The "first-generation effect" on perceptions and academic performance of pharmacy students.

INTRODUCTION: The "first-generation effect" refers to familial educational attainment's role in first-generation student academic success. It often implies low academic achievements at associate and bachelor degree levels. Would this be true at the doctor of pharmacy (PharmD) level? This study assessed perceptions and first-professional (P1) year student academic performance of first-generation vs. non-first-generation PharmD cohorts at the Feik School of Pharmacy. METHODS: Perceptions (academic and personal support) were assessed via a 49-question survey at the start of the second- and third-professional years. Academic performance was assessed via measures of academic success (course grades, grade point average, supplemental instruction enrollments, and academic infractions) in P1 year. Statistical t-tests and F-tests were used to analyze differences in perceptions and academic performance for the two cohorts. RESULTS: From 132 eligible students, 128 completed the survey (97% response rate) and 58 (45%) were first-generation students. First-generation students had a lower perception of their academic success, and they perceived finances as one of their greatest barriers (86% vs. 64%). Fifteen P1 courses were reviewed for academic performance, and first generations had lower final course grades in only two courses (Anatomy and Physiology 1; Medical Microbiology and Immunology). For measures of academic success, no significant differences were noted. CONCLUSIONS: Overall, this study suggested that first-generation status may not be a hindrance to academic performance at the PharmD level, but that financial perceptions and a lower self-perception of academic success seem to be major barriers for first-generation PharmD students.

Sources of stress in a pharmacy student population.

OBJECTIVE: To assess the sources of stress for pharmacy students and relationships to demographic factors and perceived stress. METHODS: Survey study of students at three pharmacy schools investigating student stress using the Perceived Stress Scale (PSS10), a two-tiered sources of stress questionnaire and demographic information. RESULTS: Student perceived stress levels were significantly higher than standard populations, but consistent with other pharmacy student populations. The strongest predictor of perceived stress was when students anticipated lower stress levels than actually experienced, followed by pressure to succeed. Additional variables were self-reported grade point average (GPA) and stress from relationships and experiential rotations. For first year (P1) students, having less than a bachelor's degree significantly influenced perceived stress. For the entire sample, male gender and health-related stress were significant. Academic performance (81%) and pressure to succeed (77%) were the most frequently reported general sources of stress. School B students were significantly less likely to report stress about postgraduate opportunities, career choices, and health issues. Students at school C were significantly less likely to report stress about academic issues. CONCLUSIONS: Pharmacy students' perceived stress is associated with their expectations, several general stressor categories, and demographic characteristics. Sources of stress appear to differ between pharmacy programs. Programs could examine their policies to see if there were more effective and timely means to address student stress. By better understanding the specific reasons for stress, we may be better able to mitigate its negative effects.

Exercise as a Stress Coping Mechanism in a Pharmacy Student Population.

Objective. To assess the coping mechanisms used by pharmacy students and their relationship to perceived stress. Methods. Data were gathered utilizing the Perceived Stress Scale (PSS10) and Brief COPE with the additional coping mechanisms of exercise and use of prescribed medications. Results. A survey that was sent to 368 students had an 81% response rate. Perceived stress was significantly higher than standard populations, but consistent with other pharmacy student populations. The most frequently reported coping mechanisms were the adaptive strategies of active coping, acceptance and planning. Maladaptive strategies of behavioral disengagement, venting and self-blame were significantly associated with higher perceived stress scores and the new addition of an exercise coping mechanism significantly associated with lower perceived stress scores. Use of prescribed medications was not significantly associated with perceived stress levels. Conclusion. Inclusion of exercise as a coping mechanism may be beneficial in similar populations.

The concordance of self-report with other measures of medication adherence: a summary of the literature.

