Impact of Teaching Social Determinants of Health on PIF in the Health Professions.

OBJECTIVE: To address the lack of methods for assessing learning on social determinants of health, particularly from a health systems perspective. Using a conceptual framework of professional identity formation applied across 3 professions (athletic training, occupational therapy, and pharmacy), the study aimed to describe students' level of professional identity when applying knowledge of structural factors' impact on health. METHODS: This study was a deductive content analysis of students' written reflections. Identified themes explored how students explained sociopolitical influences on health as well as their assessed level of professional identity. RESULTS: Students were inclined to author narratives focused on the ways in which structural factors influence individual outcomes and aspects within the health care system. Most students were assessed to be at the initial levels of professional identity formation, but those with a comparatively higher level of professional identity expressed a commitment to professional behaviors that address social determinants of health. CONCLUSION: This analysis created a foundation for future pedagogical work in health care system-related structural learning outcomes within and between different health professions. Findings suggest that across professions, most first-year students demonstrated the ability to reconcile different perspectives and were in the early stages of aligning personal values with professional values. The use of reflection has the potential to assess professional identity formation among a range of health professional students.

Decision-making during initiation of medication therapy.

BACKGROUND: Individuals' frequent and consistent interaction with medications can serve as a unifying element to help coordinate individuals' health care services. Despite its potential to improve coordination of heath care, initiation of medication therapy from the perspective of individuals' experiences remains largely unexamined. OBJECTIVES: The objectives for this study were to describe the viewpoints of consumers, physicians, pharmacists, and social workers regarding initiation of medication therapy in terms of: (1) activation and engagement, (2) information processing, and (3) economic factors. METHODS: Data were collected via mailed survey methodology from random samples of 400 adults, 400 physicians, 400 pharmacists, and 400 social workers residing in Minnesota. Responses to open-ended questions were coded using content analysis and summarized with descriptive statistics. RESULTS: The findings showed that consumer views of (1) activation and engagement, (2) information processing, and (3) economic factors differed from the views of physicians, pharmacists, and social workers. Consumers typically view initiation of medication therapy within the context of their overall lives. Physicians view it as a biomedical puzzle in which diagnosis, drug product selection, and risk assessment are main concerns. Pharmacists view it as a health care systems puzzle in which insurance coverage, cost, and risk management are main concerns. Social workers view it as a social systems puzzle in which access to care, cost, and social support are main concerns. CONCLUSIONS: Initiation of medication therapy is a disjointed experience for many consumers. The best timing for providing information about prescription drugs to individuals depends largely on what kinds of thoughts and impressions they have about a new therapy at various stages of the medication use process. The findings from this study can be useful for (1) developing consumer-centered approaches for medication use and (2) coordinating health care through the integration of the medication experience using consumer viewpoints.

A comparison of drug formularies and the potential for cost-savings.

BACKGROUND: Brand-name drug costs have been escalating in the United States, and the reasons for this are not immediately clear. A lack of adequate and accurate information about drug effectiveness, safety, and cost has implications for drug utilization and cost. OBJECTIVE: To explore the extent to which health plan formularies were consistent with recommended drug listings and identify what would be the potential cost-savings on total drug expenditures if the utilization rate of the recommended therapies was increased. METHOD: This study compared publicly available recommended drug listings with the formularies of 8 major health plans in Minnesota. Data from 1 of the health plans underwent an in-depth case analysis to evaluate the potential impact on pharmaceutical expenditures, using increased utilization rate scenarios of the recommended drugs. RESULTS: Health plans were similar with respect to degree of coverage for the recommended drugs. However, the case analysis showed that by increasing the utilization rate of recommended drugs, a potential cost-savings of more than 50% could be realized for the evaluated health plan for some therapeutic categories. CONCLUSION: This study demonstrates an approach to assessing drug formularies using publicly available, recommended drug lists that incorporated evidence for effectiveness, safety, and cost. By using the application of this type of reliable information, formulary changes can be guided to incentivize value-based utilization for patient populations.

A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process.

BACKGROUND: Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. OBJECTIVES: To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. METHODS: Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. RESULTS: The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. CONCLUSIONS: It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.