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1.
Nephron ; : 1-10, 2020 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-32434210

RESUMEN

INTRODUCTION: Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs). OBJECTIVE: The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant. METHODS: Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed. RESULTS: A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07-0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03-0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses. CONCLUSIONS: Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.

2.
Am J Pharm Educ ; 84(2): 7561, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32226072

RESUMEN

Objective. To examine predictors of Doctor of Pharmacy (PharmD) students' on-time graduation, dismissal from pharmacy school, and scores on their first attempt at taking the North American Pharmacist Licensure Examination (NAPLEX). Methods. A retrospective review of student records for the graduating classes of 2015-2018 at a college of pharmacy was performed. Data on the following were collected: student demographics/characteristics (age, gender, race/ethnicity, financial need), having an undergraduate degree, undergraduate science grade point average (GPA), Pharmacy College Admission Test composite score percentile, pharmacy school GPAs for the didactic portion of the curriculum, Pre-NAPLEX score, on-time graduation from pharmacy school, dismissal from pharmacy school, and outcome (pass/fail) of first-attempt at taking the NAPLEX. Binary logistic regression analysis was conducted. Results. Of the 657 students whose records were included in the study, the majority were female (60%) and non-Hispanic white (70%). Higher first-year GPA was associated with increased likelihood of on-time graduation, while increased age and having an undergraduate degree were associated with a decreased likelihood of on-time graduation. A higher first-year GPA was associated with decreased likelihood of being dismissed from pharmacy school. Appearing before the Academic Standing and Promotion Review Committee for unsatisfactory academic performance was associated with decreased likelihood of passing the NAPLEX. Conclusion. First-year pharmacy school GPA is a critical predictor for student pharmacists in terms of on-time graduation and dismissal, and may have consequences for later NAPLEX outcome. Pharmacy schools should closely monitor students' performance during the first year and provide support to students experiencing academic difficulties.

3.
Artículo en Inglés | MEDLINE | ID: mdl-32146134

RESUMEN

OBJECTIVES: Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone. DESIGN: A cross-sectional survey conducted via telephone. SETTING AND PARTICIPANTS: All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties). OUTCOME MEASURES: Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted. RESULTS: Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers. CONCLUSION: Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.

4.
Am J Pharm Educ ; 83(9): 7460, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31871361

RESUMEN

Objective. To evaluate educational debt-to-income trends in pharmacy, dentistry, medicine, optometry, and veterinary medicine in the United States from 2010 to 2016. Methods. A retrospective analysis of educational debt and income for selected health professions was conducted. Data on student loan debt were collected from professional organizations and data on income were collected from the American Community Survey. Ratios of the mean educational debt of graduating students to the median annual income for their respective profession were calculated for 2010 through 2016. Average change per year in debt, income, and debt-to-income ratio were calculated. Results. Debt-to-income ratios for all selected health professions except medicine exceeded 100%. For physicians, debt-to-income ratios ranged from 89% to 95%. On average, physicians (-0.3 percentage point) and optometrists (-0.5 percentage point) had negative changes in their debt-to-income ratios from 2010 to 2016. Average increases per year in debt-to-income ratio of veterinarians, pharmacists, and dentists were 5.5, 5.7, and 6.0 percentage points, respectively. From 2010 to 2016, dentists had the largest average increase per year in debt ($10,525), while physicians had the largest average increase per year in income ($6667) and a minimal average debt increase per year ($5436). Pharmacists had the second largest average increase per year in debt ($8356). Conclusion. Educational debt-to-income ratios in the United States increased considerably over the past decade among pharmacists, dentists, and veterinarians and can negatively impact health professionals as well as patient care. Innovative strategies are needed to alleviate the educational debt burden.

6.
Am J Pharm Educ ; 83(6): 6896, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31507286

RESUMEN

Objective. To develop a valid and reliable academic resilience scale for use in the didactic portion of the Doctor of Pharmacy curriculum to identify those pharmacy students who have greater capacity to overcome academic adversity. Methods. A cross-sectional survey was conducted among first-year, second-year, and third-year pharmacy students to assess psychometric properties of a 30-item adapted academic resilience scale. Data were also collected using the Short Grit Scale (Grit-S). Demographic characteristics were collected from student records. Exploratory factor analysis was applied to determine the number of underlying factors responsible for data covariation. Principal components analysis was used as the extraction method. Varimax rotation method was used, and the Cronbach alpha was estimated. Validity testing was conducted by calculating Pearson's r correlations between the adapted academic resilience scale and Grit-S. Results. The survey response rate was 84%. The final version of the scale, the Academic Pharmacy Resilience Scale (APRS-16), had four subscales and 16 items (14 items failed to load on any of the factors and were deleted). The Cronbach alpha was .84, indicating strong internal consistency. The APRS-16 and its subscales were significantly correlated to the Grit-S and its subscales, providing evidence of effective convergent validity. Conclusion. Evidence supports the reliability and validity of the APRS-16 as a measure of academic resilience in pharmacy students. Future studies should use the APRS-16 to investigate the relationship between academic resilience and performance outcomes among pharmacy students.

