Predictors of Success in Obtaining Postgraduate Residency or Fellowship.

OBJECTIVE: As more pharmacy students are pursuing postgraduate training, colleges of pharmacy are investigating ways to predict success in matching for residency or fellowship. While data have been published about characteristics predictive of matching, we sought to study student scores, rotation types, and rotation evaluations as predictors of success. METHODS: Data were collected from students in the graduating classes of 2021, 2022, and 2023. Students were surveyed on participation in mock interviews, numbers of programs to which they applied, and number of interviews received. In addition, data were collected on impostor phenomenon, grit, perceived stress, anxiety, grade point average (GPA), types of patient care rotations, and preceptor evaluations. RESULTS: Overall, 295 students were included, with 69 unsuccessful and 226 successful students. Successful students were more likely to have lower Perceived Stress Scale-10 scores in the final 3 semesters of school, a higher GPA, more elective patient care rotations, and more preceptors who answered "Yes" to "Would you hire this student?" after graduation. In the multivariate logistic regression analysis, final GPA and preceptors answering affirmatively to "Would you hire this student?" were independent predictors of success in obtaining a postgraduate position. CONCLUSION: As colleges of pharmacy prepare students for postgraduate residencies or fellowships, in addition to GPA, stress levels during the final 3 semesters of pharmacy school may be areas on which to focus. Given that willingness of a preceptor to hire a student after graduation was a predictor of success in securing a postgraduate position, this should be explored in future research.

Evaluation of Academic and Nonacademic Factors of First-Generation Students Transitioning to a Pharmacy Program.

OBJECTIVE: To evaluate the academic transition of first-generation (FG) students to a Doctor of Pharmacy program and the impact of early intervention/outreach. METHODS: The retrospective study evaluated the first semester performance in three classes of student pharmacists (beginning fall 2020, 2021, 2022) at a public university in the mid-South. Student demographics (age, sex, race, relationship status), nonacademic factors (Grit, impostor syndrome, testing anxiety, perceived stress), and academic factors (grade point average, academic probation, early intervention) were assessed. In fall 2022, a required academic meeting was added to the early intervention process after exam one for high-risk students. The data between FG and non-FG students were compared; Mann-Whitney tests for continuous variables and Chi-square tests with risk estimates for categorical variables. RESULTS: There were 152 FG and 274 non-FG students identified over the three classes. A total of 88 (57.9%) FG students represented racial minority groups. More FG students and non-White students were identified for early intervention. First-generation students were more likely to receive two or more grades less than C- and less likely to progress to the spring. No significance was noted with generational status and undergraduate grade point average, academic performance, or nonacademic factors. The required meeting after exam one in fall 2022 resulted in less disparity between FG and non-FG students identified for early intervention for exam two. CONCLUSION: First-generation and non-White students were more likely to struggle when transitioning to the Doctor of Pharmacy curriculum. A proactive, individualized approach incorporated into early intervention procedures is needed to promote academic success and belonging.

Exploring the Relationship Between Imposter Phenomenon and Myers-Briggs Personality Types in Pharmacy Education.

OBJECTIVE: To investigate the relationship between imposter phenomenon (IP) and Myers-Briggs Type Indicator (MBTI) personality types in pharmacy students. METHODS: This was a retrospective, observational study of doctor of pharmacy students who had previously completed MBTI and Clance Imposter Phenomenon Scale (CIPS) assessments. CIPS scores and categories were compared between the 4 MBTI personality type dichotomies using independent samples t tests and chi-square. RESULTS: Mean CIPS score for included pharmacy students (N = 668) was 62.52 (SD 14.82). Clance Imposter Phenomenon Scale scores were significantly higher in students with MBTI of introversion (mean 64.14, SD 14.27), intuition (mean 63.80, SD 15.78), and perceiving (mean 64.38, SD 15.55) as compared to their dichotomous counterparts. No significant difference in mean CIPS scores was found within the thinking/feeling dichotomy. When analyzing IP risk associated with the various MBTI personality dichotomies, introverts were at a 1.8 times greater risk of high/severe IP than extroverts. Additionally, students with perceiving personality types were at a 1.4 times greater risk of high/severe IP than those with judging personality types. CONCLUSION: Our study suggests that pharmacy students with introversion, intuitive, and perceptive personality types exhibit higher CIPS scores, and those with introversion or perceptive personality types are at risk for high/severe IP. Given the common MBTI types and a high degree of IP in pharmacy students, our findings underlie the need for open, targeted discussions about IP and proactively incorporating strategies and resources within a curriculum to support students in normalizing and easing anxiety.

