Comparing South Dakota Pharmacist Perspectives of Pharmacy Services in Rural versus Urban settings.

Background: Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. Objective: The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. Methods: This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. Results: Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. Conclusions: Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Pharmacists' perceived barriers providing non-dispensing services to underserved populations.

Pharmacists have shown to increase clinical and humanistic outcomes in medically underserved populations through non-dispensing services. Limited information is available regarding the pharmacy workforce's involvement and ability to serve in this role. The objectives were to measure the proportion of pharmacists working with underserved populations and to assess barriers they encountered when trying to assist. 363 licensed Ohio pharmacists responded to an electronic survey between December 2011 and March 2012 (response rate 19.7 %). The survey assessed personal and environmental barriers that prevent pharmacist involvement with underserved populations using 5-point Likert scales. Multiple logistic regressions identified barriers that influenced pharmacists' involvement in providing non-dispensing services to underserved populations. 43 % of respondents were assisting underserved populations mostly in their place of work (83 %). Environmental barriers were indicated to effect pharmacists most. Uninvolved pharmacists most agreed with environmental barriers of "Hesitant to volunteer before knowing commitment", "Never approached to assist", and "Not enough time during shifts". Logistic regression 1 incorporated all pharmacists and indicated barriers of "Not interested in this area of work" (OR = 0.589) and "Unsure where to volunteer" (OR = 0.660) as significant. Logistic regression 2 was limited to pharmacists with access to patients at place of work and indicated "Not interested in this area of work" (OR = 0.443), "Employer never approached to assist" (OR = 0.557), "No time during work shifts" (OR = 0.537), and "Work location low underserved accessibility" (OR = 0.487) as significant predictors. More pharmacists might become engaged as volunteers. Increasing communication between community and pharmacists may reduce reported volunteering barriers.

Understanding awareness of pharmacist-led medication therapy management among primary care physicians in New York City, Part II: Findings and implications.

Pharmacist scope of practice has evolved over the last few decades. As such, pharmacists are more widely involved in disease management, medication therapy management (MTM), and patient education. As the primary care shortage continues to be of concern for the U.S. healthcare system, pharmacists are well positioned as accessible, trusted, and knowledgeable professionals to help ease physician burden in assisting patients with medication management. Very few studies have been done to understand the perceptions of primary care providers regarding the involvement and role of pharmacists in MTM programs. The New York City Department of Health and Mental Hygiene performed a qualitative study to obtain a better understanding of the perceptions related to pharmacist-led MTM programs among primary care physicians in New York City. Physician education around the role of pharmacists was found to be critical in building collaborative relationships between physicians and pharmacists. Our study rationale, design, and preliminary findings have been discussed previously. This paper provides the detailed report and potential impact of our study findings on building collaborative team-based relationships that will allow for improved patient outcomes.

Understanding awareness of pharmacist-led medication therapy management among primary care physicians in New York City using qualitative methods: part I.

Pharmacist-led medication therapy management (MTM) programs have been shown to be an effective method of optimizing patient therapy for multiple disease states through improved clinical outcomes and decreased healthcare costs. Physicians have recognized pharmacists' ability to identify and prevent prescription errors, and educate patients about safe and appropriate medication use. Pharmacist interventions may help ease the burden of chronic disease among primary care providers and pave the way for a team-based approach in caring for underserved patients with heavy disease burdens. The New York City Department of Health and Mental Hygiene performed a qualitative study to obtain a better understanding of the perceptions related to pharmacist-led MTM programs among primary care physicians in New York City. Key findings from our study suggest that educating physicians on MTM and the role of pharmacists in the healthcare team is crucial to building trusting relationships for collaborative patient care. Key concerns among physicians included demonstrated pharmacist competency, integration of documentation systems, impact on workload, and effective collaboration between physicians and pharmacists. In this article, we describe our study rationale, design, and preliminary findings. A more detailed report and potential impact of our findings will be provided in Part II of this article.

Evaluation of outcomes of a medication therapy management program for patients with diabetes.

