Preemptive pharmacogenetic testing: exploring the knowledge and perspectives of US payers.

PURPOSE: Preemptive pharmacogenetic testing aims to optimize medication use by having genetic information at the point of prescribing. Payers' decisions influence implementation of this technology. We investigated US payers' knowledge, awareness, and perspectives on preemptive pharmacogenetic testing. METHODS: A qualitative study was conducted using semistructured interviews. Participants were screened for eligibility through an online survey. A blended inductive and deductive approach was used to analyze the transcripts. Two authors conducted an iterative reading process to code and categorize the data. RESULTS: Medical or pharmacy directors from 14 payer organizations covering 122 million US lives were interviewed. Three concept domains and ten dimensions were developed. Key findings include clinical utility concerns and limited exposure to preemptive germ-line testing, continued preference for outcomes from randomized controlled trials, interest in guideline development, importance of demonstrating an impact on clinical decision making, concerns of downstream costs and benefit predictability, and the impact of public stakeholders such as the Food and Drug Administration and Centers for Medicare and Medicaid Services. CONCLUSION: Both barriers and potential facilitators exist to developing cohesive reimbursement policy for pharmacogenetics, and there are unique challenges for the preemptive testing model. Prospective outcome studies, more precisely defining target populations, and predictive economic models are important considerations for future research.

Autism Prevalence in the Medicaid Program and Healthcare Utilization and Costs Among Adult Enrollees Diagnosed with Autism.

As the number of individuals diagnosed with autism increases, there is an increase in demand to provide support throughout their lifespan. This study aimed to: (1) estimate trends in the prevalence of autism diagnoses and medical services use in adults with autism diagnoses; (2) assess predictors of healthcare utilization and costs among adults with autism diagnoses enrolled in Medicaid. A retrospective analysis of 2006-2008 Medicaid claims for 39 states was conducted. There was a 38% increase in the prevalence of autism diagnoses from 2006 to 2008. Total expenditures and outpatient and ER visits varied significantly by demographic variables.

Patient perceptions of a pharmacy star rating model.

OBJECTIVES: To identify patients' understanding of what constitutes a "quality pharmacy" and to obtain their feedback regarding the development and use of the pharmacy star rating model, a pharmacy-specific aggregate performance score based on the Centers for Medicare and Medicaid Services' Medicare Star Rating. DESIGN: Prospective cross-sectional study. SETTING AND PARTICIPANTS: Focus groups were conducted in Arizona, California, Mississippi, Maryland, and the District of Columbia, and one-on-one interviews were conducted in Indiana. Eligible patients were required to routinely use a community pharmacy. MAIN OUTCOME MEASURES: Consumer insights on their experiences with their pharmacies and their input on the pharmacy star rating model were attained. Key themes from the focus groups and interviews were obtained through the use of qualitative data analyses. RESULTS: Forty-nine subjects from 5 states and DC participated in 6 focus groups and 4 one-on-one interviews. Eighty-eight percent of participants reported currently taking at least 1 medication, and 87% reported having at least 1 health condition. The 7 themes identified during qualitative analysis included patient care, relational factors for choosing a pharmacy, physical factors for choosing a pharmacy, factors related to use of the pharmacy star rating model, reliability of the pharmacy star rating model, trust in pharmacists, and measures of pharmacy quality. Most participants agreed that the ratings would be useful and could aid in selecting a pharmacy, especially if they were moving to a new place or if they were dissatisfied with their current pharmacy. CONCLUSION: Pharmacy quality measures are new to patients. Therefore, training and education will need to be provided to patients, as pharmacies begin to offer additional clinical services, such as medication therapy management and diabetes education. The use of the pharmacy star rating model was dependent on the participants' situation when choosing a pharmacy.

The Report of the 2021-2022 AACP Research and Graduate Affairs Committee.