Assessing Student Perceptions of Blended and Online Learning Courses in Pharmacoeconomics, Management, and Leadership.

Objective. Blended learning combines traditional face-to-face education with online instruction. This learner-centered approach has been shown to improve student engagement, critical thinking, and performance outcomes. The objective of this study was to assess and trend student pharmacist perceptions of blended and online learning used to teach pharmacy management, leadership, and economics within a Doctor of Pharmacy (PharmD) curriculum.Methods. Qualitative methods were employed using in-depth, semistructured interviews. Second- and third-year student pharmacists were recruited by purposeful and snowball sampling and interviewed to a point of saturation. The interview guide was based on social cognitive theory. Themes identified through initial deductive thematic analysis were categorized by the three domains of social cognitive theory: cognitive, behavioral, and environmental factors. The coding team additionally analyzed the transcripts using inductive thematic analysis to ensure no themes outside of social cognitive theory were missed.Results. Twenty students were interviewed. Themes reveal perceptions that blended learning facilitated greater understanding of course material, increased motivation among learners, provided more flexibility in workload completion, and was a more enjoyable way to learn compared to traditional didactic instruction. Furthermore, blended learning offered additional distinct advantages over traditional and online-only pedagogies.Conclusion. Student pharmacists perceived blended and online learning positively and acceptable for the delivery of a pharmacy course on management, leadership, and economics over traditional didactic instruction. Blended learning may enhance innovation, leadership, management, and economics content delivery and the student learning experience.

Empowering Student Pharmacists through Social Determinants of Health Activities to Address Patient Outcomes.

The pharmacy education and its educators have to expose the student pharmacists to a plethora of activities regarding health disparities. It is essential for student pharmacists to be introduced to the key elements that comprise the Social Determinants of Health (SDOH) during their didactic curriculum. However, while there have been efforts made in the United States to incorporate the SDOH in the pharmacy curricula, there is limited research on student pharmacists' perspectives of how content in the didactic curriculum prepared them to provide patient care. A quantitative approach was used for this study. For the Class of 2023, activities were added to a skills-based course series and a professional development course series to introduce, apply, and illustrate how SDOH can impact pharmacist-provided care and patient health experiences. As part of the College's assessment plan, a survey is sent to the third-year student pharmacists in January prior to beginning Advanced Pharmacy Practice Experiences (APPEs). The online survey consists of 24 Likert Scale questions with five choices ranging from Strongly Agree to Strongly Disagree and not applicable. Four of the 24 questions pertained to health disparities and SDOH and were evaluated in this study. The responses were analyzed using SPSS for Windows, version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics were calculated for all variables. Chi-square tests were used for all nominal data and Mann-Whitney test was used for all nonparametric numeric data. A total of 530 student pharmacists completed the survey. The mean age was 26 years and majority of the respondents identified as female (64%). More students strongly agreed that they had the ability to identify and address SDOH to improve access to or the delivery of healthcare in the class of 2023 (51.4%) compared to the class of 2022 (37.8%) and class of 2021 (35.8%). In addition, the mean survey score for the question between the class of 2023 improved significantly compared to the class of 2022 (p = 0.015) and 2021 (p = 0.004). Overall, this study suggests that longitudinal activities involving SDOH can improve student pharmacists' assessment of their abilities to interact with and care for a diverse patient population. The results suggest that the curriculum activities implemented to address a plethora of patients improve student assessment of their abilities to identify and incorporate SDOH in providing patient-centered care.

