Pharmacists' Perceptions of the Economic Value of Compounded Pharmaceuticals: A Comparison of Compounded and Commercial Pharmaceuticals in Select Disease States.

Studies have been conducted to assess patient satisfaction with compounded pharmaceuticals and to directly compare compounded pharmaceuticals with their comparable commercial pharmaceuticals. Yet, the economic value of or potential for economic value derived from compounded pharmaceuticals relative to commercial pharmaceuticals is still not known. Therefore, the purpose of this study was to assess and compare compounding and non-compounding pharmacists' perceptions of the economic value of compounded preparations relative to commercial products. In-depth interviews with 10 compounding pharmacists and physicians who prescribe compounded prescription pharmaceutical preparations were conducted to help develop a self-administered questionnaire distributed to 50 compounding and 50 non-compounding pharmacists. Compounding and non-compounding pharmacists' perceptions differed most often in the context of compounded pharmaceuticals for pediatric patients. However, both groups responded with moderate agreement that compounded prescription treatments are more profitable for the pharmacy than commercial prescription treatments in most therapeutic areas. This research sought to understand the perception of pharmacists of areas for potential direct and indirect economic cost savings as a result of compounding. For all items whereby compounding and non-compounding pharmacists' ratings were significantly different, compounding pharmacists more strongly believed that compounding pharmaceuticals offered benefit and vice versa. The differences in ratings that were most common were those that directly compared the economic value of compounding and commercial pharmaceuticals, with compounding pharmacists more strongly agreeing with the potential cost savings associated with compounded pharmaceuticals. Based on these findings, prescription compounds are believed to have a benefit to the health system by those who provide them. Future research should proactively explore the economic benefit of compounded preparations compared to conventionally manufactured products to determine the economic value of compounded pharmaceuticals for patients, pharmacies, physicians, and the healthcare system.

The influence of symbols on the short-term recall of pharmacy-generated prescription medication information in a low health literate sample.

The effect of symbols on conveying health information has been studied in a variety of contexts and populations. This investigation assessed whether short-term recall of prescription medication information could be enhanced in a low health literate population through the use of symbols. Participants recruited from various nonpharmacy educational service locations were randomly assigned to receive a prescription medication information leaflet in either a text-only, text with symbols, or symbols-only format and then administered the Rapid Estimate of Adult Literacy in Medicine (REALM). Only those with REALM scores indicative of a sixth grade or lower reading level were included in data analysis. An 8-item, interviewer-administered questionnaire was used to assess participants' recall of information contained in the leaflet. A fictitious medication was used to control for participants' past experiences with medications. Results of statistical testing revealed that the three groups did not differ with respect to their ability to recall the medication information, F(2, 157) = 0.943, p = .392. The symbols used in this investigation were not found to enhance the short-term recall of the medication information presented. These findings should not be considered a wholesale indictment of the use of symbols within health care and in pharmacies. Rather, they should serve as a caution to their widespread use without careful consideration.

Instrument to measure psychological contract violation in pharmacy students.

OBJECTIVES: To adapt and evaluate an instrument that measures perceived psychological contract violations in pharmacy students by schools and colleges of pharmacy. DESIGN: A psychological contract violations measure was developed from existing literature and the 1997 ACPE Guidelines and pilot-tested with second-year pharmacy students at 2 schools of pharmacy. A revised measure then was administered to second-year pharmacy students at 6 schools of pharmacy. Using a 5-point Likert-type scale, participants were asked to indicate the level of obligations they received compared to what was promised by the school of pharmacy. RESULTS: Exploratory factor analysis on the psychological contract violations measure was conducted using principal components analysis resulting in 7 factors, which led to a revised measure with 26 items. Using a sample of 339 students, the proposed 7-factor measurement model was tested using confirmatory factor analysis. In general, the results supported the hypothesized model. The final 23-item scale demonstrated both reliability and validity. Some students perceived certain aspects of the psychological contract that exists with their school of pharmacy were being violated. CONCLUSION: The psychological contract violations measure may serve as a valuable tool in helping to identify areas where their students believe that schools/colleges of pharmacy have not fulfilled promised obligations.

Nonadherence to angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers among high-risk patients with diabetes in Medicare Part D programs.