EXECUTIVE SUMMARY. The work of the 2021-2022 AACP Research and Graduate Affairs Committee (RGAC) focused on barriers to graduate education and research-related careers in pharmacy education. AACP President Stuart Haines charged the RGAC with identifying the critical barriers that hinder current PharmD students/recent graduates as well as under-represented groups (e.g., Black and Latino) from pursuing advanced degrees and research-related career paths in the pharmaceutical, social & behavioral, and clinical sciences and recommending changes that might address these barriers - this may include recommendations to change the fundamental structure of graduate education.The committee began its work with a literature review to survey current perspectives on these barriers and assess the supporting evidence for effective solutions and programs, including their relevance to pharmacy education. Based on the review, the committee was able to identify numerous obstacles to entry into and progression through research training, for both underrepresented learners and student pharmacists. Obstacles are individual, e.g., lack of exposure to and self-efficacy in research, financial constraints, structural, e.g., lengthy training time, programmatic rigidity, and institutional, e.g., implicit and explicit bias. The committee found evidence of effective approaches and programs to address these barriers that could be applied in pharmacy schools. These approaches include improvements to existing practices in recruitment, admissions and hiring practices as well as creation of new programs and structural changes to existing programs to increase accessibility to learners. The committee also recognized a need for more research and development of additional approaches to address these barriers.The committee makes a series of recommendations that AACP develop resource guides and programs to address key issues in the recruitment and retention of underrepresented students and student pharmacists into graduate education and research careers, including as faculty. The committee also proposes new AACP policies to support innovative graduate programs and early, longitudinal engagement of learners from elementary school onward to increase access to graduate education and to support environments and cultures of commitment to accessibility, diversity, equity, inclusiveness, antiracism in pharmacy education.

Comparing algorithms for composite measures of intra-disease multiple medication adherence: The case of diabetes.

BACKGROUND: Adherence to multiple medications (i.e., separate dosage forms) intended for a disease can be measured by different single estimators, termed as composite estimators of intra-disease multiple medication adherence: 80% days covered (a) by at least one medication ("at least one"); (b) by both medications ("both"); (c) by each medication measured separately ("all"); and (d) computing an average of the individual medication adherence estimates ("average"). OBJECTIVES: (a) Assess different composite adherence estimators regarding their ability to predict healthcare utilization; (b) compare and contrast composite estimators. METHODS: Using MarketScan 2002-2003 data, 6043 nonelderly patients who filled separate prescriptions of sulfonylurea [SU] and thiazolidinedione [TZD] were identified. Adherence was measured by the proportion of days covered (PDC) over periods of 90 days, 30 days, and cumulatively over such periods. Cox proportional hazards models analyzed all-cause and diabetes-related emergency room (ER) visits as the outcome variables. RESULTS: All composite measures predicted hazards of all-cause or diabetes ER visits (P < 0.001) and each measure showed statistically significant discriminatory power (concordance statistics from 0.55 to 0.58). Cox regression was performed multiple times in which composite estimators measured on a continuous scale (e.g., 'average') were dichotomized using several cut-points. In the majority of cases (≤3 out of 8 times in analyses of ER outcomes), optimal results did not occur when the dichotomization cut-point was set at 80%. CONCLUSIONS: Each composite estimator showed the fundamental quality of a good measure. Although 'average' and 'all' approaches offer ease of measurement, there was no clear trend in superiority of one measure over the others. Clinical and practical considerations should dictate the choice of measure.

Evaluation of a Tool to Measure Pharmacists' Readiness to Manage Intimate Partner Violence.

Intimate partner violence (IPV) is a public health problem that demands a comprehensive health care response. Provider education and training is needed for the entire health care team, including pharmacists, to competently care for IPV-impacted patients. Standardized assessments are needed to determine need for training and to evaluate the effectiveness of IPV training initiatives. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) has previously been validated for physicians. This study adapted and evaluated the PREMIS instrument for use with pharmacists to assess knowledge, attitudes, behaviors, and intentions related to IPV and IPV screening. A total of 144 surveys from community pharmacists were analyzed. Pharmacists had low levels of IPV knowledge. Exploratory factor analysis revealed a five-factor structure: workplace and self-efficacy, preparation, legal requirements, alcohol and drugs, and constraints. This instrument can be utilized to guide the development and implementation of IPV-related training initiatives for pharmacists.

The Potential for Screening for Intimate Partner Violence in Community Pharmacies: An Exploratory Study of Female Consumers' Perspectives.

