Parents' perspectives on their children's health insurance: plight of the underinsured.

OBJECTIVES: To determine the prevalence and correlates of children's underinsurance within a primary care, practice-based research network. STUDY DESIGN: A survey of 13 practices within the Southwestern Ohio Ambulatory Research Network using the Medical Expenses for Children Survey in 2009 and 2010 yielded a sample of 2972 parents of children >6 months old with health insurance in the previous 12 months. Data were analyzed using bivariate and loglinear model analyses. RESULTS: Of the study children, 17.2% were classified as underinsured because of their inability to pay for ≥ 1 of their pediatrician's recommendations for care in the past 12 months. In addition, 15.5% reported it was harder to get medical care for their child in the past 3 years, and 6.5% indicated that their child's health had suffered. Multivariate analysis reveals complex relationships among the 3 factors related to ability to obtain care and between these factors and sociodemographic and health status factors. Across education and income categories, the underinsured rate ranged from 57% to 93% for parents who reported their child's health had suffered. CONCLUSIONS: One in 6 parents reported that their child was underinsured. A similar percentage reported that it had become more difficult to get needed medical care over the past 3 years. The relationship between the perception that an underinsured child's health has suffered is much stronger for the highest socioeconomic category in this sample than for the other categories; 93% of these families were underinsured in 2009. It is possible that high deductible features of insurance plans contribute to these circumstances.

Prescribing by pharmacists in Alberta and its relation to culture and personality traits.

BACKGROUND: As evidence for the efficacy of pharmacists' interventions, governments worldwide are developing legislation to formalize new practice approaches, including independent prescribing by pharmacists. Pharmacists in Alberta became the first in Canada availed of this opportunity; however, uptake of such has been slow. One approach to understanding this problem is through an examination of pharmacists who have already gained this ability. OBJECTIVES: The primary objective of this study was to gain descriptive insight into the culture and personality traits of innovator, and early adopter, Alberta pharmacists with Additional Prescribing Authorization using the Organizational Culture Profile and Big Five Inventory. METHODS: The study was a cross-sectional online survey of Alberta pharmacists who obtained Additional Prescribing Authorization (independent prescribing authority), in the fall of 2012. The survey contained three sections; the first contained basic demographic, background and practice questions; the second section contained the Organizational Culture Profile; and the third section contained the Big Five Inventory. RESULTS: Sixty-five survey instruments were returned, for a response rate of 39%. Respondents' mean age was 40 (SD 10) years. The top reason cited by respondents for applying for prescribing authority was to improve patient care. The majority of respondents perceived greater value in the cultural factors of competitiveness, social responsibility, supportiveness, performance orientation and stability, and may be more likely to exhibit behavior in line with the personality traits of extraversion, agreeableness, conscientiousness and openness. Inferential statistical analysis revealed a significant linear relationship between Organizational Culture Profile responses to cultural factors of social responsibility and competitiveness and the number of prescription adaptations provided. CONCLUSIONS: This insight into the experiences of innovators and early adopter pharmacist prescribers can be used to develop more specific and targeted knowledge implementation studies to improve the uptake and integration of prescribing by pharmacists.

Prescribing by pharmacists in Alberta.

PURPOSE: The evolution of prescribing by pharmacists in Alberta is described. SUMMARY: The prescribing model for pharmacists registered with the Alberta College of Pharmacists is defined by three categories of prescribing a Schedule 1 drug, a drug available only by prescription in Alberta. Pharmacists are not authorized to prescribe narcotics and controlled drugs (i.e., opium and its derivatives, barbiturates, and benzodiazepines) that are federally regulated. The first two categories of prescribing, adapting a prescription and prescribing in an emergency, legitimize existing practices that were not previously recognized in legislation. When adapting a prescription, the pharmacist modifies an existing prescription either to meet the unique needs of the patient or to extend therapy on an incidental basis when the patient is unable to contact the original prescriber. Emergency prescribing enables pharmacists to prescribe in unique situations when patients are unable to access other health services. Additional prescribing, the third category, provides pharmacists who successfully complete an application process the ability to independently prescribe--a privilege that is not authorized in any other jurisdiction in North America. By April 1, 2007, over 2800 pharmacists who were registered on the clinical registry had completed the orientation program necessary for prescribing to adapt a prescription or for an emergency encounter, and by September 1, 2007, over 3300 had completed the program. Fifteen pharmacists were granted additional prescribing privileges after completing a pilot program. CONCLUSION: Collaborative efforts among health care professionals, regulatory health authorities, and patients led to the development of the current prescribing model for pharmacists practicing in Alberta. The model includes provisions for adapting a prescription, prescribing in an emergency, and additional prescribing by pharmacists who obtain authorization.