Changes in Academic Performance after Transitioning to Remote Proctoring: A Before-After Evaluation.

Remote proctoring is often used to ensure testing integrity in a distance education environment but may impact academic performance. This quasi-experimental study aimed to evaluate changes in examination scores after transitioning to remote proctoring during the COVID-19 pandemic. Student pharmacists (n = 384) served as their own controls in this before-after analysis of examination scores with in-person versus remote proctoring. To assess differences in examination scores among students with varying levels of testing anxiety, students were classified into low, moderate, or high testing anxiety groups based on their Cognitive Test Anxiety Scale-Second Edition (CTAS-2) score. Students were also stratified into two groups based on their cumulative grade point average (GPA). After transitioning to remote proctoring, examination scores significantly decreased for first-year (P1) students but significantly increased for second-year (P2) students. When stratified by CTAS-2 score, no significant difference in examination scores was found. When stratified by GPA, no significant difference in examination scores was found for P1 students, but a significant improvement was noted for P2 students with remote proctoring. The results of this study indicate that examination scores do not consistently improve or decline after introducing remote proctoring even when considering a student's GPA and level of testing anxiety.

Examining Preparatory Testing and Other Factors Associated With Performance on the Multistate Pharmacy Jurisprudence Examination.

Objective. To evaluate whether the score on the Pre-Multistate Pharmacy Jurisprudence Examination (Pre-MPJE) predicts pharmacy students' performance on the MPJE, and to determine whether demographics, pre-pharmacy school factors, or pharmacy school factors affect MPJE outcomes.Methods. We performed a retrospective review of pharmacy school graduates' (N = 156) MPJE scores, Pre-MPJE scores, demographics, pre-pharmacy school academic performance factors, and pharmacy school academic performance factors. Bivariate and correlational analyses were conducted along with multiple linear regression models to determine the influence of variables on the MPJE total scaled score.Results. A total of 136 pharmacy school graduates were included, with most being female (59%) and non-Hispanic White students (75%). The score on the Pre-MPJE was not significantly correlated with students' first-attempt MPJE pass-fail outcome or total scaled score. Factors that were correlated with passing the MPJE were a younger age at graduation, a higher pharmacy law course grade, Pharmacy Curriculum Outcomes Assessment (PCOA) examination scores, specifically scaled total scores and scaled scores for content areas 1-4 and final pharmacy school grade point average (GPA). The MPJE total scaled score was correlated with a higher pre-pharmacy school GPA, pharmacy law course grade, PCOA total and content area 1-4 scaled scores, and final pharmacy school GPA. However, regression models found that the greatest variance in MPJE total scaled score was contributed by the pharmacy law course grade. The total scaled score on the PCOA contributed to some variance for all MPJE takers, but only the pharmacy law course grade significantly influenced the in-state MPJE total scaled score.Conclusion. The findings did not show that the Pre-MPJE score was a predictor for passing the MPJE or for the MPJE total scaled score. The most important determinant of the MPJE total scaled score was a student's performance in the pharmacy law course.

Effects of Remote Proctoring on Composite Examination Performance Among Doctor of Pharmacy Students.

Objective. To determine the impact of remote proctoring on the academic performance of Doctor of Pharmacy (PharmD) students.Methods. This was a retrospective, observational study that compared first professional year (P1) and second professional year (P2) pharmacy students' scores on eight composite examinations administered in spring 2020 (n = 387), the final three of which were proctored remotely, to that of a historical cohort of pharmacy students who took the same examinations in spring 2019 (n = 368). To assess whether remote proctoring affected academic performance, spring 2020 scores for examinations 6, 7, and 8 were compared to those of a historical cohort who took the same examinations in person with a proctor present in spring 2019. Academic performance on examinations 1 through 4 was also compared between the two cohorts to evaluate any possible year-to-year variation in academic performance during non-remote circumstances. Mann Whitney tests were used to compare scores between the two cohorts.Results. The median scores of students in the spring 2020 cohort were significantly lower than the scores of the historical cohort on the first composite examination administered to P1 students after the implementation of remote proctoring. In contrast, median scores were significantly higher on two of the three examinations administered to P2 students using remote proctoring.Conclusion. Remote proctoring has minimal impact on pharmacy students' examination performance and its use should be considered to ensure academic honesty and security of testing content in a distance learning environment.