Intimate partner violence (IPV) is a substantial public health problem. The U.S. Preventive Services Task Force recently updated guidelines to recommend IPV screening for all women of childbearing age. Expansion of screening efforts to the community pharmacy setting could provide an opportunity to substantially impact the health of consumers. To date, no research has explored consumers' perspective on IPV screening in the community pharmacy environment. To address this gap, a descriptive survey research study was conducted to examine female consumers' attitudes and preferences for IPV screening in community pharmacies. Female pharmacy customers ( N = 60) completed an online survey assessing knowledge of and attitudes about community pharmacies as sources of health care advice, beliefs about IPV and IPV screening, and perspectives on IPV screening in the community pharmacy environment. Consumers who utilized pharmacies with more patient care services were more likely to report interest in IPV screening in the pharmacy environment. The majority of respondents thought IPV screening is an important thing to do (85.0%), and 33.3% agreed that it should happen in a pharmacy. A statistically significant relationship between the belief that the pharmacy is a good place for health education and preference for IPV screening in the community pharmacy environment was found, r(58) = .43, p < .001. Concern regarding the time required to conduct screenings and about the availability of appropriate space were identified as potential barriers to screening in the pharmacy environment.

Factors Influencing the Use of Second-Generation Antipsychotics in Children with Psychosis.

BACKGROUND: In 2011, the U.S. Department of Health and Human Services sent a letter to state Medicaid directors explaining the need for oversight of psychiatric prescriptions for children with mental health disorders. The National Committee for Quality Alliance proposed 3 quality measures for rating managed care organizations (MCOs) that involve use of second-generation or atypical antipsychotics in children. In order to ensure appropriate use and to effectively manage the use of second-generation antipsychotics in children, MCOs need to better understand the factors that influence medication treatment decisions for children. OBJECTIVES: To (a) determine how patient-level and physician-level factors influence decisions to prescribe second-generation antipsychotics to children (aged under 18 years) diagnosed with psychosis and (b) evaluate how the influence of these factors may differ between primary care providers and psychiatrists. METHODS: This study employed a cross-sectional survey of 193 primary care providers and psychiatrists. A web-based patient simulation survey using a fractional factorial design was administered via a commercial vendor. Respondents were presented with simulated patient profiles described by various levels of factors considered to be essential to decision making. Respondents were asked to make treatment recommendations for each profile evaluated. In addition to treatment recommendations, demographics and beliefs about products were measured. Modified Poisson regression accounting for multilevel data was used to identify the factors that significantly affect treatment recommendations. RESULTS: Psychiatrists were more likely to recommend second-generation antipsychotics than primary care practitioners (unadjusted RR = 1.36, 95% CI = 1.23-1.51). Social factors such as foster status or parental concern were not found to be significant predictors of prescribing second-generation antipsychotics. The percentage of a provider's patients using second-generation antipsychotics (RR = 1.002, 95% CI = 1.0002-1.003), patient age (aged 4 years: RR = 0.75, 95% CI = 0.68-0.84; aged 10 years: RR = 0.94, 95% CI = 0.91-0.99; reference group: aged 15 years), and patient disease severity (severe: RR = 1.11, 95% CI = 1.04-1.18; moderate: RR = 1.10, 95% CI = 1.05-1.17; reference group: mild) significantly predicted prescription behavior among primary care providers and psychiatrists. Primary care providers were about twice as likely to recommend antipsychotics if they believed the use of antipsychotics was a labeled indication (RR = 2.16, 95% CI = 1.56-2.98) or a medically accepted use (RR = 1.88, 95% CI = 1.33-2.67), when compared with physicians who believed there was no evidence available. This effect was not significant among psychiatrists. Primary care providers, but not psychiatrists, were also significantly influenced by patient white blood cell (WBC) count. Patients with healthy WBC counts were 1.11 times as likely (95% CI = 1.05-1.17) to receive antipsychotics from primary care providers compared with those with low WBC count. Patient body mass index (BMI) was not found to significantly influence prescribing behavior. Nearly 50% of patients did not receive recommendations for psychosocial care. Primary care providers recommended antipsychotic polypharmacy in 23% of the patient profiles, while psychiatrists did so in 42% of the profiles. CONCLUSIONS: This study provides valuable insight into physician-prescribing practices for antipsychotics. The lack of significance of foster status and parental concern, after controlling for other factors, shows that physicians base their decisions on clinical factors more than social factors. Results for patient BMI and frequency of recommendations of polypharmacy are concerning. The general lack of awareness of evidence supporting use of antipsychotics is also highly concerning. The effects of patient BMI, beliefs about evidence supporting use, and prescribing practices with regard to psychosocial care and antipsychotic polypharmacy provide actionable results for managed care programs looking to improve their quality metrics. The results of this study further demonstrate the need for the immediate implementation of the various proposed quality metrics in this area and for new practice guidelines to raise the current standard of care. DISCLOSURES: No outside funding supported this research. Bentley reports the receipt of grants from PQA and the NACDS Foundation. Patel is employed by Medical Marketing Economics. The authors report no other conflicting interests, potential or otherwise. Study concept and design were contributed by Ramachandran, Banahan, West-Strum, and Bentley. Ramachandran, Banahan, and Patel collected data; data interpretation was performed primarily by Ramachandran, Banahan, and Patel, along with Bentley and West-Strum. The manuscript was primarily written by Ramachandran, along with Banahan and Bentley, and revised by Banahan, Bentley, West-Strum, and Patel.