OBJECTIVE: To measure the impact of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program on clinical outcomes and social and process measures for patients with diabetes with or without associated comorbid conditions. METHODS: Prospective longitudinal study that took place at seven independent pharmacies in Lucas County, OH. A total of 228 patients with diabetes were enrolled. At 6-month intervals, patients were counseled by their pharmacists. Outcome measures included clinical outcomes (glycosylated hemoglobin [A1C], systolic blood pressure (SBP), and diastolic blood pressure [DBP]), social measures (caffeine intake, alcohol consumption, smoking, and exercise), and process measures (visits to ophthalmologist, podiatrist, and dentist). Wilcoxon signed-rank test and percentages were used to report findings. RESULTS: Mean (± SD) A1C concentration decreased from 7.08 ± 1.54% to 6.89 ± 1.30% at 12 months. Patients with A1C levels greater than 7% at baseline averaged a decrease of 0.5% at 6 months and 0.75% at 12 months. Mean SBP values decreased significantly from baseline to 12 months. A total of 87 patients with a baseline SBP greater than 130 mm Hg experienced a significant change in blood pressure from baseline to 6 months (-7.1 ± 3.32 mm Hg), and 65 patients experienced a significant change in blood pressure from baseline to 12 months (-11.49 ± 0.15 mm Hg). A total of 104 patients with a baseline DBP more than 80 mm Hg experienced a significant decrease of 4.44 ± 1.25 mm Hg at 6 months. Caffeine and alcohol consumption and smoking decreased and exercise increased. In addition, the percentage of patients who visited specialists increased. CONCLUSION: Patients with diabetes experienced improvements in multiple clinical, social, and process measures.

Impact of a Public Health Awareness Campaign on Patients' Perceptions of Expanded Pharmacy Services in South Dakota Using the Theory of Planned Behavior.

Background: Pharmacists can offer medication expertise to help better control diabetes and cardiovascular disease (CVD) and improve patient outcomes, particularly in rural communities. This project evaluated the impact of an awareness campaign on perceptions of expanded pharmacy services. Methods: The "Your Pharmacists Knows" campaign included a 30-s commercial, print material, and media announcements. A non-randomized pre-post study was completed using a modified theory of planned behavior (mTPB) to assess knowledge, attitude, perceived benefits and norms, and perceived control. A 73-item survey was administered to a convenience sample (n = 172) across South Dakota. Regression models to assess intent and utilization were conducted using age, gender, race, education, population, and insurance status as predictors for mTPB constructs. Results: Most common predictors were female gender and higher education level (p < 0.001). All mTPB constructs were significant predictors of intent to use services (p < 0.001). Knowledge and perceived control had the largest influence on intent. Additionally, there was significant improvement in post-campaign service utilization (p < 0.001). Conclusions: This campaign positively influenced intent to seek and utilize services in rural communities where pharmacies may be the only healthcare option for miles. Through targeted campaigns, patients with diabetes or CVD may find access to services to better manage their conditions.

Identifying factors that affect patients' willingness to pay for inhaled insulin.

UNLABELLED: Predictors of patients' willingness to pay for inhaled insulin are unknown. This study found patients with higher annual household income and those who were dissatisfied with their current insulin therapy were willing to pay for inhaled products. BACKGROUND: Not all diabetes patients are receptive to taking injectable insulin and may therefore be noncompliant. Inhaled insulin has been shown to be as efficacious as subcutaneous insulin, but determinants of patients' willingness to pay (WTP) for inhaled insulin are unknown. OBJECTIVES: The objective of this study was to determine the relationship between various patient characteristics and patient satisfaction variables with WTP for inhaled insulin. METHODS: Exploratory cross-sectional study using a random sample of patients with diabetes from a national database. Data were collected using a mailed survey focusing on patient satisfaction with current insulin therapy, WTP, and general patient information. Any WTP (categorical) and the amount (continuous) patients were willing to pay were the 2 dependent variables in the study. Data were analyzed using SPSS v.15.0. Descriptive statistics as well as linear and logistic regression analyses were conducted. RESULTS: One hundred twenty-eight patients responded. The logistic regression analysis indicated that annual household income (P=.038) and patient satisfaction (P=.002) predict WTP. Additionally, the current cost of insulin therapy (P=.009) and annual household income (P=.049) were found to predict the amount patients were willing to pay. On average, patients were willing to pay $55.49 out of pocket for inhaled insulin per month. CONCLUSIONS: The out-of-pocket cost that patients were willing to pay was the same as the amount patients pay presently for their insulin and syringes. Although Exubera is no longer on the market, the study findings can have an impact on pharmaceutical companies working on new inhaled insulin products in their efforts to care for patients with diabetes.

Factors Associated with Poor Hemoglobin A1c Control in Patients with Type 2 Diabetes.

BACKGROUND: The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. OBJECTIVE: To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. METHODS: Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. RESULTS: Medication adherence was inversely associated with HbA1c values (ß = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (ß = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (ß = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (ß = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. CONCLUSION: Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.

Patients' perspective of the impact of COPD on quality of life: a focus group study for patients with COPD.

