J, Caiola S, Brock T, Spencer S, University
of North Carolina at Chapel Hill. E-mail:
[email protected]
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-THECOUNTER DRUG USE AND MISUSE IN HIVINFECTED PATIENTS. Ngo C, Sansgiry S,
University of Houston College of Pharmacy. Email: [email protected]
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 SATISFACTION AND OUTCOMES. Michalcik L,
Randolph R, Marcrom R, University of Tennessee.
E-mail: [email protected]
Objective: The objective of this study is to evaluate 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/m2 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.
Conclusions: NA.
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
APhA–APRS Basic Sciences
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:
[email protected]
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 temperVol. 44, No. 2
March/April 2004
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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: [email protected]
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 MEDMARX 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.
Conclusions: NA.
183—A NEW ORAL OPIOID, OXYMORPHONE 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 [14CH3 Nmethyl]-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 Г— 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 14CO2 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 14CO2 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 14CO2 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-PROPORTIONALITY STUDY OF OXYMORPHONE
IMMEDIATE-RELEASE TABLETS. Adams M,
SFBC New Drug Services, Inc., Ahdieh H, Endo
Pharmaceuticals,
Inc.
E-mail:
[email protected]
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
Journal of the American Pharmacists Association
271
2004 Abstracts of Contributed Papers
180—A QUICK AND SIMPLE HPLC
METHOD FOR THE DETERMINATION OF
CRYPTOLEPINE IN A COMMERCIAL SAMPLE 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: [email protected]
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 Г— 250 mm) column. The mobile phase consisted of acetonitrile and
10 mM potassium phosphate buffer in the ratio
30:70 at pH 3 and 35В°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 (r2) 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.
atures (32В° C, 22В° C, and 4В° 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
doses of 5, 10, or 20 mg, the oxymorphone IR mean
AUC (4.5, 9.1, and 20.1 ng•h/mL, respectively) and
Cmax (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 Cmax 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 Tmax 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 Tmax 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 ANTIMICROBIAL 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:
[email protected]
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 4В°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 10Г— and 100Г— average therapeutic
serum concentrations. Cultures were anaerobically
incubated for 30 hours at 37В°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 10Г— (7.65 mcg/mL) and
100Г— (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
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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 NALTREXONE IMPLANTABLE PELLET IN OPIOID
ADDICTS. Baker J, Barr W, Virginia
Commonwealth University, Coleman P, Coleman
Institute. E-mail: [email protected]
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 ANTICOAGULATION PARAMETERS BETWEEN PATIENTS
SEEN AT A PHARMACIST-MANAGED
CLINIC AND ROUTINE MEDICAL CARE.
Conner C, Pfizer, Inc., Pauly D, Dean Medical
Center. E-mail: [email protected]
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 FUNCTIONING IN PATIENTS RECEIVING
DULOXETINE OR PAROXETINE: ACUTEAND 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. Email: [email protected]
Objective: Evaluate sexual functioning following acute- and long-term treatment with duloxetine,
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
189—DULOXETINE FOR THE TREATMENT 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. Email: [email protected]
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
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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, UHSCOM, 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: [email protected]
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 (В± 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:
[email protected]
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 lansopraJournal of the American Pharmacists Association
273
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 SERVICELEARNING–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: [email protected]
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,
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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: [email protected]
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 SYMPTOMS AMONG PATIENTS WITH A PRIOR
HISTORY OF DEPRESSION TREATED
WITH VERAPAMIL SR-LED VERSUS
ATENOLOL-LED TREATMENT STRATEGIES. Ried L, University of Florida/Department of
Veterans Affairs, Tueth M, Department of Veterans
Affairs, Handberg E, Pepine C, University of
Florida. E-mail: [email protected]
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 FACTORS AFFECTING GOAL ATTAINMENT IN
LATIN AMERICA. Alemao E, Merck and Co.,
Meaney E, Cardiovascular Unit Head, ISSSTE
Regional Hospital 1Вє 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:
[email protected]
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-equivwww.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
196—NOVEL, EPIDURAL, SUSTAINEDRELEASE 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: [email protected]
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, sustainedVol. 44, No. 2
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release 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 (В± SD)
fentanyl use versus placebo (510 В± 708 mcg versus
2,091 В± 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 В± 28 versus 52 В± 29 and 29 В± 28 versus 39 В± 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. Email: [email protected]
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 DEPRESSIVE DISORDER. Gonzales J, Detke M, Wang F,
Wiltse C, Prakash A, Wohlreich M, Eli Lilly and
Company. E-mail: [email protected]
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
Journal of the American Pharmacists Association
275
2004 Abstracts of Contributed Papers
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 (В±
SD) age was 57 (В± 12) years, 53% were female.