OBJECTIVES: To identify predictors of nonadherence to angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs) and to assess the association between nonadherence to ACEIs/ARBs and potentially avoidable hospitalizations (PAHs) among elderly high-risk patients with diabetes. METHODS: Medicare Part D enrollees from six states who had diabetes and coexisting hypertension and/or renal disease, were aged 65 years or older, and who had filled at least one prescription for ACEIs/ARBs in the first 6 months of 2006 were included in this retrospective cohort study. The primary outcomes of interests were patient nonadherence to ACEI/ARB therapy, which was defined as a proportion of days covered (PDC) less than 0.8 and PAH for diabetes during the patient follow-up period (July 1, 2006, to March 31, 2007). RESULTS: A total of 599,141 patients (mean [+/-SD] age 75.6 +/-7.3 years, 66% women, 63% white, 15% black, and 9% Hispanic) were included. Among them, 46% were nonadherent to ACEI/ARB therapy and 6.3% had a PAH during the follow-up period. In multivariate logistic regressions, patients with diabetes and both hypertension and renal disease and patients with diabetes and renal disease only were 24% and 15% more likely, respectively, to be nonadherent to ACEI/ARB therapy compared with patients with diabetes and hypertension. Black and Hispanic patients were also more likely to be nonadherent to ACEI/ARB therapy. Nonadherence to ACEI/ARB therapy was associated with a 5% increase in the likelihood of PAH. CONCLUSION: Adherence to ACEI/ARB therapy is suboptimal among elderly high-risk patients with diabetes enrolled in Medicare Part D programs from six states, and nonadherence to ACEIs/ARBs is associated with a slightly increased risk for PAH.

High-risk diabetic patients in Medicare Part D programs: are they getting the recommended ACEI/ARB therapy?

BACKGROUND: Diabetes patients with hypertension and/or renal disease are at an increased risk of cardiovascular morbidity and mortality. Clinical evidence suggests that the use of ACEI/ARB for these patients improves patient outcomes. OBJECTIVE: To describe ACEI/ARB utilization among high-risk patients with diabetes and to identify patient characteristics that predict suboptimal utilization of ACEI/ARB. DESIGN: A retrospective cohort study. PATIENTS: Diabetic patients with coexisting hypertension and/or renal disease with continuous Medicare coverage from October 1, 2005 through June 30, 2006 in six states (Alabama, California, Florida, Mississippi, New York, and Ohio). INTERVENTIONS AND MEASUREMENTS: Any ACEI/ARB use during the first 6 months of 2006. RESULTS: A total of 1,250,466 Medicare Part D enrollees met our inclusion criteria. ACEI/ARB utilization rates were 63%, 58.3%, and 43.1% among diabetic patients with hypertension and renal disease, hypertension without renal disease, and renal involvement without hypertension, respectively. After adjusting for all other characteristics studied, patients in the hypertension only (OR 0.83; 95% CI: 0.82-0.84) and renal disease only (OR: 0.48; 95% CI: 0.46-0.50) risk groups were less likely to use ACEI/ARB compared to diabetes patients with both hypertension and renal disease. Several demographics, including male gender, age older than 65, and white race, were all predictors of suboptimal ACEI/ARB use. Results from state-specific analyses are consistent with those for all six states. CONCLUSION: In this cohort, less than 60% of high-risk patients with diabetes were receiving the recommended ACEI/ARB therapy. Several patient demographic and clinical characteristics are strongly associated with suboptimal ACEI/ARB use.

Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: a retrospective cohort study.

OBJECTIVES: This study examined the prevalence of nonadherence with oral hypoglycemic agents, antihypertensive drugs (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]), and statin medications among Medicare Part D enrollees with diabetes and analyzed the potential demographic and clinical factors that predict medication nonadherence. METHODS: This was a retrospective cohort study of Medicare Part D enrollees with diabetes from 6 states (Alabama, California, Florida, Mississippi, New York, and Ohio). Adherence was calculated as the proportion of days covered (PDC; number of days with medication on hand/number of days in the specified time interval). A PDC was derived for each of the 3 categories of medications for patients who had at least 1 claim for the same class of medication. A comorbidity measure was created for each beneficiary using the Deyo-adapted Charlson Comorbidity Index (CCI). Associations between nonadherence and patient characteristics including age, sex, race/ethnicity, and Deyo-adapted CCI were examined. Logistic regression models were constructed to identify predictors of nonadherence. RESULTS: The study included 1,888,682 patients with diabetes. The mean (SD) age was 71.6 (11.6) years, and 59.5% (1,123,220/1,888,682) were female. A total of 66.4% (1,254,538/1,888,682) were white, 16.3% (308,158/1,888,682) were black, and 7.8% (147,498/1,888,682) were Hispanic. Estimated rates of non-adherence for oral hypoglycemic agents, ACEIs/ARBs, and statins were 35.1% (386,666/1,101,533), 41.8% (449,561/1,075,285), and 46.4% (447,106/962,877), respectively. In unadjusted analyses, patients aged <65 years, women, black or Hispanic patients, and patients with higher Deyo-adapted CCI were more likely to be nonadherent to all 3 classes of medications. The results were consistent in multivariate analyses, and all results were statistically significant at P < 0.001. CONCLUSIONS: In this study of Medicare Part D enrollees with diabetes, patients aged <65 years, women, black or Hispanic patients, and those with higher comorbidity scores were more likely to be nonadherent to medications. Interventions should be developed to improve medication adherence among these subgroups so that patients can achieve the full benefits of prescribed pharmacologic therapies.