OBJECTIVE: The objective of this study was to evaluate the concordance of self-report measures of medication adherence (interview, diary, or questionnaire) with nonself-report measures of adherence (administrative claims, pill count or canister weight, plasma drug concentration, electronic monitors, or clinical opinion). METHODS: A literature search was conducted to identify published reports in which self-report and nonself-report measures of adherence were used within the same study. The concordance of measures within each study was categorized as high, moderate, or low based on a comparison of the adherence estimates. RESULTS: Eight-six comparisons of self-report to nonself-report measures of adherence were identified. Thirty-seven of the 86 comparisons (43%) were categorized as highly concordant. However, concordance varied substantially by type of self-report measure and nonself-report measure. Self-report measures, in general, were highly concordant with electronic measures in only 17% of comparisons, whereas they were highly concordant with other types of nonself-report measures in 58% of comparisons (chi-square = 14.30, P <0.01). When comparing self-report measures, interviews had significantly lower concordance with nonself-report measures as compared with questionnaires or diaries (chi-square = 8.47, P = 0.01). In 15 comparisons of interviews with electronic measures, none of the comparisons were highly concordant, whereas questionnaires and diaries had moderate-to-high concordance with electronic measures in 12 of 16 comparisons (75%). CONCLUSIONS: The concordance of self-report and other measures of medication adherence varies widely based on the type of measures used. Questionnaires and diaries tend to have moderate-to-high concordance with other measures of medication adherence. However, interview-based self-reports are not concordant with electronic measures. Questionnaire and diary methods could be preferable to interviews for self-reported medication adherence.

The intensification of drug therapy for diabetes and its complications: evidence from 2 HMOs.

OBJECTIVES: To identify trends in the utilization of multidrug therapy for glycemic control, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), and lipid-modifying agents for persons with diabetes from 1997 to 2001. The trends in drug and total expenditures for diabetes patients also were examined. STUDY DESIGN: Cross-sectional analysis for each year from 1997 through 2001. PATIENTS AND METHODS: Subjects were identified from pharmacy and medical claims data by using Health Employer Data and Information Set diabetes indicator criteria, with the additional criterion that subjects must be receiving drug therapy for diabetes. All subjects were continuously enrolled within the commercial segment of 1 of 2 health maintenance organizations (HMOs) in different geographic areas. The proportion of patients in each year who used multiple antihyperglycemic agents was measured, as was the proportion of diabetes patients receiving ACEI/ARBs or lipid-modifying agents. Drug and total expenditures were estimated for the subjects in each HMO. RESULTS: Both HMOs experienced a substantial growth in the proportion of patients receiving multidrug therapy for glycemic control from 1997 to 2001. HMO 1 saw an increase from 27.1% to 43.4%; the increase in HMO 2 was from 27.3% to 39.6%. The use of ACEI/ARBs and lipid-modifying agents nearly doubled during this time period. Expenditures for drugs increased at a much greater rate than medical expenditures. CONCLUSIONS: The intensity of drug therapy for persons with diabetes increased between 1997 and 2001. Consequently, drugs now represent a greater proportion of total expenditures for persons with diabetes.

Association between hospital size and quality improvement for pharmaceutical services.

PURPOSE: The relationship between hospital size and quality improvement (QI) for pharmaceutical services was studied. METHODS: A questionnaire on QI was sent to hospital pharmacy directors in Michigan and Florida in 2002. The questionnaire included items on QI lead-team composition, QI tools, QI training, and QI culture. RESULTS: Usable responses were received from 162 (57%) of 282 pharmacy directors. Pharmacy QI lead teams were present in 57% of institutions, with larger teams in large hospitals (> or = 300 patients). Only two QI tools were used by a majority of hospitals: root-cause analysis (62%) and flow charts (66%). Small hospitals (< 50 patients) were less likely than medium-sized hospitals (50-299 patients) and large hospitals to use several QI tools, including control charts, cause-and-effect diagrams, root-cause analysis, flow charts, and histograms. Large hospitals were more likely than small and medium-sized hospitals to use root-cause analysis and control charts. There was no relationship between hospital size and the frequency with which physician or patient satisfaction with pharmaceutical services was measured. There were no differences in QI training or QI culture across hospital size categories. CONCLUSION: A survey suggested that a majority of hospital pharmacies in Michigan and Florida have begun to adopt QI techniques but that most are not using rigorous QI tools. Pharmacies in large hospitals had more QI lead-team members and were more likely to use certain QI tools, but there was no relationship between hospital size and satisfaction measurements, QI training, or QI culture.