Effects of peer-led study sessions on first-year student pharmacist performance in pharmacy math.

INTRODUCTION: To evaluate effects of peer-led study sessions on performance in a traditionally challenging course, Pharmacy Math, among first-year student pharmacists (P1s). METHODS: Peer-led study sessions were conducted throughout fall 2019 for P1s. Sessions were led by two second-year student pharmacists and focused on study skills and course-related strategies, principles, and content. P1s who attended the majority (at least five) of study sessions were compared to those who attended fewer sessions on student demographics, undergraduate science grade point average, and course outcome (pass/did not pass) using chi-square and independent samples t-tests. Relative risk (RR) was calculated. A sub-analysis of students considered at risk of failing was also conducted. RESULTS: There were 200 P1 participants. Twenty-four students (12%) attended the majority of the sessions and 176 students (88%) attended fewer sessions. Of the 24 students who attended ≥ five study sessions, all passed Pharmacy Math, while 12 of the 176 students who attended fewer sessions failed Pharmacy Math. Students who attended ≥ five sessions had a 6.8% reduction in risk of failing compared to students who attended fewer sessions (RR = 0.93, 95% CI = 0.895, 0.97). More striking, at-risk students who attended ≥ five study sessions had a 17.1% reduction in risk of failing. CONCLUSIONS: Peer-led study sessions contribute to reduced risk of failing Pharmacy Math among students who attend a majority of study sessions. Improvements for the future were identified, including mandatory attendance, group structure, and creative ways to cover concepts.

Longitudinal examination of perceived stress and academic performance of first-year student pharmacists.

INTRODUCTION: First-year pharmacy students (P1s) may experience a number of stressors that may affect academic performance due to the transition into a professional program. Study objectives were to evaluate student demographic and pre-pharmacy factors associated with perceived stress among P1s, analyze relative change in perceived stress over the P1 year, and assess associations between perceived stress and academic performance. METHODS: The Perceived Stress Scale (PSS-10) was administered three times to P1s: during orientation, midpoint of fall semester, and midpoint of spring semester. Data were also collected using school records, including demographics, P1 fall grade point average (GPA), P1 spring GPA, and P1 year GPA. Paired-sample t-tests, independent samples t-tests, Analysis of Variance, correlational analysis, and multiple linear regression were conducted. RESULTS: Of 202 P1s, 201 (99.5%) completed the orientation survey administration and 110 (54.5%) completed all three administrations. PSS-10 score significantly increased across survey administrations. Differences in PSS-10 scores at orientation were noted based on gender and race/ethnicity (P < .05), with female and minority students experiencing greater levels of stress. PSS-10 score (spring administration) was significantly, inversely correlated to P1 fall GPA, spring GPA, and year GPA (P < .05). Undergraduate science GPA, PSS-10 score (orientation administration), and age were included in the final version of the regression model as significant predictors of P1 year GPA. CONCLUSIONS: Perceived stress increased over the P1 year, and higher perceived stress was associated with lower P1 academic performance. Future studies should examine strategies to assist P1s in managing stress.

The need to prioritize "prioritization" in clinical pharmacy service practice and implementation.

Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.

Genetic Variation in CYP2R1 and GC Genes Associated With Vitamin D Deficiency Status.