Educating Pharmacists in Quality (EPIQ): Recipient, Academy for Healthcare Improvement 2015 Duncan Neuhauser Award for Curricular Innovation.

The Duncan Neuhauser Award for curriculum Innovation is presented annually at the Academy for Healthcare Improvement meeting. The award recognizes education providers that show innovation and improvement in advancing skills in health care. Duncan B. Neuhauser, PhD, a Senior Editor with the Quality Management in Health Care journal is a Professor of Health Services Research and the Charles Elton Blanchard Professor of Health Management at Case Western Reserve University. Dr Neuhauser has devoted his working life to the science of the improvement of health care and has served as a pioneer in the development of curriculum to promote health care improvement. The 2015 first place recipient was Educating Pharmacists in Quality (EPIQ) developed by the Pharmacy Quality Alliance. EPIQ was developed as a quality improvement education resource for use by pharmacy faculty and other professionals to teach students pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. EPIQ has been integrated into more than 20 doctor of pharmacy curricula and has been used as part of employee training programs. Students and faculty members who have used the program have indicated via surveys that the program has a positive impact on awareness and knowledge of quality improvement in pharmacy.

Validity and reliability of the Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2) among adults with autism.

BACKGROUND: The purpose of the study was to assess the validity and reliability of the Medical Outcomes Study Short Form-12 version 2 (SF-12v2) instrument among adults with autism. METHODS: Study data was collected using a cross-sectional online survey of adults with autism enrolled with the Interactive Autism Network (N=291). Factorial validity was assessed using confirmatory factor analysis technique. Item-scale correlations were examined for convergent validity. Known-groups validity was assessed by examining the variation in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores by autism severity. Cronbach's alpha was determined for internal consistency reliability. Floor and ceiling effects were also assessed. RESULTS: A two-factor model with correlated error terms was found to have a good fit. The PCS scale strongly correlated with the underlying items representing the scale. The MCS scale had strong to moderate correlation with its underlying items. For known-groups validity, the MCS score varied as expected with lower score observed among adults with high severity as compared to low severity; however, PCS score varied inversely. Internal consistent reliability of the SF-12v2 was good, and there were no floor and ceiling effects. CONCLUSIONS: Except for known-groups validity, all other psychometric indicators performed well for the SF-12v2.

Impact of Preexisting Mental Illnesses on Receipt of Guideline-Consistent Breast Cancer Treatment and Health Care Utilization.

This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness.

Store and prescription characteristics associated with primary medication nonadherence.

BACKGROUND: Primary medication nonadherence (PMN) is any instance whereby patients fail to initiate a pharmacotherapy regimen after receiving a prescription for new therapy. The Pharmacy Quality Alliance (PQA) has proposed a standardized definition for PMN and a quality measure to assess the rates of PMN in community pharmacies. OBJECTIVES: To (a) measure PMN using the proposed PQA measure with data available from a pharmacy dispensing system and (b) identify the prescription-level (patient, prescriber, and medication) and store-level (store and neighborhood) characteristics associated with PMN. METHODS: This study was approved by a southern university institutional review board, and a data use agreement was in place. A large national pharmacy grocery chain provided de-identified, transactional data for 2010 through January 2012, for 100 pharmacies (de-identified unique patient and store codes were available). The proposed PQA-PMN measure was used, and PMN rates were calculated. Investigators examined adult individuals with a new electronic prescription for any of the included medications during the measurement period and determined whether the medication or an appropriate alternative was claimed within 30 days. Multilevel logistic regression with a random intercept was used to evaluate prescription-level and store-level predictors of PMN. Prescription-level variables included prescriber type, PQA-defined drug class, patient gender and age, whether the prescription was accompanied by another prescription on the same day, payment source, and out-of-pocket costs. A daily average prescription volume variable was calculated for each pharmacy as a store-level variable. Additional store-level variables were derived from the 2007-2011 American Community Survey, available from the U.S. Census Bureau (median household income, educational level, percentage of minorities, and percentage aged 65 years and over in the census tracts where the pharmacies are located).  RESULTS: Of the e-prescriptions during the 1-year measurement period, 29,238 were for new therapies as defined by the PMN measure, and 3,570 (12.2%) of those new prescriptions were not claimed within a 30-day period. There was significant variability among the pharmacies (intraclass correlation coefficient=0.140). In the adjusted multilevel model, the estimated odds of an unclaimed prescription were significantly different among drug classes comprising the PQA-PMN measure and were higher as out-of-pocket costs increased, when the prescription was accompanied by another prescription on the same day, and for primary care physicians relative to physician assistants and advanced practice nurses. The estimated odds were slightly higher for younger individuals, when originating at stores with lower prescription volumes and when originating at stores located in neighborhoods with higher household incomes. Although neither the gender of the patient nor the payment source were related to whether the prescription went unclaimed in the multivariable model, these variables, along with out-of-pocket costs and the accompaniment of the prescription with another prescription on the same day, were involved in cross-level interactions with household income and educational level.  CONCLUSIONS: This study is one of the first to use pharmacy prescription data to calculate PMN using the PQA standardized measure and to identify prescription-level and store-level factors associated with PMN. PMN remains a significant challenge in this setting, and there is significant variation in the outcome among pharmacies in the same chain, even after accounting for several potential store-level predictors. There is considerable opportunity for quality improvement to reduce the number of unclaimed prescriptions. Efforts directed at further understanding this behavior and how to design tailored interventions to reduce its occurrence are warranted.

Measuring pharmacy performance in the area of medication adherence: addressing the issue of risk adjustment.

BACKGROUND: Pharmacies and pharmacists play an important role in the health care system, improving health outcomes and enhancing quality through better pharmaceutical care. Yet, little information is available to accurately evaluate pharmacy store quality and thereby encourage quality improvement at the pharmacy store level. OBJECTIVES: To (a) assess pharmacy performance in the area of medication adherence and (b) examine the impact of risk adjustment of performance scores on pharmacy rankings. METHODS: We used proportion of days covered (PDC) to compute pharmacy performance scores using the 2007 Mississippi Medicare administrative claims dataset. We calculated unadjusted and adjusted quality scores for 685 pharmacies serving 137,497 eligible Medicare beneficiaries. Risk-adjusted quality scores were computed using a hierarchical logistic regression model (Method 1) and the shrinkage estimators of the model (Method 2). Patient demographics, income subsidy status, and comorbidity burden were used as variables for risk adjustment.  RESULTS: Unadjusted scores showed low levels of agreement (Cohen's kappa less than 0.45) with risk-adjusted scores in identifying statistical outliers based on 95% CIs. Unadjusted scores also failed to identify 39%-43% of the top 20% and bottom 20% of pharmacies and displayed moderate agreement (0.4 less than kappa less than 0.5) with risk-adjusted scores. Pharmacy classifications based on risk-adjusted scores obtained from different statistical methods showed high levels of agreement (0.79 less than kappa less than 0.98).  CONCLUSIONS: In the risk-adjustment methods presented here, we account for many patient characteristics previously reported to be associated with medication adherence and available in our dataset. Risk-adjusted scores produced more robust indicators of pharmacy quality than unadjusted scores. Depending on the availability of important variables in the source data, the use of risk-adjusted quality indicators may lead to better evaluation of pharmacy quality and should be considered when providing public reports on pharmacy quality. 

Adherence to multiple medications prescribed for a chronic disease: a methodological investigation.