Median reduction in LDL-C required to attain ATPIII 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 ATPIII 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 LDLC 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 COMORBIDITIES IN DVT AND PE PATIENTS. Yin H,
University of Illinois at Chicago, Vogenberg R, Aon
Consulting. E-mail: [email protected]
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 ANALGESIA WITH SINGLE-DOSE, ENCAPSULATED
MORPHINE VERSUS STANDARD EPIDURAL 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. Email: [email protected]
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.
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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
В± 230 mcg, 261 В± 95 mcg, and 143 В± 101 mcg,
respectively, and 1,095 В± 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:
[email protected]
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 effica-
cy 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 (В± SD) total fentanyl use through
48 hours decreased from 995.1 В± 987.0 mcg to
682.5 В± 620.0 mcg, respectively, with DM 10 and
25 mg compared with 1,213.3 В± 1079 mcg and
1217.1 В± 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 DULOXETINE 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:
[email protected]
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 52week 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
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March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
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.
APhA–APRS Economic,
Social & Administrative
Sciences
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.
204—A
CONFIRMATORY
FACTOR
ANALYSIS OF THE CENTER FOR EPIDEMIOLOGIC STUDIES DEPRESSION SCALE OF
VERAPAMIL SR-LED AND ATENOLOL-LED
HYPERTENSION TREATMENT STRATEGIES. Wilson D, Mueller M, Meng X, Ried L,
University of Florida. E-mail: [email protected]
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.
Methods: A subset of consecutively randomized
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 CESD 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
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 5year 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.
Mean (В± SD) PIF (L/minute)
Age Group (years of age)
Diskus
Aerolizer
Turbuhaler
2
29.2 В± 4.1
30.5 В± 6.1
20.2 В± 2.8
3
43.8 В± 17.1
44.7 В± 10.3
37.9 В± 26
4
41.6 В± 14
51.1 В± 20.9
35.0 В± 15.8
5
51.1 В± 15.6
54.6 В± 18.3
44.6 В± 23.1
6–9
58.5 В± 18.7
65.5 В± 27.6
39.7 В± 13.2
10–12
58.6 В± 22.7
75.0 В± 28
47.9 В± 15.6
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206—A STUDY OF FACTORS RELATED
TO PATIENTS’ SHARING OF SIDE EFFECT
AND
SYMPTOM
SELF-MONITORING
INFORMATION WITH THEIR ONCOLOGISTS. Hermansen-Kobulnicky C, University of
Wyoming. E-mail: [email protected]
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,
Journal of the American Pharmacists Association
277
2004 Abstracts of Contributed Papers
203—INSPIRATORY FLOW THROUGH
DRY-POWDER INHALERS (DPI) IN ASTHMATIC CHILDREN 2 TO 12 YEARS OLD.
Monske M, McNutt DH, Raissy H, University of
New Mexico. E-mail: [email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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’ SelfEfficacy 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 PHARMACISTS 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:
[email protected]
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,
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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 В±
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:
[email protected]
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 1week 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
GLUCOCORTICOIDINDUCED OSTEOPOROSIS. McDonough R,
Doucette W, Kumbera P, Klepser D, University of
Iowa. E-mail: [email protected]
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: [email protected]
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.
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211—COLLEGE STUDENTS AND STRESS:
WHAT IS THE CONNECTION? A HUMANISTIC OUTCOMES ASSESSMENT. White A,
University of Florida, Xiao H, Florida A&M
University. E-mail: [email protected]
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, CrossSectional 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 (Вµ =
4.13), (2) preparing for examinations (Вµ = 4.11), (3)
lack of money (Вµ = 3.48), (4) schoolwork (working
on term papers, reading tedious hard material; Вµ =
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3.42), and (5) unavailable resources (Вµ = 3.18). For
women (P < .01), the five highest ranked items were
(1) parking problems (Вµ = 4.36), (2) examination (Вµ
= 4.20), (3) schoolwork (Вµ = 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 В± SD,
4.49 В± 1.23). Most did not think that DDI alerts
were a waste of time (mean В± SD, 2.14 В± 1.13).