This cross-sectional study enrolled 180 patients at a private family practice in Virginia. Total serum vitamin D concentrations were obtained weekly from January 30, 2013, through March 30, 2013, in consecutive patients regularly scheduled for laboratory work at the practice. Patients were categorized into 2 groups and analyzed for variant alleles in vitamin D receptor ( VDR; rs2228570), cytochrome P450 2R1 ( CYP2R1; rs10741657), 7-dehydrocholesterol reductase ( DHCR7; rs12785878), and group-specific component ( GC; rs2282679) to determine whether variants of those alleles influenced total serum 25(OH)D concentrations. One-hundred and eighty patients were enrolled, with 40 (22%) being sufficient, 25-hydroxy vitamin D level 25(OH)D ≥ 30 ng/mL, and 140 (78%) being insufficient, 25(OH)D < 30 ng/mL. Of the 4 genes, 2 genes, CYP2R1 (rs10741657) and GC (rs2282679), demonstrated a significant association related to vitamin D status. Subjects with 1 or more variant alleles at rs10741657 were almost 3.7 (odds ratio [OR] 3.67; 95% confidence interval [CI]: 1.35-9.99) times more likely be insufficient in vitamin D and subjects with 1 or more variant alleles at rs2282679 were about half (OR 0.42; 95% CI: 0.18-0.93) as likely to be insufficient in vitamin D. Allelic variations in CYP2R1 (rs10741657) and GC (rs2282679) affect vitamin D levels, but variant alleles on VDR (rs2228570) and DHCR7 (rs12785878) were not correlated with vitamin D deficiency, 25(OH)D < 30 ng/mL.

Management of prediabetes: a comparison of the treatment approaches utilized by a family practice clinic and an internal medicine/endocrinology practice.

PURPOSE: To compare the management of prediabetes between a family practice clinic and internal medicine/endocrinology practice. METHODS: A randomized, retrospective evaluation of the medical history in 168 eligible patients with a diagnosis of prediabetes or abnormal blood glucose (BG) at a family practice clinic (n = 78) and an internal medicine/endocrinology practice (n = 90). RESULTS: The internal medicine/endocrinology practice provided more counseling regarding lifestyle modifications (91.1% vs 76.9%, P = .039), specific physical activity recommendations (26.7% vs 7.7%, P = .003), and recommended more patients receive 150 minutes/week of moderate exercise (8.9% vs 1.3%, P = .038). The family practice clinic provided more written dietary information (16.9% vs 13.3%, P = .044) and specific weight loss goals (20.5% vs 6.7%, P = .015). The internal medicine/endocrinology practice initiated pharmacological therapy in more patients (51.1% vs 3.8%, P< .001) and had a significant decrease in fasting BG from baseline compared to the family practice clinic (-9.0 vs -5.6 mg/dL, P< .001). CONCLUSION: Providers are likely to initiate nonpharmacological therapy but may not provide specific education recommended by the American Diabetes Association. The integration of a multidisciplinary team to provide guideline-based nonpharmacologic counseling may be beneficial in improving outcomes in the management of prediabetes.

Guidelines for resident teaching experiences.

Postgraduate year one (PGY1) and postgraduate year two (PGY2) residencies serve to develop pharmacists into skillful clinicians who provide advanced patient-centered care in various general and specialized areas of pharmacy practice. Pharmacy residencies are a minimum requirement for many clinical pharmacy positions, as well as for positions in academia. The role of clinical pharmacists typically includes teaching, regardless of whether they pursue an academic appointment. Common teaching duties of pharmacist-clinicians include giving continuing education or other invited presentations, providing education to colleagues regarding clinical initiatives, precepting pharmacy students (early and advanced experiences) and residents, and educating other health care professionals. Although ASHP provides accreditation standards for PGY1 and PGY2 residencies, the standards pertaining to teaching or education training are vague. Through the years, teaching certificate programs that develop residents' teaching skills and better prepare residents for a diverse pharmacy job market have increased in popularity; moreover, teaching certificate programs serve as an attractive recruitment tool. However, the consistency of requirements for teaching certificate programs is lacking, and standardization is needed. The Task Force on Residencies developed two sets of guidelines to define teaching experiences within residencies. The first guideline defines the minimum standards for teaching experiences in any residency-training program. The second guideline is for programs offering a teaching certificate program to provide standardization, ensuring similar outcomes and quality on program completion. One of the main differences between the guidelines is the recommendation that residency programs offering a teaching certificate program be affiliated with an academic institution to provide the pedagogy and variety of teaching experiences for the resident. Residency program directors should consider adopting these guidelines to offer consistent teaching experiences. In addition, residents should inquire about the elements of teaching in a program as an aid to selecting the training best suited to their needs.