BACKGROUND: Many patients receive multiple medications for the treatment of a disease. While monitoring adherence is important, a composite measure of adherence is useful for estimating adherence to multiple medications in these patients. There are multiple ways to compute composite estimates of adherence to multiple medications, including (a) 80% of days covered by at least 1 medication ("at least 1"); (b) 80% of days covered by both medications ("both"); (c) 80% of days covered by each medication measured separately ("all"); and (d) computing an average of the individual medication adherence estimates ("average"). Comparison of adherence rates to individual medications and that of composite estimates are important for intervention decisions and effective disease management.  OBJECTIVES: To (a) examine adherence to multiple medications prescribed for a disease; (b) estimate composite adherence to multiple medications prescribed for a disease; and (c) determine the rate of differential classification of a patient being adherent as is estimated by different available algorithms.   METHODS: A retrospective cohort study was designed using 2002-2003 MarketScan Commercial Claims and Encounters data. To be included in the cohort, patients had to be less than aged 65 years and had to have separate prescriptions filled for 2 classes of diabetes medications (i.e., any sulfonylurea [SU] and any thiazolidinedione [TZD]) at least once; patients taking other diabetic medications over the observation period were excluded. Adherence was measured by proportion of days covered (PDC) over periods of 90 days (8 quarters total) and cumulatively over the 2-year study period. For some composite adherence estimates, patients were considered adherent if PDC ≥ 80%. Survival curves using the life-table method were constructed to compare the time until PDC became less than 80% as estimated by the 3 different categorical composite measures. RESULTS: A total of 6,043 patients were included in the analysis. Across the 8 quarters under consideration, the average PDC estimates ranged between 69.8%-84.2% for SUs and 70.3%-85.6% for TZDs. The mean composite PDC based on the average algorithm varied between 69.4% and 84.9% when measured over each quarter or cumulatively. Similarly, the rates of composite adherence ranged from 74.5% to 88.2%, 46.4% to 61.2%, and 47.7% to 62.9% for the "at least 1," "both," and "all" methods, respectively. Many subjects were classified as adherent by 1 composite dichotomous measure but not by all 3 dichotomous measures (i.e., "all," "at least 1," and "both"); of these patients, 30.6%-38.2% were classified differently as to their adherence status over different quarters by different measures. Survival curves of categorical composite measures were different (P less than 0.05) from one another. "At least 1" identified more patients as persistent and showed a much slower decline than did the "all" or "both" approaches.  CONCLUSIONS: Subjects were found to have a level of adherence-as estimated by individual medication adherence and composite adherence metrics-for multiple medications prescribed for a disease that, while not optimal from the perspective of patient care, was not entirely poor. In addition, composite estimates of adherence considerably varied depending on algorithms used. Most importantly, a large number of patients appeared to be subject to inconsistent classification based on adherence measurement algorithm. Adherence estimates produced by different composite measurement approaches give rise to difficulty in consistent interpretation, which may be detrimental to appropriate patient care decision making.

Association between health-related quality of life and colorectal cancer screening.

Conflicting information currently exists about the role played by health-related quality of life (HRQOL) in influencing colorectal cancer screening. The current study aimed to determine the relationship between HRQOL and colorectal cancer screening, using nationally representative public data from the Behavioral Risk Factor Surveillance System (BRFSS). The 2010 BRFSS data were used for this study. Individuals younger than age 50 years were excluded from the study. Missing data were imputed using the multiple imputation technique. Multiple multivariate logistic regression models were fitted to the data to determine the association between different components of HRQOL (physical HRQOL, mental HRQOL, activity limitation caused by poor mental or physical HRQOL, and general health status) and receipt of colorectal cancer screening tests (fecal occult blood testing [FOBT] in the past year, sigmoidoscopy in the past 5 years, and colonoscopy in the past 10 years). The study sample comprised 301,488 individuals. Approximately 12% of the respondents had received FOBT in the past year, 62.6% had received sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years, and 65.4% had received either of the screening tests within appropriate time frames. After controlling for demographic and health-related covariates, an inverse relationship was observed between HRQOL and colorectal cancer screening with the exception of mental HRQOL and FOBT. The relationship between mental HRQOL and FOBT was found to be nonsignificant. Policy makers should consider including HRQOL as an important parameter when designing interventions aimed at improving colorectal cancer screening rates.

Hospitalization burden among individuals with autism.