Pharmacy managers agreed with the statement that
they had confidence in their own ability to identify
DDIs (mean В± SD, 4.91 В± 0.91) and that DDIs are
easily differentiated from other DUR alerts (mean В±
SD, 4.14 В± 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 MEDICAID 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:
[email protected]
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
Journal of the American Pharmacists Association
279
2004 Abstracts of Contributed Papers
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.
FEATURE
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 ADVERTISEMENTS TO DETERMINE NUMBER
AND SPECIFICITY OF RISK STATEMENTS.
Valluri S, Pedersen C, Ohio State University. Email: [email protected]
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.
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215—COST-EFFECTIVENESS ANALYSIS
OF A CONTRACEPTIVE PATCH: AN
EMPLOYER’S PERSPECTIVE. Patkar A,
Holdford D, Virginia Commonwealth University.
E-mail: [email protected]
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 ALTERNATIVE
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. Email: [email protected]
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 DEPRESSION SIX MONTHS AFTER INITIATING
BETA-BLOCKER TREATMENT. Taylor M,
Sauer B, Munyer T, Ried L, University of Florida.
E-mail: [email protected]
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 6month 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
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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.
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219—DETERMINANTS OF PERCEIVED
NEED AND INTENTION TO ADOPT
HEALTHIER LIFESTYLE CHOICES IN INDIVIDUALS WITH DIABETES. Maddigan S,
Institute of Health Economics/University of
Alberta, Johnson J, University of Alberta. E-mail:
[email protected]
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 RELATIONSHIP IMPORTANT? Worley-Louis M, University
of Minnesota. E-mail: [email protected]
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 ADVERTISING OF PRESCRIPTION DRUGS: MEASURING EFFECTIVENESS AND EDUCATIONAL VALUE ACROSS DIFFERENT
MEDIA. Sullivan D, Ohio Northern University.
E-mail: [email protected]
Objective: To assess the educational value, information, understandability, and consumer attitudes
toward direct-to-consumer (DTC) advertising in
television, print, and Internet ads.
Journal of the American Pharmacists Association
281
2004 Abstracts of Contributed Papers
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: [email protected]
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.
Methods: A subset of consecutively randomized
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 SF36. 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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
В± SD = 4.44 В± 1.29 and 4.51 В± 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 В± 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 В± SD 4.36 В± 1.40) and in
magazines/newspapers (mean = 4.19 В± 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
В± SD = 3.64 В± 1.37) than television ads (mean В± SD
= 3.42 В± 1.38) (t = 2.54, df = 172, P = .012).
Conclusions: NA.
222—DISABILITY IN STROKE OUTCOMES RESEARCH. Kwon S, Hartzema A,
Duncan P, University of Florida, Lai S, University
of
Kansas
Medical
Center.
E-mail:
[email protected]
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
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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’ MEDICATION USE BELIEFS AND PERCEIVED ABILITIES VARY BY ACTUAL, PREFERRED,
AND POTENTIAL SOURCES OF MEDICATION HELP? Worley-Louis M, University of
Minnesota, Hermansen-Kobulnicky C, University
of Wyoming. E-mail: [email protected]
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. Email: [email protected]
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 CAROLINA. Trygstad T, Christensen D, University of
North Carolina at Chapel Hill, Thorpe J,
AccessCare Inc. E-mail: [email protected]
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
226—EFFECT OF AN AUTOMATED PRESCRIPTION FILLING SYSTEM AND
INSPECTION ENHANCEMENT TOOL ON
DISPENSING ACCURACY. Flynn E, Barker K,
Auburn University. E-mail: [email protected]
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 pharVol. 44, No. 2
March/April 2004
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macy. 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 INSTRUCTIONAL DESIGN OF A WEB-ENHANCED PROGRAM FOR TEACHING THE PRACTICE OF
PHARMACEUTICAL CARE. Droege M, Nova
Southeastern University. E-mail: [email protected]
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 DISEASE. 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 1year 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.