Continuity of care between family practice physicians and hospitalist services.

PURPOSE: Hospitalist services are increasing in popularity and fewer primary care providers (PCPs) are caring for patients while hospitalized. Due to concerns with discontinuity of care, this study evaluated communication and medication discrepancies on admission and discharge between PCPs without admitting privileges and hospitalist physicians. METHODS: This retrospective analysis evaluated patients from a PCP office admitted to hospitalist services from January 2009 through July 2009. Patient charts were evaluated for PCP, age, gender, insurance, modes and timeliness of PCP notification, medications on admission and discharge, and medication discrepancies. RESULTS: A total of 120 charts were evaluated. Physicians were contacted by receipt of admission summaries for 93% of patients and by phone for 5.8% of patients. Twenty-one percent of admission summaries were received by the PCP after the patient was discharged from the hospital and 7% of discharge summaries were received after the first hospital follow-up with the PCP. Medication errors occurred frequently and the rate increased in patients at least 65 years old, if they had Medicare, Medicaid, or were without insurance coverage. CONCLUSION: Better communication and documentation of medication regimens are needed to improve continuity of care of patients between outpatient and inpatient settings and avoid potentially harmful medication errors.

Student pharmacist, pharmacy resident, and graduate student perceptions of social interactions with faculty members.

OBJECTIVE: To describe the perceptions of student pharmacists, graduate students, and pharmacy residents regarding social situations involving students or residents and faculty members at public and private universities. METHODS: Focus groups of student pharmacists, graduate students, and pharmacy residents were formed at 2 pharmacy schools. Given 3 scenarios, participants indicated if they thought any boundaries had been violated and why. Responses were grouped into similar categories and frequencies were determined. RESULTS: Compared with private university students or pharmacy residents, student pharmacists at a public university were more likely to think "friending" on Facebook violated a boundary. No participants considered reasonable consumption of alcohol in social settings a violation. "Tagging" faculty members in photos on Facebook was thought to be less problematic, but most participants stated they would be conscious of what they were posting. CONCLUSIONS: The social interactions between faculty members and students or residents, especially student pharmacists, should be kept professional. Students indicated that social networking may pose threats to maintaining professional boundaries.

Faculty perceptions of appropriate faculty behaviors in social interactions with student pharmacists.

OBJECTIVE: To determine faculty and administrator perceptions about appropriate behavior in social interactions between pharmacy students and faculty members. METHODS: Four private and 2 public colleges and schools of pharmacy conducted focus groups of faculty members and interviews with administrators. Three scenarios describing social interactions between faculty members and students were used. For each scenario, participants reported whether the faculty member's behavior was appropriate and provided reasons for their opinions. RESULTS: Forty-four percent of those surveyed or interviewed considered interactions between faculty members and pharmacy students at a bar to be a boundary violation. Administrators were more likely than faculty members to consider discussing other faculty members with a student to be a boundary violation (82% vs. 46%, respectively, P <0.009). A majority (87%) of faculty members and administrators considered "friending" students on Facebook a boundary violation. CONCLUSIONS: There was no clear consensus about whether socializing with students at a bar was a boundary violation. In general, study participants agreed that faculty members should not initiate friendships with current students on social networks but that taking a student employee to lunch was acceptable.

Impact of obtaining medications from pharmaceutical company assistance programs on therapeutic goals.

BACKGROUND: Limited data exist regarding whether improved access to medications for indigent persons through pharmaceutical company assistance programs (PCAPs) leads to attainment of therapeutic goals. OBJECTIVE: To evaluate the impact of obtaining medications through PCAPs with pharmacist assistance versus prescription insurance on the likelihood of achieving therapeutic goals. METHODS: A retrospective chart review was conducted in a private family practice clinic. Individuals prescribed one or more drugs for the treatment of hypertension, diabetes, or dyslipidemia and receiving medication through a PCAP or prescription insurance were included. Eligible records were reviewed for pertinent laboratory and medication information and to assess achievement of hypertension, diabetic, and dyslipidemia goals. RESULTS: A total of 458 persons were eligible for inclusion: 250 with prescription insurance and 208 using a PCAP. The PCAP group was older, with more females and multiple disease states. There was no significant difference between the groups in reaching hypertension goals; the goals were not predicted by PCAP, presence of diabetes, or class of drug. More PCAP individuals (67.1%) achieved hemoglobin A1C values less than 7% compared with patients in the prescription insurance group (39.6%; p = 0.002). The PCAP group had lower low-density lipoprotein cholesterol (LDL-C) values (95.8 +/- 28.0 mg/dL; mean +/- SD) and higher high-density lipoprotein cholesterol (HDL-C) values (40.8 +/- 12.1 mg/dL) compared with the prescription insurance group (111.8 +/- 37.5 mg/dL; p < 0.001 and 33.7 +/- 13.6 mg/dL; p = 0.011, respectively). Achieving LDL-C goals were significant only for a goal less than 130 mg/dL and less than 160 mg/dL (p = 0.007); diabetes patients were less likely to achieve LDL-C goals compared with those without diabetes in both groups. Enrollment in PCAP was a predictor in reaching diabetic and some dyslipidemia therapeutic goals. CONCLUSIONS: Individuals without prescription insurance and receiving pharmacist and PCAP assistance in obtaining medications were more likely to reach diabetic goals and have better cholesterol values compared with persons with prescription insurance. The presence of prescription insurance alone does not guarantee reaching therapeutic goals; pharmacist involvement with PCAP and obtaining drugs enhances the likelihood of persons achieving therapeutic goals.

Impact of the Medicare modernization act on low-income persons.

BACKGROUND: Low-income Medicare beneficiaries without prescription benefits have high out-of-pocket medication expenses that can discourage adherence to treatment regimens. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created a temporary drug discount card program and a prescription benefit with low-income provisions to assist with medication expenditures for eligible seniors. OBJECTIVE: To determine the impact of the new drug discount card and prescription benefit on medication expenditures by low-income Medicare recipients who require pharmaceutical company assistance for obtaining medications. DESIGN: Retrospective, nonrandomized evaluation. SETTING: Family practice physicians' office in northern Virginia. PATIENTS: 137 Medicare recipients without prescription coverage who received assistance from pharmaceutical companies for medications. MEASUREMENTS: Patients were stratified into 3 categories according to income, household size, and the federal poverty line (FPL), as defined by the new Medicare act. Participants' long-term oral and inhaled medications, dosages, and instructions for use were obtained. The MMA criteria for low-income provisions were applied for the drug discount program and for the prescription benefit. Medication costs under the new Medicare benefits were compared with those incurred without assistance and with the use of pharmaceutical company programs for the cohort and FPL categories. RESULTS: In all income categories, medication costs were lower after enrollment in all programs than those of patients without assistance. Compared with pharmaceutical company assistance, Medicare drug discount cards resulted in less savings for all income groups. For the prescription benefit, persons with incomes less than 135% of FPL had the greatest benefit because of low-income subsidies. Persons ineligible for low-income subsidies receiving the standard benefit had a smaller reduction in out-of-pocket costs and variable monthly expenditures; they realized a superior savings with pharmaceutical company assistance programs. LIMITATIONS: The generalizability of these findings is limited because the authors used a discount pharmacy to determine drug costs for persons receiving no assistance, could not determine asset criteria for the MMA drug benefit low-income subsidy, and used a selected Medicare population. CONCLUSIONS: In a low-income Medicare population without prescription coverage, pharmaceutical company programs offered considerable savings and were superior to the Medicare drug discount cards. For the Medicare prescription plan, the greatest savings was among those eligible for low-income subsidies. Month-to-month medication costs may vary substantially for persons ineligible for such subsidies, and pharmaceutical company assistance may be a better alternative.