The objective of this study was to assess the inpatient care burden among individuals with autism using the 2007 Health Care Utilization Project Nationwide Inpatient Sample [HCUP-NIS]). There were ~26,000 hospitalizations among individuals with autism in 2007, with an overall rate of 65.6/100,000 admissions. Rates of hospitalizations were the highest among individuals with autism aged 10-20 years, males, having household income >$63,000, and with private insurance, respectively. In terms of hospital characteristics, rates were the highest in hospitals in large urban areas, located in the Northeast region, and with teaching status, respectively. Individuals with autism had significantly higher LOS (6.5 vs. 4.2; p < 0.0001) and total charges ($24,862 vs. $23,225; p < 0.0001) as compared to those without autism.

Do statins improve outcomes in patients with asthma on inhaled corticosteroid therapy? A retrospective cohort analysis.

OBJECTIVES: Animal studies and clinical trials have examined the potential benefits of statins in asthma management with contradictory results. The objective of this study was to determine if asthma patients on concurrent statins are less likely to have asthma-related hospitalisations. DESIGN: A retrospective cohort study using Mississippi Medicaid data for 2002-2004. PARTICIPANTS: Asthma patients ≥18 years were identified using the ICD9 code 493.xx from 1 July 2002 through 31 December 2003. The index date for an exposed subject was any date within the identification period, 180 days prior to which the subject had at least one inhaled corticosteroid prescription and at least an 80% adherence rate to statins. Asthma patients on inhaled corticosteroids, but not on statins, were selected as the unexposed population. The two groups were matched and followed for 1 year beginning the index date. MAIN OUTCOMES MEASURES: Patient outcomes in terms of hospitalisations and ER visits were compared using conditional logistic regression. RESULTS: After matching, there were 479 exposed subjects and 958 corresponding unexposed subjects. The odds of asthma-related hospitalisation and/or emergency room (ER) visits for asthma patients on concurrent statins were almost half the odds for patients not on statins (OR=0.55; 95% CI (0.37 to 0.84); p=0.0059). Similarly, the odds of asthma-related ER visits were significantly lower for patients on statins (OR=0.48; 95% CI (0.28 to 0.82); p=0.0069). CONCLUSION: The findings suggest beneficial effects of statins in asthma management. Further prospective investigations are required to provide more conclusive evidence.

Educating Pharmacy Students to Improve Quality (EPIQ) in colleges and schools of pharmacy.

OBJECTIVE: To assess course instructors' and students' perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum. METHODS: Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students' perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire. RESULTS: Scores on all questionnaire items indicated improvement in students' perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students' scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education. CONCLUSION: The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement.

Teaching the science of safety in US colleges and schools of pharmacy.

This paper provides baseline information on integrating the science of safety into the professional degree curriculum at colleges and schools of pharmacy. A multi-method examination was conducted that included a literature review, key informant interviews of 30 individuals, and in-depth case studies of 5 colleges and schools of pharmacy. Educators believe that they are devoting adequate time to science of safety topics and doing a good job teaching students to identify, understand, report, manage, and communicate medication risk. Areas perceived to be in need of improvement include educating pharmacy students about the Food and Drug Administration's (FDA's) role in product safety, how to work with the FDA in post-marketing surveillance and other FDA safety initiatives, teaching students methods to improve safety, and educating students to practice in interprofessional teams. The report makes 10 recommendations to help pharmacy school graduates be more effective in protecting patients from preventable drug-related problems.

The science of safety curriculum in US colleges and schools of pharmacy.

OBJECTIVE: To describe the integration of science of safety (SoS) topics in doctor of pharmacy (PharmD) curricula of US colleges and schools of pharmacy. METHODS: A questionnaire that contained items pertaining to what and how SoS topics are taught in PharmD curricula was e-mailed to representatives at 107 US colleges and schools of pharmacy. RESULTS: The majority of the colleges and schools responding indicated that they had integrated SoS topics into their curriculum, however, some gaps (eg, teaching students about communicating risk, Food and Drug Administration [FDA] Sentinel Initiative, utilizing patient databases) were identified that need to be addressed. CONCLUSIONS: The FDA and the American Association of Colleges of Pharmacy (AACP) should continue to collaborate to develop resources needed to ensure that topics proposed by the FDA in their SoS framework are taught at all colleges and schools of pharmacy.