The effect of DTC advertisement content on belief tenacity: a study of appeals and argument types.

BACKGROUND: Direct-to-consumer advertising (DTCA) has an influence on patients' perceptions, awareness, and behaviors. Inoculation theory and the model of belief processing provide insights into cognition that stand to increase our understanding of how patients process the information presented in these advertisements and form beliefs about medications. OBJECTIVE: This study was conducted to evaluate the effect of sidedness of appeals and argument types in understanding beliefs that are formed after exposure to advertisements. DTCA and negative experiences were used to study these constructs. METHODS: A 2 (1-sided vs 2-sided appeals) x 2 (causal vs authoritative arguments) factorial study design was used. A total of 263 undergraduate students were assigned to view 1 of the 4 mock flu-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 intent to inquire, and standardized price change. Data were analyzed using 2-way analysis of variance. RESULTS: Subjects exposed to 2-sided appeals showed lower belief change, standardized price change, and change in intent to inquire following a negative experience than subjects exposed to 1-sided appeals (P<.05). No significant difference was found between subjects who received causal arguments and those who received authoritative arguments. A significant interaction effect was observed between sidedness of appeal and argument type on initial belief and initial intent to inquire. 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 2-sided appeals increase the tenacity of consumers' beliefs. Higher initial belief and intent to inquire when causal arguments are used in 2-sided promotional messages suggest that use of data to substantiate claims in advertisements may result in enhanced beliefs about the merits of advertised medication.

The predictive utility of nontraditional test scores for first-year pharmacy student academic performance.

OBJECTIVES: To determine the value of employing the Learning and Study Strategies Inventory (LASSI), Defining Issues Test (DIT), and Watson-Glaser Critical Thinking Appraisal (WGCTA) in predictive models for first-year pharmacy student academic performance. METHODS: Six years of pharmacy student admission and progression data were evaluated. Additional predictive validity offered by these variables over a model of prepharmacy grade point average and pharmacy college admission test (PCAT) score was examined. RESULTS: None of the 3 measures offered the ability to predict first-semester or first-year academic performance over and above GPA and PCAT. CONCLUSIONS: The LASSI, DIT, and WGCTA do not appear to assess abilities that are directly related to academic performance; however, these instruments may be useful in assessing other student attributes that are highly desirable for the practice of pharmacy.

Patient evaluations of pharmacist performance with variations in attire and communication levels.

OBJECTIVE: To determine whether the attire of a pharmacist has any effect on how he is evaluated when a patient also considers the pharmacist's performance and to assess whether attire and performance interact to influence patients' evaluations. DESIGN: Randomized, cross-sectional, three-factor design. SETTING: Community pharmacy settings were portrayed. PARTICIPANTS: 179 university staff members. INTERVENTIONS: Videos of pharmacist-patient interactions were encoded and placed on a Web site to be viewed by participants. MAIN OUTCOME MEASURES: Service encounter satisfaction, perceptions of overall service quality, trust in the service provider, and behavioral intentions based on two levels of pharmacist communication performance (high or adequate), three levels of dress style (casual, business casual, formal), and two levels of white coat (wearing or not). RESULTS: Of the three independent variables, only communication performance was found to significantly influence the dependent variables. High communication performance resulted in higher satisfaction scores, higher perceptions of quality, higher levels of trust, and behavioral intention scores that reflected a greater willingness to use and recommend the pharmacist. CONCLUSION: Style of dress or whether the pharmacist was wearing a white coat did not significantly influence participants' evaluations of the pharmacist in this study. Rather, the level of the pharmacist's communication performance was the most important cue used by participants in their ratings of service encounter satisfaction, perceptions of overall service quality, and trust in the service provider.

Direct-to-consumer advertising via the Internet: the role of Web site design.

BACKGROUND: Recent attempts to propose criteria for judging the quality of pharmaceutical and healthcare Web sites do not distinguish between attributes of Web site design related to content and other attributes not related to the content. OBJECTIVES: The Elaboration Likelihood Model from persuasion literature is used as a framework for investigating the effects of Web site design on consequents like attitude and knowledge acquisition. METHODS: A between-subjects, 2 (high or low involvement)x2 (Web site designed with high or low aspects of visual appeal) factorial design was used in this research. RESULTS: College students were randomly assigned to these treatment groups yielding a balanced design with 29 observations per treatment cell. Analysis of variance results for the effects of involvement and Web site design on attitude and knowledge indicated that the interaction between the independent variables was not significant in both analyses. Examination of main effects revealed that participants who viewed the Web site with higher visual appeal actually had slightly lower knowledge scores (6.32) than those who viewed the Web site with lower visual appeal (7.03, F(1,112)=3.827, P=.053). CONCLUSIONS: Results of this research seem to indicate that aspects of Web site design (namely aspects of visual appeal and quality) may not play a role in attaining desired promotional objectives, which can include development of favorable attitudes toward the product and facilitating knowledge acquisition.

Role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness.

The role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness was studied. Study participants were recruited from three primary care clinics. They were provided a pharmacy scenario that contained information that could be used to form causal and authoritative arguments. The participants rated the trustworthiness of the pharmacist in the scenario on a 10-point, Likert-type scale and provided the arguments used to form the trustworthiness belief. Information that contradicted the pharmacist's trustworthiness was then presented in the form of an addendum, and the participants reassessed the pharmacist's trustworthiness. Participants rated the pharmacist using a Likert-type scale. Responses were coded and analyzed. Initial trustworthiness and post-trustworthiness scores were calculated. Participants' pharmacy experience score was also determined. Reliability and principal components analyses were conducted to determine the quality of the trustworthiness and pharmacy experience scores. A total of 130 patients participated in the study. There was a positive correlation between pharmacy experience and the number of causal arguments that subjects used to form their beliefs about pharmacist trustworthiness (r = 0.223, p = 0.012). Results of t tests revealed that belief strength was similar among subjects using more causal than authoritative arguments to form beliefs and in those using fewer causal arguments (t = 1.35, p = 0.179), but belief tenacity differed significantly between the groups (t = -2.303, p = 0.023). The role of external sources in influencing the formation of beliefs about trustworthiness of a pharmacist may be limited as a patient gains pharmacy experience, as experience is based on causal associations. Moreover, causal arguments are correlated with belief tenacity.

Understanding how patients form beliefs about pharmacists' trustworthiness using a model of belief processing.

OBJECTIVE: To determine what information people use in forming beliefs about pharmacists' trustworthiness and to determine whether these pieces of information can be categorized using elements of a model of belief processing. DESIGN: Participants in two focus groups were asked about the trustworthiness of pharmacists in one dispensing scenario and two pharmaceutical care scenarios. Transcripts were analyzed, and each piece of information provided was coded as an evidence statement or a claim, according to a model of belief processing. SETTING: University campus. PARTICIPANTS: University staff and students. MAIN OUTCOME MEASURES: Information used to form beliefs about pharmacists' trustworthiness and classification of the information using constructs from the model of belief processing. RESULTS: Coders identified 92 evidence statements and 19 claims. An evaluation of the data across the scenarios using predetermined criteria showed 20 evidence statements and 11 claims to be the most salient pieces of information used to form beliefs about pharmacists' trustworthiness. In considering the pharmaceutical care scenarios, participants focused more on communication and interpersonal skills when forming a trustworthiness belief. The information could be categorized as evidence statements or claims, which are parts of arguments as described by a model of belief processing. CONCLUSION: The study participants used the pharmacists' credentials, communication skills, personableness, and appearance to form trustworthiness beliefs. Overall, they wanted pharmacists to be honest, knowledgeable, and caring. Variables used to form trustworthiness beliefs represent different levels of abstraction that can be detected and coded using a model of belief processing.