Journal of the American Pharmacists Association
283
2004 Abstracts of Contributed Papers
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 6month 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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
229—EXAMINING THE RELATIONSHIPS
WITHIN AND PRESENCE OF THE SERVICE
PROFIT CHAIN IN INDEPENDENT COMMUNITY PHARMACY. Bonnarens J, University of
Wisconsin–Madison, Wilkin N, University of
Mississippi Medical Center, McCaffrey D, Garner
D,
University
of
Mississippi.
E-mail:
[email protected]
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 evaluat-
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ed, 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 BARGAINING POWER OF DRUG-PURCHASING
GROUPS IN THAILAND. Ngorsuraches S,
Saichol S, Faculty of Pharmaceutical Sciences,
Prince
of
Songkla
University.
E-mail:
[email protected]
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 nbutylbromide 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 UTILIZATION OF NEW PRESCRIPTION DRUGS.
Agarwal S, Ye X, Cline R, University of Minnesota.
E-mail: [email protected]
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.
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
234—FUNCTIONAL HEALTH LITERACY
AMONG CHINESE POPULATION IN CHICAGO. Ko Y, University of Arizona, Lin S, Salmon J,
Crawford S, University of Illinois at Chicago. Email: [email protected]
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.
Vol. 44, No. 2
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Methods: A convenience sample of Chinese
adults was recruited in the city of Chicago in May
2003. A sociodemographic questionnaire and the STOFHLA 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 NONELDERLY INDIVIDUALS. Agarwal S, Zhang D,
Schondelmeyer S, University of Minnesota. E-mail:
[email protected]
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: [email protected]
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
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2004 Abstracts of Contributed Papers
233—FORECASTING THE IMPACT ON
COX-2 NSAID UTILIZATION IN A MEDICAID PROGRAM USING PRIOR AUTHORIZATION CRITERIA. Vuchetich P, Juracek J,
Jorgensen A, Creighton University. E-mail:
[email protected]
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 COX2–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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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:
[email protected]
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.
Conclusions: NA.
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
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Damien Center), Thomas J, Purdue University,
School of Pharmacy and Pharmacal Sciences. Email: [email protected]
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 В± 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 В± 10.8) and depression (45.0 В± 12.0).
Participants also had lower MCS scores than individuals with hypertension (52.2 В± 9.3) and diabetes
(51.9 В± 9.5). In multivariate analyses, employment
and higher social support were positively associated
with PCS scores (P <.05) and nonadherence was
negatively associated with MCS scores (P <.05).
Conclusions: Participants had significantly
lower HRQOL scores compared with population
norms, poorer physical health than patients with
hypertension and depression, and poorer mental
health than patients with hypertension and diabetes.
Employed participants and those with higher social
support had higher PCS scores. Participants reporting higher nonadherence had lower MCS scores.
Identifying strategies for increasing social support
and adherence for economically disadvantaged persons with HIV/AIDS may improve their HRQOL.
239—HIPAA COMPLIANCE PROCEDURES: IMPACT AND PERCEPTIONS
AMONG COMMUNITY PHARMACISTS.
Kavookjian J, Mamidi S, West Virginia University.
E-mail: [email protected]
Objective: New Health Insurance Portability and
Accountability Act of 1996 (HIPAA) compliance
regulations became effective in April 2003 for the
purpose of ensuring security of patient health information (PHI). The regulations call for training,
compliance procedures (CPs), and potential equipment that may pose burdens on community pharmacies. The objectives of this pilot study were to
explore and describe the state of HIPAA CPs in
community pharmacy, including impact of train-
ing/staffing issues, privacy statements and compliance methods, the burden of time spent gaining
patient consent, patient reactions to new HIPAA
CPs, and pharmacy staff utilization and perception
of HIPAA CPs.
Methods: The study was exploratory and
descriptive; it included an examination of HIPAA
regulations literature and open-ended interviews
with eight community pharmacists in four types of
practice settings (chains, independents, grocery
stores, mass merchandise stores). A semistructured
interview protocol was generated, pretested, and
implemented via 96 telephone interviews among
community pharmacists in West Virginia,
Pennsylvania, and Ohio. Pharmacists were identified through semirandom selection, with eight pharmacies representing each of the four categories per
state. Analyses included descriptive statistics and
ANOVA.