Background The quality of life has been shown to be poor in patients with chronic obstructive pulmonary disease (COPD). Furthermore, patients' perspective and attitudes toward COPD and its impact on their quality of life have been remarkably ignored. Objective To explore patients' views and perceptions regarding COPD and its impact on their quality of life. Setting COPD clinic at the Royal Medical Services Hospital, Amman, Jordan. Method Focus groups discussions to explore patients' views and perceptions about COPD were conducted using purposive sampling technique till data saturation achieved. A predesigned topic guides including knowledge about COPD and its management and the impact of COPD on the quality of life in patients with COPD was used to facilitate discussion during the interviews. All interviews were transcribed and analyzed using a thematic analysis approach. Main outcome measure Impact of COPD on patients' quality of life. Results The main themes emerged included information needs about COPD and its management, physical and psychological impact of COPD and reliance on others. The most commonly expressed problem was breathlessness which restricted physical activity and led to panic and anxiety attacks. Constant breathlessness coupled with anxiety can force COPD patient to avoid all physical activity and becoming reliant on others. Conclusion In addition to the lack of knowledge about COPD and its management, it was evident that COPD had a negative physical and psychological impact on COPD patients. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health outcomes for patients with COPD.

Preparing pharmacists for medication therapy management services: designing lementing pharmacist-run diabetes management program in a community setting.

The role of pharmacists in disease management has been well-documented in the face of numerous disease states, including diabetes. Recently, Medicare recognized the pharmacy profession in disease management programs under the Medicare Modernization Act of 2006 with the introduction of medication therapy management (MTM) and Medicare Health Support. Therefore, pharmacists must understand how to design and implement MTM services. This paper describes a disease management program at an independent pharmacy, and discusses potential areas of consideration in relation to the implementation of a disease management program in a community pharmacy setting.

Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer Survivors: An Application of the Protection Motivation Theory.

The purpose of this observational study was to determine if the Protection Motivation Theory could predict and explain adherence to aromatase inhibitor (AI) therapy among breast cancer survivors. Purposive sampling was used to identify 288 survivors who had been prescribed AI therapy. A valid and reliable survey was mailed to survivors. A total of 145 survivors completed the survey. The Morisky scale was used to measure adherence to AI. The survivors reported a mean score of 6.84 (±0.66) on the scale. Nearly 4 in 10 survivors (38%) were non-adherent. Adherence differed by age, marital status, insurance status, income, and presence of co-morbid conditions. Self-efficacy (r=0.485), protection motivation (r=0.310), and Response Efficacy (r=0.206) were positively and significantly correlated with adherence. Response Cost (r=-0.235) was negatively correlated with adherence. The coping appraisal constructs were statistically significant predictors medication adherence (ß=0.437) with self-efficacy being the strongest significant predictor of adherence (ß = 0.429).

Using the Health Belief Model to test factors affecting patient retention in diabetes-related pharmaceutical care services.

BACKGROUND: Diabetes is one of the deadliest and most costly diseases. Attrition rates among patients in diabetes management programs may preclude optimal success. Theoretical models, such as the Health Belief Model, may be useful for identifying factors responsible for patients' continued enrollment in such programs. OBJECTIVES: (1) To design and test a reliable and valid survey instrument for assessing patients' perceptions of diabetes-related pharmaceutical care services. (2) To determine factors affecting patient retention in pharmaceutical care services. METHODS: This cross-sectional exploratory study used convenience sampling to survey type 1 and 2 diabetes patients receiving pharmaceutical care at 25 Eckerd Pharmacy sites in Florida. Survey items were designed using constructs from the Health Belief Model. Reliability (Cronbach's alpha) and validity (exploratory factor analysis) were assessed. Independent t tests, Pearson's correlation coefficients, and multiple regression analysis were conducted. RESULTS: Seventy usable surveys were returned (47%). In the absence of pharmaceutical care, patients felt susceptible to at least one of 8 diabetes-related conditions (hypoglycemia, hyperglycemia, diabetic foot infections, eye problems, cardiovascular risks, blood pressure problems, cholesterol problems, and kidney diseases). For these conditions, about 48% to 95% of patients perceived that their threat had reduced because of pharmaceutical care. Accordingly, more than half perceived the services as beneficial, with counseling for blood sugar monitoring rated as the most beneficial. All respondents rated the services as helpful, and 64 intended to continue regular utilization. Overall helpfulness of the service and patient retention were positively correlated (r=0.33, P<.00). Perceived susceptibility predicted perceived threat reduction (R(2)=0.22, P<.01). Perceived threat reduction, blood sugar monitoring, and overall helpfulness of the service predicted patient retention in the service (R(2)=0.41, P<.00). Factor analysis extracted 4 factors: perceived threat reduction, perceived susceptibility, perceived benefits, and blood sugar monitoring. Cronbach's alphas for the scales ranged from 0.63 to 0.91. CONCLUSION: Two key constructs of the Health Belief Model influence use of diabetes-related pharmaceutical care services: perceived susceptibility and threat reduction. In an effort to increase patient retention, pharmacists need to assess patient perceptions and structure their services to address patient perceptions and concerns.