7.
Res Social Adm Pharm ; 2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31371234

RESUMEN

BACKGROUND: Significant racial and ethnic disparities in statin prescribing and utilization have been constantly documented. OBJECTIVE: To examine whether racial/ethnic disparities in statin treatment have decreased among the diabetic population after the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. METHODS: This retrospective study analyzed patients with diabetes aged 40-75 years old in the Medicare Expenditure Panel Survey (2011-2012 and 2014-2015). Racial and ethnic disparities in the likelihood of statin use and number of statin prescriptions were compared before and after the guideline release. Logistic and negative binomial regressions were used to adjust for patient characteristics. A difference-in-difference model (DID) was used to examine disparity changes. RESULTS: This study included 2584 patients from 2011 to 2012 and 2610 from 2014 to 2015. During 2011-2012, racial/ethnic disparities were significant for the likelihood of statin use. For the number of statin prescriptions, racial disparity was significant, but not for the ethnic disparity. During 2014-2015, racial/ethnic disparities were significant for the likelihood of statin use but were not significant for the number of statin prescriptions. The DID model found that the 2013 guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment. CONCLUSIONS: This study found persistent disparities in the likelihood of statin use. The 2013 ACC/AHA guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment.

8.
Am J Health Syst Pharm ; 76(7): 424-435, 2019 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-31361827

RESUMEN

PURPOSE: The purpose of this review is to (1) provide information concerning the opioid crisis including origins, trends, and some important related laws/policies; and (2) summarize the current involvement and impact of pharmacists in helping to address the crisis, as well as examine practices in other healthcare disciplines from which pharmacists might derive guidance and strategies. SUMMARY: Contributors to the opioid crisis included campaigns to treat pain as a fifth vital sign and to use opioids in treatment of non-cancer-related pain, as well as aggressive marketing of opioid analgesics by pharmaceutical companies. To address the crisis, numerous strategies have been implemented at the policy/legislative, health-system, and patient levels, such as prescription drug monitoring programs (PDMPs), increased regulation of pain clinics, and expanded use of naloxone. Pharmacists have a critical role to play in interventions to address opioid misuse and reduce harm resulting from misuse. Such interventions include patient screening and risk stratification, patient and community education and outreach concerning appropriate pain management, medication reviews/medication therapy management, education on safe storage and disposal, distribution of naloxone/opioid rescue kits and training on their proper use, and referral of patients to addiction treatment, among other strategies. CONCLUSION: Pharmacists have multiple, complex roles in addressing the opioid crisis. Outcomes of several studies provide substantial evidence that pharmacists can make an impact through appropriate pain management, use of PDMPs, opioid overdose prevention training, and medication reviews and counseling, among other interventions.


Asunto(s)
Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/epidemiología , Manejo del Dolor/métodos , Farmacéuticos/organización & administración , Consejo , Publicidad Directa al Consumidor/legislación & jurisprudencia , Revisión de la Utilización de Medicamentos/organización & administración , Política de Salud , Humanos , Prescripción Inadecuada/efectos adversos , Prescripción Inadecuada/legislación & jurisprudencia , Prescripción Inadecuada/prevención & control , Administración del Tratamiento Farmacológico/organización & administración , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/terapia , Servicios Farmacéuticos/organización & administración , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Mal Uso de Medicamentos de Venta con Receta/legislación & jurisprudencia , Mal Uso de Medicamentos de Venta con Receta/prevención & control , Rol Profesional , Estados Unidos/epidemiología
9.
Am J Pharm Educ ; 83(2): 6516, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30962637

RESUMEN

Objective. To examine relationships between students' demographic and academic performance factors and their scores on the Pharmacy Curriculum Outcomes Assessment (PCOA). Methods. Students' PCOA scores and demographics (eg, age, race/ethnicity, sex), preadmission data [eg, cumulative and science grade point average (GPA), Pharmacy College Admissions Test (PCAT)], and academic performance variables (eg, pharmacy GPA, academic standing) were analyzed for one class of third-year pharmacy students (N=159). Independent t-tests and Analysis of Variance (ANOVA) were used to compare scores by demographic variables. Pearson's r correlations were used to assess relationships between PCOA scores and age, PCAT scores, and GPA. Stepwise linear regression was conducted to determine the predictive ability of variables with significant correlations to PCOA performance. Results. Significant correlations were found between sex and PCOA scores with males scoring higher than females. Significant correlations with PCOA scores were also found for PCAT scores, pre-pharmacy science GPA, and pharmacy didactic GPA. Significant differences were found by academic standing, where students in academic difficulty who were allowed to proceed without repeating curricular content scored significantly lower on the PCOA than those who did not experience academic difficulty. Conversely, there were no statistical differences between those who repeated courses and those who never experienced academic difficulty. PCOA performance predictors in the final regression model included PCAT composite score, pharmacy GPA and sex. Conclusion. New findings included differences in PCOA scores by sex and by academic standing, a variable not previously explored in published studies. Findings have implications for remediation decisions in pharmacy curricula.

10.
J Am Geriatr Soc ; 67(3): 581-587, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30674080

RESUMEN

BACKGROUND/OBJECTIVES: Previous research indicates that eligibility criteria for medication therapy management (MTM) services in Medicare prescription drug (Part D) plans, defined under the Medicare Modernization Act (MMA), are associated with racial/ethnic disparities and ineffective in identifying individuals with medication utilization issues. Our study's objective was to determine the comparative effectiveness of MTM eligibility criteria under MMA and in the Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial/ethnic groups. DESIGN: ACA and MMA MTM eligibility criteria were compared on proportions of eligible individuals among patients with medication utilization issues. Multinomial logistic regression was conducted to control for patient/community characteristics. Need-based and demand-based analyses were used to determine disparities due to need and demand for healthcare. Main/sensitivity analyses were conducted for the range of eligibility thresholds. SETTING: Medicare data (2012-2013) linked to Area Health Resources Files. PARTICIPANTS: A total of 964 610 patients 65 years or older. MEASUREMENTS: Medication safety/adherence measures, developed primarily by the Pharmacy Quality Alliance, were used to determine medication utilization issues. RESULTS: Higher proportions of patients were eligible based on ACA than MMA MTM eligibility criteria. For example, in 2013, proportions based on ACA and MMA MTM eligibility criteria would be 99.7% and 26.2%, respectively, in the main analysis (p < .001); in the demand-based main analysis, ACA criteria were associated with 13.6% and 9.8%, respectively, higher effectiveness than MMA criteria among non-Hispanic blacks and Hispanics than non-Hispanic whites. CONCLUSION: ACA MTM eligibility criteria are more effective than MMA criteria in identifying older patients needing MTM, particularly among minorities. J Am Geriatr Soc 67:581-587, 2019.

11.
Patient Prefer Adherence ; 12: 2325-2338, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30464420

RESUMEN

Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.

12.
Inquiry ; 55: 46958018795749, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30175638

RESUMEN

The objective of this study was to examine positive predictive value (PPV) of medication therapy management (MTM) eligibility criteria under Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial and ethnic groups. The study analyzed Medicare data (2012-2013) for 2 213 594 beneficiaries. Medication utilization issues were determined based on medication utilization measures mostly developed by Pharmacy Quality Alliance. MMA was associated with higher PPV than ACA in identifying individuals with medication utilization issues among non-Hispanic blacks (blacks) and Hispanics than non-Hispanic whites (whites). For example, odds ratio for having medication utilization issues to whites when examining MMA in 2013 and ACA were 1.09 (95% confidence interval [CI] = 1.04-1.15) among blacks, and 1.17 (95% CI = 1.10-1.24) among Hispanics, in the main analysis. Therefore, MMA was associated with 9% and 17% higher PPV than ACA in identifying patients with medication utilization issues among blacks and Hispanics, respectively, than whites.


Asunto(s)
Grupos de Población Continentales , Determinación de la Elegibilidad/tendencias , Grupos Étnicos , Disparidades en Atención de Salud/etnología , Administración del Tratamiento Farmacológico/tendencias , Patient Protection and Affordable Care Act , Afroamericanos/estadística & datos numéricos , Anciano , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Medicare Part D/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
13.
Am J Transplant ; 18(3): 564-573, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29288623

RESUMEN

The Food and Drug Administration (FDA) held a public meeting and scientific workshop in September 2016 to obtain perspectives from solid organ transplant recipients, family caregivers, and other patient representatives. The morning sessions focused on the impact of organ transplantation on patients' daily lives and the spectrum of activities undertaken to maintain grafts. Participants described the physical, emotional, and social impacts of their transplant on daily life. They also discussed their posttransplant treatment regimens, including the most burdensome side effects and their hopes for future treatment. The afternoon scientific session consisted of presentations on prevalence and risk factors for medication nonadherence after transplantation in adults and children, and interventions to manage it. As new modalities of Immunosuppressive Drug Therapy are being developed, the patient perceptions and input must play larger roles if organ transplantation is to be truly successful.


Asunto(s)
Desarrollo de Medicamentos/legislación & jurisprudencia , Rechazo de Injerto/prevención & control , Inmunosupresión/normas , Inmunosupresores/uso terapéutico , Cumplimiento de la Medicación , Trasplante de Órganos/normas , Humanos , Pronóstico , Estados Unidos , United States Food and Drug Administration
14.
Am J Pharm Educ ; 81(7): 5918, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29109558

RESUMEN

Objective. To assess graduating pharmacy students' attitudes toward debt and determine associations with stress, student loan debt, financial need, current employment, post-graduation plans, and expected length of time to repay loans. Methods. Survey was conducted using an attitudes-toward-debt scale (sub-scales: tolerant attitudes toward debt; contemplation and knowledge about loans; fear of debt), Perceived Stress Scale, and questions concerning current employment, estimated total student loan debt, post-graduation plans, and expected length of time to repay loans. Federal loan data were collected using financial aid records. Independent samples t-test, ANOVA, and Pearson's r correlations were conducted. Results. There were 147 students (96.7%) who participated. The majority were female (59.2%), white (69.4%), and had federal student loans (90.5%). Mean total loan amount was $153,276 (SD $59,810), which included federal students loans accumulated before and during pharmacy school. No significant differences were noted on attitudes toward debt or stress based on whether respondents had federal student loans. Greater "fear of debt" was correlated with increased stress, estimated total student loan debt, total federal loan debt, and pharmacy school loan debt. Greater "contemplation and knowledge about loans" was correlated with lower estimated total student loan debt, total federal loan amount, and pharmacy school loan amount. Students with higher "contemplation and knowledge" scores expected to repay loans within a shorter time frame than students with lower scores. Conclusion. Increased fear of debt was related to greater perceived stress and higher student loan amounts borrowed, while increased contemplation and knowledge about loans was associated with lower amounts borrowed. Educational programming concerning loans, debt, and personal financial management may help reduce stress and amount borrowed.


Asunto(s)
Educación en Farmacia/economía , Facultades de Farmacia/economía , Estrés Psicológico/psicología , Estudiantes de Farmacia/psicología , Apoyo a la Formación Profesional/economía , Adulto , Actitud , Estudios Transversales , Femenino , Humanos , Masculino
15.
Am J Pharm Educ ; 81(5): 86, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28720914

RESUMEN

Objective. To examine the relationship between the NAPLEX and Pre-NAPLEX among pharmacy graduates, as well as determine effects of pre-pharmacy, pharmacy school, and demographic variables on NAPLEX performance. Methods. A retrospective review of pharmacy graduates' NAPLEX scores, Pre-NAPLEX scores, demographics, pre-pharmacy academic performance factors, and pharmacy school academic performance factors was performed. Bivariate (eg, ANOVA, independent samples t-test) and correlational analyses were conducted, as was stepwise linear regression to examine the significance of Pre-NAPLEX score and other factors as related to NAPLEX score. Results. One hundred fifty graduates were included, with the majority being female (60.7%) and white (72%). Mean NAPLEX score was 104.7. Mean Pre-NAPLEX score was 68.6. White students had significantly higher NAPLEX scores compared to Black/African American students. NAPLEX score was correlated to Pre-NAPLEX score, race/ethnicity, PCAT composite and section scores, undergraduate overall and science GPAs, pharmacy GPA, and on-time graduation. The regression model included pharmacy GPA and Pre-NAPLEX score. Conclusion. The findings provide evidence that, although pharmacy GPA is the most critical determinant, the Pre-NAPLEX score is also a significant predictor of NAPLEX score.


Asunto(s)
Composición de Medicamentos/normas , Quimioterapia/normas , Evaluación Educacional/métodos , Evaluación Educacional/normas , Licencia en Farmacia , Criterios de Admisión Escolar , Grupo de Ascendencia Continental Africana , Análisis de Varianza , Composición de Medicamentos/métodos , Educación en Farmacia , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Estudios Retrospectivos , Facultades de Farmacia , Estudiantes de Farmacia , Tennessee
16.
Am J Pharm Educ ; 81(4): 65, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28630506

RESUMEN

Objectives. To develop and validate a scale measuring pharmacy students' attitudes toward social media professionalism, and assess the impact of an educational presentation on social media professionalism. Methods. A social media professionalism scale was used in a pre- and post-survey to determine the effects of a social media professionalism presentation. The 26-item scale was administered to 197 first-year pharmacy (P1) students during orientation. Exploratory factor analysis was applied to determine the number of underlying factors responsible for covariation of the data. Principal components analysis was used as the extraction method. Varimax was selected as the rotation method. Cronbach's alpha was estimated. Wilcoxon signed rank test was used to compare pre- and post-scores of each item, subscale, and total scale. Results. There were 187 (95%) students who participated. The final scale had five subscales and 15 items. Subscales were named according to the professionalism tenet they best represented. Scores of items addressing reading/posting to social media during class, an employer's use of social media when making hiring decisions, and a college/university's use of social media as a measure of professional conduct significantly increased from pre-test to post-test. The "honesty and integrity" subscale score also significantly increased. Conclusion. The social media professionalism scale measures five tenets of professionalism and exhibits satisfactory reliability. The presentation improved P1 students' attitudes regarding social media professionalism.


Asunto(s)
Profesionalismo , Medios de Comunicación Sociales , Estudiantes de Farmacia/psicología , Actitud , Educación en Farmacia , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto Joven
17.
Am J Health Syst Pharm ; 74(10): 653-668, 2017 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-28377378

RESUMEN

PURPOSE: Results of a study to determine if disparities in drug pricing, pharmacy services, and community pharmacy access exist in a Tennessee county with a predominantly minority population are reported. METHODS: A cross-sectional survey of community pharmacies in Shelby County, a jurisdiction with a total population more than 60% composed of racial and ethnic minority groups, was conducted. Data collection included "out-of-pocket" (i.e., cash purchase) prices for generic levothyroxine, methylphenidate, and hydrocodone-acetaminophen; pharmacy hours of operation; availability of selected pharmacy services; and ZIP code-level data on demographics and crime risk. Analysis of variance, chi-square testing, correlational analysis, and data mapping were performed. RESULTS: Survey data were obtained from 90 pharmacies in 25 of the county's 33 residential ZIP code areas. Areas with fewer pharmacies per 10,000 residents tended to have a higher percentage of minority residents (p = 0.031). Methylphenidate pricing was typically lower in areas with lower employment rates (p = 0.027). Availability of home medication delivery service correlated with income level (p = 0.015), employment rate (p = 0.022), and crime risk (p = 0.014). CONCLUSION: A survey of community pharmacies in Shelby County, Tennessee, found that areas with a high percentage of minority residents had lower pharmacy density than areas with a high percentage of white residents. Pharmacies located in communities with low average income levels, low employment rates, and high scores for personal crime risk were less likely to offer home medication delivery services.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Farmacias/provisión & distribución , Acetaminofén/economía , Servicios Comunitarios de Farmacia/provisión & distribución , Crimen/estadística & datos numéricos , Combinación de Medicamentos , Medicamentos Genéricos/economía , Disparidades en Atención de Salud/economía , Humanos , Hidrocodona/economía , Metilfenidato/economía , Factores Socioeconómicos , Tennessee , Tiroxina/economía
19.
Am J Pharm Educ ; 80(7): 117, 2016 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-27756925

RESUMEN

Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.


Asunto(s)
Educación en Farmacia/economía , Docentes de Farmacia/estadística & datos numéricos , Renta , Farmacias/economía , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Adolescente , Adulto , Anciano , Selección de Profesión , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Facultades de Farmacia/economía , Apoyo a la Formación Profesional/economía , Estados Unidos , Adulto Joven
20.
Patient Prefer Adherence ; 10: 703-9, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27175070

RESUMEN

BACKGROUND: Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients' (RTRs) immunosuppressant therapy (IST) adherence. This study's purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. METHODS: Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. RESULTS: In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02-1.26, P=0.02). CONCLUSION: The findings provide evidence that access to MTM services increases IST adherence among RTRs.

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