Results: Respondent pharmacists were 61.8%
women, had been practicing an average 13.16 years,
and experienced an average daily prescription volume of 206. Nearly all staff (96.8%) were HIPAA
trained at the time of the study, predominantly using
in-store computerized training. All pharmacies had
HIPAA CPs in place, including logbook or electronic signature “box”. Time spent explaining privacy to patients was a mean 1.81 minutes, conducted
an average 31.16 times per day. 42.2% of pharmacists agreed that HIPAA CPs took time away from
patient counseling, with independent pharmacists
being more concerned about this than chain pharmacists. Most patients were receptive; some were
appreciative. Pharmacist and staff reaction was
mixed, with the cons for HIPAA CPs being more
salient than the pros.
Conclusions: These findings suggest implications for future research to expand the study of the
impact of HIPAA compliance procedures, and could
perhaps lay the groundwork for exploration of cost
impact variables in community pharmacy.
240—HYPERTENSION
OUTCOMES
THROUGH BLOOD PRESSURE MONITORING AND EVALUATION BY PHARMACISTS
(HOME STUDY). Zillich A, Purdue University,
Carter B, University of Iowa, Kumbera P, Outcomes
Pharmaceutical health Care. E-mail: [email protected]
Objective: To evaluate the effectiveness of a
community pharmacist–based home blood pressure
monitoring program.
Methods: This was a randomized, controlled trial
conducted in 12 community pharmacies. Six intervention pharmacies provided a pharmacist-based
home blood pressure (BP) monitoring program. Six
additional pharmacies served as control sites.
Patients with uncontrolled BP were eligible to participate. The program comprised four face-to-face
visits with a trained pharmacist. Pharmacists provided patient specific education about hypertension
including: (1) disease process and complications,
(2) medication use and adherence, (3) lifestyle modification, and (4) proper home BP monitoring.
Following the first and third visits, patients were
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241—IMPACT OF MEDICATION MANAGEMENT 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: [email protected]
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
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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:
[email protected]
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: [email protected]
Journal of the American Pharmacists Association
287
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 CHOICES: RESULTS OF A SURVEY IN MINNESOTA. Cline R, Farley J, University of Minnesota,
Hansen R, University of North Carolina at Chapel
Hill, Schommer J, University of Minnesota. E-mail:
[email protected]
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
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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, PERCEPTIONS ON PERFORMANCE AND SATISFACTION WITH PHARMACIST DIRECTIVE
GUIDANCE. Stroud L, Bharmal M, Thomas J,
Purdue University. E-mail: [email protected]
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 4week 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 CONDITIONS BASED ON TRANSTHEORETICAL
MODEL READINESS STAGE OF CHANGE
PROFILES FOR SELF-MANAGEMENT.
Sankaranarayanan J, Mason H, Purdue University.
E-mail: [email protected]
Objective: To determine the: (1) distribution of
readiness stages for Transtheoretical Model
Readiness Stage of Change Profiles for SelfManagement (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
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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.
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249—PDA PRESCRIBING IN OUTPATIENT SETTINGS: BARRIERS AND SOLUTIONS. 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:
[email protected]
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 MANAGEMENT: A CASE OF IDENTIFYING AND
RESOLVING DRUG-RELATED PROBLEMS
IN THE COMMUNITY. Klepser D, Doucette W,
McDonough R, McCarthy R, University of Iowa. Email: [email protected]
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: [email protected]
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 =
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248—PATIENTS’ EVALUATION OF CARE
FOLLOWING A DENIAL OF AN ADVERTISEMENT-RELATED
PRESCRIPTION
DRUG REQUEST: THE ROLE OF EXPECTATIONS, SYMPTOM SEVERITY AND PHYSICIAN DECISION-MAKING STYLE. Shah M,
Bentley J, McCaffrey D, University of Mississippi.
E-mail: [email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 В± SD = 3.85 В± 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 В± 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’ ORGANIZATIONAL COMMITMENT: AFFECTIVE, CONTINUANCE, AND NORMATIVE. Kahaleh A, Ohio
Northern University, Gaither C, University of
Michigan. E-mail: [email protected]
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 В± 1.8. Also, 67% of the pharmacists indicated that they are willing to spend the rest
of their careers with their organizations, 51% said
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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 DEVELOPING
COLLABORATIVE
WORKING
RELATIONSHIPS WITH PHYSICIANS.
Nevins J, McDonough R, Doucette W, University of
Iowa. E-mail: [email protected]
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
R2 = 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 IMMUNIZATION 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: [email protected]
Objective: The objective was to determine
human factors (attitudes, beliefs, and abilities) assowww.japha.org
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256—PHYSICIAN ATTITUDES TOWARD
DIRECT-TO-CONSUMER ADVERTISING OF
PRESCRIPTION DRUGS: A CONTENT
ANALYSIS OF OPINION-BASED PUBLICATIONS. Zhang D, Carlson A, University of
Minnesota. E-mail: [email protected]
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
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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:
[email protected]
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–COMPARISONS BETWEEN LOGISTIC REGRESSION
AND CHAID MODELS. Lin S, Tan H, University
of Illinois at Chicago. E-mail: [email protected]
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 SATISFACTION AND COMMITMENT TO THEIR
PHARMACY SCHOOL. Holdford D, Patkar A,
Virginia Commonwealth University. E-mail:
[email protected]
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 5point Likert scale was selected to assess seven
Journal of the American Pharmacists Association
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2004 Abstracts of Contributed Papers
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.
FEATURE
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 (R2 =
.619) and school commitment (R2 = .307). Courses
had the greatest impact on perceived value (R2 =
.384) and willingness to serve (R2 = .200) and significant influence on overall satisfaction (R2 = .101)
and school commitment (R2 = .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 PHARMACIST CONSULTATION PROGRAM FOR
FAMILY PHYSICIANS AND THEIR ELDERLY 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: [email protected]
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.
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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 MEDICARE 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 PATTERNS 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:
[email protected]
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: 75item 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.
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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.
264—SURVEY OF PHARMACY STUDENT
WORK EXPERIENCE. Siracuse M, Creighton
University, Schondelmeyer S, Hadsall R,
Schommer J, University of Minnesota. E-mail:
[email protected]
Objective: The objective of this study was to survey pharmacy students to determine the type of
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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: [email protected]
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
Journal of the American Pharmacists Association
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2004 Abstracts of Contributed Papers
263—RESPONSE QUALITY OF INFORMATION 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: [email protected]
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.
enced 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.
Conclusions: NA.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 ENDSTAGE RENAL DISEASE IN FLORIDA MEDICAID PATIENTS. White A, University of
Florida, Odedina F, Florida A&M University. Email: [email protected]
Objective: The purpose of this study was to
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.
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268—THE EFFECT OF DIRECT-TO-CONSUMER ADVERTISING ON PRESCRIPTION
DRUG USE AMONG THE INSURED. Hansen
R, University of North Carolina at Chapel Hill,
Schommer J, Cline R, University of Minnesota. Email: [email protected]
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-CONSUMER AD CONTENT ON BELIEF TENACITY: 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) Г— 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: [email protected]
Objective: To assess the impact of pharmacists’
position on antecedents and consequences of psychological and structural empowerment.
Methods: The study has a cross-sectional design.
Self-administered questionnaires were mailed to a
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 knowlwww.japha.org
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Vol. 44, No. 2
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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.
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272—THE EXPERIENCE OF COMMUNITY PHARMACISTS WITH MEDICATION
INTENDED FOR USE IN PRIMARY AND
SECONDAY SCHOOLS. Reutzel T, Holtorff M,
Midwestern University Chicago College of
Pharmacy. E-mail: [email protected]
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 COMMUNITY PHARMACISTS ON MULTIPLE CONSUMER 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: [email protected]
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
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2004 Abstracts of Contributed Papers
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.
Methods: The study has a cross-sectional design.
Self-administered questionnaires were mailed to a
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 CLINICAL GUIDELINES AND DIABETES MEDICATION ADHERENCE AMONG MANAGED
CARE ENROLLEES. Chao J, University of
Michigan, Nau D, University of Michigan, Aikens
J,
University
of
Michigan.
E-mail:
[email protected]
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
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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: [email protected]
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) Г— 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, per-
ceived 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 RELEVANCE AND RELIABILITY IN DIRECTTO-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 relwww.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
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.
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,
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280—TRENDS IN PRESCRIPTION COST
SHIELDING FOR MEDICARE BENEFICIARIES BY DRUG COVERAGE: 1994 TO 1999.
Kreling D, Mott D, Chou C, University of
Wisconsin–Madison.
E-mail:
dhkreling@
pharmacy.wisc.edu
Objective: The objective of this study was to
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: [email protected]
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
Journal of the American Pharmacists Association
297
2004 Abstracts of Contributed Papers
278—THEORY OF PLANNED BEHAVIOR
AND WOMEN’S DECISIONS ABOUT HORMONE-REPLACEMENT THERAPY. Huston S,
Kirking D, Shimp L, University of Michigan,
Bagozzi
R,
Rice
University.
E-mail:
[email protected]
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.
Ziemer D, Caudle J, Emory University. E-mail:
[email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 ADVERTISING OF PRESCRIPTION VERSUS NONPastakia
S,
PRESCRIPTION
DRUGS.
Wertheimer A, Temple University. E-mail:
[email protected]
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.
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283—PREVALENCE OF ANTIDEPRESSANT USE IN CHILDREN AND ADOLESCENTS: 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:
[email protected]
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 INDUSTRY BASED ON RECENT CAFC CASE LAW.
Rumore M, Scully, Scott, Murphy & Presser. Email: [email protected]
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: [email protected]
Objective: The objective of this study was to
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
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March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
286—LEGAL, ECONOMIC AND ETHICAL
ISSUES INVOLVING REIMPORTATION OF
DRUGS. Djuric M, University of Illinois at
Chicago. E-mail: [email protected]
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 pharVol. 44, No. 2
March/April 2004
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macy: 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. Email: [email protected]
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 DIRECTTO-CONSUMER PRESCRIPTION DRUG
ADVERTISING REGULATION. Palumbo F,
Mullins C, University of Maryland at Baltimore. Email: [email protected]
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
Journal of the American Pharmacists Association
299
2004 Abstracts of Contributed Papers
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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: [email protected]
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.
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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: [email protected]
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 PRINTED MATERIALS ABOUT THE PURSUIT OF
HEALTH AT MINERAL SPRINGS. Lane A,
University
of
Wyoming.
E-mail:
[email protected]
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:
[email protected]
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:
[email protected]
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
www.japha.org
March/April 2004
Vol. 44, No. 2
Annual Meeting Abstracts 2004
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-ToBac, 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.
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297—JAMES O. MAY, CONNECTICUT
DRUGGIST AND ENTREPRENEUR. Brodeur
D,
Sacred
Heart
University.
E-mail:
[email protected]
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: [email protected]
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 mid1930s, 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. Email: [email protected]
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 PHARMACY IN OUACHITA PARISH, LOUISIANA.
Sirmans S, University of Louisiana at Monroe. Email: [email protected]
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
Journal of the American Pharmacists Association
301
2004 Abstracts of Contributed Papers
295—COD AND THE CONSUMPTIVE: A
HISTORY OF COD-LIVER OIL IN THE
TREATMENT OF PULMONARY TUBERCULOSIS. Grad R, University of Alabama at
Birmingham. E-mail: [email protected]
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, PHARMACIST,
ENTREPRENEUR,
PHILANTHROPIST. Henderson M, Independent Scholar,
Worthen D, Lloyd Library and Museum. E-mail:
[email protected]
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.
FEATURE
FEATURE
Annual Meeting Abstracts 2004
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 NorthSouth 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 THERAPY. Warren F, University of Georgia, Ali M, Emory
University. E-mail: [email protected]
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:
[email protected]
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
302
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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.
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.
303—THE PROVENANCE OF THE
MEDICINA PENSYLVANIA, CA. 1770. Wilson
R,
Johns
Hopkins
University.
E-mail:
[email protected]
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.
305—THE TRADING WITH THE ENEMY
ACT OF 1917 AND ITS AFFECT ON DRUG
REGULATION. Cooper D, Independent Scholar.
E-mail: [email protected]
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.
304—THE ROACH DRUGSTORE, WASHINGTON, D.C. Jentsch E, National Museum of
American History. E-mail: [email protected]
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
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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