Pharmacist-provided medication therapy management (MTM) program impacts outcomes for employees with diabetes.

The objective of this prospective, pre-post longitudinal study was to assess the impact of pharmacist-provided medication therapy management (MTM) services on employees' health and well-being by evaluating their clinical and humanistic outcomes. City of Toledo employees and/or their spouses and dependents with diabetes with or without comorbid conditions were enrolled in the pharmacist-conducted MTM program. Participants scheduled consultations with the pharmacist at predetermined intervals. Overall health outcomes, such as clinical markers, health-related quality of life (HRQoL), disease knowledge, and social and process measures, were documented at these visits and assessed for improvement. Changes in patient outcomes over time were analyzed using Wilcoxon signed rank and Friedman test at an a priori level of 0.05. Spearman correlation was used to measure the relationship between clinical and humanistic outcomes. A total of 101 patients enrolled in the program. At the end of 1 year, patients' A1c levels decreased on average by 0.27 from their baseline values. Systolic and diastolic blood pressure also decreased on average by 6.0 and 4.2 mmHg, respectively. Patient knowledge of disease conditions and certain aspects or components of HRQoL also improved. Improvements in social and process measures also were also observed. Improved clinical outcomes and quality of life can affect employee productivity and help reduce costs for employers by reducing disease-related missed days of work. Employers seeking to save costs and impact productivity can utilize the services provided by pharmacists.

Predictors of non-adherence to pharmacotherapy in patients with type 2 diabetes.

BACKGROUND: The prevalence of diabetes in Jordan is among the highest in the world, making it a particularly alarming health problem there. It has been indicated that poor adherence to the prescribed therapy lead to poor glycemic control and enhance the development of diabetes complications and unnecessary hospitalization. OBJECTIVE: To explore factors associated with medication nonadherence in patients with type 2 diabetes in Jordan. Findings would help guide the development of future pharmaceutical care interventions for patients with type 2 diabetes. SETTING: This study was conducted in an outpatient diabetes clinic at the Royal Medical Services Hospital. METHOD: Variables including sociodemographics, disease and therapy factors, diabetes knowledge, health-related quality of life in addition to adherence assessment were collected for 171 patients with type 2 diabetes using medical records, custom-designed and validated questionnaires. Logistic regression was performed to develop a model with variables that best predicted medication non-adherence in patients with type 2 diabetes in Jordan. MAIN OUTCOME MEASURE: Variables which significantly and independently associated with medication nonadherence in patients with type 2 diabetes in Jordan. RESULTS: Patients were found four times less likely to adhere to their medications with each unit increase in the number of prescribed medications (OR = 0.244, CI = 0.08-0.63) and nine times less likely to adhere to their medications if they received more than once daily dosing of diabetic medication (OR = 0.111, CI = 0.04-2.01). Patients in the present study were also approximately three times less likely (OR = 0.362, CI = 0.24-0.87) and twice less likely (OR = 0.537, CI = 0.07-1.31) to adhere to their medications if they reported having concerns about side effects and if they were taking metformin therapy respectively. Finally, participants were found twice more likely to adhere to medications if they had one or more Microvascular complication (OR = 0.493, CI = 0.08-1.16). CONCLUSION: Simplifying dosage regimen, selecting treatments with lower side effects along with an emphasis on diabetes complications should be taken into account in future interventions designed to improve health outcomes for patients with type 2 diabetes.

Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management.

BACKGROUND: The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. METHODS: Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman's test was used to determine changes in outcomes due to the nonparametric nature of the data. RESULTS: The mean number of visits to a physician's office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. CONCLUSION: Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.

Evaluating the validity and reliability of a modified survey to assess patient satisfaction with mail-order and community pharmacy settings.

The level of patient-pharmacist interactions and services provided varies across different distribution methods and could affect patient satisfaction with services. Determining patient satisfaction with these medication distribution methods is important for improving care of chronic disease patients. This study evaluated the validity and reliability of a modified survey to assess patient satisfaction with mail-order and community pharmacy settings. Exploratory cross-sectional design using a convenience sample of HIV-infected patients at a university clinic was used. Satisfaction scale was modified from previously validated instrument resulting in 21 items on the final survey. Data collection occurred for 7 months, and 178 surveys were completed. An exploratory factor analysis was conducted using principal components and varimax rotation. Reliability and item analyses were conducted. Factor analysis resulted in a 2-factor solution, namely "satisfaction with the efficient functioning of the pharmacy" and "satisfaction with the managing therapy role of the pharmacist," respectively. Cronbach's alpha for factors 1 and 2 with mail-order were .951 and .795, for independent were .977 and .965, and for chain were .841 and .823. The study provides a valuable tool to assess patient satisfaction with pharmacy services provided through different distribution methods.

Demographic disparities in patient-reported use of inhaled corticosteroids among patients with persistent asthma.

BACKGROUND: Despite the presence of existing guidelines, underuse of inhaled corticosteroids (ICSs) still exists among patients with persistent asthma in the United States. Inappropriate utilization of asthma medications has been attributed as one of the reasons for the significant economic burden due to asthma. OBJECTIVES: To determine the demographic factors predicting patient-reported use of ICSs among patients with asthma. METHODS: The study utilized data from the 4-state sample of the National Asthma Survey (NAS), sponsored by the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention (CDC). The study population consisted of patients with persistent asthma as defined by National Heart, Lung, and Blood Institute (NHLBI) guidelines. Frequency distributions were made to characterize the study population. Logistic regression analysis was carried out to determine the odds of reported use of ICSs across various demographic variables (age, gender, race, income level, insurance coverage, and disease severity). Data were analyzed using SAS v9.0 software. RESULTS: Underutilization of ICSs was found to exist in the patients with asthma, as more than half of the study population (52.8%, n = 304) did not report the use of ICSs. African American patients were found to have much lower odds for use of ICSs (odds ratio [OR] = 0.495; confidence interval [CI], 0.248-0.987) when compared with whites. Insured patients had significantly higher odds for the use of ICSs (OR = 2.378; CI, 1.106-5.110) compared with uninsured patients. The findings held true even after adjusting for other demographic factors. CONCLUSION: Underuse of ICSs continues to be a problem in patients with asthma. Vulnerable populations identified in this study are targeted for the use of ICSs. The importance of adherence to treatment and use of ICSs is an issue that needs to be addressed.

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital.

BACKGROUND: Several complex and costly interventions reduce medication errors. Little exists on the effectiveness of providing education and feedback to institutional clinicians as a means of reducing errors. OBJECTIVE: To determine the impact on prescribing errors of a pharmacist-led educational intervention. DESIGN: Prospective, interrupted time series study. SETTING: This study was conducted among internal medicine residents at the 320-bed University of Toledo Medical Center. INTERVENTION: The educational intervention was conducted during a 6-month period beginning in November 2006. The intervention included an initial hour-long lecture followed by biweekly and then monthly discussions that used timely, institution-specific examples of prescribing errors. MEASUREMENTS: Data were collected at 5 time points: month 0 (preintervention period); months 1, 3, and 6 (intervention period); and month 7 (postintervention period). Errors were identified, transcribed, coded, and entered into a database. The primary outcome was the frequency of prescribing errors during each period. A Bonferroni-adjusted chi-square analysis was conducted with an a priori experiment-wise alpha of 0.05. RESULTS: A reduction in prescribing errors of 33% following the first intervention month and a mean 26% reduction during the study period were observed (P<0.0025). The frequencies of preintervention and postintervention errors did not differ significantly. CONCLUSIONS: A straightforward educational intervention reduced prescribing errors during the period of active intervention, but this effect was not sustained. Ongoing communication and education about institution-specific medication errors appear warranted.

Physicians' intent to comply with the American Medical Association's guidelines on gifts from the pharmaceutical industry.

OBJECTIVE: To identify factors that predict physicians' intent to comply with the American Medical Association's (AMA's) ethical guidelines on gifts from the pharmaceutical industry. METHODS: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms (eg, peers, patients, etc), facilitating conditions (eg, knowledge of the guidelines, etc), profession-specific precedents (eg, institution's policies, etc), individual-specific precedents (physicians' own discretion, policies, etc) and intent. Multivariate regression modelling was conducted. RESULTS: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% (n = 133) of respondents were aware of the guidelines; 50% (n = 107) had read them. 48% (n = 102) thought that following the guidelines would increase physicians' credibility and professional image; 68% (n = 145) agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education (CME) events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent (R(2) = 0.52, p <0) were attitude, subjective norms, the interaction term (attitude and subjective norms), sponsorship of CME events and individual-specific precedents. CONCLUSIONS: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance.